الفهرس 
Chronic hepatitis c virusOnly 14 pages are availabe for public view
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Abstract
Chronic hepatitis C may have existed since the 1940s and possibly longer but it was only identified in 1989. Several strains of the HCV are divided into six major groups designated genotypes1–6 and specific subtypes of these genotypes have also been identified (WHO, 2014).
According to recent estimates, more than 185 million people around the world have been infected with the hepatitis C virus (HCV), of whom 350 000 die each year. CHC is the most common cause of chronic liver disease, liver cirrhosis. is associated with significant morbidity and mortality patients may suffer from specific complication such as hepatocellular carcinoma, and the most common indication for liver transplantation in developed countries Globally most people infected with the virus are unaware of their infection (WHO, 2014).
The most effective and generally available treatment for HCV is a combination therapy can cure more than 90% of persons with HCV infection and is effective against genotypes that were previously difficult to treat this currently licensed treatment for HCV infection includes interferon alpha (IFN), ribavirin (RBV). However, the adverse effects with this combination therapy are most common (WHO, 2014).
Nurses are in a key position to carry out health education since they are the health care providers who have continuous contact with patients and their families and have the best opportunities to assess adverse effects which are associated with a significantly reduced quality of life. It is important to determine patient’s needs for benefits of medical intervention, and determine psychological, physical effects of treatment and disease process on patient’s daily life and determining the needs for social, psychological and physical support during period of combination therapy.
Aim of Study:
This study aimed to assess the needs of patients with chronic hepatitis C receiving combination therapy..
Research Questions:
What are needs of patient with chronic hepatitis C receiving combination therapy?
Subjects and Methods:
Design:
A descriptive exploratory design was utilized to meet the aim of this study.
Setting:
The present study was conducted at the Outpatient clinic of the Health Insurance Hospital in Banha Qalyubia Governorate city (Liver & gastrointestinal system) affiliated to the Ministry of Health.
Subjects:
A purposive sample of 80 adult patients from both sexes, with chronic hepatitis C and receiving combination therapy were selected according to a criteria a sheet in Banha Health Insurance Hospital (e.g. mild or moderate degree of liver cirrhosis, and free from chronic diseases except diabetes mellitus under control).
Tools of data collection:
Data were collected using the following tools:
Tool I- Patients’ interviewing questionnaire sheet (Appendix I)
Structured interviewing questionnaire developed by the researchers consisted of:Part one: Sociodemogrphic data such as age, sex, gander, marital status, level of education, occupation and monthly income.
Part two: Medical data duration of illness, reason for infection and severity of liver disease and laboratory investigations.
Part three: Assessment of patient knowledge about: Disease process, drug used, diet, activities, exercises, sexuality and medications. Total knowledge scored Satisfactory >60 %Unsatisfactory< 60 %.
Tool II –Needs assessment questionnaires:
It was used to assess needs of patients with HCV it included:
Part I:, (Appendix II) Somatic health complaints questionnaires adapted and modified by researcher from Brink, Karlson and Hallberg (2002) and modified by the researcher and to assess Physical needs.
The somatic health complaints’ questionnaire included 25 items; three responses for each item were ranged from 0 to 3, classified as the following:
0→Never
1→Sometimes
2→Mostly
It was concerned with assessment of patient’s physical needs. Regarding to daily living activity (Feeding, Bathing, Dressing, Toileting, Walking and Sporting) divided into two parts from 1-3 days first part of week and second part of week form 4-7 days; it consist of six items that describe activities daily and the subjects were asked to choose answer from zero to 2 scores that best describe their degree of dependence as:
Zero = totally dependent.
1= Need assistant.
2=totally independent.
Part II (Appendix III): Self-Rating Anxiety Scale (SAS) it was adapted from Zung, (1997) and modified by the researcher and used to assess psychological needs through using It included: 10 items; each item had 5 responses ranged from 1-5 as the following:
1→Never
2→Once
3→Sometime
4→Mostly
5→ Always
The total score of the instrument is 50; the higher the score is the higher the anxiety. It was considered as the following:
≤50%→ low anxiety.
51-75%→ Moderate anxiety.
≥75%→high anxiety.
Part IV (Appendix IV): Social dysfunction scale adapted from Matteson (1997) and modified by the researcher to assess social needs it included: dysfunction aspect of adjustment, effective coping and adaptive behavior, self-confidence, social relations, and satisfaction. The social dysfunction rating scale included 15 items, three responses for each item ranged from 1 to 3 and classified as the following:
1→None
2→Moderate
3→high
The total score of the instrument is 45; the higher score is the higher the social needs. It was considered that:
1-15→ Non social dysfunction.
16-30→ Moderate social dysfunctions.
31-45→ High social dysfunctions.
Pilot study:
A pilot study was carried out 10% (80 patients) for testing applicability of the study tools. Based on the results of the pilot study, necessary modifications were done.Patients included in the pilot study were excluded from the main study sample.
Results:
The main findings obtained from the study can be summarized as follows:
Socio-demographic characteristics of patients under study revealed that more than three quarters of the studied sample (76%) were males with a mean age of 44.7±9.5. the most of patients(93%) was married.
As regards patients’ residence, mostly 91.25of them reside rural area.
Concerning level of education, nearly three fifths (58.75%) of them were primary &secondary education, while minority (7.5%) of them were illiterate.
•Concerning patients’ occupation, less than half (48.75%) of them were worked with Muscular effort. According to patient income them two third of them. (63.7%) it was insufficent cost of treatment.
•As regards level of Liver cirrhosis, more than half of the study group (58.75%) has mild liver cirrhosis and less than half (41.75%) patients of the them duration of combination therapy was 17-32 weeks.
•Concerning patient knowledge, about two third (63.8%) of patients in the study group had unsatisfactory patient knowledge.Regarding level of the patient knowledge related to Hepatitis C and combination therapy, the result revaled that, most of them had unsatisfactory knowledge toward defintion and complication of hepatitis C (85% ,71.2 %, 42.5%&55%) .
•Concerning total physical and functional needs followed by effect on of means gastrointestinal symptoms (17.04±3.00) were the highest total scores followed by effect on nervous symptoms (8.13±2.04) followed by effect on integumentary symptoms (7.58±1.95.)While the lowest means scores are senses symptoms, respiratory symptoms, and urinary symptoms (3.84±1.13, 6.55±1.58, & 1.95 ±0.86).
•Concerning first part of week (1-3days) of daily level activities (ADLs), around one third of them were dependent toward feeding, bathing, dressing and toileting (32.5%, 31.25%, 26.25%&37.5 %) of patient in the study group. While half of them (50%) was to ward walking. Independent and more than one half of them (57.5%) was dependent toward sporting.
•As Regards second part of week (4-7days) of activities (ADLs) most of them were independent towed all items of activity of daily living except of sporting item which one quartier of them were Independent (68.75%,75%,73.75% 63.75%,72.5& 25%) .
•Psychological symptoms represent the highest negative effect on patient needs (55.9±2.1,), followed by physical needs (45.8±7.07) and social symptoms 36.3±6.4were highest total mean scores. While the lowest means score was knowledge defect (9. 3±2 1).
•There were a highly statistically significant relations between psychological needs and patients’ sociodemogrphic characteristics affecting in age (p= 0.049),and gender (p= 0.027).
•There was a highly statistically significant relation between social needs and patients’ sociodemogrphic characteristics affecting in age (p = 0.041).
•There were statistically significant relations between patients’ knowledge and patient needs (physical, psychological & social needs).