Arrhythmia detection by the graph convolution network and a proposed structure for communication between cardiac leads.

One of the most common causes of death worldwide is heart disease, including arrhythmia. Today, sciences such as artificial intelligence and medical statistics are looking for methods and models for correct and automatic diagnosis of cardiac arrhythmia. In pursuit of increasing the accuracy of automated methods, many studies have been conducted. However, in none of the previous articles, the relationship and structure between the heart leads have not been included in the model. It seems that the structure of ECG data can help develop the accuracy of arrhythmia detection. Therefore, in this study, a new structure of Electrocardiogram (ECG) data was introduced, and the Graph Convolution Network (GCN), which has the possibility of learning the structure, was used to develop the accuracy of cardiac arrhythmia diagnosis. Considering the relationship between the heart leads and clusters based on different ECG poles, a new structure was introduced. In this structure, the Mutual Information(MI) index was used to evaluate the relationship between the leads, and weight was given based on the poles of the leads. Weighted Mutual Information (WMI) matrices (new structure) were formed by R software. Finally, the 15-layer GCN network was adjusted by this structure and the arrhythmia of people was detected and classified by it. To evaluate the performance of the proposed new network, sensitivity, precision, specificity, accuracy, and confusion matrix indices were used. Also, the accuracy of GCN networks was compared by three different structures, including WMI, MI, and Identity. Chapman's 12-lead ECG Dataset was used in this study. The results showed that the values of sensitivity, precision, specificity, and accuracy of the GCN-WMI network with 15 intermediate layers were equal to 98.74%, 99.08%, 99.97% & 99.82%, respectively. This new proposed network was more accurate than the Graph Convolution Network-Mutual Information (GCN-MI) with an accuracy equal to 99.71% and GCN-Id with an accuracy equal to 92.68%. Therefore, utilizing this network, the types of arrhythmia were recognized and classified. Also, the new network proposed by the Graph Convolution Network-Weighted Mutual Information (GCN-WMI) was more accurate than those conducted in other studies on the same data set (Chapman). Based on the obtained results, the structure proposed in this study increased the accuracy of cardiac arrhythmia diagnosis and classification on the Chapman data set. Achieving such accuracy for arrhythmia diagnosis is a great achievement in clinical sciences.

Intention to leave the profession and related factors in nurses: A cross-sectional study in Kermanshah, Iran.

AIM: To investigate the intention to leave the profession and its related factors among nurses in Kermanshah, western Iran. DESIGN: Cross-sectional study. METHODS: A total of 377 nurses were enrolled in a stratified random sampling method. Data were collected by the Anticipated Turnover Scale and a sociodemographic information form. and analysed by descriptive and inferential statistics (logistic regression analysis). RESULTS: The results showed that 49.6% (n = 187) of nurses tended to leave the profession and the mean score of intention to leave was 36.6 ± 0.5 of 60. There were no statistically significant differences between nurses who intended to leave and those who did not in terms of age, marital status, gender, type of employment, type of shift and work experience. But a statistically significant association was found between workplace (p = 0.041, adjusted OR = 2.07) and job title (p = 0.016, adjusted OR = 0.58) and intention to leave the profession. PATIENT OR PUBLIC CONTRIBUTION: No.

Developing Graph Convolutional Networks and Mutual Information for Arrhythmic Diagnosis Based on Multichannel ECG Signals.

Cardiovascular diseases, like arrhythmia, as the leading causes of death in the world, can be automatically diagnosed using an electrocardiogram (ECG). The ECG-based diagnostic has notably resulted in reducing human errors. The main aim of this study is to increase the accuracy of arrhythmia diagnosis and classify various types of arrhythmias in individuals (suffering from cardiovascular diseases) using a novel graph convolutional network (GCN) benefitting from mutual information (MI) indices extracted from the ECG leads. In this research, for the first time, the relationships of 12 ECG leads measured using MI as an adjacency matrix were illustrated by the developed GCN and included in the ECG-based diagnostic method. Cross-validation methods were applied to select both training and testing groups. The proposed methodology was validated in practice by applying it to the large ECG database, recently published by Chapman University. The GCN-MI structure with 15 layers was selected as the best model for the selected database, which illustrates a very high accuracy in classifying different types of rhythms. The classification indicators of sensitivity, precision, specificity, and accuracy for classifying heart rhythm type, using GCN-MI, were computed as 98.45%, 97.89%, 99.85%, and 99.71%, respectively. The results of the present study and its comparison with other studies showed that considering the MI index to measure the relationship between cardiac leads has led to the improvement of GCN performance for detecting and classifying the type of arrhythmias, in comparison to the existing methods. For example, the above classification indicators for the GCN with the identity adjacency matrix (or GCN-Id) were reported to be 68.24%, 72.83%, 95.24%, and 92.68%, respectively.

Assessment of Knowledge, Attitude, and Practice of Iranian Nurses towards Toothbrush Maintenance and Use.

BACKGROUND: Since nurses are considered a role model in society, they should have sufficient knowledge, attitude, and practice in the field of oral hygiene. This study was aimed to assess the nurses' knowledge, practice, and attitude towards toothbrush maintenance and use. METHODS: In this cross-sectional study, 325 nurses working in hospitals affiliated to Kermanshah University of Medical Sciences were randomly recruited. Data collection tools included a demographic information form and a researcher-made questionnaire on knowledge, attitude, and practice regarding toothbrush maintenance and use. Data were analyzed by SPSS software using descriptive and inferential statistics (Mann-Whitney U and Kruskal-Wallis H). RESULTS: The mean scores of nurses' knowledge, attitude, and practice were 59.2 ± 16.4, 64.2 ± 20.6, and 51.4 ± 17.0 out of 100, respectively. There was no statistically significant relation between nurses' knowledge, attitude, and practice and their gender, age, level of education, and work experience. CONCLUSIONS: Nurses had moderate knowledge, attitude, and practice regarding toothbrush maintenance and use, which is not very desirable given their role model. Therefore, training courses are recommended to be held to increase the nurses' knowledge, attitude, and practice regarding toothbrush maintenance and use.

Iranian nurses' attitudes towards the necessity and barriers to developing nurse prescribing roles.

BACKGROUND: Prescribing medication by nurses as an approach to rational drug prescription has been proposed in many countries. Nursing prescribing is an effective measure in the management of critically ill patients admitted to intensive care units (ICU). This study investigated the attitude of ICU nurses towards the necessity and the barriers to developing nursing prescribing. MATERIALS AND METHODS: In this cross-sectional study, 136 ICU nurses were included by stratified random sampling. The data collection tool was the researcher-made questionnaire. Cronbach's alpha method was used to evaluate the reliability of the instrument. The validity of the instrument was also verified by the content validity method. To collect the data, the researcher referred to the nurses' workplace and provided them with a questionnaire and collected it after completion.The collected data were analyzed by IBM SPSS 16 using descriptive and inferential statistics. RESULTS: It was revealed that 58.8 % of nurses were familiar with the term 'nursing prescribing'; a majority (92.1 %) of whom considered it vital to develop this role in the ICU. Moreover, 86 % (n = 98) of the nurses assumed that it is possible to implement this role in ICU. The most potential barriers to its implementation were lack of legitimacy, disapproval of physicians, and the reluctance of nursing managers. CONCLUSIONS: Most nurses maintained a positive attitude towards nursing prescribing; hence, its legitimacy seems vital in ICUs. For the development of the 'nurse prescribing' role, the Nursing System Organization may be helpful.

Comparison of Knowledge, Attitude, and Practice of Nursing and Medical Students in Kermanshah, Iran, about Toothbrush Maintenance and Use.

Background: To promote oral health in society, medical and nursing students are required to have acceptable knowledge, attitude, and practice with respect to correct maintenance and use of a toothbrush. This study explored the knowledge, attitude, and practice of Iranian medical and nursing students about the correct maintenance and use of a toothbrush. Methods: A total of 260 nursing students and 320 medical students were randomly recruited. Data were collected by a researcher-made questionnaire on the knowledge, attitude, and practice about toothbrush maintenance and use. Data were analyzed using descriptive and inferential statistics. Results: The mean scores of knowledge, attitude, and practice were 54.53 ± 17.18, 49.67 ± 19.17, and 19 ± 51.50 in the nursing students and 54.17 ± 21.42, 51.18 ± 87.28, and 49.87 ± 17.52 out of 100 in the medical students, respectively. There was no significant difference between the medical and nursing students in the mean score of knowledge. The medical and nursing students had a similar attitude and practice in most items of toothbrush maintenance and use. Conclusion: The medical and nursing students had average knowledge, attitude, and practice regarding toothbrush maintenance and use, which is not acceptable considering their job nature. Hence, interventional measures should be taken to enhance their knowledge, attitude, and practice.

Barriers to the success of cardiopulmonary resuscitation from the perspective of Iranian nurses: A qualitative content analysis.

BACKGROUND: The survival rate following Cardiopulmonary Resuscitation (CPR) has been reported to be 7-26.7%. Various studies have shown that CPR failure is high in many countries. This study was aimed to explore the barriers to the success of CPR from the perspective of Iranian nurses. METHODS: Participants were 14 Iranian nurses recruited through purposive sampling. In-depth semi-structured interviews were used to collect data. Data were analyzed using qualitative content analysis. RESULTS: The barriers to successful CPR were developed in three main categories and nine subcategories. Some of the barriers to CPR success were: "delayed attendance of the CPR team and start of CPR", "inadequate experience and skill of the CPR team", "poor access to special units", "insufficient and deficient CPR equipment", "poor CPR location", "critical clinical conditions of the patient", and "interference of the patient's family members. CONCLUSION: The results showed that human and environmental factors can result in CPR failure. These barriers can be minimized by measures such as empowerment of the CPR team, and providing the necessary facilities and equipment.

Factors Affecting the Desire to Undergo Cosmetic Procedures Among the Nurses of Kermanshah, Iran: A Cross-Sectional Study.

The number of people undergoing cosmetic procedures (CP) has been growing around the world in recent years. The aim of this study was to determine factors involved in the desire of nurses to undergo CP. A total of 360 nurses were recruited in this cross-sectional study. Stratified random sampling was used to select the samples. The data were collected using the Social Appearance Anxiety Scale and a questionnaire addressing social factors affecting the desire to undergo CP. More than half of the nurses (56.7%) were willing. Gender, social factors, and social appearance anxiety (SAA) were associated with undergoing CP. The results of logistic regression indicated that women were four times more willing to undergo CP than men, and for each unit increase in SAA score, the odds of desiring to undergo CP increased by 1.04. The Hosmer-Lemeshow test confirmed the goodness-of-fit of the regression model. Moreover, 3 independent variables of gender, SAA, and social factors were powerful predictors of the desire to undergo CP that could explain 39.9%-53.6% of changes in the desire to undergo CP. Further studies are needed to investigate the amount of CP and motivations to undergo CP in nurses.

Knowledge, Attitude, and Performance of ICU, CCU, and Emergency Wards Nurses in Kermanshah, Iran, regarding Organ Donation.

BACKGROUND: Providing an organ for donation is a major problem worldwide and nurses play an important role in facilitating the process of organ donation. This study is aimed at investigating the knowledge, attitude, and performance of nurses working in the ICU, CCU, and emergency wards regarding organ donation. METHODS: In this descriptive-analytical study, 185 nurses working in ICU, CCU, and emergency wards were studied through systematic random sampling. The data collection was done by a self-administered questionnaire. RESULTS: The mean knowledge of nurses was 8.9 ± 1.4 out of 10. There was a significant relationship between knowledge of nurses regarding donation and religion and having organ donation card (P < 0.001). The mean attitude of nurses was 7.8 ± 2.2 out of 8. The variables, including "having a donation card and marriage," were associated with attitude of nurses toward organ donation. The mean performance of nurses was 0.4 ± 0.7 out of 3. There was a significant relationship between performance of nurses and having a donation card (P < 0.001). Knowledge was the strongest predictor of nurses' performance (P < 0.01). CONCLUSION: The studied nurses showed sufficient knowledge and favorable attitude toward organ donation; however, they had poor performance. It is suggested to hold training courses to improve performance of nurses. The revision of the nursing students' curriculum as future nurses should also be considered.

Nursing students' perceived consequences of self-medication: a qualitative study.

BACKGROUND: Self-medication associates with many problems and complications, and is considered as a global health issue. Regarding a lack of information about perception of nursing students, as a part of healthcare workers, in this issue, the current study was aimed to explore the perceived consequences of self-medication from the perspective of nursing students. METHODS: This qualitative study was conducted using semi-structured individual face-to-face interviews. Purposeful sampling method was used for selection of participants. Twelve nursing students in the age range of 21-36 years were enrolled. Five participants were male and seven were female, seven master's degree and five were undergraduate of bachelor degree. Data were collected using semi-structured interviews and analyzed as content analyses. RESULTS: Two categories and seven sub-categories were emerged from the data analysis. The main categories included; positive consequences and negative consequences, and subcategories included; time saving, cost savings, disease treatment, harming the health system, drug resistance, physical complications and death. CONCLUSION: The participants believed that self-medication has some positive and negative consequences in viewpoints of nursing students. Regarding, Self-medication that potentially has dangerous consequences, it is suggested the students will be educated and warned about the adverse effects of self-medication, and the nursing teachers should try to rectify students' misconceptions about self-medication.

Prevalence of anxiety, depression, and stress in patients with multiple sclerosis in Kermanshah-Iran: a cross-sectional study.

BACKGROUND: Multiple sclerosis (MS) is a chronic disease that decreases the physical ability and affects the mental health of the patients. This descriptive-analytical study investigated the prevalence of depression, anxiety and stress in MS patients. METHODS: A total of 87 MS patients were recruited in this study through simple random sampling method using a random number table. Data were collected by Depression, Anxiety, and Stress Scale-21 (DASS-21) and analyzed by descriptive and analytical statistics. RESULTS: The mean age of the patients was 35.5 ± 9.2 years. Of them, 41 (47.1%) had moderate depression, 34 (39.1%) had moderate anxiety, and 39 (44.8%) had moderate stress. There was a significant relationship between depression and job, education, and economic status of the participants. There was also a significant association between the participants' economic status and anxiety. There was no significant relationship between stress and any of the variables. CONCLUSION: Given the relatively high prevalence of anxiety, depression, and stress in MS patients as well as the significant relationship between their economic status and depression and anxiety, interventional measures are required to be taken to decrease their problems and to provide a favorable ground for their employment. Periodic examinations by psychologists / psychiatrists and treatment of patients with symptoms of stress, anxiety and depression are also essential.

Epidemiological study on animal bite cases referred to Haji Daii health Center in Kermanshah province, Iran during 2013-2017.

BACKGROUND: Over thousands of animal bite cases are reported annually worldwide and in Iran placing a large financial burden on the health and economy. The aim of this study was to evaluate the epidemiology of animal bite cases in Kermanshah, Iran through 2013-2017. METHODS: In this cross-sectional study, 5618 animal bite cases in Kermanshah from 2013 to 2017 were studied. Data were analyzed using descriptive and inferential statistics. RESULTS: In the study period, 5618 animal bite cases were found. The prevalence of animal bites was estimated between 42.55-45.66 per100000 populations during 2013-2017. An increasing significant trend was found for prevalence of animal bites (Average annual percent change [AAPC] + 4.9, P-trend< 0.001) over a 5-years' time period. The mean age of the subjects was 32.7 ± 18.3 years. Of the studied subjects 76.3% were male, and 34% had non-governmental jobs. Dogs were found as the cause of animal bites in 72% of the cases. Of the studied cases, 82% had received rabies vaccination for three times. CONCLUSION: The results showed an increasing significant trend for animal bites in Kermanshah. Development of interventional programs, such as limiting stray dogs, vaccination of dogs and raising public awareness are essential.

The Relationship Between Care Burden and Coping Strategies in Caregivers of Hemodialysis Patients in Kermanshah, Iran.

OBJECTIVE: The purpose of this study was to investigate the relationship between care burden and coping strategies in caregivers of hemodialysis patients. METHODS: This cross-sectional survey was conducted from September to December 2018 in Kermanshah, Iran. A total of 130 caregivers of patients admitted to the hemodialysis wards of Imam Reza and Imam Khomeini hospitals of Kermanshah, Iran were selected via convenience sampling. Data-collection tools included a demographic information form, caregiver-burden inventory, and coping inventory for stressful situations. Data were analyzed using descriptive and analytical tests. RESULTS: The mean age of the caregivers was 35.8±13.7 years, and 71 (54.6%) were patients' children. The mean caregiver-burden score was 58.5±20.5 out of 96. Mean scores of time-dependent, evolutionary, physical, social, and emotion-dependent care burdens were 17.5±5.3, 12.2±6.3, 9.1±4.7, 8.2±4.0, and 11.4±5.1, respectively. Mean scores of problem-focused, emotion-focused, and avoidance-oriented coping strategies were 46.0±80.8, 43.1±9.0, and 48.9±9.5, respectively. Among the strategies, only the avoidance-oriented one had a significant positive relationship with total care burden and all its subscales. CONCLUSION: Caregivers of hemodialysis patients experienced a relatively high care burden. However, they did not use appropriate coping strategies; therefore, they should be trained to select an effective coping strategy.

The Relationship Between the VARK Learning Styles and Academic Achievement in Dental Students.

BACKGROUND: Learning style is a factor influencing academic achievement. There are contradictory results in studies on the relationship between learning styles and academic achievement. The current study aimed at investigating the relationship between learning styles and academic achievement in dental students. METHODS: In the current descriptive-analytical study, 184 dental students were selected by simple random sampling. The VARK questionnaire was used as the data collection tool. The grade point average (GPA) of previous semester was used as an indicator of academic achievement, and accordingly, students were divided into two groups of strong (GPA ≥15) and weak (GPA ≤14.99). RESULTS: The most common learning styles in strong students were unimodal (n = 55, 42%) and bimodal (n = 41, 31.3%), while they were unimodal (n = 28, 47.2%) and bimodal (n = 24, 45.3%) in the weak students. There was no significant relationship between learning styles and academic achievement in the two groups of strong and weak students. CONCLUSION: No significant relationship was found between learning style and academic achievement. Further studies with larger sample sizes are recommended. Further studies with larger sample sizes are recommended.

Attitude of primiparous women towards their preference for delivery method: a qualitative content analysis.

BACKGROUND: The delivery method is one of the primary concerns of primiparous women. Today, due to the fear of delivery, the number of cesarean sections has increased significantly. Considering the importance of choosing the type of delivery and the lack of study in this regard, the present study was conducted to explain the attitude of primiparous women towards their preference for delivery method. METHOD: In this qualitative study, in-depth interview was conducted with 12 primiparous women. The transcripts of the interviews were read carefully by the researcher for several times. Finally, using the analytical method, the codes were extracted and subsequent subcategories and main categories were determined. To assess the credibility of the data, the Denzin & Lincoln's criteria were used, which include Credibility, Transferability, Dependability, and Confirmability. RESULTS: Because of inexperience in delivery and ambiguity in process, most of the woman had a specific fear and they commonly affected by other advices and experiences. The majority of the participants had desire to vaginal delivery with announcing its advantages such as shortage of pain process, easy breast feeding, and mother ability to better carryout the newborn works. Other participants believed on adverse effects of normal vaginal delivery including bladder prolapse, uterus rupture, and probability of experience of both happenings (CS and NVD), frequent examination, pain and urine incontinence. Some stated cesarean section have benefits of less injury to neonate and preserving her/his beauty. CONCLUSION: Results showed that, choosing a delivery method is difficult for primiparous women, and their attitude toward the type of delivery is influenced by subjective and internal factors. Giving awareness to primiparous women greatly enhances their tendency towards vaginal delivery.

Exploring the perceived factors that affect self-medication among nursing students: a qualitative study.

BACKGROUND: Self-medication is the use of one or more medications without physician's diagnosis, opinion, or prescription and supervision, which includes the use of herbal or chemical drugs. Todays, self-medication is one of the biggest socio-health and economic problems among nursing students of various societies, including Iran, and because this issue can affected by contextual factors, this study aimed to explore the perceived factors that affect self-medication among nursing students. METHODS: In this qualitative study, a semi-structured interview was conducted with 11 nursing students. The transcript of each interview was reviewed several times and classified into main categories and sub-categories by content analysis. To evaluate this study, Guba and Lincoln's four criteria, including credibility, transferability, dependability, and confirmability were considered for trustworthiness. RESULTS: After analyzing the qualitative content of the interviews, four main categories, including educational backgrounds, nature of the disease, access to the media, and beliefs and personal experiences, and ten subcategories, including contact with clinical environment, relative knowledge about medications, simplicity of the disease, recurrence of the disease, influence of the media, use of the internet, believing in own knowledge, positive experiences of traditional medicine, and using own and others' experiences, were extracted. CONCLUSIONS: It seems that, having a relative awareness about various diseases and medications, which is sometimes associated with taking a few educational courses with an internship, creates a false confidence in student for self-medication and prescribing drugs to others. It would be beneficial if the education system and associated tutors could inform the students about the possible consequences of this issue. By knowing the internal and subjective factors that influence the self-medication, this arbitrary practice can be largely prevented.