The effect of increasing duration of family members' presence on sleep status in patients with acute coronary syndrome in cardiac care unit: A randomized controlled trial.

AIM: To investigate the effect of increasing duration of family members' presence on sleep status in patients with acute coronary syndrome (ACS) admitted to the cardiac care unit. DESIGN: Randomized controlled trial. METHODS: Ninety patients with ACS randomly assigned into two groups. No intervention was performed in control group. In the intervention group, the time of family members presence was changed from 1 h per day to 2 h per day from the second to the fourth day. Then, ST Mary's Hospital Sleep Questionnaire was completed by the patients every day during the study. RESULTS: The patients in the intervention group had statistically significantly better sleep status during the course of intervention compared to the control group. PATIENT OR PUBLIC CONTRIBUTION: The increasing duration of family members' presence can improve the sleep quality and quantity of ACS patients.

Effect of couples' online training on maternal-fetal attachment in pregnant women.

BACKGROUND: Due to the importance of maternal fetal attachment (MFA) in women mental health improvement and considering the fathers' role in MFA promoting, this study conducted to investigate the effect of couple education on maternal fetal attachment. MATERIALS AND METHOD: This randomized controlled trial was conducted on 100 pregnant women and their husbands referred to six health centers in Sari from May to June 2021. The sampling method was stratified random sampling. Data collection tools included demographic information form and the Cranley MFA Scale with 24 questions. The intervention group took part in four session's weekly training about spouse support, attachment behaviors, and gender preference of parents, while the control group received only the routine antenatal care. Both groups completed Cranley's questionnaire before and 4 weeks after the intervention. Data were analyzed using Chi-square test, Fisher's exact test, paired and independent t-test by SPSS 21. RESULTS: MFA mean scores, pre-training and post-training in intervention group were 3.27 (0.54) and 3.75 (0.42), respectively; in the control group, were, 3.24 (0.49) and 3.21 (0.48). There was a significant difference between the two groups' MFA mean scores after intervention (P < 0.001). CONCLUSION: The findings of this study revealed that couple training regarding spouse support, attachment behaviors, and gender preference during pregnancy can promotes MFA even online training.

Maternal Health Literacy, Health information-seeking Behavior and Pregnancy Outcomes Among Iranian Pregnant Women: A Cross-Sectional Study.

Background: Maternal health literacy (MHL) and health information-seeking behavior (HISB) could impact maternal health and pregnancy outcomes.Purpose and Research Design: This cross-sectional study investigated MHL, HISBs, and pregnancy outcomes in Iranian pregnant women. This study was also aimed to determine the predictors of MHL and pregnancy outcomes.Study smple and Data Collection: In this study, 337 randomly selected postpartum women completed three questionnaires, including a demographics form, an obstetrics history checklist, and the Maternal Health Literacy and Pregnancy Outcome Questionnaire (MHLAPQ).Results: The mean MHL and pregnancy outcome scores were 60.80 ± 9.91 and 49.88 ± 5.69, respectively. Of the participants, 56% adopted both formal and informal HISB. Education and internet HISB was associated with the odds of being in the group with higher MHL. Participants with high MHL had more than twice higher odds for better pregnancy outcomes (OR = 2.25, p < 0.004).Conclusions: Continued efforts are required to make health information sources more accessible to pregnant women to improve their health literacy and pregnancy outcomes.

Designing and implementing an OMMID midwifery professional competence mixed test: A multimethod, multiphasic study.

The assessment of professional competence is essential to ensure the achievement of competence standards. The goal of this study is to design and implement a professional competence test model to make the test unified, comprehensive, and fair. This research was a multimethod, multiphasic study. The first qualitative phase of the nominal group technique was conducted to design the test model with specific guidelines. The second phase was a mixed-method parallel field trial conducted on 161 senior midwifery bachelor students in universities of Iran. The test was conducted following the traditional method in the control group and OMMID model in the intervention group. This model consists of three parts: the MCQs (multiple choice questions), OSCE (objective structured clinical examination), and clinically-oriented tests, which included Mini-CEX (mini-clinical evaluation exercise) and DOPS (direct observation of procedural skills). Data were collected using questionnaires and interviews, and the results were assessed qualitatively and quantitatively. The OMMID model and the associated guideline were designed. Qualitative data analysis resulted in six main themes, including organizing, structure, tension due to change, fairness, unification, and outcome. The OMMID model did not increase students' anxiety and stress and did not decrease their satisfaction. The merits of this model include having a centralized guideline, using multiple evaluation methods, comprehensive evaluation of necessary skills, promotion of fairness, and increased student satisfaction.

Comparing the effect of transcutaneous electrical nerve stimulation and massage therapy on post laparoscopic shoulder pain: a randomized clinical trial.

BACKGROUND: Shoulder pain is a common clinical problem after laparoscopic surgeries. The use of non-pharmacological massage and transcutaneous electrical nerve stimulation (TENS) as an adjunct to routine treatment is increasing to provide optimal pain relief. Therefore, we aimed to determine the effect of TENS and massage therapy on post laparoscopic shoulder pain (PLSP). METHODS: This study was conducted on 138 patients who underwent laparoscopic cholecystectomy. Patients were randomly divided into three groups: massage plus conventional pharmacological treatment (n = 46), TENS plus conventional pharmacological treatment (n = 46), and conventional pharmacological treatment (n = 46). Massage and TENS were performed three consecutive times after the patients regained consciousness in the inpatient wards. The intensity of Shoulder pain was evaluated using a visual analog scale before and 20 min after each treatment. RESULTS: Both massage therapy and TENS led to a significant reduction in the intensity of PLPS compared to the control group in all three measured times (p < 0.001). However, no significant difference was observed between TENS and massage at any of the three-time points. CONCLUSIONS: This study's findings demonstrated that massage and TENS techniques could reduce PLSP. TRIAL REGISTRATION: Registered in the Iranian registry of clinical trials ( www.irct.ir ) in 05/02/2022 with the following code: IRCT20200206046395N1.

The relationship between teamwork, moral sensitivity, and missed nursing care in intensive care unit nurses.

BACKGROUND: Teamwork, moral sensitivity, and missed nursing care are important healthcare challenges for Intensive Care Unit (ICU) nurses and the existence of a relationship between these variables can be useful for developing better care improvement strategies. This study aimed to determine the relationship between teamwork, moral sensitivity, and missed nursing care in ICU nurses. METHODS: This is a descriptive cross-sectional study conducted on a total of 200 ICU nurses working at teaching hospitals affiliated to Semnan and Shahroud Universities of Medical Sciences, Semnan, Iran in 2022. Sampling was conducted using the census method. Data collection was conducted using a demographic checklist, the TeamSTEPPS Team Perception Questionnaire (T-TPQ), Lützén Moral Sensitivity Questionnaire (L-MSQ), and Kalisch and Williams Missed Nursing Care (MISSCARE) Survey. The examination of the relationship between the three variables was conducted using Pearson's correlation coefficient and multiple regression analysis. RESULTS: The mean and standard deviation of teamwork, moral sensitivity, and missed nursing care was 3.47 ± 0.69, 64.19 ± 13.43, and 55.04 ± 34.10, respectively. The variable of teamwork had a significant positive relationship with moral sensitivity (p < .001) and a significant negative relationship with missed nursing care (p < .001). Teamwork was also a positive predictor of moral sensitivity (p < .001) and a negative predictor of missed nursing care (p < .001). The clinical experience of ICU nurses was a positive predictor of teamwork (p = .01) and a negative predictor of missed nursing care (p = .001). The age of ICU nurses was a positive predictor of moral sensitivity (p = .001) and a negative predictor of missed nursing care (p = .008). CONCLUSION: The findings showed that a higher level of teamwork was associated with increased moral sensitivity and reduced missed nursing care among ICU nurses. Therefore, focusing on planning interventions on teamwork improvement can lead ICU nurses to improve moral sensitivity, lower missed nursing care, and promote the quality of patient care.

Effect of transcutaneous electrical nerve stimulation of acupoints on respiratory outcomes of COVID-19 patients with moderate pulmonary involvement: A parallel randomized clinical trial.

Background and aims: Experiencing respiratory symptoms, especially dyspnea and decreased oxygen saturation (SpO2) level in patients with coronavirus disease 2019 (COVID-19) is associated with increased mortality. The present study was conducted to investigate the effect of transcutaneous electrical nerve stimulation of acupoints (Acu-TENS) on the respiratory outcomes of COVID-19 patients with moderate pulmonary involvement. Methods: In these three-blind parallel randomized clinical trials, 84 patients with COVID-19 admitted to a referral hospital were selected by the convenience sampling method. Participants were randomly assigned to Acu-TENS (n = 42) and control (n = 42) groups. The Acu-TENS group received Acu-TENS over the EX-B1 (Dingchuan) acupuncture point for 45 min for four consecutive days, while participants in the control group received no intervention. Participants' respiratory outcomes, including oxygen saturation, vital signs, and the severity of dyspnea, were evaluated before and after each intervention on four consecutive days. In addition, the need for mechanical ventilation on Days 4, 8, and 12 and the disease's outcome (death or survival) were recorded in SPSS software version 16, and finally, data were analyzed using an independent samples t-test. Results: SpO2, the number of patients without the need for mechanical ventilation, and patient survival after the intervention were significantly higher in the Acu-TENS group compared with the control group (<0.001). However, respiratory rate, heart rate, and the severity of dyspnea after the intervention were not significantly different between the two groups (p > 0.05). Conclusion: The use of Acu-TENS could improve SpO2 as a respiratory outcome of patients with COVID-19 with moderate pulmonary involvement and it can be used as a therapeutic intervention.

COVID-19 cases, hospitalizations and deaths after vaccination: a cohort event monitoring study, Islamic Republic of Iran.

Objective: To investigate the incidence of coronavirus disease 2019 (COVID-19) cases, hospitalizations and deaths in Iranians vaccinated with either AZD1222 Vaxzevria, CovIran® vaccine, SARS-CoV-2 Vaccine (Vero Cell), Inactivated (lnCoV) or Sputnik V. Methods: We enrolled individuals 18 years or older receiving their first COVID-19 vaccine dose between April 2021 and January 2022 in seven Iranian cities. Participants completed weekly follow-up surveys for 17 weeks (25 weeks for AZD1222) to report their COVID-19 status and hospitalization. We used Cox regression models to assess risk factors for contracting COVID-19, hospitalization and death. Findings: Of 89 783 participants enrolled, incidence rates per 1 000 000 person-days were: 528.2 (95% confidence interval, CI: 514.0-542.7) for contracting COVID-19; 55.8 (95% CI: 51.4-60.5) for hospitalization; and 4.1 (95% CI: 3.0-5.5) for death. Compared with SARS-CoV-2 Vaccine (Vero Cell), hazard ratios (HR) for contracting COVID-19 were: 0.70 (95% CI: 0.61-0.80) with AZD1222; 0.73 (95% CI: 0.62-0.86) with Sputnik V; and 0.73 (95% CI: 0.63-0.86) with CovIran®. For hospitalization and death, all vaccines provided similar protection 14 days after the second dose. History of COVID-19 protected against contracting COVID-19 again (HR: 0.76; 95% CI: 0.69-0.84). Diabetes and respiratory, cardiac and renal disease were associated with higher risks of contracting COVID-19 after vaccination. Conclusion: The rates of contracting COVID-19 after vaccination were relatively high. SARS-CoV-2 Vaccine (Vero Cell) provided lower protection against COVID-19 than other vaccines. People with comorbidities had higher risks of contracting COVID-19 and hospitalization and should be prioritized for preventive interventions.

Risk Factors Associated with Mortality in COVID-19 Patient's: Survival Analysis.

Background: The effect of related factors on recovery or death rates may vary from country to country. Therefore, we aimed to investigate the relationship between demographic, clinical, laboratory factors on the survival rates of confirmed cases of COVID-19 in Shahroud, Iran. Methods: This is an analytical study of the estimation of the survival of patients with COVID-19. Patients who had positive PCR test were considered as COVID-19 cases, and the 2-month survival of these patients was estimated. Among the diseases, heart disease and diabetes were considered as separate variables, and the patients' histories of other diseases were included in the model as comorbidities. Results: Of 396 confirmed patients hospitalized, 109 patients (27.5%) had a history of heart disease, 100 (25.3%) were diabetic, and 80 (20.2%) had a history of other comorbidities. The number of deaths due to the disease was 59 (14.9%). The median age of those who died was 76 years. The multivariate Cox regression analysis shows that heart disease increases hazard ratio more than two times (HR=2.37, 95% CI: 1.33-4.23). The neutrophil-to-lymphocyte ratio (NLR) factor, (HR=1.15, 95% 1.08-1.22), and older age (HR=1.06, 95% CI: 1.03-1.08) increases the risk of death significantly. Conclusion: The heart disease history, NLR factor and older age are associated with death of COVID-19 and may be helpful for the early warning and prediction of disease progression.

Assessment of Medicalization of Pregnancy and Childbirth in Low-risk Pregnancies: A Cross-sectional Study.

BACKGROUND: Medicalization may lead to over-testing during pregnancy and increased cesarean section (CS). This study investigated the medicalization of low-risk pregnancies and childbirths in Rasht, Iran. METHODS: In this cross-sectional study, 337 postpartum women completed a demographic questionnaire and the Medicalized Pregnancy and Childbirth checklist. In this study, medicalization indicators were the source of providing prenatal care, prenatal screening for aneuploidy, number of received care, hospitalization before the onset of labor, intrapartum drug use, and CS. Demographic data were reported using descriptive statistics. Chi-square or Fisher's exact and Man-Whitney tests were used for comparison purposes. Logistic regression was run to determine the medicalization indicators associated with the mode of childbirth. RESULTS: Of the participants, 82.2% received prenatal care from obstetricians, 85.8% had undergone prenatal screening tests. There was a significant difference between the median number of ultrasound examinations (P=0.006), prenatal screening for aneuploidy (P=0.002), and multivitamin/mineral supplements use (P<0.001), according to the source of providing prenatal care. Of the participants, 67.1% had CS. Women who received prenatal care from obstetricians had about 2.3 times more odds of CS (OR=2.23, P=0.019). Furthermore, with the increased number of ultrasounds, the odds of CS augmented by 25% (OR=1.25, P=0.013). Finally, 26.4% of the participants were hospitalized before the onset of labor; the intervention increased the odds of CS more than twice (OR=2.08, P=0.026). CONCLUSION: The study showed a picture of medicalization in low-risk pregnancies. Of the medicalization indicators, the source of providing prenatal care, time of admission, and use of ultrasounds were associated with CS. Midwife-led care could diminish medicalization.

Effectiveness of nurse-led counselling and education on self-efficacy of patients with acute coronary syndrome: A randomized controlled trial.

AIM: Adherence to lifestyle recommendations, medical regimens and cardiac rehabilitation is poor among patients with acute coronary syndrome. The aim of this study was to examine the effect of nurse-led counselling and education using a person-centred care approach on short-term cardiac self-efficacy in patients with acute coronary syndrome. DESIGN: A parallel, two-armed, randomized controlled trial was conducted. METHODS: One hundred twenty patients who were hospitalized with diagnosis of acute coronary syndrome were selected and randomly assigned into intervention (n = 60) or control (n = 60) groups. In the intervention group, in addition to routine care, the nurse-led counselling and education programme included two face-to-face sessions, two telephone counselling and education sessions, using the person-centred care approach. Participants in the control group received only routine care. Data were collected using the cardiac self-efficacy scale before the intervention and 1 month after discharge. RESULTS: After the intervention, we found that cardiac self-efficacy, including the perceived self-efficacy to control symptoms and maintain function, was statistically significantly higher in the intervention group than the control group.

Epidemiological patterns of syndromic symptoms in suspected patients with COVID-19 in Iran: A Latent Class Analysis.

BACKGROUND: Early diagnosis and supportive treatments are essential to patients with coronavirus disease 2019 (COVID-19). Therefore, the current study aimed to determine different patterns of syndromic symptoms and sensitivity and specificity of each of them in the diagnosis of COVID-19 in suspected patients. STUDY DESIGN: Cross-sectional study . METHODS: In this study, the retrospective data of 1,539 patients suspected of COVID-19 were obtained from a local registry under the supervision of the officials at Shahroud University of Medical Sciences, Shahroud, Iran. A Latent Class Analysis (LCA) was carried out on syndromic symptoms, and the associations of some risk factors and latent subclasses were accessed using one-way analysis of variance and Chi-square test. RESULTS: The LCA indicated that there were three distinct subclasses of syndromic symptoms among the COVID-19 suspected patients. The age, former smoking status, and body mass index were associated with the categorization of individuals into different subclasses. In addition, the sensitivity and specificity of class 2 (labeled as "High probability of polymerase chain reaction [PCR]+") in the diagnosis of COVID-19 were 67.43% and 76.17%, respectively. Furthermore, the sensitivity and specificity of class 3 (labeled as "Moderate probability of PCR+") in the diagnosis of COVID-19 were 75.92% and 50.23%, respectively. CONCLUSION: The findings of the present study showed that syndromic symptoms, such as dry cough, dyspnea, myalgia, fatigue, and anorexia, might be helpful in the diagnosis of suspected COVID-19 patients.

The effect of zinc supplementation on fatigue among elderly community dwellers: A parallel clinical trial.

BACKGROUND AND AIMS: Fatigue is one of the most common complaints of the elderly. This study was conducted to assess the effect of zinc supplements on fatigue among the elderly. METHODS: This randomized clinical trial was conducted on 150 elderly aged ≥60 years who were recruited from the health centers (Kashan, Iran) with a convenience sampling method. Participants were allocated to intervention and control groups by block randomization. Participants in the intervention group received a daily dose of 30 mg of zinc supplement for 70 days; meanwhile, in the control group, no intervention was performed. The level of fatigue was measured by the multidimensional fatigue inventory before and after the intervention. Both groups were homogeneous in terms of demographic variables, fatigue, and serum zinc level before the intervention. The significance level was considered as 0.05 in all tests. RESULTS: Zinc supplementation significantly reduced fatigue (mean difference: -10.41 vs 1.37, P < .001) and increased serum zinc level (mean difference: 14.22, vs -0.57, P < .001) compared to the control group. CONCLUSION: Consumption of zinc supplements for the elderly is recommended to overcome fatigue.

Evaluating the effect of prenatal interventions on maternal-foetal attachment: A systematic review and meta-analysis.

Aim: This study aimed to evaluate the effect of prenatal interventions on maternal foetal attachment. Design: Systematic review and meta-analysis. Methods: In this study, a comprehensive review was performed to find articles published from January 2000 - December 2019 in the form of randomized and non-randomized clinical trials. To this end, online databases including PubMed, Scopus, Google Scholar, ScienceDirect, Proquest, Ovid, CINAHL and JAMA were searched. Duplicate articles were also excluded using Endnote X7 Reference. The results were then analysed via RevMan 5.3 software. Results: The results showed that foetal movement counting did not seem to be effective in increasing MFA by itself. But, this intervention alongside other attachment behaviours such as touching the belly and talking to foetus could enhance MFA. Therefore, the best interventions to improve MFA might be combined ones implemented in the form of counselling and training sessions.

Factors affecting triage accuracy in patients with a definitive diagnosis of acute myocardial infarction.

BACKGROUND: Triage is important to identifying patients with patients acute myocardial infartction (AMI) patients' triage accuracy, this research aims to study it in the ED, regarding factors affecting it. METHODS: This retrospective study analyzed data from patients with an ultimate diagnosis of AMI who had been admitted to the ED of Imam Hossein Hospital in Shahroud, Iran, over the last three years and had met the study criteria. Data were collected from the hospital archives. RESULTS: The triage accuracy was 82 % for a total of 400 patients with an ultimate diagnosis of AMI. Men, smokers, and those who had complained about chest pain and sweating at the time of their admission, as well as patients who had used pre-hospital medical services, had higher triage accuracy; indigestion or burning sensation had led to under triage. Based on multiple regression analysis, gender, chest pain, and sweating were found to be significant predictors of triage accuracy. Accordingly, male patients and those with chest pain and sweating had higher triage accuracy. CONCLUSIONS: Despite the increase in triage accuracy rate in this study compared to previous studies, under triage continues to be a problem in the triage of patients with an ultimate diagnosis of AMI.

Survival Prediction and Feature Selection in Patients with Breast Cancer Using Support Vector Regression.

The Support Vector Regression (SVR) model has been broadly used for response prediction. However, few researchers have used SVR for survival analysis. In this study, a new SVR model is proposed and SVR with different kernels and the traditional Cox model are trained. The models are compared based on different performance measures. We also select the best subset of features using three feature selection methods: combination of SVR and statistical tests, univariate feature selection based on concordance index, and recursive feature elimination. The evaluations are performed using available medical datasets and also a Breast Cancer (BC) dataset consisting of 573 patients who visited the Oncology Clinic of Hamadan province in Iran. Results show that, for the BC dataset, survival time can be predicted more accurately by linear SVR than nonlinear SVR. Based on the three feature selection methods, metastasis status, progesterone receptor status, and human epidermal growth factor receptor 2 status are the best features associated to survival. Also, according to the obtained results, performance of linear and nonlinear kernels is comparable. The proposed SVR model performs similar to or slightly better than other models. Also, SVR performs similar to or better than Cox when all features are included in model.

Application of mixture models for estimating the prevalence of cigarette smoking in hamadan, iran.

BACKGROUND: So far, several studies were conducted to estimate the prevalence of cigarette smoking in Iran, but none of them used a statistical model to deal with unobserved smokers. The present study planned to estimate the accurate prevalence of cigarette smoking using mixture of truncated Poisson distribution. METHODS: A cross-sectional study was conducted in Hamadan, west of Iran in 2009, using cluster sampling and 1146 men and women aged ≥18 years were enrolled. The data collection was done by an expert group of psychologists and sociologists. A truncated mixture Poisson distribution was fitted to the daily number of cigarettes smoked by smokers. The number of components of the mixture model and related mean and weight were specified using Bayesian information criteria. Accordingly, the number of cigarette smokers who answered incorrectly to the relevant question was estimated. To investigate the validity of the results, a simulation study was conducted using CAMCR software. RESULTS: Mixture Poisson distribution with four components was the most appropriate model fitted to the count data. After correction for underestimation, the prevalence rate of cigarette smoking in the population was 20.6%, including 36.2% for men and 3.3% for women. According to the simulation study, the bias of estimated prevalence was about zero and the root mean square error was estimated 2.5. CONCLUSION: The number of unobserved data can be estimated by fitting model to truncated count data. The mixture of truncated Poisson distribution is particularly useful to estimate population size when the main objective of the study is to investigate negative traits to which the participants may answer incorrectly.