Exploring nurses' experiences of recommended patient care: a descriptive phenomenological study.

BACKGROUND: Caring for recommended patients creates work and emotional challenges for nurses. Nurses are obligated to provide care regardless of the patient's situation. Therefore, knowing the experiences of nurses in dealing with recommended patients in order to provide quality and effective care can be the basis for increasing patient satisfaction. The present study was conducted aimed to explain nurses' experiences of caring for recommended patients. METHODS: This was a qualitative study with descriptive phenomenological approach. Participants were 12 nurses working in different wards of hospitals affiliated to Kermanshah University of Medical Sciences, selected by purposive sampling method with maximum diversity. The data collected using semi-structured interviews in face-to-face and audio-recorded methods. MAXQDA 2020 software was used for data management. The analysis of the data was done using the Colaizzi's 7-step method. In order to verify the trustworthiness of the data, Lincoln and Guba criteria were used. RESULTS: After continuous data analysis, 110 initial codes were extracted. These codes emerged in 18 sub-themes and 6 main themes including: catastrophe, be in decline, be in progress, discrimination, work overload, and poor prognosis. CONCLUSIONS: The results showed information about the presence of recommended patients in the hospital, which can have consequences for patients and nurses. Therefore, it is advised that nurses provide standard care and avoid any kind of discrimination against all patients regardless of whether the patient is recommended or not.

The Effect of Religious-Spiritual Education and Care on the Life Quality of Iranian Elderly: A Systematic Review and Meta-Analysis.

Aging causes the reduction in physical and physiological strength and an increase in the odds of affliction with chronic physical and mental diseases ultimately affecting the quality of life (QoL). So far, several primary studies have been conducted on the impact of religious-spiritual education and care on the QoL of the elderly. However, to the best of our knowledge, a study that compiles and represents these findings in a published paper is lacking. Therefore, the current study conducted a systematic review and meta-analysis to investigate the effect of religious-spiritual education and care on the QoL of the elderly population. To access studies related to the aim of the study, SID, MagIran, IranMedex, IranDoc, Embase, PubMed, Scopus, Web of Science, and Google Scholar databases were searched. The search was done using relevant and validated keywords with MeSH/Emtree without time limitations until December 2021. The qualitative appraisal of the papers was done using the JBI checklist. To estimate the heterogeneity of studies, I2 index was used, and to combine the data and carry out a meta-analysis, Random Effects model was used. In the primary research, 1065 studies were found. The omission of the redundant cases led to a total number of 12 papers with a sample size of 317 in the intervention group and 321 in the control to be included in the meta-analysis. After the intervention, the mean score of QoL showed a significant increase by 1.42 ± 0.31 with a Confidence Interval of 95% (P<0.001). Meta-regression results showed that the increase in the year of conducting the study, and the number of intervention sessions, that the standardized mean difference had a decreasing trend, and that with the increase in the average age of the elderly, there was a rising trend (P<0.001). Therefore, it seems that the application of religious-spiritual education and care could be part of a program to improve the QoL of the elderly.

The impact of omega-3 polyunsaturated fatty acids on primary dysmenorrhea: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Primary dysmenorrhea is one of the most common complaints in women. To date, no definitive results have been reported on the effect of omega-3 polyunsaturated fatty acids (n-3 PUFAs) on primary dysmenorrhea. Therefore, this study aimed to determine the effect of n-3 PUFAs on primary dysmenorrhea using a systematic review and meta-analysis. METHODS: This study is a systematic review and meta-analysis in which the electronic databases of PubMed, Scopus, Web of Science, ProQuest, Google Scholar, and SID were searched. In this regard, randomized controlled trials (RCTs) conducted to investigate the effect of n-3 PUFAs on primary dysmenorrhea were included. The quality of the studies was assessed using the Cochrane Collaboration's Risk of Bias Tool. Meta-analysis was performed based on the random-effects model using CMA software version 2. RESULTS: The results of the meta-analysis showed that n-3 PUFAs reduce the severity of primary dysmenorrhea in women (SMD = -1.075, 95% CI: -1.871 to -0.279); meta-regression showed that the daily intake of n-3 PUFAs (ß = 0.005, 95% CI 0.003 to 0.008, p < 0.001) and age of women (ß = 0.256, 95% CI -0.157 to -0.354, p < 0.001) had a significant effect on the severity of primary dysmenorrhea. CONCLUSION: The present study showed that n-3 PUFAs could have a mild effect on the severity of primary dysmenorrhea in women. Furthermore, the highest effectiveness of treatment was seen at low doses of n-3 PUFAs, and with increasing daily intake, the effectiveness of treatment with n-3 PUFAs decreased. Another finding indicated that with the increasing age of women, n-3 PUFAs showed lesser effectiveness in reducing the severity of primary dysmenorrhea. The results of the present study provide valuable evidence to primary healthcare providers and health policymakers in the treatment of primary dysmenorrhea.

Vaginal misoprostol and intravenous oxytocin for success of termination in the second-trimester intrauterine fetal demise: A randomized controlled clinical trial.

AIM: To compare the success rate of vaginal misoprostol versus intravenous (IV) oxytocin in termination of pregnancy in the second trimester intrauterine fetal death (IUFD). METHODS: This was an open-label randomized controlled study for 106 women with second trimester IUFD. Patients were randomly divided into two groups: women given vaginal misoprostol (400 mcg every 6 h up to 48 h) versus those given IV oxytocin (starting with 50 units up to a maximum of 300 units). When the first-line treatment (as mentioned above) failed, treatment methods were replaced with each other. When the second-line treatment failed, the patients underwent dilation and evacuation. RESULTS: The first-line treatment yielded the successful rate of 88.7% versus 73.7% for misoprostol versus oxytocin, respectively (p = 0.047). Among those with first-line treatment failure, the second-line treatment yielded success rate of 85.7% versus 83.3% for misoprostol versus oxytocin (p = 0.891). The mean duration of induction to delivery in women with successful response to first-line treatment was 28.72 and 20.55 h after initially receiving misoprostol versus oxytocin, respectively (p < 0.001). While during second-line treatment, this mean interval was not significantly different among those with misoprostol versus oxytocin (p = 0.128). No severe adverse events were observed. CONCLUSION: Vaginal misoprostol was associated with higher termination rate than oxytocin without adverse events when used as the first-line treatment. Both methods yielded the same success rate when used as the second-line treatment.

Predictive value of vascular endothelial growth factor and placenta growth factor for placenta accreta spectrum.

This study aimed to assess the maternal features, Vascular Endothelial Growth Factor (VEGF) and Placenta Growth Factor (PLGF) in the Placenta Accreta Spectrum (PAS); then, to determine a predictive value of VEGF and PLGF in the PAS. This prospective case-control study was conducted on 90 pregnant women including 45 PAS, and 45 Normal Placenta (NP). Maternal age, gravidity, C/S, and serum levels of VEGF and PLGF were assessed between NP and PAS, and among NP and PAS sub-groups, including Placenta Accreta (PA), Placenta Increta (PI), and Placenta Percreta (PP). The Multi-gravidity, previous C/S, maternal age, and serum level of PLGF were significantly higher in the PAS group compared to the NP group OR = 42, 8.1, 1.17, and 1.002 (p-value <.05 for all); however, there was no difference regarding serum level of VEGF (p-value >.05). The same differences were seen among NP with PA, PI, and PP sub-groups (p-value <.05 for all, but p-value >.05 for VEGF). Placenta Previa was uniformly distributed across the PAS sub-groups (p-value >.05), also the VEGF and PLGF serum levels did not differ between PAS with Previa and PAS without Previa groups (p-value >.05). A valid cut-off point for PLGF was reported at 63.55. A predictive value of PLGF for the PAS patients is presented enjoying high accuracy and generalisability for the study population.Impact statementWhat is already known on this subject? The Placenta Accreta Spectrum (PAS), in which the placenta grows too deep in the uterine wall, is responsible for maternal-foetal morbidity and mortality worldwide; so, the antenatal diagnosis of PAS is an important key to improve maternal-foetal health. Normal placental implantation requires a fine balance among the levels of angiogenic and anti-angiogenic factors, such as the Placenta Growth Factor (PLGF), the Vascular Endothelial Growth Factor (VEGF), and soluble Fms-like tyrosine kinase-1. However, there is still controversy regarding The PLGF and VEGF level changes in PAS patients.What do the results of this study add? Despite traditional measuring the levels of PLGF and VEGF from the placenta at the time of delivery; in this study including 90 participants (28-34 weeks of gestation) the maternal serum levels of PLGF and VEGF were measured in advance (temporality causation), resulted in presenting a more valid cut-off point for PLGF in PAS group. In addition, the serum level of PLGF was significantly higher in the PAS and PAS sub-groups compared to the Normal Placenta group. Also, the Previa status of PAS patients did not affect the VEGF and PLGF serum levels.What are the implications of these findings for clinical practice and/or further research? PLGF cut-off point derived from the maternal serum level could predict PAS validly and, if used as a screening test in an earlier pregnancy, the maternal-foetal morbidity and mortality would decrease.

The impact of betamethasone on fetal pulmonary, umbilical and middle cerebral artery Doppler velocimetry and its relationship with neonatal respiratory distress syndrome.

BACKGROUND: Prenatal corticosteroid administration is known to be an effective strategy in improving fetal pulmonary maturity. This study aimed to evaluate the impact of maternal betamethasone administration on fetal pulmonary and other arteries Doppler velocity and the correlation between RDS development and Doppler indices results. METHODS: Fifty one singleton pregnancies between 26 and 34 gestational weeks with a diagnosis of preterm labor were included in the exposed group and received betamethasone. Fifty one uncomplicated pregnancies were included in the non-exposed group. Fetal pulmonary, umbilical and middle cerebral arteries Doppler parameters were evaluated before and 24 to 48 h after steroid administration in the exposed group and two times at same intervals in the non-exposed group. Maternal records were matched to neonatal charts if delivery happened, and demographic and outcome data were abstracted. RESULTS: When compared with the nonexposed group, fetuses treated with corticosteroids demonstrated significantly decreased umbilical artery Pulsatility index (PI) and significantly increased the middle cerebral artery PI, pulmonary artery Acceleration time (AT) and pulmonary artery AT/ET (Ejection time), while all other indices remained similar. We found significantly decreased pulmonary artery AT in the fetuses with respiratory distress syndrome (RDS) compared to those that did not. CONCLUSIONS: The results of our study showed that maternal antenatal betamethasone administration caused significant changes in the fetus blood velocity waveforms and also affected the blood flow in the pulmonary artery which led to an increase in the pulmonary artery AT and AT/ET. Among those fetuses with RDS, we found a significant decrease in the pulmonary artery AT, but we did not observe any pulmonary artery AT/ET differences.

Awareness of professional rules among Iranian nurses: a cross-sectional study.

BACKGROUND: One of the main responsibilities of professional nurses is protecting themselves against legal complications. Hence, they have to be sufficiently aware of the professional rules. This study examines the Iranian nurses' awareness of professional rules. METHODS: A total of 260 nurses were randomly selected from among the nurses working at various wards and included in this cross-sectional descriptive analytical study. Data were collected using a researcher-made questionnaire. The collected data were then analyzed using descriptive (mean and frequency percentage) and inferential (Kolmogorov-Smirnov, Mann-Whitney U, and Kruskal-Wallis) statistics. RESULTS: The nurses' mean awareness of professional rules was 28.3 ± 4.0 out of 37. There was a significant relationship between the mean awareness of the nurses and ward (p = 0.001). However, this relationship was not significant regarding demographic variables age, sex, marital status, job title, working experience, education and history of participation in retraining courses on professional rules. CONCLUSION: A significant number of nurses were not adequately aware of professional rules, which can put them and their working organization at serious risks. Some measures such as holding web-based or in-person training courses and providing educational booklets and pamphlets can be helpful in this regard.

Effects of oral glibenclamide versus subcutaneous insulin on perinatal outcome of patients with gestational diabetes mellitus: A randomized clinical trial.

Background: The first-line treatment for gestational diabetes mellitus remains insulin, but oral hypoglycemic agents are easier and cheaper to use. The aim of the current study was to compare the efficacy and safety of oral glibenclamide and subcutaneous insulin on the serum glucose control and perinatal outcome of patients with gestational diabetes mellitus. Materials and methods: This randomized clinical trial was conducted during a 2-year period from 2017 to 2019 in two tertiary healthcare centers in Shiraz, Iran. We included 84 singleton pregnancies between 24 and 34 weeks of gestation diagnosed with gestational diabetes mellitus. Patients were randomly assigned to oral glibenclamide (n = 44) or subcutaneous insulin (n = 40) according to a standard protocol and followed until delivery. The primary endpoint was to compare the glycemic level of patients, and the secondary outcomes included pregnancy adverse events and neonatal complications such as preeclampsia, preterm and premature rupture of membranes, preterm labor, placental abruption, maternal hypoglycemia, birth weight, neonatal hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, and neonatal intensive care unit admission. Results: The two study groups had comparable baseline characteristics. After treatment, the two study groups were comparable regarding fasting blood glucose (p = 0.398) and 2 h postprandial glucose (p = 0.085). There was no significant difference between the two groups regarding the rate of preeclampsia (p = 0.250), preterm rupture of membranes (p = 0.998), preterm labor (p = 0.495), hypoglycemia (p = 0.476), and abruption (p = 0.815). There was no significant difference between the two study groups in birth weight (p = 0.863) and the Apgar score at 1 (p = 0.190) and 5 min (p = 0.055). The rates of neonatal adverse events including hypoglycemia (p = 0.999), hyperbilirubinemia (p = 0.160), neonatal intensive care unit admission (p = 0.852), and respiratory distress syndrome (p = 0.665) were comparable between the two groups. Conclusion: The results of the current study demonstrate that oral glibenclamide is as effective and safe as subcutaneous insulin in glycemic control and maternal and neonatal outcomes in women with gestational diabetes mellitus. Thus, it could be used as first-line treatment of gestational diabetes mellitus.

The effect of hemodialysis with cool dialysate on nausea in hemodialysis patients: A randomized clinical trial.

Background and Aims: Experiencing nausea leads to decreased self-esteem and social isolation in hemodialysis patients and affects all aspects of their quality of life. Nausea and vomiting make hemodialysis unpleasant for patients leading to premature termination of hemodialysis. Therefore, based on this necessity, the present study was conducted to determine the effect of hemodialysis with cool dialysate on nausea in hemodialysis patients. Methods: In this clinical trial, 60 eligible patients receiving hemodialysis were randomly assigned to the control (30 participants) and intervention (30 participants) groups. In the control group, the patients received standard hemodialysis (37°C) for three sessions. Simultaneously, patients in the intervention group received hemodialysis with a cold solution (of 36°C) for three sessions. The patients' nausea and shivering rates were measured using the visual analog scale and the shivering standard assessment scale, respectively. Both groups were evaluated before and after 1 week of intervention. The study did not include blinding. The trial has been registered in the Iranian Registry of Clinical Trials (IRCT) with the number IRCT20200530047597N1. The present study was financially supported by Kermanshah University of Medical Sciences, Kermanshah, Iran (no. 990220). Data were analyzed using SPSS-25 software. Findings: The independent t test showed no statistically significant difference between the two control and experimental groups regarding the nausea rate in the three evaluation times (p < 0.05). Nevertheless, nausea severity decreased significantly after the intervention in the two groups. However, the rate of nausea in the intervention group with cold solution decreased more compared to the control group. Moreover, no patient in the intervention group experienced shivering during hemodialysis with a cool dialysate. Conclusion: According to the results of this study, it can be stated that the use of cold hemodialysis to control nausea in patients undergoing hemodialysis requires further studies and can be recommended as a nonpharmacological treatment to manage the treatment costs in case of efficiency.

Alteration in IFN-γ and CCL2 serum levels at first trimester of pregnancy contribute to development of preeclampsia and fetal growth restriction.

OBJECTIVE: Pregnancy is a unique challenge for the immune system. Any disturbance in the immune system in the first trimester could result in further pregnancy complications. In this regard, the current study aimed to investigate the association between serum levels of a group of cytokines in the first trimester of pregnancy with the onset of preeclampsia (PE) and fetal growth restriction (FGR). MATERIALS AND METHODS: Serum samples were collected from 550 pregnant women at their 11th - 13th weeks of pregnancy and followed up to delivery. Out of all cases, 15 women complicated with preeclampsia and 15 ones diagnosed with FGR were included in the study. The serum levels of IFN-γ, CCL2, IL-10, IL-35 and IL-27 were checked in the collected sera of mentioned patients and compared to 60 women with normal pregnancy outcomes. RESULTS: In the preeclampsia group, the mean level of IFN-γ was significantly higher (p < 0.001) while the CCL2 serum level was significantly lower (p < 0.003) as compared to control group. There was no significant difference between the preeclampsia group and controls regarding other cytokines. In the FGR group, the mean serum level of IFN-γ was significantly higher compared to the healthy pregnancy group (p < 0.001) but other cytokines showed no significant differences. In the FGR group, a significant positive correlation was found between IL-10 level and neonates' weight (p < 0.05). CONCLUSION: Based on the results of the present study, an elevated level of IFN-γ and a reduced level of CCL2 at the first trimester of pregnancy could lead to complications such as PE and/or FGR.

COVID-19 pneumonia and pregnancy; a systematic review and meta-analysis.

BACKGROUND: The new SARS-CoV-2 originated from Wuhan, China is spreading rapidly worldwide. A number of SARS-CoV-2 positive pregnant women have been reported. However, more information is still needed on the pregnancy outcome and the neonates regarding COVID-19 pneumonia. MATERIAL AND METHODS: A systematic search was done and nine articles on COVID-19 pneumonia and SARS-CoV-2 positive pregnant women were extracted. Some maternal-fetal characteristics were extracted to be included in the meta-analysis. RESULTS: The present meta-analysis was conducted on 87 SARS-CoV-2 positive pregnant women. Almost 65% of the patients reported a history of exposure to an infected person, 78% suffered from mild or moderate COVID-19, 99.9% had successful termination, 86% had cough, and 68% had fever (p = .022 and p < .001). The overall proportions of vertical transmission, still birth, and neonatal death were zero, 0.002, and, 0.002, respectively (p = 1, p = .86, and p = .89, respectively). The means of the first- and fifth-minute Apgar scores were 8.86 and 9, respectively (p < .001 for both). The confounding role of history of underlying diseases with an estimated overall proportion of 33% (p = .03) resulted in further investigations due to sample size limitation. A natural history of COVID-19 pneumonia in the adult population was presented, as well. CONCLUSION: Currently, no evidence of vertical transmission has been suggested at least in late pregnancy. No hazards have been detected for fetuses or neonates. Although pregnant women are at an immunosuppressive state due to the physiological changes during pregnancy, most patients suffered from mild or moderate COVID-19 pneumonia with no pregnancy loss, proposing a similar pattern of the clinical characteristics of COVID-19 pneumonia to that of other adult populations.

Effectiveness of pentoxifylline in severe early-onset fetal growth restriction: A randomized double-blinded clinical trial.

OBJECTIVE: Management of pregnancy complicated by severe early-onset fetal growth restriction (FGR) is one of the most challenging obstetrical issues. So far, there has not been a proven option for the treatment or improvement of this condition. Improper immune response during placentation leads to inadequate trophoblast invasion and impaired utero-placental perfusion. Pentoxifylline improves the endothelial function and induces vasodilation by reducing the inflammatory-mediated cytokines. We have evaluated the effect of Pentoxifylline on fetal-placental perfusion, neonatal outcome, and the level of oxidative stress markers before and after the intervention in the setting of severe early-onset FGR. MATERIALS AND METHODS: This study is a pilot randomized clinical trial on 40 pregnant women who had developed early-onset growth restricted fetus. Pentoxifylline and placebo were given with a dose of 400 mg per os two times daily until delivery. Serial ultrasound examination regarding fetal weight, amniotic fluid and also utero-placenta-fetal Doppler's were done. For the assessment of serum Antioxidant level, blood sampling was done once at the beginning of the study and again, at least, three weeks after the investigation. After delivery, umbilical-cord blood gas analysis, APGAR score at 1 and 5 min, NICU admission, and neonatal death were recorded and compared between the two groups. RESULTS: Utero-placenta-fetal Doppler's in the Pentoxifylline group did not significantly change compared to the control group. Fetal weight gain was significantly higher in the Pentoxifylline group before (996.33 ± 317.41) and after (1616.89 ± 527.90) treatment (P = 0.002). Total serum antioxidant capacity significantly increased in the Pentoxifylline group (p < 0.036). Average 5 min Apgar score was significantly higher (P < 0.036) and the percentage of babies admitted to NICU was significantly lower (P < 0.030) in the treated group. CONCLUSION: Using Pentoxifylline in pregnancy affected by FGR might show promising effects. In this study, Pentoxifylline improved the neonatal outcome, increased fetal weight gain, and reduced neonatal mortality by decreasing the level of oxidative stress markers and cutting down the inflammatory cascade.

Evaluating Quality of Life and Marital Contentment among Seroconcordant and Serodiscordant HIV-Infected Couples in Comparison to Non- HIV Couples.

BACKGROUND: Quality of life (QOL) and marital contentment, especially marital satisfaction, are important aspects of life. These items are more important in couples involved in HIV due to the present social stigma among this population considering women more vulnerable. The aim of this study was to determine the QOL and marital contentment status among seroconcordant and serodiscordant HIV couples compared to non-HIV ones. METHODS: In this cross-sectional study, 66 serodiscordant, 74 seroconcordant, and 70 non-HIV couples who referred to Lavan High-risk Behavior Counseling Center, Shiraz during September 2017 and December 2019 were studied. QOL and marital contentment were assessed by World Health Organization Quality of Life-BRIEF (WHOQOL BREF) and ENRICH questionnaire, respectively. Chi-square test for qualitative variables, independent T-test and ANOVA followed by LSD post hoc test for quantitative variables were performed. All statistical analyses were performed using SPSS 19.0, and P<0.05 was set as the significant level. RESULTS: The score of QOL questionnaire was significantly higher in non-HIV couples than serodiscordant and seroconcordant groups (P<0.001). There was no significant difference among seroconcordant and serodiscordant groups (P=0.99), and infected males vs. females (P=0.13). Non-HIV couples had significantly higher marital contentment in comparison to serodiscordant and seroconcordant groups (P<0.001). No difference was detected among seroconcordant and serodiscordant groups (P=0.81) although more contentment was observed among the males (P=0.01). CONCLUSION: Our study revealed that QOL and marital contentment were different among non-HIV and HIV infected couples. Besides, marital contentment was higher among males than female's in infected patients.

Term Spontaneous Heterotopic Pregnancy (Abdominal and Intrauterine): A Case Report.

Spontaneous heterotopic pregnancy is a potentially life-threatening condition rarely considered when a patient with an intrauterine pregnancy is asymptomatic or presents with complaints such as abdominal pain. An advanced abdominal pregnancy is even more unusual as the form of the ectopic component outside the context of assisted reproduction and is difficult in diagnosis with very few cases reported in the literature. We report such a case in a 31-year-old primigravida with heterotopic pregnancy which is a fetus in the uterine cavity and the other in the abdominal cavity. Her pregnancy was initially misdiagnosed and managed as a di-amniotic di-chorionic gestation. The correct diagnosis was only made after term delivery of the intrauterine pregnancy. The patient was complicated with severe bleeding which led to disseminated intravascular coagulopathy and massive transfusion. Two other operations were imposed on the patient because of bleeding. The clinical risk factor for ectopic pregnancy was only previous pelvic inflammatory disease in this woman.

Cultural validation of the competence in evidence-based practice questionnaire (EBP-COQ) for nursing students.

BACKGROUND: Evidence-based performance competence has a significant impact on the performance of care measures. The higher the qualifications of nurses, the more effective and desirable their performance. Evidence-based practice demonstrates the competencies and abilities of nurses. There is a need for valid and reliable tools for evaluating and promoting evidence-based competence in nursing students, and there are few tools in reviewing studies, but they have not considered the cultural dimension. The purpose of this study is to validate cultural competence in evidence-based practice for nursing students. MATERIALS AND METHODS: A methodological and validation study was conducted in the School of Nursing and Midwifery of Kermanshah and Ilam University of Medical Sciences in 2018. The Evidence-Based Performance Competency Questionnaire ( EBP-COQ) is one of the most valid tools used in various studies by Ruzafa-Martinez et al. Initially, the original version of the competence in evidence-based practice questionnaire was translated into Persian after securing a permission from the designer of the tool. Totally 300 nursing students were selected through simple sampling method and entered into the study. The validity of the tool was evaluated using face validity and performing factor analysis. The reliability of the questionnaire was evaluated using Cronbach's alpha and internal consistency. Statistical works were carried out in SPSS and AMOS. RESULTS: To determine the content validity of the tool, comparative fit index of the statements was obtained equal to 0.88. Factor analysis of the items yielded acceptable and statistically significant results (P < 0.001). The reliability of the tool was determined using internal consistency method (Cronbach's alpha) for the whole tool, which was equal to 0.7. The reliability of the questionnaire was investigated at two stages, and pretest/posttest correlation coefficients were obtained (P < 0.05). CONCLUSION: The questionnaire had an acceptable validity and reliability. It can be used to evaluate evidence-based practice. Among advantages of the tool is that it is easy to administer in health-care fields.

Teaching adults how to prevent COVID-19 infection by health workers: The application of intervention mapping approach.

INTRODUCTION: Education is one of the most important approaches to preventing infectious diseases at the time of the pandemic. The purpose of the study was to develop an intervention-training program using an intervention mapping approach (IMA) to prevent COVID-19 infection in adults at the time of the pandemic by health workers. MATERIALS AND METHODS: The present study was a study protocol where IMA was used as a planning framework for developing an intervention-training program to prevent COVID-19 infection in adults at the time of the pandemic by health workers in Ardabil city. Six intervention mapping (IM) steps have been described in this protocol. As the first step, needs assessment was performed by reviewing the studies, qualitative evaluation, and interviews. In the second step, the matrix of change objectives was designed from the intersection of performance goals and determinants. Later on, after designing the program and planning the program implementation, the program evaluation plan was developed. RESULTS: IMA guided us in designing and implementing a control-oriented training program with the participation of the participants along with the definition of outcomes, performance goals and determinants, theoretical methods and practical applications, intervention program, implementation, and step by step assessment. CONCLUSION: IM is a control-oriented, systematic, participation-based approach to design and implement targeted and on-going health promotion programs based on the needs of the target group at the time of the pandemic by health workers.

TGF-ß1 role in uterine leiomyoma and endometrial polyp: an insight to drug-based treatment instead of surgical techniques.

OBJECTIVE: Considering the high prevalence of leiomyoma and endometrial polyps, investigating the contributing factors and determining the pathophysiology of these lesions are essential. Target therapy is now an acceptable method for the treatment of some diseases. We aimed to determine the expression of transforming growth factor (TGF)-ß1 in endometrial polyps and leiomyomas to discover a drug-based method to overcome surgical treatments. METHODS: In this cross-sectional study, 55 patients with leiomyoma and 55 patients with polyps were included. Prepared slides from leiomyoma and adjacent myometrium or polyp lesions and adjacent endometrium were obtained and investigated for TGF-ß1. Then, data were collected and analyzed using SPSS version 22. RESULTS: The mean age of participants was 40.6±5.8 years. Based on their reports, 88.2% (n=97) of patients in the study population had abnormal uterine bleeding with similar distributions among both groups. In contrast, 63.5% of the leiomyoma group did not express TGF-ß1. However, in normal myometrium, 23.6% had the highest degree of TGF-ß1 expression. Polyp tissue did not show staining for TGF-ß1 in any patients. Additionally, 89.1% of non-polypoid endometrium did not express TGF-ß1. Normal tissue had a significantly greater amount of TGF-ß1 compared to leiomyoma and endometrial polyps. CONCLUSION: TGF-ß1 is expressed more prominently in normal myometrium with mostly high-intensity features compared to leiomyoma. Additionally, polyps showed no staining for TGF-ß1, while normal endometrium showed a low-density staining pattern.

Evaluation of the educational services quality from the viewpoint of postgraduate students at Kermanshah University of medical sciences in 2019.

BACKGROUND: At present, the SERVQUAL model is one of the most significant tools for measuring customers' expectations and perceptions in organizations. Determination of expectations and perceptions of students who are the main university customers from educational services can provide valuable information to the programmers to improve the condition of educational services. Therefore, this study aims to measure the quality of education services from the viewpoint of postgraduate students at Kermanshah Medical Sciences University using the SERVQUAL model in 2019. MATERIALS AND METHODS: This was a descriptive cross-sectional study. The population under the study consisted of 162 students at the postgraduate education section (Master's degree and Ph.D.) studying in the second semester of the academic year of 2019 at Kermanshah Medical Sciences University. The standard SERVQUAL questionnaire was used for data collection, which included five dimensions of the quality of educational services, and the random-stratified sampling method was employed. The data were analyzed using the SPSS Statistics software (version 23.0, SPSS Inc., Chicago, IL, USA), and descriptive and other statistical tests, including the Pearson correlation coefficient, and paired and independent t-tests were performed. RESULTS: Based on the students' perspective in the provision of service there was quality gap existed in all services, and the largest gap was in the reliability dimension (-0.37), and after that, empathy (-0.37), guaranty (0.27), and responsiveness (-0.24) dimensions, respectively, and the lowest one was in the tangible dimension (0.15). There was a statistically significant observed difference between the quality gap in different educational dimensions (P > 0.001). CONCLUSION: Research findings showed that students were not meeting their expectations from the presented educational services. Hence, holding a training workshop is suggested in the field of how to serve and enhance communication skills for employees and teachers.

Episiotomy wound healing by Commiphora myrrha (Nees) Engl. and Boswellia carteri Birdw. in primiparous women: A randomized controlled trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional Persian medicine manuscripts refer to plants such as Commiphora myrrha (Nees) Engl. (myrrh) and Boswellia carteri Birdw. (frankincense), which could be used to improve wound healing process. Since that time, local midwives in Iran continue to provide these herbs to precipitate episiotomy wound healing. AIM OF THE STUDY: To investigate the efficacy and safety of myrrh- and frankincense-based sitz-baths on episiotomy wound healing in primiparous women. MATERIALS AND METHODS: This randomized controlled trial was conducted on 90 primiparous women with singleton pregnancies after normal vaginal delivery at Hafez hospital affiliated to Shiraz University of Medical Sciences from July to October 2019. Study participants were randomly allocated in three groups (2 intervention groups and 1 control group). Women in intervention groups were assigned to receive either 10-min sitz-bath of myrrh extract or frankincense extract twice a day for 1 week. While the women in control group received the betadine sitz-bath for the same period of time. The main outcome was the episiotomy wound healing, which was measured using the REEDA scale before intervention, on 2nd and 7th postpartum days. RESULTS: An improvement in the episiotomy wound healing was significantly greater in patients receiving myrrh than those receiving the frankincense or betadine on 2nd (p = 0.003 and p < 0.001) and 7th (p = 0.043 and p = 0.015) postpartum days. However, the total REEDA score was not statistically different between the frankincense and betadine groups on 2nd and 7th postpartum days (p > 0.05). CONCLUSION: The present results suggest that myrrh was more efficient than frankincense and betadine in healing of the episiotomy wound and could be recommended as a safe natural therapy.

Treatment of women's sexual dysfunction using Apium graveolens L. Fruit (celery seed): A double-blind, randomized, placebo-controlled clinical trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional manuscripts refer to plants such as Apium graveolens L. Fruit (celery seed), which could be used to improve sexual function among women. Since that time, local herbal shops in Iran continue to provide this herb as a natural aphrodisiac product. AIM OF THE STUDY: This study aimed to evaluate the efficacy and safety of celery seed for the treatment of female sexual dysfunction. METHODS AND MATERIALS: In this parallel, randomized, double-blinded clinical trial, 80 women were assigned to receive either 500 mg of celery seed or placebo 3 times a day for a period of 6 weeks (n = 40 per group). The female sexual function index (FSFI) questionnaire was used to evaluate women's sexual function before and after treatment. RESULTS: At the end of the sixth week, an improvement in the total FSFI score was significantly greater in celery seed-treated women than those receiving the placebo (P < 0.001). Increased total FSFI score is mainly contributed by improvement in the sexual desire (p < 0.001), arousal (p < 0.001), lubrication (p < 0.001), and pain (p = 0.033) domains at the endpoint of study. No serious side effects were noticed in both groups during the study period. CONCLUSION: It seems that celery seed improved sexual function in women and could be used as a safe, well-tolerated, and effective herbal medicine in women with sexual dysfunction.