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  Background and Objective : Recirculation rate is essential for the quality of Hemodialysis . Since the treatment of patients is based on the Dialysis Adequacy, the evaluation of recirculation is especially important. This study was performed with the aim of measuring arteriovenous fistula recirculation and its relationship with some factors in Hemodialysis patients.

  Material and Methods: In this Descriptive-Analytical study, all Hemodialysis patients (n=100), in Panje Azar Hospital of Gorgan, whose vessels were accessed by arteriovenous Fistula was studied in the summer of 2009. In order to determine recirculation rate ، we used urea based classic method. The cut point of recirculation was considered 10%. The variables studied are Fistula longevity ، direction of needle insertion ، the space between needles and the place of needles fistula and KUF filteration. Data were analyzed by using descriptive statistics and logistic regression test (odds ratio and ci reported) in the SPSS software.

  Results: Patients were male (53) and female (47) with the mean age of 50.93± 17.23. The mean year of Dialysis history was 4.04 ± 5.04. Fifteen percent of patients had recirculation. Average access recirculation of all patients was 0.067 ± 0.118. Recirculation rate had significant relationship (P <0­.­05) with direction of two Arterial-Venous needle and the place of the two needles ، which may have been higher.

Conclusion: Considering the results of this study, we conclude that emphasis should be applied on instructing correct needle insertion in order to decrease recirculation

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  Background and Objective : Human resources are the most valuable sources of an organization. Nurses, because of special nature of their job, are influenced by various stressors affecting on their job satisfaction and organizational commitment. The aim of this study was to compare Nurses’ job satisfaction and their organizational commitment in intensive care and general wards of Golestan University of medical sciences.

  Material and Methods: In this descriptive & analytical study, 389 Nurses were selected via census sampling in 1387. The instrument were job satisfaction questionnaire reliabled by alpha chronbach and meyer organizational commitment scale.To analyze the data, we used Pearson correlation coefficient, independent test, regression and one way anova in spss 16 soft ware environment.

  Results: Participants were between 22-55 years. Their mean age was 32.6 ± 7.4 and most of them (72.7%) were female. Intensive care and emergency wards’ Nurses had the lowest organizational commitment and job satisfaction, respectively. There was a significant relationship between job satisfaction and organizational commitment in studied wards (P<0.05).

Conclusion : Whereas job satisfaction can predict organizational commitment of Nurses, it is essential for administrators to consider factors such as salary, participation in decision making, job security, and job enrichment and so on to promote quality of services

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  Background and Objective: Smoking and drug abuse are among the most important causes of mortality in both developing and developed countries. The aim of this study was to survey of eleventh grade student’s attitude, based on health belief model (HBM), toward smoking and its complications in Zahedan, Iran.

  Material and Methods : In this cross-sectional study, we selected 380 students through multi
stage clustered sampling. Data gathering was performed by using a valid and reliable researcher- made questionnaire designed on the basis of HBM.

  Results: The mean age of the subjects is 15.9 ± 7. The subjects experienced smoking at least once are 23.2% and regular smokers are 2.1% of them. The results of health belief constructs
are perceived susceptibility­ (74.8%), perceived severity­ (68.2%), perceived barriers­ (42.1%) and perceived benefits (72.1%). About cues to action construct, 61(16.1%) have at least one smoker in their family and 260(68.4%) mention that they have studied about smoking and its' disadvantages. The majority of them had high self- efficacy related to smoking temptation situations and its avoidance.

  Conclusion: The results show that most of the students have a favorite attitude toward smoking and its complication, based on health belief model. Hence, it is a necessity to maintain and reinforce this condition to prevent from smoking.

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  Background and Objective: Student's ­ mental ­ health­ is one of the effective factors on academic achievement and it seems that the experience of university environment leads to some changes in it. The aim of this study was the assessment of Golestan medical university students' mental health, when they enter university and after one year.

  Material and Methods: In this descriptive and analytical study,the mental health of 132 students of Golestan university of medical sciences were measured in two times. The first was in entrance to university and the second was after one year.The date was gathered by a demographic data sheet and general health questionnaire (GHQ-28). Statistical analysis was done in SPSS­-16 software environment,using descriptive statistics, spearman correlation coefficient, paired T-­test and independent T-­test.

  Results: The subjects aged19.89 ± 1.22 are both boys(n=43,32.6%) and girls(n=89,67.4%). In entrance to university, 22% of students are indicaled as an inappropriate mental health.Paired­ T-test indicated that students' total mental health score and its subscales (somatic symptom, anxiety and sleep disorder, social dysfunction and depression) has no significant difference in two measurements­(P>0.05).Based on independent T-test, the second measurement of mental health is not significant between dormitory residents and non dormitory students, and between native and nonnative students (P>0.05).

   Conclusion: According to our finding, in first year of university, student's mental health has no special changes. Small sample size and lack of follow up in later years of university can be our study limitation.

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  Background and Objective : After suffering from some diseases,car accident is the most common cause of mortality in Iran.Using safety seat belt has a considerable role in reducing the injuries. This study has been established for comparing the trend of safety belt use from 2007to­ 2010 in Golestan province.

  Material and Methods: This population-based cross-sectional study was carried out on 3999 subjects aged 15-65,­during four years,in 11 urban and rural public health centers.They were selected by stratified and cluster sampling.­ Interviewers recorded the data using a all of them filled demographic data sheet,and were asked whether they asked seat belt or not.We used Chi-2 test to compare the frequencies and regression logistic to estimate seat belt use odds ratio.

  Results: The rate of seat belt use in the years of 2007, 2008, 2009 and 2010 were 71%, 69.8%, 74.5 and 86.4%, respectively.The difference is signficant(P<0.01) safety belt use during the four years increases by 15.4%.­ This increase in urban area is 19% while in rural area is 14.9%. In under 35-­year-old group,the increase is 17.85% and in over 35 is 14.3% .In 2010,­using seat belt in men was more than women, by 14.8%.

  Conclusion: Using safety belt increased by 3.85% for each year.It^,s use in urban higher that rural are,and in institutionalization to use the safety belt and a growing trend to use clear men more them women was reported.Interalization horizon in the province in reducing mortality from accidents will open of using seat belt and it^,s increasing use is considerable in this Province.

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  Background and Objective: Hydrogenated vegetable oils consumption ­–­rich sources of both saturated ­fatty acids and trans fatty­ acids is one of the most important risk factor for Coronary Vascular Diseases(CVD) .The aim of the current ­study was to investigat the hydrogenated vegetable oil consumption based on Precede model among women who attained in Khomein and Mahallat health centers in 2008.

  Material and Methods: In this descriptive-analytic a study, 136 women who were covered ­by Khomein and Mahallat health centers selected through a systematic random sampling. Data gathering instrument was a researcher-­designed valid and reliable questionnaire bases on Precede constructs. The data was analyzed by using independent T-test and Pearson correlation coefficient(p<0.05).
Results: Three point five percent have appropriate knowledge, 60.3% have favorite attitude and 67.7% have­ incorrect practice. Hydrogenated vegetable oil consumption rate is 72%.The expensive ­of unhydrogenated oil 77.9% and­ subsiding­ distribution­ of hydrogenated oil 77% are the most important enabling­ factors.­ Meanwhile, husband unwelcoming 66.2% is the most reinforcing factor that impede as an appropriale practice. 

  Conclusion: The­ results­ indicated­ that the­ majority of subjects have inappropriale nutritional practice. Reinforcing and enabling factors­ are effective on unhydrogenated oil consumption. Decrease­ of unhydrogenated oil price and encouragement of the spouses are recommended.

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  Background and Objective: Understanding and improving traffic behaviors, especially, the use of helmet is known as a strategy for preventing from road accidents. prevention of road accidents are caused Azsdma The aim of ­the present study was to assess the barriers to helmet use, based on health belief model in Khomein city.

  Material and Methods: ­ The subjects of this Cross-­sectional study were 384 drivers recruited via convenience sampling.­­The instrument was a research-made questionnaire based on HBM items.­The data related to performance, Perceived susceptibility, Perceived barriers, Perceived severity ­and Perceived benefits were analyzed by­ independent T-test,­Pearson, spearman correlation, chi square and wilcoxon (p≤0.05).

  Results: The barriers to helmet use are sweating, decreased hearing, expensiveness, heaviness, and visual limitation, ­chocking feeling, hairstyle, losing ­the helmet, shyness and time consuming, respectively. ­The rate of helmet use is 16.2%. ­According to the the subjects, ­education­(61.4%) paying fines (22.7%) and confining motorcycles (15.9%) are effective on wearing helmet.

  Conclusion:­ ­ According to the results, we recommend performing proper educational programs about wearing helmet, based­ on HBM,­­ designing new helmet by considering fore mentioned problems and modifying police treatments toward education.

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  Background and Objective : Health behaviors are undertaken to prevent from a disease or to maintain health. According to the effect of behavior patterns on the Health of community, we aimed to compare health behaviors of first and last semester students in Amirkabir and Tehran University and their relations with demographic factors.

  Materials and Methods : In this descriptive -analytical study, 149 (99 first semester, 50 last) students of Tehran and Amirkabir university were recruited through stratified sampling in 2007. Data were collected by Health Behavior questionnaire and analyzed by descriptive statistics and independent t test (p≤0.05) using SPSS-16 software.

  Results: There is no significant relation between first semester’s physical exercises (p=0.6) and smoke cessation (p=0.07) ­and ­ those of last semester’s ,but it is significant for proper nutrition pattern( p= 0.03)­.­Health behaviors of first semester’s is better than that of last semester’s.

  Conclusion: This survey shows that students have not good health behaviors therefore,­ we recommend designing and performing some educational programs for promoting proper health behaviors for freshmen and other students.

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  Background and Objective : Academic achievement is associated with the knowledge and application of effective study skills. The aim of the current study was to investigate the study skills of nursing and midwifery students of Golestan University of Medical Sciences.

  Material and Methods : In this descriptive study, 211 students were recruited through census in 2008-2009 academic years. The data was collected by using Cangas Study Skills Inventory (CSSI).Reading ability, note-taking, memory enhancement, readiness to exam , concentration and time managements were the subscales surveyed.­ the data derived from the instrument was analyzed by statistical tests, using SPSS software.

  Results: The mean standard deviation is 2.47±0.40 of four. The reported study skills are weak (43.6%), moderate­ (53.6%) ­and sufficient­ (2.8%).­The study skills of female students is significantly higher than males (p=0.017) and freshmen’s Study skills is better than that others (p<0.0001).

  Conclusion: The study skills of the majority of students are not sufficient. It seems that studying in university could not improve study skills and it is a necessity for the students to pass study skills workshop or even a course as a part of university curriculum.

  Keywords: Study skills, Students, Medical sciences

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  Background and Objective : Brucellosis is a zonosis that can be transmitted between species from animals to humans or from humans to animals, which is still a major health and economic problem. The main preventive strategy for ­brucellosis is to educate rural ranchers on the basis of Precede framework. ­We aimed to study the effect of educational intervention program based on Precede Model and its main components on preventive behaviors to reduce Brucellosis in the rural district of Khomein.

  Material and Methods : In this pre-experimental randomized controlled study, the samples were 400 adult men of rural district of Khomein city randomly allocate d to case and control groups. Data gathering instrument was a questionnaire based on Precede framework. Reliability of the questionnaire through the internal consistency test on the pilot phase was approved on 25 individual and the validity was confirmed by face validity. The intervention, based Precede framework, was a package of three 60-90 minute sessions conducted weekly. The subjects were followed for three months and the data analyzed by independent T-­test, paired T-­test, analysis variance with repeated observations.

  Results: After intervention, the mean scores of predisposing­(knowledge and attitude), reinforcing and enabling factors in case group is different significantly from that in control group (p<0.05).

  Conclusion:­ Planning and implementation­ of health education intervention via Precede framework could be positive in increasing preventive behaviors to reduce brucellosis incidence.

  Keywords: Health education, Brucellosis, Precede framework

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  Background and Objective: Cardiac angiography, which is widely used in Iran, is a diagnostic and therapeutic procedure for cardiac diseases. The patients suffer from back pain due to complete bed rest after angiography. Thus, this study aimed at determining the correlated factors with the severity of back pain after cardiac angiography in Dr. Ganjavian Hospital of Dezful­, 2011.

  Material and Methods: In this correlational study, 140 candidates of cardiac angiography were selected via convenience sampling. We used a checklist to collect the data about age, sex, body mass index(BMI), smoking, high blood pressure, diabetes and duration of angiography, which are the influential factors of the severity of back pain. Then, the severity of back pain was measured at first, second, fourth and sixth hour after angiography, using a numerical scale of pain assessment.­­To analyze the data, we used descriptive statistic, Mann Whitney and Spearman correlation.

  Results: ­The subjects are males (N=67), females (N=64) and smokers (­12%). The mean age is 55.7±7.7, and body mass index is 27.6±3.07. None of them has history of back pain and previous angiography. Based on Spearman, there is no significance correlation between back pain of 1, 2, 4, and 6 hours after angiography and factors such as age, BMI and duration of angiography. Man Whitney test indicates a statistical significance between gender and severity of pain in the first hour (Z=-2.17) and sixth hour (Z=-2.4) after angiography, whereas there is no statistical significance in the second, fourth and fifth hour after angiography.­ As well, there is no significant correlation between back pain and variables such as smoking, diabetes and hypertension.

  Conclusion: The findings showthat the nurses by being aware of related factors to back pain severity can try to reduce the pain and promote the patients’ convenience.

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  Background and Objective: The concepts are defined differently upon the dominated philosophy and ideology of the communities. Thus, it can be possible to define the main concepts of nursing based on the philosophical and ideological foundation of Islamic ideology in Iran. The aim of the present study was to explain the human’s concepts based on Islamic documents and compare with nursing theories.

  Material and Methods: The concept derivation of Walker and Avant was used for theory construction. In this method, by studying the existing Islamic theories about human, the researchers chose the best theories adjusting to nursing and redefined them on the basis of nursing concepts. Finally the human’s concept was derived of theories of Ayatollah Javadi Amoli, Mesbah Yazdi and Mohammad Taghi Jafari.

  Results: Human, consists of body and spirit, which have been created based on Fetrat . The movement according to Fetrat is accomplished by the help of wisdom, authority and faith to reach Ghalbe Salim, which is the summit of spiritual health. To reach Ghalbe Salim, human should consider the fields including plant, animal and wisdom. Thus, the nurse’s duty is to help the clients to achieve their real Fetrat, based on the human areas.

  Conclusion: In terms of this definition that verifies the superiority of spirit over body, nurses must pay attention to the spirit more than the body. In contrast with caring theories, the leader of nursing programs is Fetrat rather than the individual needs and experiences. Hence, the nurses’ duty is to help the human, based on Fetrat, to reach the highest health that is Ghalbe Salim.

   

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 Background and Objective : ­ Teachers’ evaluation is considered one of the important strategies for education quality enhancement in universities. The objective of the current study was to investigate the students’ viewpoints about the evaluation criteria of teacher’s performance in theoretical courses in Golestan University of Medical Sciences.

  Material and Methods: This cross- sectional study was conducted, in 2008, on 330 students of various disciplines. They were recruited via stratified random sampling and asked to fill out a valid and reliable questionnaire including 63 closed questions, which are related to individual, scientific and professional fields. ­Using SPSS software, we analyzed the data by descriptive statistics, independent t­-test, and Anova and Pearson correlation.

 Results: Seventy-three-point-three (n=242) are females and 26.7% (n=88) males. ­The most important factors in teacher's evaluation are Professional characteristics (4.22±0.42).­­Their scientific ability (4.14) and individual characteristics (3.86%), respectively, are the other factors. In professional characteristics, ­“The verbal skills and teaching methods " with the mean of 4.64 in scientific ability, "the knowledge and scientific power" with the mean of 4.65 and in individual issue, “patience and good humor" with the mean of 4.61 are the most important issues. Sixty-two-point-four percent of students believe that they are honest about their evaluation and 59.4% of them claim that their evaluation is reliable.

  Conclusion : In spite of the importance of the scientific abilities, the verbal skills and teaching methods are considered the most prominent ones. ­The Students’ viewpoints can be used as an important part of teachers' evaluation for recognizing and eliminating the shortcomings.

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Background and Objective:  Transtheoretical model (TTM) is one of the models applied to  assess the regular physical activity. The aim of the current study was to investigate the regular physical activity based on transtheoretical model constructs among Golestan University of Medical Sciences’ students.

Material and Methods: ­In this cross-sectional study, 295 students were recruited through convenience sampling. The instruments were Marcos et al. Stages of change and Nigg et al. Decisional balance questionnaires. Their validity was approved by content and face validity andtheir reliability by test re test method.­­ Data analysis was conducted by Chi-­square ,Logestic regression, and ANOVA followed by Tukey post hoc tests.

Results:­ The mean age of the participants is 21.89±3.05.­Eighty nine point five percent are unmarried and 67.5% females .The results show that they are in precontemplation (60.3%) contemplation(8.8%), preparation(11.9%), action(9.5%)­ and maintanenec (9.5%)stages. There is a significant relationship between stage of change with cons and pros of physicalactivity(p<0.05) .Male gender, Bsc and lower educational levels along with cons are the best predictors of regular physical activity(p<0.05).

Conclusion: Since the majority of the students(81%) have a  sedentary life, It is a necessity to conduct some  planned interventions for their progress on maintenance stage. Increasing of pros and decreasing of cons could be useful.

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 Background and Objective: Substance abuse is a worldwide problem and converted to a big challenge for human society. The trend of this phenomenon is rapidly increasing in the world and our country . Because of quick change of substance abuse profile, a comprehensive assessment for exact identification of this phenomenon is needed. The present study was designed to evaluate the association between substance abuse route and age related factors in substance abuser.

 Material and Methods: In this cross-sectional study (2008), 120 subjects referred to the addiction clinic of Panje-Azar Hospital in Gorgan, Golestan University and medical sciences were selected via systemic random sampling. The data was gathered by a questionnaire and interview and analyzed by, using SPSS software, ANOVA and Tukey post hoc test (P<0.05).

 Results: The mean age of the subjects is 34.2±10.96, with the range of 16-66 years. The subjects are males (107 89.2%) and married (78 65%). The first Substance abuse of 87 (72.5%) is opium, which is the most commonly abused substance before withdrawal for 64.2% of the subjects. The main causes of the first use are having pleasure (38.8%), getting rid of psychological problem (23.3%) and being curios (23.3%). Sixty (50%) of them report that they first experienced it at home. The relation between age and route of substance abuse is statistically significant (P=0.025).

 Conclusion: According to rapid change in substance abuse profile and the characteristics of addicted people, periodically assessments are necessary for identifying this phenomenon and planning evidence based preventive plans.

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  Background and Objective: Non-alcoholic fatty liver disease is the most prevalent cause of hepatic related problems. , which has not been introduced any crucial treatment for it so far. Insulin resistance and oxidative stress are the most important risk factors for this disease. As anti-oxidant and insulin resistance decreasing effect of Cinnamon has been shown in prior studies, we carried out this research to determine the effect of cinnamon on lipid profile, liver enzymes, insulin resistance and hs-CRP inflammatory factor in patients with nonalcoholic fatty liver.

  

  Material and Methods: this clinical trial was conducted on 50 patients with fatty liver, selected on the basis of including criteria. The Intervention group was given 1.5 gram Cinnamon and placebo group taken placebo for 12 weeks. Lipid profile (triglycerides, total cholesterol, HDL and LDL), fasting blood glucose, serum insulin , hs - CRP inflammatory factor, liver enzymes (ALT and AST and GGT), insulin resistance index (HOMA-IR) and insulin sensitivity (QUICKI), diet, physical activity and anthropometric indices were measured in the beginning and end of the study. Statistical analysis was performed by SPSS software, using Covariance, Students t-test, Paired t-test, Wilcoxon and Mann-Whitney.

  

  Results: A significant decrease in HOMA, fasting blood glucose, total cholesterol, ALT, AST, GGT and hs-CRP , and a significant increase in Quicki were seen in Cinnamon group (p <0.05). The change of LDL cholesterol in both groups was significant (p <0.05), whereas the reduction of HDL cholesterol wasn’t significant ­­ (p=0.130).

  

  Conclusion: based on the results, the use of Cinnamon may be effective in the patients with non-alcoholic fatty liver disease.

  

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  Background and Objective: Type 2 diabetes is a major public health problem with increasing morbidity and mortality. Complementary therapies are widely used by the people with diabetes. Massage therapy (MT) is an increasingly popular complementary therapy. Since few studies have been conducted on the effect of MT on people with diabetes, we aimed to investigate the effect of massage therapy on glycemic control (FBS, HBA1C) in women with diabetes.

  

  Material and Methods: this clinical trial was conducted on fifty women with type 2 diabetes selected by convenience sampling and placed randomly in treatment and control groups. The test group received 30 mins-long massage therapies in a week (10 sessions) and the control group received just standard care. Glycemic control indices including HbA1C, FBS were measured at baseline, after 10 weeks of therapy and then analyzed by paired-t test and MANOVA (p≤ 0.05) .

  

  Results: the mean and standard deviation of HBA1C of massage group (7.18±0.14) was significantly (P < 0.01) different from control (8.06±0.22) and the difference of FBS in massage group (1.46±5.28) from control (1.6±4.87) was meaningful statistically (P < 0.05).

  

  Conclusion: accordingly, massage therapy can be useful for glycemic control (FBS, HBA1C) in women with type 2 diabetes.

 

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  Background and Objective: Injection of subcutaneous low molecular weight heparin often causes some local reactions such as ­bruising, hematoma­, and pain, directly related to inappropriate injection method­. This study aimed at determining the effect of injection duration of­ Subcutaneous Enoxaparin Sodium on the size of bruising and the severity of injection pain.

  Material and Methods: This experimental study was conducted on 36 patients medicated by subcutaneous Enoxaparin Sodium (60mg). ­­They were randomly divided into two groups.­ The first group received routine method of subcutaneous anoxaparine injection (10 second duration injection technique) and in the second group in addition to routine method, ­“10 second waits” before removing needle was performed. Data collection was carried out by using a researcher-made check-list consisting of a section for demographic data and a section to record the extent o f bruising and pain intensity.­ The Extent of bruising was measured by using a clear flexible ruler within 24, ­ 48 and 72 hours and pain intensity by visual analog scale (VAS) ,immediately after injection­.­­We analyzed the Data by independent T test and Chi square.

  Results: ­ The ­Results indicate ­­that­ the mean ­of pain intensity in second group (­3.05 ± 1.71­)­ is less than first group (­3.86 ± 2.75­)­.­There is no significant difference between two groups for the extent of bruising in 24, ­ 48 and 72 hours (P>0.05).

  Conclusion: with regard to ­pain intensity and the size­ of the bruising, the two groups are not significantly different.

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  Background and Objective: Breast cancer is the most frequent cancer among women worldwide. The objective of the current study was to assess the breast cancer screening behaviors adherence rate and its relation with perceived susceptibility and perceived severity in Gorgan, Iran.

  Material and Methods: In a cross sectional study, 300 women referring to two health centers were ­selected through cluster sampling .­Data gathering instrument was a questionnaire including demographic, knowledge and practice questions related to breast cancer screening behaviors. Perceived susceptibility and perceived severity measured by Champion’s Health Belief Model Scale .

  Results: ­ The subjects are 18 to 60 years (30.3 ± 7.3). ­In knowledge part, 88.3% could not answer any question. In practice section, they have breast self examination (33%), clinical breast examination (11.3%) and mammography (5%) in their past history. Four- point -seven percent have high level of susceptibility and 46.7% high level of severity. Higher susceptibility was significantly associated with mammography (p=0.042) performance and not associated with breast self examination and clinical breast examination.

  Conclusion: The participant's knowledge about breast cancer screening was inappropriate. Meanwhile, the majority of them have low level of perceived susceptibility. It is a necessity to improve the knowledge and perceived susceptibility for enhancing the breast cancer screening behaviors.

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  Background and Objective: ­ ­Delirium is a kind of fluctuating cognitive­ destruction , disorientation and ­a common problem for inpatients, which leads to increased mortality, prolonged hospital stay, increased cost and decreased rehabilitation.­ This study evaluates the incidence of delirium and its associated risk factors in open heart surgery.

  Material and Methods: This descriptive-analytical study was conducted ­­in six month (2011), via convenience sampling, on 404 patients undergoing elective cardiac surgery in the heart center of Fatemeh Zahra in Sari, Iran. Using Neecham questionnaire and demographic checklist, delirium was evaluated from the first till the fifth day of surgical operation. We used survival analysis (Kaplan-Meier and Cox regression) to­ analyze the findings, using SPSS software version18.
Results: The incidence of delirium is reported 28.5%. There is a significant relation between the incidence of delirium and variables such as age , lower education, rural, history of kidney failure, heart failure, stroke, hearing disorder, atrial fibrillation, increased serum potassium and increased serum urea.

  Conclusion: ­ According to the results, screening for d elirium is a matter of the utmost importance . With attention to individual profile and preoperative factors related to delirium, it is necessary to train elder and lower education patients, to maintain electrolyte balance before operation and to eliminate sensory deprivation in order to lessen the incidence of delirium.