Educational intervention based on the extended parallel process model improves adherence to diabetic diet and glycaemic control indices: a randomised, double-blind, controlled, factorial field trial.

Nutritional education is pivotal in the medical nutritional therapy of type 2 diabetes mellitus (T2DM). The extended parallel process model (EPPM) is a health education method for inducing desirable health behaviours. The present study aimed to investigate the effect of nutritional education based on the EPPM in T2DM patients on knowledge, attitude, practice, anthropometric indices, glycaemic factors, lipid profile and adherence to the diabetic diet. A randomised, double-blind, controlled, factorial field trial was designed for T2DM patients aged 30-59 years (n 88). Participants were randomly allocated into four groups to receive EPPM-based nutritional education through gain framed message (GFM), loss framed message (LFM), their combination (G\LFM) or usual diabetic education in the control group (CG). Participants were assessed before and after the study duration. After 3 months of intervention, eighty participants finished the study. The EPPM-based intervention increased participants' knowledge, behavioural intention, perceived sensitivity, severity, self-efficacy (P < 0·001 for all) and response efficacy (P = 0·029) in comparison with CG. GFM (P = 0·004) and G\FLM (P = 0·034) reduced carbohydrate intake and LFM (P = 0·034) and G\LFM (P = 0·047) decreased fat intake. Between-group analysis indicated interventions reduced weight (P = 0·046), BMI (P = 0·038), fasting blood sugar (P = 0·030), 2-hour postprandial blood glucose (P = 0·027) and TAG (P = 0·002) in comparison with the CG. Results were NS for protein intake, waist and hip circumference, waist:hip ratio, HbA1c, total cholesterol, LDL and HDL. Nutritional education based on EPPM could increase the knowledge and awareness of T2DM patients. Also, it could be beneficial for blood glucose amendment. Further investigations are recommended.

Need assessment of medical school curriculum for MOOCs: perspectives of instructors and students of Shiraz University of Medical Sciences.

INTRODUCTION: Designing, developing, and implementing a course without assessing and prioritizing instructional needs may result in inefficiency due to the disregard for the actual needs of the target population. The present study aimed to determine and prioritize medical students' instructional needs regarding Massive Open Online Courses (MOOCs) at Shiraz University of Medical Sciences. METHODS: This survey study was carried out in three stages (2020-2021) using the Delphi technique. Purposive and snowball sampling methods were used to select the instructors. The students were selected through simple random sampling. The first round of the Delphi technique involved a questionnaire consisting of one open-ended question, completed by 49 basic/clinical faculty members and 47 senior medical students. In the second round, a 5-point Likert scale-based questionnaire was used to prioritize the instructional needs. The reliability of the questionnaire was verified by Cronbach's alpha coefficient. In the third round, a focus group was used. A total of six expert faculty members and one senior medical student were invited to the focus group session to prioritize the needs. Data were analyzed using Friedman's non-parametric ranking test in SPSS version 26. RESULTS: Ten instructional needs priorities were extracted, including common pharmacotherapies (antibiotics and narcotics), prescriptions, physiology, anatomy, physical examination, electrocardiography interpretation, radiography, computed tomography scans, serum electrolyte disorders, and cardiovascular and internal (endocrine and metabolic) diseases. The chi-squared calculated value (715.584) indicated a significant difference in the importance of the questionnaire's questions (P < 0.001). These questions did not have equal value, and the importance, from the respondent's point of view and the observed distribution of ranks, was not the output of a random factor. CONCLUSIONS: The findings of this study can be used to design MOOCs, revise instructional programs, and adapt the curriculum to meet the needs of general practitioners, which will, in turn, help meet the medical needs of the general population.

Which virtual education methods do e­students prefer? Design and validation of Virtual Education Preferences Questionnaire (VEPQ).

BACKGROUND: With the prevalence of new technologies and evolving student learning styles, virtual teaching methods have become increasingly popular. As a result, more and more students are opting to learn online. However, one common concern is that they may feel disconnected from their teachers, leading to feelings of loneliness and doubts about the quality of education they are receiving. To address this issue, a study was conducted to gather data on students' preferences for virtual education and to validate a tool for measuring students' preferences for virtual education. METHODS: The research was conducted in a mixed method with a quantitative-qualitative sequence. A virtual education preferences questionnaire (VEPQ) for students with a total of 17 items was created and validated as part of the qualitative component by looking at the theoretical underpinnings and experts' opinions in the focus group. The scale of the six-point Likert questionnaire was from very high to very low. To validate the tool and determine preferences, exploratory factor analysis was used. A total of 155 samples answered the questions and the data were analyzed using SPSS-24 software. RESULTS: A total of 155 complete questionnaires were returned; among them, 110 (71%) were filled out by women, 73 (47.1%) by respondents between the ages of 36 and 45, 107 (69%) were already employed in paramedical fields, and 48 (31%) were enrolled in a medical school. The opinions of ten experts were used to confirm the face validity of the questionnaire. With CVI = 0.924 and CVR = 0.805, content validity was verified. Using the internal consistency method of the questions with a Cronbach's alpha coefficient of R = 0.824, the validity of the entire questionnaire was confirmed. Exploratory factor analysis revealed that a total of five components-self-directed projects (29.58%), e-content (13.00%), online presentation (10.97%), face-to-face interactions (9.12%), and text interactions (7.11%) had the highest load, with a total of 69.77% of the structure explaining virtual education preferences. The factor analysis test and the suitability of the sample are both confirmed by the value of KMO = 0.721 and the significance of Pvalue < 0.001. CONCLUSION: It appears that the highly valid tool developed can be used to ascertain the educational preferences of students. Also, the high factor load of self-directed educational methods and e-content shows that independence and flexibility in time and place are more important for students.

Post-dural puncture headache prevention and treatment with aminophylline or theophylline: a systematic review and meta-analysis.

BACKGROUND: Post-dural puncture headache (PDPH) is one of the most common complications in patients undergoing spinal anesthesia. The present systematic review and meta-analysis aimed to assess the therapeutic and prophylactic effects of aminophylline and theophylline on PDPH. METHODS: Relevant studies were identified by searching the following electronic databases, without language restriction, until June 2020: Scopus, EMBASE, MEDLINE, Google Scholar, Web of Science, Cochrane Library-CENTRAL, and CINAHL Complete. Random effects models were used to calculate the standardized mean difference (SMD) and risk ratios (RRs) with 95% confidence intervals (95% CI) to assess the therapeutic and prophylactic effects of aminophylline and theophylline on PDPH, respectively. The Cochrane tool was used for the quality assessment of the included studies. The certainty of the evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation method. RESULTS: Of the 1,349 initial records, 15 met our eligibility criteria (6 studies on therapeutic and 9 on prophylactic effects). A significant reduction in the pain score was observed following aminophylline/theophylline treatment (SMD = -1.67; 95% CI, -2.28 to -1.05; P < 0.001, I2 = 84.7%; P < 0.001). Subgroup analysis revealed that the therapeutic effect was significantly higher when these agents were compared to placebo than when conventional therapies were used. The risk of PDPH after aminophylline administration was not significantly reduced (RR = 0.74; 95% CI, 0.42 to 1.31; P = 0.290). CONCLUSIONS: Theophylline and aminophylline have therapeutic, but not prophylactic, effects on PDPH.

The effects of mobile-based education on nurse self-concept among nursing students: an embedded mixed methods study.

OBJECTIVES: This study evaluates the effects of mobile-based education (MBE) on nurse self-concept (NSC) among nursing students. METHODS: This embedded mixed methods study was conducted in 2020-2021 in a main quantitative phase and a supplementary qualitative phase. In the quantitative phase, a quasi-experimental study with the Solomon four-group design was conducted on 117 second-year nursing students of Shiraz University of Medical Sciences, Shiraz, Iran. 70 students in the first (C1: n=37) and the second (C2: n=33) semesters of the 2020 academic year were respectively considered as the control groups, and 40 students in the first semester of the 2021 academic year considered as the experimental groups (I1: n=20 and I2: n=20). Participants in the experimental groups received NSC-related MBE through an Android application, while their counterparts in the control groups received no NSC-related MBE. Cowin's Nurse Self-Concept Questionnaire was used to assess the NSC. In the qualitative phase, six students from the experimental groups were purposively selected and interviewed through face-to-face semi-structured interviews. Moreover, two focus group discussions were held with a six-person and a five-person group of students from the experimental groups. RESULTS: While the mean scores of NSC and its dimensions did not significantly change in the C1 group, the posttest mean scores of them in the E1 group were significantly greater than the corresponding pretest values (p<0.05), expect for the care dimension (p=0.586). Moreover, except for the care dimension (p>0.05), the posttest means scores of NSC and its other dimensions in the E1 and the E2 groups were significantly greater than the C1 and the C2 groups, respectively (p<0.05). Analysis of the qualitative data resulted in the generation of the main theme of multidimensional growth and development with three main categories, namely development of coping strategies, knowing professionalization strategies, and development of managerial potentials. CONCLUSIONS: NSC-related MBE is effective in improving nursing students' NSC.

Evaluating the effect of digital game-based nutrition education on anemia indicators in adolescent girls: A randomized clinical trial.

Iron deficiency anemia is the most common type of micronutrient deficiency in the world. Adolescence represents a period of increased risk of iron deficiency. Therefore, we aimed to determine the impact of nutrition education by a digital game on markers of iron-deficient anemia in adolescent girls. In this study, 176 adolescent girls were randomly dichotomized into the intervention and control groups. At the beginning and the end of the intervention, knowledge, attitude, and practice of both groups were assessed by a questionnaire. Girls in the intervention group received the necessary education through a digital game during a 14-week period, while those in the control group received basic nutritional education through PowerPoint and pamphlets. Additionally, serum transferrin, serum iron, transferrin saturation, ferritin, CBC difference, and total iron binding capacity (TIBC) tests were checked. In this study, nutrition education significantly increased the level of knowledge, attitude, and practice of adolescent girls regarding their diet (p Ë‚ .05). Hemoglobin level was also significantly raised (p Ë‚ .05). However, no significant effect was observed on other markers of iron-deficient anemia, such as serum iron, TIBC, and hematocrit, in the intervention group compared with the control group (p Ëƒ .05). The results of this study indicated the positive impact of nutrition education based on digital game on knowledge, attitude, and practice scores, as well as a significant difference in hemoglobin. It is recommended that educational games be designed for students in the future to promote health and nutrition information.

Alterations in the Course of Inflammatory Bowel Disease Following Liver Transplantation: A Systematic Review and Meta-analysis.

BACKGROUND: This study aimed to systematically review and pool data regarding the alterations in the clinical course of inflammatory bowel disease (IBD) following liver transplantation (LT). METHODS: Relevant prospective and retrospective observational studies were identified by searching databases and gray literature through December 2020. Random-effects models were used to calculate the pooled frequency of IBD patients with disease course alterations ("improved," "unchanged," or "aggravated") after LT and the corresponding 95% confidence intervals (CIs). RESULTS: Twenty-five studies met our inclusion criteria, reporting the outcomes in 2 or 3 categories. In the analysis of studies with 3-category outcomes (n = 13), the pooled frequencies of patients with improved, unchanged, or aggravated IBD course after LT were 29.4% (95% CI, 16.9% to 41.9%), 51.4% (95% CI, 45.5% to 57.3%), and 25.2% (95% CI, 15.6% to 34.8%), respectively. Subgroup analyses revealed that patients with ulcerative colitis (UC), younger age at LT, or shorter duration of follow-up were more likely to have an improved disease course. Moreover, higher IBD exacerbation estimates were observed in studies with a low risk of bias. In the analysis of studies with 2-category outcomes (n = 12), the pooled frequencies of patients with improved/unchanged or aggravated IBD course were 73.6% (95% CI, 62.2% to 85.0%) and 24.1% (95% CI, 15.1% to 33.2%), respectively. The cumulative incidence of an exacerbated IBD course following LT was 0.22 (95% CI, 0.16-0.29; P < .001). CONCLUSION: We conclude that IBD activity remains unchanged (or improved/unchanged) in most IBD patients following LT. Furthermore, IBD type, age, and follow-up length can influence the IBD course after LT.

Our meta-analysis revealed that inflammatory bowel disease (IBD) activity remained "unchanged" (or "improved/unchanged") in most IBD patients following liver transplantation. IBD type, age, and follow-up length could influence the IBD course after liver transplantation.

Synchronous online lecturing or blended flipped classroom with jigsaw: an educational intervention during the Covid-19 pandemic.

BACKGROUND: The Covid-19 pandemic has changed the education system throughout the world. This study aimed to compare synchronous online lecturing with blended flipped classroom plus jigsaw in terms of their effects on the students' learning, communication skills and critical thinking disposition. METHODS: This is an educational intervention conducted at the Nursing and Midwifery School of Shiraz University of Medical Sciences. Two incoming students of nursing and midwifery were selected by complete enumeration. Then synchronous online lecturing was given to one group (n = 40) and blended flipped classroom and jigsaw to the other (n = 44). After that, given the prevailing conditions, both methods were performed fully online. Then Participants completed an online questionnaire. A researcher-made learning questionnaire, the Interpersonal Communication Skills Questionnaire developed by Fetro, and Ricketts' Critical Thinking Disposition Inventory were used to assess the study variables. RESULTS: The mean learning scores in the blended group were slightly higher but this difference was not significant (P = 0.767). In the blended group, the mean scores of communication skills were significantly higher after the intervention in all the dimensions, except for empathy & intimacy and listening skills. In the online lecture group, there was no significant difference between before and after the intervention. Communication skills (P < 0.001) scored significantly higher in the blended group after the intervention than that in the synchronous online lecturing group in all the dimensions except for empathy & intimacy. In the online lecture group, there was no significant difference in critical thinking disposition between before and after the intervention. In the blended group, the overall score of critical thinking disposition and its dimensions was significantly higher after the intervention (P < 0.001), except for the perfection dimension. There was no significant difference between the two groups in terms of the mean total score of critical thinking disposition and its dimensions before and after the intervention. CONCLUSION: Given the global circumstances, the blended method was more effective in promoting learning outcomes and communication skills than synchronous online lectures. Furthermore, it seems that this new approach could improve critical thinking.

The effect of case-based e-learning on academic performance and problem-solving ability in nursing students: A pre- and post-test study.

BACKGROUND: Case-based learning is a modern learning approach, aims to prepare students for practical skills. In the present study, we aimed to determine the effectiveness of case-based e-learning (CBEL) on the academic performance and problem-solving ability of nursing students. MATERIALS AND METHODS: In this pre- and post-test study, census sampling method was used to select 128 nursing students who had nutrition courses during 2015-2017 at (blinded). Before and after the educational intervention, the students completed the problem-solving inventory including problem-solving confidence (PSC), approach-avoidance style (AA), and personal control (PC) and a scientific test for evaluating academic function. Continuous variables before and after the intervention and categorical variables were analyzed using paired t-test and Chi-square test, respectively. RESULTS: The mean scores of PSC, AA, and PC decreased after the intervention (P < 0.001). The mean scientific score of the students improved after the intervention (P < 0.001). CONCLUSION: This study showed that the CBEL method had a positive effect on the ability to solve the learning problems and the academic performance of the students and can be used to train nurses to improve their ability to confront clinical problems in the future.

The effect of micro-learning on learning and self-efficacy of nursing students: an interventional study.

BACKGROUND: In the present age, e-learning has been playing a good role in educational and clinical settings along with face-to-face training. This study aimed to determine the effect of distance class using micro-learning contents on learning outcomes and self-efficacy in the clinical education of nursing students in 2021. METHODS: This research is a quasi-experimental pre-test-post-test study conducted at Shiraz University of Medical Sciences. The study population consisted of 46 nursing students who were recruited by the full census method. Students were randomly divided into two groups of intervention and control. Before and after educational interventions in both groups, students' learning and self-efficacy were evaluated using a questionnaire. Data Analysis was done using descriptive and analytical statistical methods and with SPSS software version 23. RESULTS: The results revealed a statistically significant difference in the mean score of clinical learning level of nursing students between the control and experimental groups after the intervention (p = 0.041). Also, the difference between the mean score of self-efficacy in the intervention group before and after the training was statistically significant (p = 0.001). CONCLUSION: Micro-learning is an effective training method for raising learning outcomes and self-efficacy among nursing students, especially in internship units. This method is recommended since multimedia pays attention to all learning styles of learners and affects the learning outcomes and self-efficacy of learners.

Effect of a multi-disciplinary program on anthropometric and biochemical parameters in obese and overweight elementary school girls: A randomized clinical trial.

BACKGROUND AND AIMS: Obesity and overweight in children are associated with an increased risk of several health issues. The present study aimed to assess the effects of a multi-disciplinary program (including nutrition education using a smartphone game, physical activity, and cognitive behavioral therapy [CBT]) on the management of obesity and overweight in elementary school girls. METHODS AND RESULTS: Sixty-two school girls above the 85th percentile of body mass index (BMI) for age were randomly assigned to two groups. During 10 weeks of study, the intervention group received a multi-disciplinary intervention, including nutrition education using a smartphone game, aerobic exercise, and CBT. The control group received usual traditional nutritional education. Biochemical and metabolic factors were assessed, including fasting blood sugar (FBS), lipid profile, serum leptin, and anthropometric measurements. The Dutch Eating Behavior Questionnaire (DEBQ) and metabolic equivalent test (MET) were also conducted. The intervention group showed more promising results in weight loss, waist circumference (WC), hip circumference (HC), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), and FBS compared to the control group (P < 0.05). In addition, MET and DEBQ scores in all three sections of emotions, stimuli, and restriction were better in the intervention group than in the control group (P < 0.05). However, there was no significant difference between groups regarding the results of serum leptin and waist-to-hip ratio (WHR; p > 0.05). CONCLUSIONS: The results indicated that education through smartphone games could possibly affect performance in real life. In addition, the multi-disciplinary approach to childhood obesity might have better performance in most areas than the single-intervention approach in obesity management.

Promoting self-management behaviors in adolescents with type 1 diabetes, using digital storytelling: a pilot randomized controlled trial.

BACKGROUND: This study aimed to assess the effects of digital storytelling on the self-management behavior of adolescents with type 1 diabetes (TID). METHODS: In this pilot randomized controlled clinical trial, 60 adolescents with TID were randomly allocated into two parallel groups: intervention (training with digital storytelling method, n = 33) or control (training with a conventional method, n = 33). The primary outcome was assessing the Self-Management behavior of adolescents with TID (SMOD-A) at baseline and three months after the intervention. RESULTS: The results revealed that digital storytelling could significantly improve self-management behaviors amongst adolescents with TID (P = 0.005). In contrast, in the control group, no significant changes were observed (P > 0.05). Furthermore, the mean score of Collaboration with Parents subscale was significantly higher in the digital storytelling group than in the control group after the intervention (p = 0.022). The results also showed that the level of Collaboration With Parents' subscale scores had a meaningful reverse relationship with the adolescent age after digital storytelling (p = 0.048). Repeated measures ANOVAs showed that there were significant main effects of time and group on collaboration with parents(p = 0.002) and goal subscales (p = 0.035). With respect to HbA1c levels, significant changes were not observed in any of the groups (P > 0.05). CONCLUSIONS: Digital storytelling is practicable and a potentially beneficial training modality for adolescents with TID. TRIAL REGISTRATION: This trial was respectively registered. CLINICALTRIALS: gov Identifier: IRCT20191220045828N1 . Date of registration: Oct 29. 2020.

Medical education and COVID-19 pandemic: a crisis management model towards an evolutionary pathway.

The COVID-19 crisis has had a profound effect on higher education, especially medical education due to its sensitive nature, dealing with people's life and wellbeing. This study presented a crisis management model of how to direct medical education during crises. A qualitative design was used via a focus group among 83 medical education administrators at Shiraz University of Medical Sciences. Four major challenges emerged regarding medical education during the COVID-19 pandemic including "The health and wellbeing of faculty members and students"; "Spatial constraints"; "Time constraints", and "Access to resources". A total of 13 strategies were suggested to tackle the challenges, including virtualization, technological support, empowerment, participation, sharing, helping, integration, compression, omission, flexibility and diversity, severance, protection; and monitoring. For a sustainable educational pathway in medical education, personalized approach to education via the incorporation of technology is essential. This provides opportunities to tackle the issues caused by the crisis, by provision of any time and anywhere approach to education via flexible technologies/platforms adjusted based on the audiences. The scope of crisis management expands not only on individual and academic levels but also on social and global relations.

A multi-disciplinary approach to weight management of school-age girls: a study protocol.

INTRODUCTION: There is lack of data about the combination of multiple approaches to control being overweight and obesity in adolescents. This study aimed to evaluate the effect of a combination program including smart-phone nutrition education, physical activity, and cognitive behavioral therapy (CBT) programs in the management of obesity and overweight among elementary school girls in comparison with a traditional education method. MATERIAL AND METHODS: The primary outcome of this study is the assessment of changes in anthropometric data after 10 weeks. The secondary outcome is investigating the effect of treatment on biochemical data. Sixty-two elementary school girls aged 9-12 years with the body mass index (BMI) for age above 85th percentile will be chosen and randomly assigned to one of the two groups of control or intervention. During the 10 weeks of the intervention, smartphone games will be given to the children with some information at the beginning about the causes and complications of obesity, food sources of fiber and vitamins, and banned foods during the intervention period. Students in the intervention group will participate in an aerobics exercise for 45 minutes three times per week under the supervision of an experienced trainer and eight CBT Sessions which were designed for children by a clinical psychologist. Anthropometric measurements, including height, weight, waist circumference (WC), hip circumference and waist to hip ratio(WHR), and biochemical and metabolic lab data, including fasting blood sugar (FBS), total cholesterol, high density lipoproteins (HDL), low density lipoproteins (LDL), leptin and will be measured at the baseline and 10 weeks later at the end of intervention period . Also, both questionnaires of metabolic equivalent test (MET) and Dutch Eating Behavior Questionnaire (DEBQ) will be completed for each student at baseline and after 10 weeks. The students in the control group will receive traditional education in the form of lectures given by a nutritionist regarding weight management. DISCUSSION: The primary outcome of this study is the assessment of changes in anthropometric data after 10 weeks. The secondary outcome is investigating the effect of treatment on biochemical data. Sixty-two elementary school girls aged 9-12 years with the body mass index (BMI) for age above 85th percentile will be chosen and randomly assigned to one of the two groups of control or intervention. During the 10 weeks of the intervention, smartphone games will be given to the children with some information at the beginning about the causes and complications of obesity, food sources of fiber and vitamins, and banned foods during the intervention period. Students in the intervention group will participate in an aerobics exercise for 45 minutes three times per week under the supervision of an experienced trainer and eight CBT Sessions which were designed for children by a clinical psychologist. Anthropometric measurements, including height, weight, waist circumference (WC), hip circumference and waist to hip ratio(WHR), and biochemical and metabolic lab data, including fasting blood sugar (FBS), total cholesterol, high density lipoproteins (HDL), low density lipoproteins (LDL), leptin and will be measured at the baseline and 10 weeks later at the end of intervention period . Also, both questionnaires of metabolic equivalent test (MET) and Dutch Eating Behavior Questionnaire (DEBQ) will be completed for each student at baseline and after 10 weeks. The students in the control group will receive traditional education in the form of lectures given by a nutritionist regarding weight management.

The effect of learning style and general self-efficacy on satisfaction of e-Learning in dental students.

INTRODUCTION: The COVID-19 pandemic has had a significant impact on education. e-Learning has been becoming most popular. Satisfaction of the student is one of important goal of e-Learning, therefore factors affecting this satisfaction should be considered extensively. This study aims to evaluate the effect of learning style and General Self-Efficacy (GSE) on satisfaction of e-Learning in dental student. METHOD: Electronic questionnaires were sent to 85 fifth and sixth-year students who had passed the face-to-face orthodontics course in the previous semester and were studying online orthodontics at the time of this study. Three questionnaires were used including Soloman and Felder learning styles index, General self-efficacy questionnaire and Satisfaction questionnaire for online education. RESULTS: The results of the reliability test showed that Cronbach's alpha index for the self-efficacy and satisfaction questionnaire was 0.836 and 0.96, respectively. The correlation between satisfaction and the dimensions of learning style showed that the active dimension of processing information had a significant relationship with the level of satisfaction. In the understanding dimension, a relatively strong correlation was observed in the Global dimension. Moderate significant relationship between the total score of self-efficacy and the level of satisfaction has been found. CONCLUSION: The results of the present study highlight the necessity of more studies regarding defining effective on student satisfaction during e-Learning. GSES and active learning style in the processing dimension and global learning style in the understanding dimension affect students' satisfaction.

The effect of a smartphone application on women's performance and health beliefs about breast self-examination: a quasi-experimental study.

BACKGROUND: Breast Self-Examination (BSE) is a simple and inexpensive method for early diagnosis of breast cancer. This study aimed to determine the effect of a smartphone application on women's performance and health beliefs regarding BSE. METHODS: In this quasi-experimental study, 150 women referring to therapeutic clinics in Jahrom, Iran from December 2019 to May 2020 were randomly assigned to an intervention or a control group. The intervention group participants had access to a smartphone application including BSE reminder, training, alarm, and feedback to the therapist. The application also contained educational movies and self-assessment. The study data were collected using Champion's Health Belief Model Scale and BSE information record form before and six months after the intervention. Then, the data were entered into the SPSS 21 software and were analyzed using descriptive statistics, paired t-test, independent t-test, Chi-square, ANCOVA, Mann-Whitney, and Wilcoxon tests. RESULTS: After the intervention, the largest number of BSEs was four times among 60% of the participants in the intervention group and once among 24% of the participants in the control group during four months (p = 0.001). After the intervention, the mean differences of the scores of perceived susceptibility (1.03 ± 2.65 vs. 0.01 ± 0.42, p = 0.001), BSE barriers (2.80 ± 5.32 vs. 0.04 ± 1.43, p = 0.001), self-efficacy (10.75 ± 7.63 vs. - 2.75 ± 2.44, p = 0.001), and health motivation (2.77 ± 3.70 vs. - 0.29 ± 0.63, p = 0.001) were significantly higher in the intervention group compared to the control group. However, no significant difference was observed between the two groups with regard to perceived severity and BSE benefits after the intervention. CONCLUSIONS: Access to the smartphone application enhanced the participants' performance and health beliefs regarding BSE in the areas of perceived susceptibility, self-efficacy, and health motivation. Therefore, we recommend using the same smartphone application to improve women's performance and health beliefs regarding BSE.

Effects of Psychoeducational Interventions Using Mobile Apps and Mobile-Based Online Group Discussions on Anxiety and Self-Esteem in Women With Breast Cancer: Randomized Controlled Trial.

BACKGROUND: Psychoeducation has turned into an effective tool in taking care of cancer patients and improving their psychophysical symptoms and quality of life. Despite the growing use of mobile phone apps in medical settings for improving health, evidence supporting their effectiveness in the psychoeducation of patients with breast cancer is rarely available. OBJECTIVE: This study was conducted to investigate the effect of psychoeducational interventions on anxiety and self-esteem in women with breast cancer using a mobile app and an online support group. METHODS: An unblinded randomized controlled trial based on mobile phones was conducted in Shiraz, Iran. A research assistant recruited 82 women with nonmetastatic breast cancer aged 20 to 60 years were from clinics during a face-to-face visit at the point of care and randomly assigned to an intervention group (n=41) and a wait-list control group (n=41) through blocked randomization. The intervention group received psychoeducational interventions through a mobile phone app and participated in nurse-assisted online mobile support sessions for a total four weeks, whereas the control group was put on a waiting list. The State-Trait Anxiety Inventory (STAI) and the Rosenberg Self-Esteem Scale (RSES) were used to measure the levels of anxiety and self-esteem as the main outcomes at baseline and one week after the intervention. RESULTS: A total of 82 patients with a mean age of 46.45 (SD 9.29) years recruited in Winter 2016 were randomly assigned to a wait-list control group (n=41) and intervention group (n=41). Five patients dropped out for different reasons. Comparing the postintervention mean scores of anxiety and its subscales using the independent t test showed statistically significant differences between the mobile psychoeducation group and controls (P<.001). The paired t test used to compare the postintervention mean scores of anxiety with its preintervention scores in the intervention group showed significant reductions in the scores of anxiety (95% CI -17.44 to -8.90, P<.001, d=1.02) and its two subscales (state anxiety: 95% CI -9.20 to -4.21, P<.001, d=0.88 and trait anxiety: 95% CI -8.50 to -4.12, P<.001, d=0.94). Comparing the postintervention mean scores of self-esteem showed statistically insignificant differences between the control and intervention groups (16.87 vs 17.97, P=.24). In contrast with the controls, using the paired t test showed that the increase in the postintervention mean scores of self-esteem were statistically significant in the intervention group compared with the preintervention scores (mean difference 2.05, 95% CI 1.28 to 2.82, P<.001). CONCLUSIONS: This study demonstrated the key role of mobile apps in decreasing anxiety and improving self-esteem in women with breast cancer through psychoeducational interventions. Similar studies with longer follow-ups are recommended that be conducted in this context. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT2015072123279N2; https://en.irct.ir/trial/19882.

Aminophylline for Prevention and/or Treatment of Post-Dural Puncture Headache: A Systematic Review and Meta-Analysis Study Protocol.

OBJECTIVES: Post-dural Puncture Headache (PDPH) is prevalent among individuals undergoing lumbar punctures. The non-invasive effect of some drugs, such as aminophylline on PDPH has been investigated in several clinical studies. As there is no comprehensive systematic review and meta-analysis about the preventive and therapeutic effects of aminophylline on PDPH in the literature, the clinical effectiveness of this drug on the prevention and/or treatment of PDPH will be assessed in this study. METHODS: PubMed/MEDLINE, Embase, WoS (Clarivate Analytics), the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL Complete, Scopus, and Google Scholar as electronic databases will be precisely searched for clinical studies that assessed the effect of aminophylline on PDPH. Studies between 01-01-1980 and 30-06-2020 will be evaluated in this study, and there will not be any language restrictions. Contradictions between the reviewers within any phase of the study (screening, selecting, quality assessment, and data extraction) will be resolved by consensus; in case of unsolved disagreements, a third reviewer will eventually decide. The combination method will be applied according to the methodological resemblance in the selected articles using the Random Effect Model or the Fixed Effect Model. Also, for the included articles, forest plots will be drawn. For assessing statistical heterogeneity, the I2 statistic and the Q-statistic test will be applied. In addition, funnel plots will be used for assessing non-significant study effects and potential reporting bias. Furthermore, Egger's and Begg's tests will be done, and publication bias will be indicated by significant findings (P < 0.05). CONCLUSIONS: It is expected that the results of this study will be of benefit to researchers and clinicians for managing PDPH, and will be reported in conferences and publications.

[Factors affecting nursing students' professional self-concept in Iran: a qualitative study]. / Fattori che influenzano il concetto di sé professionale degli studenti infermieri in Iran: uno studio qualitativo.

INTRODUCTION: Professional self-concept is a contextualized multidimensional concept that describes the subjective experiences and feelings of nurses with regard to nursing roles. Professional self-concept starts to develop during the academic years. Yet, there is still limited understanding about the factors affecting nursing students' professional self-concept, which is a potential problem. Poor professional self-concept negatively affects nurses' clinical practice, job satisfaction, and retention in the profession. AIM: This study aimed to explore factors affecting Iranian nursing students' professional self- concept from the perspectives of nursing students, nursing instructors, and hospital nurses. METHODS: This exploratory qualitative study was carried out from June 2018 to April 2019. Participants were four hospital nurses, three clinical nursing instructors, and four nursing stu- dents who were purposively selected from the Shiraz University of Medical Sciences, Shiraz, Iran. Data were gathered via in-depth semi-structured interviews and were analyzed via con- ventional content analysis proposed by Graneheim and Lundman. FINDINGS: In total, 610 primary codes were generated and grouped into eleven subthemes and five main themes. The main themes of the study were professional instructors, competent nur- ses, informed choice of nursing profession, difficulties of nursing profession, and congruence between students' personal-professional values and nursing profession. CONCLUSION: Professional self-concept is affected by different personal, educational, envi- ronmental, and social factors. Nursing instructors, hospital managers, and nurse managers can use the findings of this study to support nursing students, promote their professional self-con- cept, and ensure their retention in the profession.