Skewed data is the main issue in statistical models in healthcare costs. Data transformation is a conventional method to decrease skewness, but there are some disadvantages. Some recent studies have employed generalized linear models (GLMs) and Cox proportional hazard regression as alternative estimators.The aim of this study was to investigate how well these alternative estimators perform in terms of bias and precision when the data are skewed. The primary outcome was an estimation of population means of healthcare costs and the secondary outcome was the impact of a covariate on healthcare cost. Alternative estimators, such as ordinary least squares (OLS) for Ln(y) or Log(y), Gamma, Weibull and Cox proportional hazard regression models, were compared using Monte Carlo simulation under different situations, which were generated from skewed distributions.We found that there was not one best model across all generated conditions. However, GLMs, especially the Gamma regression model, behaved well in the estimation of population means of healthcare costs. The results showed that the Cox proportional hazard model exhibited a poor estimation of population means of healthcare costs and the β1 even under proportional hazard data. Approximately results are consistent by increasing the sample size. However, increasing the sample size could improve the performance of the OLS-based model.

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most common chronic liver disorders. The main causes of NAFLD are associated with insulin resistance, severe lipid metabolism disorders, oxidative stress and inflammation. Previous studies have reported that ginger has positive metabolic results. Aim: The aim of this study was to determine the effect of ginger powder supplement on lipid profiles, insulin resistance, liver enzymes, inflammatory cytokines and antioxidant status in patients with NAFLD. Methods: In this randomized clinical trial, 46 people with NAFLD were parted into two groups and subjected to the ginger or placebo capsules (3 capsules daily, each containing 500 mg of ginger or wheat flour) over 12 weeks. All patients received a diet with balanced energy and physical activity during the intervention period. Liver ultrasonography, anthropometric indices and biochemical parameters were measured before and after intervention. Results: No significant difference was found between the two groups in the baseline variables at the beginning of the study. At the end of the study, serum levels of alanine aminotransferase (ALT), total cholesterol, low-density lipoprotein (LDL-C), fasting blood glucose, and insulin resistance index (HOMA), C-reactive protein (hs-CRP), and fetuin-A in the group receiving a ginger supplement significantly decreased compared to placebo. However, there was no significant difference between the two groups in body weight, fasting insulin, HDL-C, triglyceride, adiponectin, alpha-tumor necrosis factor (TNF-α), total antioxidant capacity (TAC), gamma-glutamyl transferase (GGT), aspartate aminotransferase (AST), fatty liver index (FLI), fatty liver grade and blood pressure. Conclusion: The ginger supplement may be used as a complementary therapy along with existing therapies to reduce insulin resistance, liver enzymes and inflammation in patients with non-alcoholic fatty liver.

Background: Non-alcoholic fatty liver disease (NAFLD) is a major worldwide public health problem with no effective treatment options. Green coffee bean extract (GCBE) is a rich source of bioactive phytochemicals with a variety of biochemical and physiological effects. Objectives: The aim of this study was to investigate the effects of GCBE on the management of patients with NAFLD. Methods: 44 patients with NAFLD were enrolled in a parallel, double-blind, placebo-controlled clinical trial. The participants were administered either GCBE or placebo (1 gram/day) for 8 weeks. They also were advised to follow a standard energy-balanced diet and physical activity. Liver ultrasonography, anthropometric variables, and biochemical parameters were compared at pre-and post-intervention.

Oncology nurses can increase their knowledge regarding this symptom cluster and work to diminish the cluster components by using SSBM in adult leukemia patients.

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The aim of this study was to investigate the relationship between pain, fatigue, sleep disorders and quality of life and assess the most powerful predictor of quality of life in patients with acute leukaemia. In this cross‐sectional multicentre study, 406 patients were recruited. Data were collected using the Iranian Short‐Form 36‐item Health Survey, the Pittsburgh Sleep Quality Index, and the Numeric Rating Scale for Pain and Fatigue Intensity. It was found that pain and fatigue had direct relationship with sleep disorders. Statistically significant relationships were reported between pain, fatigue, sleep disorders and QoL. Also, a statistically significant relationship was found between pain and QoL (p < .001). Pain, fatigue and sleep disorders in total had the predictive power for quality of life (R2 = 36%). The most powerful predictor of quality of life was pain. It is suggested that healthcare professionals note the importance of patients' symptoms in clinical investigations and take appropriate measures for their management. The assessment of pain as the most powerful predictor of quality of life can be considered a basis for the improvement of quality of life, fatigue and sleep quality in patients with acute leukaemia.

Aim: Heart failure is a progressive, debilitating disease with exacerbated physical and psychological symptoms that reduces the quality of life of patients. Nursing intervention based on nursing theories could help in the adaptation of patients to the disease and improving quality of life. The aim of this study was to determine the effect of an educational program based on Roy's adaptation model on the quality of life of patients with heart failure. Methods and Material: In this randomized controlled trial, 76 patients with heart failure were allocated to either the intervention or control group through a blocked randomization method. The data were collected between May and October 2017. The intervention group received oral and written educational programs for 4 weeks. Minnesota quality-of-life questionnaire and Roy's adaptation model-based evaluation form was completed at the beginning of the trial, and 1 month after the completion of the study. Results: Intervention patients showed statistically significantly improved scores on the physiologic, role function, independence-interdependence dimensions and the total score of Roy's adaptation model over time compared with control patients (p < .05). The mean score of all of the three quality-of-life dimensions and total score of quality of life increased significantly (p < .05). Conclusion: The study results help nursing staff detect the stimuli and the behaviors of patients with heart failure. Roy's adaptation model can be used as a standard practice to increase adaptation to the disease and improving quality of life. K E Y W O R D S adaptation, heart failure, quality of life, Roy's adaptation model

Background: Studies show that infertility can result in body image changes, which can majorly affect personality. Objectives: The current study aimed to determine the effects of cognitive behavioral therapy (CBT) on body image in infertile women. Methods: This clinical trial was performed on 24 infertile women, admitted to the Infertility Research and Treatment Center of Ahvaz, Iran in 2016-2017. In the first stage, convenience sampling was applied, and the participants were allocated to 2 groups (12 patients per group), using a table of random numbers. The experimental group participated in 10 sessions of CBT weekly, based on the 8-step program by Cash. body-self relations questionnaire and Beck Self-Concept inventory were completed in each group before, immediately after, and 1 month after the intervention.