Using a mobile application for psychiatry training in medical students: a quasi-experimental study.

OBJECTIVE: Microlearning and gamification through mobile technology can significantly enhance knowledge acquisition and satisfaction. Roozbehyar application, was designed using microlearning and gamification approaches for psychiatry clerkship training. METHOD: This quasi-experimental study was conducted in Roozbeh Hospital, in 2021. The intervention group was assigned to the Roozbehyar during a 4-week course. Knowledge and satisfaction were assessed after 4 weeks. RESULTS: We recruited 27 (F/M: 19/8) and 35 students (F/M: 22/13) in the intervention and control groups, respectively. Learning through Roozbehyar was associated with higher scores in the final written exam (p value: 0.031). No difference was seen in the final global assessment scores. The satisfaction scores of the students regarding the content and learners' aspect of the application were above average, yet scores in structural and support aspects were below average. CONCLUSIONS: We highlighted the effect of a microlearning mobile application in increasing knowledge and satisfaction in psychiatry training in medical students.

Effects of technology-based educational tools on nursing learning outcomes in intensive care units: a systematic review and meta-analysis.

BACKGROUND: Nurses working in the Intensive Care Unit (ICU), due to the sensitivity and difficulty of tasks, need continuous and scientific training to be able to offer the best performance in difficult situations and use their knowledge in the best way. Also, nursing students spend internships in ICUs and receive special training in practice in the actual center. Educational tools based on new technologies can potentially improve the educational outcomes of nursing in ICUs. OBJECTIVES:  The present study aims to review and evaluate the effect of using technology-based educational tools for training critical care nurses and nursing students. METHODS:  A comprehensive search was conducted to identify peer-reviewed English language articles in Embase, Medline (through PubMed), Scopus, and ISI web of science published from 2010 to Feb 18, 2022. The studies that examined the effectiveness of technology-based educational interventions with control groups were included. The risk of bias in each study was assessed using the Cochrane Collaboration's tool. Also, we used Standard Mean Difference (SMD) to estimate the effect of technology-based educational tools on learning outcomes. All meta-analyses were performed with a random effects model in Stata Ver.16. RESULTS:  Altogether, ten studies were eligible for the quality assessment and systematic review, while one study that had not reported the pre-intervention analysis was excluded from the meta-analysis. Nine studies were considered to have a low RoB regarding reporting ways, and one of them showed a high risk. Performance and selection bias caused a high risk in six and five of the studies, respectively. In the meta-analysis, improvement in knowledge (SMD = 0.91), skills (SMD = 0.52), and self-confidence (SMD = 0.96) was noticed by applying technology-based educational tools. CONCLUSION: It can be offered that if the learning method based on the new technologies tested is more effective than conventional teaching methods, they are likely to improve the learning outcome significantly. The new-developed tools also have great potential in improving health care functions among nurses or nursing students as well as enhancing the quality of life and patient satisfaction.

Educational approaches for patients with heart surgery: a systematic review of main features and effects.

INTRODUCTION: Patients who undergo heart surgery are exposed to mental and physical difficulties after discharge from hospital. They often need support and follow-up after discharge. The use of educational approaches or solutions before or after heart surgery can increase patients' knowledge on the post-operative complications and self-care. The main purpose of this systematic review is to determine the applications of educational approaches and investigate the effects of these approaches on patients with heart surgery. METHOD AND MATERIEL: A thorough search was conducted in Medline (through PubMed), Scopus, ISI web of science to select related articles published between 2011 and May 2022. All of the retrieved papers were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. RESULTS: A total of 29 articles were obtained from the search, which included in this systematic review after being assessed based on inclusion and exclusion criteria. Most of the articles (n = 10, 34.48%) had been conducted in Canada and Iran, with the most significant number published in 2016. Out of 29 studies, 23 were experimental studies, and six were observational-analytical studies. The number of participants in the studies ranged from 11 to 600 (IQR1: 57.5, median: 88, IQR3: 190). In 28 (96.55%) studies, the educational approaches had a significant effect on clinical, economic or patient-reported outcomes. The greatest effect reported by the studies was related to clinical outcomes such as patient care improvement or change in clinical practice. The most effects in the patient-reported outcomes were related to improving patient satisfaction and patient knowledge. In terms of global rating scores, 17.24% of the included studies were considered as weak, 20.68% as moderate, and 62.06% as strong. CONCLUSION: The results of systematic review showed that the use of educational approaches by patients before and after heart surgery can have significant effects on reducing stress and financial burden, and increasing the quality of care and level of knowledge in patients.

Comparison of Hydrocolloid Dressings and Silver Nanoparticles in Treatment of Pressure Ulcers in Patients with Spinal Cord Injuries: A Randomized Clinical Trial.

Introduction: There are numerous dressings used to treat pressure ulcers (PUs), depending on their advantages to achieve optimum patient outcomes. This study aimed to compare hydrocolloid dressings and silver nanoparticles in treating PUs among patients with spinal cord injury (SCI). Methods: This randomized clinical trial was conducted on 70 patients with SCI in Iran. Participants were randomly divided into two equal groups (n=35) receiving silver nanoparticle dressing and hydrocolloid dressing, respectively. The groups were evaluated in four assessment periods using the Bates-Jensen Wound Assessment Tool (BWAT). Data analysis was performed using SPSS software version 13, repeated measures ANOVA, non-parametric tests, and chi-square. Results: Chi-square test was used to investigate the difference between the scores before the intervention, the results of which were not statistically significant. In repetitive measurements, the results of the analysis of variance showed that the average assessment score in both groups decreased and both dressings were effective in the treatment process. Although PU improvement status in the group that received silver nanoparticles was better, between-group analysis of variance did not show any statistically significant difference between the two groups. Conclusion: Our results indicated that silver nanoparticles and hydrocolloid dressings can be used interchangeably in the treatment of PUs.

Barriers and facilitators of using mobile devices as an educational tool by nursing students: a qualitative research.

BACKGROUND: Although the use of mobile devices can facilitate the learning process, there may be barriers to using them for learning purposes. This study aimed to identify and investigate the barriers and facilitators of using mobile devices as an educational device from the perspective of nursing students. METHODS: This qualitative descriptive study was conducted in 2020 on undergraduate nursing students of the Nursing and Midwifery Faculty, Tehran University of Medical Sciences. A total of 22 undergraduate nursing students were selected by purposive sampling with maximum variability. Inclusion criteria were Undergraduate nursing education, having mobile devices, and willingness to participate in research. Data were collected through semi-structured individual interviews for 45-75 min in the proposed environment of students until the data were saturated. Data analysis was performed manually using the framework analysis method with the steps: familiarization, identifying a thematic framework, indexing, Charting and Synthesis, Mapping, and Interpretation. Trustworthiness was determined by methods of Credibility, Dependability, Conformability, and Transferability. RESULTS: The majority of participants (45.45%) were 21 years old, 63.63% were women, and 36.36% studied in the 8th semester. Findings from the analysis of interviews showed that barriers to the use of mobile devices were classified into 4 main categories (barriers related to mobile devices, barriers related to Internet access, barriers related to information literacy, cultural-environmental barriers) and 15 subcategories, and facilitating the use of mobile devices was divided into 2 main categories (easy to use mobile devices and easy access to information) and 6 subcategories. CONCLUSION: The results of this study help educational managers and curriculum planners to adapt to technological change, to focus on the many benefits of mobile devices as an educational tool, and to plan to overcome barriers to mobile device use, and use mobile devices to teach theoretical topics and clinical nursing skills effectively.

Development and evaluation of a gamified smart phone mobile health application for oral health promotion in early childhood: a randomized controlled trial.

BACKGROUND: This study aimed to design a gamified smartphone application (app) and assess its efficacy for education of mothers regarding oral healthcare of their children. METHODS: In this pretest-posttest controlled clinical trial, a simple app and a gamified version of it were designed to enhance the oral health knowledge and practice of mothers. The app contains information about early childhood caries, health diet, sugars, baby-oral hygiene, fluoride effect, fluoride toothpaste, tooth-brushing training video and regular dental visits. The opinion of experts and 3 mothers were obtained and both apps were revised accordingly. The intervention was implemented on mothers of preschoolers referring to the specialty dental clinic of Tehran School of Dentistry in 2019. The mothers were randomly allocated to the simple app or gamified app group. Before the intervention, all mothers filled out a questionnaire regarding oral health knowledge and practice, and their demographics were collected. The plaque index (PI) of children was also measured. The mothers filled out the same questionnaire 1 month after the intervention, and the PI of children was measured again. Paired t test and linear regression model were used for statistical analysis of the data. RESULTS: Totally, 58 mother and child pairs entered the study; 40% of children were boys. The mean age of children was 4.7 ± 1.2 years. The mean knowledge score of mothers in the pretest was 10.5 and 11.3 in simple app and gamified app group, respectively, which changed to 13.1 and 14.3, respectively in the posttest. The mean practice score of mothers was 4.4 and 4.8 in simple app and gamified app groups, respectively in the pretest, which changed to 8.5 and 8, respectively in the posttest. The mean dental plaque index of children in the pretest was 0.8 and 1 in simple app and gamified app groups, respectively, which changed to 0.5 and 0.5, respectively in the posttest. Children had better Plaque control in gamified app group (P < 0.05). CONCLUSION: After 1 month, both apps effectively improved the oral-health knowledge and practice of mothers while oral hygiene as a result of plaque control was superior in children of mothers using the gamified app. Trial registration IRCT, IRCT20131102015238N2. Registered 24 February 2019-Retrospectively registered, https://fa.irct.ir/trial/36600 .

Factors Influencing The Participation Of Nurses In Knowledge-Sharing Within Mobile Instant Messaging Based Virtual Communities Of Practice: A Qualitative Content Analysis.

INTRODUCTION: The emergence of mobile instant messaging (MIM) based virtual communities of practice (VCoPs) has provided new opportunities for nurses to share their knowledge and promote collaborative learning. This study was conducted with the aim of exploring the factors influencing nurses' participation in knowledge-sharing within MIM-based VCoPs. MATERIAL AND METHODS: This is a qualitative study conducted in Tehran, Iran, between April 2017 and July 2018. The participants were 18 nurses that selected through purposeful sampling technique; then, in-depth and semi-structured interviews were conducted with them. Data was analyzed using conventional content analysis based on Graneheim and Lundman (2004). Accordingly, all interviews were transcribed and read several times; then, meaning units were identified from the transcribed text based on the aim of the study and codes were extracted from them. Finally, the codes were classified into categories and themes. RESULTS: A total of 26 sub-categories, seven categories, and two themes were extracted. Motivations for nurses' participating in knowledge-sharing activities within MIM-based VCoPs included the theme "Stimuli for professional interactions" with three categories: "The individual drives", "Attractive interactive environment", and "User-friendly media". On the other hand, participation barriers included the theme "Impediments for professional interactions" with four categories of "Individual hindrances", "Social harm", "Unprofessional interactive environment" and "Undesirable media". CONCLUSION: The findings of this exploratory study indicated that individual, social and technological factors as well as factors associated with the virtual-community interactive environment could influence nurses' participation in knowledge-sharing within MIM-based VcoPs as motivations and barriers. The insights obtained from this study can be a guide for administrators and educators in the nursing profession to facilitate and enhance nurses' participation in knowledge-sharing within MIM-based VCoPs by strengthening motivations and minimizing barriers.

Evaluating the Effect of Monitoring through Telephone (Tele-Monitoring) on Self-Care Behaviors and Readmission of Patients with Heart Failure after Discharge.

BACKGROUND: Heart failure is one of the serious cardiovascular diseases, which poses a global pandemic and places a heavy burden on health care systems worldwide. The incidence of this disease in Iran is higher than in other Asian countries. To reduce patients' complications, readmission rates, and health care expenditures, it is necessary to design interventions, which are culturally appropriate and based on community needs. METHODS: In 2016, a randomized clinical trial (IRCT2017010731804N1) was initiated to compare tailored tele-monitoring intervention with usual care. In total, 80 patients completed the study after a follow-up period of 8 weeks. The primary end point was heart failure self-care, which was measured using the Iranian version of the European Heart Failure self-care questionnaire. Secondary end points were heart failure related readmission rates. RESULTS: The mean scores for self-care behaviors of the two groups showed significant difference at the baseline (p = 0.045). The results of the analysis of covariance that was used to control the differences in the pretest scores of self-care behaviors showed that the difference between both groups after the intervention was still significant (p < 0.001). The percentage of patients' readmissions in the intervention group (20%) was less than that in the control group (42.2%); however, the results were not statistically significant (p = 0/066). CONCLUSION: This study showed that tele-monitoring improved self-care behaviors in Iranian patients with heart failure but did not reduce their readmission rates.

E-Learning Model in Chronic Kidney Disease Management: a Controlled Clinical Trial.

INTRODUCTION: Chronic kidney disease (CKD) is a challenging health problem. The present study examined impact of self-care education through e-learning on improving kidney function among individuals with CKD. MATERIALS AND METHODS: The studied population consisted of CKD patients receiving care at 10 centers for treating noncommunicable diseases in Tehran. Three centers were randomly selected and 39 patients with a glomerular filtration rate (GFR) less than 60 mL/min/1.73 m2, minimum education of grade 9, minimum of 2 years of referrals, and computer literacy of the individual or a first-degree relative were included in the study, while 92 patients were assigned into the control group. Changes in GFR were compared after 6 months following an e-learning program for the patients in the intervention group. RESULTS: The mean change in GFR was 7.5 ± 8.9 mL/min/1.73 m2 for the intervention group after the e-learning intervention, while this was -2.3 ± 8.5 mL/min/1.73 m2. The two groups were also significantly different in terms of age, marital status, education level, mean arterial pressure, and serum high-density lipoprotein level, and therefore, multivariable comparison of GFR was made incorporating these factor into the analysis and showed a significant improvement of GFR in the intervention group. CONCLUSIONS: According to the results of this study, effects of the e-learning educational intervention on improvement in kidney function and CKD treatment were established.

Comparing nurses' knowledge retention following electronic continuous education and educational booklet: a controlled trial study.

BACKGROUND: Training methods that enhance nurses' learning and retention will increase the quality of patient care. This study aimed to compare the effectiveness of electronic learning and educational booklet on the nurses' retention of diabetes updates. METHODS: In this controlled trial study, convenience sampling was used to select 123 nurses from the endocrinology and internal medicine wards of three hospitals affiliated to Tehran University of Medical Sciences (Tehran, Iran). The participants were allocated to three groups of manual, electronic learning, and control. The booklet and electronic learning groups were trained using educational booklet and electronic continuous medical education (CME) website, respectively. The control group did not receive any intervention. In all the three groups, the nurses' knowledge was measured before the intervention, and one and four weeks after the intervention. Data were collected by a questionnaire. RESULTS: Significant differences were observed between the mean scores of the three groups one and four weeks after the intervention (F=26.17, p=0.001 and F=4.07, p=0.020, respectively), and post hoc test showed that this difference was due to the higher score in e-learning group. Both e-learning and booklet methods could effectively improve nurses' knowledge (χ²=23.03, p=0.001 and χ²=51.71, p=0.001, respectively). CONCLUSION: According to the results of this study, electronic learning was more effective than booklet in enhancing the learning and retention of knowledge. Electronic learning is suggested as a more suitable method as it provides appropriate interactions and attractive virtual environments to motivate the learners and promote retention.

Determining the Criteria and Their Weights for Medical Schools' Ranking: A National Consensus.

Delphi as a consensus development technique enables anonymous, systematic refinement of expert opinion with the aim of arriving at a combined or consensual position. In this study, we determined the criteria and their weights for Iranian Medical Schools' ranking through a Delphi process. An expert committee devised 13 proposed criteria with 32 indicators with their weights, which were arranged hierarchically in the form of a tree diagram. We used the Delphi technique to reach a consensus on these criteria and weights among the deans of 38 public Iranian medical schools. For this purpose, we devised and sent a questionnaire to schools and asked them to suggest or correct the criteria and their weights. We repeated this process in two rounds till all the schools reached an acceptable consensus on them. All schools reached a consensus on the set of 13 criteria and 30 indicators and their weights in three main contexts of education, research and facilities, and equipment which were used for Medical Schools' ranking. Using Delphi technique for devising the criteria and their weights in evaluation processes such as ranking makes their results more acceptable among universities.

Promotion of critical thinking in e-learning: a qualitative study on the experiences of instructors and students.

BACKGROUND: With the increasing popularity of e-learning programs, educational stakeholders are attempting to promote critical thinking in the virtual education system. This study aimed to explore the experiences of both the instructors and the students about critical thinking promotion within the virtual education system. METHODS: This qualitative study recruited the instructors and students from four academic disciplines provided by the Virtual School of Tehran University of Medical Sciences (Tehran, Iran). All programs were master's degree programs and utilized a blended (combination of e-learning and face to face) training. Semistructured interviews with the participants were used to collect data. RESULTS: The participants had a variety of experiences about how to promote critical thinking. These experiences were conceptualized in four main themes, namely, instructional design, educational leadership and management, local evidence, and belief systems. CONCLUSION: The present study clarified the factors affecting critical thinking promotion in e-learning. Not only the instructors but also the educational designers and leaders can benefit from our findings to improve the quality of virtual education programs and promote critical thinking.

Nurses Use of Critical Care Pain Observational Tool in Patients with Low Consciousness.

OBJECTIVES: The diagnosis of pain in patients with low consciousness is a major challenge in the intensive care unit (ICU). Therefore, the use of behavioral tools for pain assessment could be an effective tool to manage pain in this group of patients. The aim of this study was to determine the effects on pain management by nurses using a critical care pain observational tool in patients with a decreased level of consciousness. . METHODS: Our research used a before and after design to evaluate the ability of nurses to manage pain in patients with low consciousness. A total of 106 ICU nurses were included in the study. The study was divided into three phases: pre-implementation, implementation, and post-implementation. The researchers first observed the nurses management of pain in their patients; this was done three times using a checklist following tracheal suctioning and position change procedures. The nurses were then taught how to apply the critical-care pain observational tool (CPOT). Post-implementation of the tool, the researchers re-evaluated trained the nurses' pain management. . RESULTS: Performance scores after training improved with relation to the nurses diagnosis of pain, pharmacological and nonpharmacological actions, reassessment of pain, and re-relieving of any pain. However, use of the tool did not improve the recording of the patient's pain and the relief measures used. . CONCLUSION: Use of the CPOT can increase nurse's sensitivity to pain in non-conscious patients and drive them to track and perform pain management.

Family-Centered Education and Its Clinical Outcomes in Patients Undergoing Hemodialysis Short Running.

BACKGROUND: Poor adherence to treatment in patients undergoing hemodialysis leads to many complications, including death of the patient. OBJECTIVES: This study was aimed to investigate the effect of family-based training on common side-effects during dialysis. PATIENTS AND METHODS: The present randomized controlled trial study was conducted on 60 patients undergoing hemodialysis at hospitals of Tehran University of Medical Sciences, Iran, from May 2012 to October 2012. Samples were randomly divided into two groups of patient-education (n = 30) and education of patient associated with an active member of the family (n = 30). Blood pressure, chest pain, nausea, vomiting, headaches and muscle cramps were followed with a check list and a questionnaire. The frequencies of the abovementioned complications at the mentioned intervals were recorded in three stages (before the intervention as well as two and four weeks after the intervention). Data analysis was performed using SPSS software, version 16, with chi-square test, Fisher's exact test and independent t-test. RESULTS: The mean ages of the patients in patient-centered and the family-oriented groups were 47.41 ± 10.31 and 48.16 ± 9.21, respectively. The result showed that some of the variables such as chest pain (P = 0.50, P = 0.01), nausea (P = 0.50, P = 0.01), headache (P = 0.81, P = 0.016), and blood pressure (P = 0.91, P = 0.016) were statistically significant before and four weeks after the intervention. CONCLUSIONS: According to the result of this study, the presence of families in a treatment plan could be essential to follow the treatment plan and subsequently reduced the complications of hemodialysis.

Comparison of two educational methods (family-centered and patient-centered) on hemodialysis: Related complications.

BACKGROUND: Hypotension and muscular cramp are the common complications of hemodialysis. Effective control of hemodialysis complications increases the survival time and the quality of life of patients on hemodialysis. Considering that failure to follow a therapeutic plan is one of the most prevalent causes of hemodialysis complications, the present research was conducted to study the effect of two educational methods (family-centered and patient-centered) on some complications that occur during hemodialysis. MATERIALS AND METHODS: This clinical trial was performed from June to November 2012 in the hemodialysis ward of Imam Khomeini Hospital and Tehran Amir Aalam Hospital. Research samples included 60 patients in the age range of 18-65 years who were randomly included in patient-centered education (30 people in even days) and family-centered education (30 people in odd days). Blood pressure and muscle cramp were checked using researcher-made checklist in three stages (before and at the second and fourth week after intervention). Hypotension (before the start of dialysis, at the first, second, and third hour, and at the end hours) and muscle cramp (in the middle of hemodialysis and the end half an hour) were also checked. Data were analyzed using SPSS software, version 16, with Chi-square test, Fisher test, and independent t-test. RESULTS: Before intervention, the two groups did not show significant difference in terms of hypotension [with P = 0.91 and variations mean of 1.60 (1.30)] and muscle cramp [with P = 0.50 and variations mean of 1.06 (1.01)]. In the second and fourth week after intervention, there was significant difference between the two groups in terms of hypotension [with P = 0.016 and variations mean of 0.70 (0.70) and P = 0.02 and variations mean of 0.86 (0.62)] and muscle cramp [with P = 0.01 and variations mean of 0.46 (0.86) and P = 0.02 and variations mean of 1 (1.05)]. CONCLUSIONS: Considering that the study results showed that family-centered education was more effective on reduction of hemodialysis complications than patient-centered education, it is recommended that educational interventions relating to therapeutic program should be done in patients under hemodialysis, with participation of families.

Does henna impact pulse oximetry results?

OBJECTIVE: To evaluate the effects of henna on the results of pulse oximetry in healthy women. METHODS: 100 young women (20-60 years of age) were recruited. The Iranian original red henna was used to colour the index finger of THE non-dominant hand; the middle finger of the same hand was the control. Blood oxygen saturation was simultaneously measured by two calibrated pulse oximeters. RESULT: Henna did not affect pulse oximetry measurement of oxygen saturation. There was no statistically significant difference between the control and the henna dyed fingers. CONCLUSIONS: Henna is not likely to change the accuracy of oxygen saturation measured by pulse oximeter. CLINICAL TRIAL REGISTRATION: 20120906159N20.

Bed rest duration after sheath removal following percutaneous coronary interventions: a systematic review and meta-analysis.

AIMS AND OBJECTIVES: To explore the effect of bed rest duration after sheath removal following percutaneous coronary interventions on the incidence of vascular complications, back pain and urinary problems. BACKGROUND: According to the literature, the duration of bed rest after sheath removal following percutaneous coronary interventions ranges from 2-24 hours. Several studies have assessed the effect of duration of bed rest on vascular complications, but a clear final conclusion about the exact duration of bed rest has not been reached. DESIGN: Systematic review and meta-analysis. METHODS: Cochrane Library, MEDLINE, SCOPUS, CINAHL, IranMedex and IranDoc were searched. No language limitation was applied. RCTs that used two different periods for ambulation were included. Two reviewers separately assessed the quality of each included study and extracted the data. Dichotomous outcomes were recorded as odds ratio with 95% confidence interval. RESULTS: Five studies involving 1115 participants were included in the review. Among them, two studies had three comparison groups. The studies considered a variety of periods as early and late ambulation, ranging from 2-10 hours. Totally, there were no statistically significant differences in the incidence of bleeding, pseudoaneurysm, arteriovenous fistula and urinary problems between early and late ambulation. There was a statistically significant reduction in the risk of haematoma formation at four to six hours of bed rest compared with eight hours of bed rest (odds ratio = 0·37, 95% CI: 0·15, 0·91). Back pain was reported in one study evaluating three hours of bed rest with an odds ratio of 0·45 (95% confidence interval: 0·28, 0·71) when compared with 10 hours of bed rest. CONCLUSIONS: Early ambulation after percutaneous coronary interventions is safe and feasible; however, the results should be used with caution as the majority of included studies had methodological flaws. RELEVANCE TO CLINICAL PRACTICE: The results of this study suggest that patients could be ambulated three to four hours after sheath removal following percutaneous coronary interventions and early ambulation dose does not increase the risk of vascular complications, but it moderates back pain occurrence.

Early ambulation after diagnostic transfemoral catheterisation: a systematic review and meta-analysis.

BACKGROUND: Femoral arterial puncture is the most common method of vascular access for angiography. Because of possible vascular events, all patients are restricted to strict immobilisation and bed rest for 2-24h, which is accompanied by back pain and discomfort. OBJECTIVE: To assess the effects of the duration of bed rest after transfemoral catheterisation on the prevention of vascular complications and general discomfort, pain, urinary discomfort and patient satisfaction. DATA SOURCES: We searched the Cochrane Library, MEDLINE, SCOPUS, CINAHL, Proquest Dissertations, Open SIGLE, Iranmedex and Irandoc. STUDY SELECTION: We included blinded or unblinded randomised controlled trials and quasi-randomised controlled trials that used two different durations of bed rest after angiography before the ambulation was permitted. DATA EXTRACTION AND ANALYSIS: Two reviewers separately assessed the quality of each study and extracted the data. We present dichotomous outcomes as odds ratios with 95% confidence intervals (CI) and continuous outcomes as mean differences with 95% CI. DATA SYNTHESIS: Twenty studies involving a total of 4019 participants with a mean age of 59.5 years were included. The studies considered periods of bed rest ranging from 2 to 24h, which we compared in three main categories. There were no statistically significant differences between categories in the incidence of bleeding, haematoma, bruising, pseudoaneurysm, thrombus or arteriovenous fistula. Back pain intensity was assessed in four studies. Patients had significantly less back pain after 2-4h bed rest compared to 6h bed rest at 2h (mean difference: -0.70, 95% CI: -1.07, -0.32), 4h (mean difference: -0.60, 95% CI: -0.96, -0.24) and 6h of follow-up (mean difference: -3.77, 95% CI: -4.48, -2.92). One study that assessed urinary discomfort reported less urinary discomfort when bed rest lasted 4h compared to 12-24h (mean difference: -1.48; 95% CI: -2.37, -0.59). In addition, reduced bed rest time may significantly decrease the costs of hospital care. CONCLUSIONS: This systematic review suggests that patients can be ambulated after 2-3h following transfemoral catheterisation, and that early ambulation had no significant effect on the incidence of vascular complications and may reduce back pain and urinary discomfort.

Developing a blended learning program for nursing and midwifery students in Iran: Process and preliminary outcomes.

BACKGROUND: We aimed to develop and evaluate outcomes of a blended learning (BL) program for educating nursing and midwifery students of Tehran university of medical sciences (Tehran, Iran). MATERIALS AND METHODS: This was a participatory action research project. After designing BL website, providing technological infrastructures, and holding preparatory workshops, 22 blended courses were designed. BL method was implemented for one semester. Students' grade point average, participation with courses, and opinion about educational methods, and instructors' attitude and opinion about educational methods were assessed. RESULTS: Most students (n = 181; 72.1%) and 17 instructors (28.3%) consented to participate in the study. Students' grade point average and participation was significantly higher in BL rather than in face-to-face method (P < 0.0001). Most instructors (n = 11, 65%) had positive attitude toward BL method. Textual analysis of participants' opinion showed that most students preferred BL method and felt more independent in this method. However, they complained about lack of easy access to Internet and weakness in computer skills. Instructors admired the flexibility and incentives that had been provided in the program. However, some of them complained about the time-consuming nature of BL course design. CONCLUSION: The program showed positive effect on students' learning outcomes and participation. The strengths and weaknesses of the program should be considered for development of next phase of the project. Lessons learned in this phase might be helpful for decision makers who tend to develop similar programs in Iran. Motivational and communicational issues and users' IT skills should be addressed in every BL program.

Effects of therapeutic touch on anxiety, vital signs, and cardiac dysrhythmia in a sample of Iranian women undergoing cardiac catheterization: a quasi-experimental study.

PURPOSE OF THE STUDY: To investigate the effects of Therapeutic Touch (TT) on anxiety, vital signs, and cardiac dysrhythmia in women undergoing cardiac catheterization. DESIGN: It was a quasi-experimental study. The participants had no history of hallucination, anxiety, or other psychological problems. Participants had to be conscious and have attained at least sixth-grade literacy level. Participants were randomly assigned into an intervention group (n = 23; received 10-15 minutes TT), a placebo group (n = 23; received 10-15 minutes simulated touch), and a control group (n = 23; did not receive any therapy). Data were collected using Spielberger's anxiety test, cardiac dysrhythmia checklist, and vital signs recording sheet. Statistical analyses were considered to be significant at α = .05 levels. FINDINGS: Sixty-nine women ranging in age from 35 to 65 years participated. TT significantly decreased state anxiety p < 0.0001 but not trait anxiety (p = .88), decreased the incidence of all cardiac dysrhythmias p < 0.0001 except premature ventricular contraction (p = .01), and regulated vital signs p < 0.0001 in the intervention group versus placebo and control group. CONCLUSIONS: TT is an effective approach for managing state anxiety, regulating vital signs, and decreasing the incidence of cardiac dysrhythmia during stressful situations, such as cardiac catheterization, in Iranian cardiac patients.