Skin graft surgery and its impact on platelet counts in Iranian burn patients: a non-randomized clinical trial.

BACKGROUND: Platelets are critical in maintaining homeostasis and immune response in burn patients. The concentration of platelets decreases in burn patients, and any intervention that increases serum platelet concentration can prevent serious consequences and patient death. The present study aimed to assess the impact of skin graft surgery on burn patients' platelet counts. METHODS: In this non-randomized clinical trial, 200 burn patients were investigated. The patients were recruited from the surgical ward of Imam Khomeini Teaching Hospital during the first six months of 2021. After completing the checklist, patients underwent skin graft surgery. Blood was taken from the patients during surgery in the operating room and on the third and fifth day after the surgery to check platelets. Data analysis was conducted using SPSS software (ver. 22.0). RESULTS: Most patients (63.5%) were male, and 73 (36.5%) were female. One hundred eighty-one patients (90.5%) had deep burns, and 19 (9.5%) had superficial burns. The mean burns percentage in the patients was 19.3 ± 15.4%, the lowest was 2%, and the highest was 90%. The most common burns were caused by flame (42%) and boiling water (30.5%). The patients' outcomes revealed that 6% gained complete recovery, 86.5% partial recovery, 2.5% showed transplant rejection, and 5% died. Mean platelet levels in deceased patients had an upward trend. The mean platelet counts of patients were elevated during surgery (289,855 ± 165,378), decreased three days after surgery (282,778 ± 317,310), and elevated again five days after surgery (330,375 ± 208,571). However, no significant difference was found between the mean platelet counts during surgery, the third and fifth days after surgery in patients undergoing skin grafts (P = 0.057). CONCLUSIONS: This study suggests that skin graft positively increases the patient's platelets. Further studies are needed to confirm the findings and elucidate the mechanism. Iranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N8 & 06/01/2024).

Comparing the Efficacy of Acupressure and Foot Reflexology on Sleep Quality in Patients With Leukemia: A Comparative Clinical Trial.

BACKGROUND: Among leukemia patients, sleep disruptions are prevalent and can profoundly affect their overall quality of life. Acupressure and foot reflexology, modalities rooted in traditional Chinese medicine, have garnered attention for their potential to address sleep disturbances and mitigate associated symptoms. METHODS: This research utilized a randomized controlled trial with a pretest-posttest design involving 102 leukemia patients admitted to Imam Khomeini Hospital in Urmia. Participants were randomly allocated to 3 groups: acupressure (n = 34), reflexology (n = 34), or control (n = 34). Prior to the intervention, patients completed a demographic survey and the Pittsburgh Sleep Quality Index (PSQI) for baseline assessments. Acupressure involved stimulation of the SP6 point twice daily for 10 minutes over 4 weeks, while reflexology entailed daily 10-minute sessions with sweet almond oil on the soles for the same duration. The control group received standard care without additional interventions. Following the 4-week intervention period, post-intervention evaluations were conducted using identical measurement tools. RESULTS: The findings underscored the efficacy of both acupressure and foot reflexology in significantly improving sleep quality within the intervention groups (P < .001). Initially, there were no notable differences in sleep quality among the 3 groups (P > .05). Subsequently, pairwise comparisons adjusted with Bonferroni corrections revealed significant disparities in sleep quality between the acupressure and reflexology groups compared to the control group (P < .001). However, post-intervention analysis indicated no statistically significant variance in enhancing sleep quality between the acupressure and foot reflexology groups (P < .05). CONCLUSION: This study demonstrates that acupressure and foot reflexology interventions can enhance sleep quality in individuals with leukemia. These findings support the effectiveness of these complementary modalities, offering targeted relief and relaxation. While these non-invasive therapies show promise in improving well-being, further research is needed to confirm and expand upon these results due to study limitations.

Religio-cultural facilitators and barriers in decision-making on organ donation: The experiences of families of brain-dead patients in Iran.

This study aimed to explore the experiences of families of brain-dead patients regarding religio-cultural facilitators and barriers in decision-making for organ donation. This is a qualitative descriptive study, in which a total of eighteen families of brain-dead patients were recruited using purposive sampling. Data were collected using semi-structured face-to-face interviews. After recording and transcribing the interviews, concepts were extracted using conventional content analysis. The main theme was entitled "religio-cultural facilitators and barriers in decision-making on organ donation" and consisted of four main categories, including two facilitators of "life-giving culture" and "life-giving sacredness" and two barriers of "decision-making skepticism" and "opportunity-burning religiousization". Therefore, cultural and religious issues require further attention and a more realistic and logical cultural and religious perspective toward organ donation should be created at the societal level.

Comparing the impact of acupressure and reflexology on fatigue in chronic lymphocytic leukemia patients: A randomized controlled trial with three arms.

PURPOSE: This study aimed to evaluate the effects of acupressure and reflexology on fatigue in chronic lymphocytic leukemia patients. METHOD: In this randomized controlled trial with three arms and a pretest-posttest design, 102 CLL patients were randomly allocated to acupressure (n = 34), reflexology (n = 34), or control (n = 34) groups. Pre-intervention assessments were conducted using a demographic questionnaire and a fatigue scale for cancer patients. The acupressure group received routine care with acupressure targeting the SP6 point for 10 min twice daily over four weeks. The reflexology group received daily 10-minute reflexology sessions over four consecutive weeks following the preparation and lubrication of the soles of their feet with sweet almond oil. Post-intervention assessments were administered to all groups using the same instruments. RESULTS: Results showed both acupressure and reflexology significantly reduced fatigue compared to the control group (P < 0.001). While differences were noted between acupressure, reflexology, and control groups initially, the post-intervention analysis revealed no significant variance between acupressure and reflexology in reducing fatigue (P < 0.05), suggesting similar improvement between acupressure and reflexology. CONCLUSIONS: Acupressure and reflexology are recommended as cost-effective and low risk complementary approaches for managing fatigue in chronic lymphocytic leukemia patients. These therapies offer promise in alleviating fatigue and enhancing the quality of life for cancer patients.

NSAID (nonsteroidal anti-inflammatory drugs) Induced Stevens Johnson Syndrome in a 50-year-old woman: A case study.

Stevens-Johnson Syndrome (SJS) is a severe and rare adverse drug reaction associated with significant morbidity and mortality. Although SJS is commonly triggered by multiple drugs, non-steroidal anti-inflammatory drugs (NSAIDs), including diclofenac, have been frequently implicated. A middle-aged woman, who is 50 years old, has a prior medical record of high blood pressure, type 2 diabetes, and has recently suffered from a pulmonary embolism. She was later admitted to the intensive care unit (ICU), where she was ultimately diagnosed with Steven Johnson syndrome. Careful drug selection, close monitoring of patients with predisposing factors, and prompt identification of adverse events are crucial to prevent severe drug reactions.

The effect of the Yara smartphone application on anxiety, sleep quality, and suicidal thoughts in patients with major depressive disorder in Iran: a randomized controlled trial.

BACKGROUND: Depression is one of the most common mental disorders that leads to anxiety, sleep disturbances, and suicidal thoughts. Due to the high cost of treatment and the reluctance of many patients to seek medical help, major depressive disorder (MDD) is becoming more prevalent. Therefore, alternative methods like smartphone applications can help prevent and improve depression symptoms. The present study aimed to determine the effect of the newly developed Yara smartphone application on anxiety, sleep quality, and suicidal thoughts in patients with MDD. METHODS: This randomized controlled trial with a pretest-posttest design was conducted on Iranian patients with MDD in 2022. Sixty-four patients were recruited using convenience sampling and randomly assigned to two control and intervention groups. The intervention was conducted using the Yara smartphone application for three months. Data were collected using the Spielberger State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI), and Beck Scale for Suicidal Ideation (BSSI). Data were first entered into IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA) and then analyzed using descriptive and analytical statistics. RESULTS: There was no statistically significant difference in the mean score of anxiety and sleep quality between the intervention and control groups before the intervention (p ≥ .05). However, this difference in the mean score of anxiety and sleep quality was statistically significant in the two groups after the intervention (p < .05). The results showed no statistically significant difference in the mean score of suicidal thoughts between the two groups before and after the intervention (p ≥ .05). The use of the Yara smartphone application had a significant positive effect on anxiety and sleep quality in depressed patients (p < .001). At the same time, it had no significant effect on suicidal thoughts (p ≥ .05). CONCLUSION: Considering the positive effect of using the Yara smartphone application on reducing anxiety and improving sleep quality in depressed patients, this application can help alleviate the problems of depressed patients alongside existing treatment methods. Thus, this application is recommended for this group of patients in psychiatric clinics and departments. The Yara application's effectiveness was not approved on suicidal thoughts in this study so that further investigation would be necessary. TRIAL REGISTRATION: Iranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N7).

Orchiectomy after testicular trauma in a 45-year-old man: A case report.

Testicular trauma is a rare but significant condition that can result in severe damage to the testicles. In some cases, when the trauma is extensive and irreparable, orchiectomy, which refers to the surgical removal of one or both testicles, may be necessary. A 45-year-old man experienced testicular trauma as a result of a sporting event. Upon examination, it was determined that the trauma had caused severe damage to the affected testicle, leading to compromised blood supply and persistent pain. The presence of compromised blood supply was assessed through a combination of clinical evaluation and diagnostic imaging (scrotal ultrasound). The imaging findings indicate reduced blood flow to the testicle. Considering alternative treatment options and potential complications, the medical team decided to proceed with orchiectomy. Orchiectomy is a significant surgical procedure performed as a last resort when other treatments are not viable or when complications such as infection or severe pain are present. The decision to perform orchiectomy depends on the extent of the testicular trauma and the patient's overall health. It has implications for fertility and hormone production, with the remaining testicle typically compensating for the functions of the removed testicle. Prompt medical intervention is crucial in evaluating the severity of the injury and determining the appropriate course of treatment. Orchiectomy should be considered when the testicle is extensively damaged and irreparable, making testicular trauma resulting in the need for orchiectomy a complex and challenging situation.

Fighting diabetic foot ulcer by combination therapy, including larva therapy, Medi honey ointment, and silver alginate dressings: A case report.

INTRODUCTION AND IMPORTANCE: Diabetic foot ulcers (DFUs) are a common complication of diabetes and can be challenging to manage. A combined approach can lead to faster healing and better outcomes for individuals with DFUs. CASE PRESENTATION: This case report presents a 70-year-old man with a 15-year history of diabetes who developed a diabetic foot ulcer. The patient was undergoing treatment with routine therapy. Despite the severity of the ulcer, a combination therapy approach, including larva therapy, Medi honey ointment, and silver alginate dressings, was implemented, leading to successful healing. CLINICAL DISCUSSION: By combining these three treatment modalities, we may be able to achieve a synergistic effect and maximize wound healing and infection control benefits. CONCLUSION: The combined use a honey-based Media Honey ointment and silver alginate larva therapy can be an effective treatment option for diabetic foot ulcers.

Evaluation of occupational stress and job performance in Iranian nurses: the mediating effect of moral and emotional intelligence.

BACKGROUND: Nurses' Job performance could be affected by occupational stress. Previous studies reported contradictory results in this regard. Factors such as moral and emotional intelligence could impact occupational stress. However, the extent of any mediating effect is unclear. Thus, this study aimed to determine the effect of occupational stress on nurses' Job performance and the mediating impact of moral and emotional intelligence. METHODS: This cross-sectional study was conducted in Urmia teaching hospitals (Imam Khomeini, Motahari, Taleghani, Kosar, and Seyed al-Shohada Hospitals). Six hundred twenty-one nurses were selected using quota sampling from February 2022 to April 2022. Data were collected using demographic questionnaires, the Nursing Stress Scale, Paterson's Job Performance Questionnaire, Siberia Schering's Emotional Intelligence Standard Questionnaire, and Lennik and Keil's Moral Intelligence Questionnaire. Data were analyzed using SPSS ver. 23 and SmartPLS ver. 2. RESULTS: Occupational stress had a positive, direct, and minor effect on nurses' job performance (ß = 0.088, t-value = 2.245, p < 0.01). Occupational stress had a positive and direct impact on moral intelligence (ß = 0.161, t-value = 2.945, p < 0.01) and a negative and direct effect on emotional intelligence (ß = -0.351, t-value = 7.484, p < 0.01). Occupational stress negatively and indirectly affected job performance through moral intelligence (ß =-0.560, t-value = 14.773, p < 0.01). Occupational stress also positively and indirectly impacted job performance through emotional intelligence (ß = 0.098, t-value = 2.177, p < 0.01). CONCLUSIONS: Occupational stress slightly affects nurses' job performance, and emotional and moral intelligence mediates the impact of occupational stress and improves nurses' job performance. Low occupational stress improves nurses' job performance, but too much occupational stress could harm nurses' job performance. Healthcare administrators should work to help reduce nurses' occupational stress and improve their job performance by adopting practical strategies to help nurses manage and control their stress. Holding stress reduction classes, eliminating the nursing shortage, reducing working hours, reducing workload, and providing financial and spiritual support to nurses would be recommended. It is also recommended to provide theoretical and practical emotional and moral intelligence-oriented courses for nursing students and hold training workshops for nurses to improve their emotional and moral intelligence.

Maggot therapy, alginate dressing, and surgical sharp debridement: Unique path to save unresponsive diabetic foot ulcer.

INTRODUCTION AND IMPORTANCE: Diabetic foot ulcers are a severe complication of diabetes mellitus, affecting a significant proportion of the diabetic population. In some cases, ulcer progression and infection can lead to the need for amputation. CASE PRESENTATION: An 84-year-old male with a history of poorly controlled type 2 DM and HTN presented with an infected DFU on the plantar aspect of his right foot. This case report illustrates the successful management of an 84-year-old patient with a DFU amputation candidate, emphasizing the effectiveness of a combined treatment approach. CLINICAL DISCUSSION: Conventional treatment options, including antibiotic therapy, often fail to provide adequate healing in these high-risk patients. Alternative approaches, such as maggot therapy, which involves the application of sterile maggots to the wound bed, have shown promising results. CONCLUSION: This case highlights the potential therapeutic benefits and clinical efficacy of such a combined treatment approach, particularly in challenging cases with limited response to conventional therapies. Further studies and randomized trials may be warranted to support the incorporation of this therapy combination into clinical practice guidelines for DFU management.

The effects of electronic nursing handover on patient safety in the general (non-COVID-19) and COVID-19 intensive care units: a quasi-experimental study.

BACKGROUND: The unprecedented increase in the nurses' workload is one of the issues affecting the quality and safety of patient care in the Intensive Care Units (ICUs). The electronic nursing handover can share sufficient, relevant, and necessary data about patients with greater efficiency and accuracy and prevent their information from being deleted. Therefore, this study aimed to determine and compare the effect of the Electronic Nursing Handover System (ENHS) on patient safety in General ICU and COVID-19 ICU. METHOD: This is a quasi-experimental study conducted during an 8-month period from 22 to 2021 to 26 June 2022 using a test-retest design. A total of 29 nurses working in the General and COVID-19 ICUs participated in this study. Data were collected using a five-part questionnaire consisting of demographic information, handover quality, handover efficiency, error reduction, and handover time. Data analysis was conducted in IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA) using the chi-squared test, paired t-test, and Analysis of Covariance (ANCOVA). RESULTS: The results showed that the mean scores of handover quality and efficiency, reduction of clinical error, and handover time in the electronic handover were significantly higher than those obtained in the paper-based method. The results showed that the mean score of patient safety in the COVID-19 ICU was 177.40 ± 30.416 for the paper-based handover and 251.40 ± 29.049 for the electronic handover (p = .0001). Moreover, the mean score of patient safety in the general ICU was 209.21 ± 23.072 for the paper-based handover and 251.93 ± 23.381 for the electronic one (p = .0001). CONCLUSION: The use of ENHS significantly improved the quality and efficiency of shift handover, reduced the possibility of clinical error, saved handover time, and finally increased patient safety compared to the paper-based method. The results also showed the positive perspectives of ICU nurses toward the positive effect of ENHS on the patient safety improvement.

Fighting postsurgical infection after myelomeningocele repair with medical honey (Medihoney): a case report.

Surgical site infection (SSI) prolongs the treatment period, delays wound healing, increases antibiotic consumption, and leads to patient death in complicated cases. This case was a 10-day female infant born at 37-week- and 6-day of gestational age with a birth weight of 3700 g and Apgar 5/8 by emergency cesarean section due to spina bifida cystica with myelomeningocele (MMC). She was admitted to the neonatal intensive care unit (NICU) because of respiratory distress and hypotonic lower extremities on June 2, 2022. A cardiovascular and neurosurgery consult was okay for reconstructive surgery, and she had MMC repair surgery by a plastic surgeon on June 5, 2022. The surgical site was infected, and SSI had no improvement, despite regularly receiving wet and Vaseline gauze dressing and intravenous antibiotic therapy. We started the treatment using Medihoney™, honey antibacterial wound dressing, on SSI once a day for 2 weeks, then once every other day for the next 6 weeks. Her SSI was cured entirely after 2 months, and she was discharged from our wound treatment team in satisfactory general condition. Clinicians and wound care management teams could use honey antibacterial wound gel to treat SSI, particularly in newborns with weakened immune systems after spinal birth defects repair.

"We are really starving for respect and support," the struggle of Iranian nurses in adhering to professional values: A qualitative study.

AIMS: To investigate nurses' experiences of adhering to professional values in clinical settings. DESIGN: A qualitative study with a conventional content analysis approach. METHODS: This study was conducted from January 2021 to March 2022. Semi-structured interviews were conducted with 12 nurses working in different wards of five public and private hospitals in West Azerbaijan of Iran. Data were analysed using the conventional content analysis approach proposed by Graneheim and Lundman (Nurse education today, 24, 2004, 105) RESULTS: "Barriers to nurses' professional values" emerged as the main category of Iranian nurses' experiences in adhering to professional values. Three subcategories of barriers were revealed: "nurses' challenges," "professional suppressors" and "poor working conditions." CONCLUSION: Barriers in clinical settings can overshadow nurses' professional performance and disrupt their adherence to professional values. Nursing managers must pay attention to nurses' challenges, their professional suppressors and poor working condition to help them promote their professional performance in clinical settings. Thus, nursing managers should not neglect the continuous education of nurses to assist them in increasing their clinical skills by holding practical and theoretical workshops. Improving the working conditions and clinical atmosphere by recruiting a capable workforce and applying psychological and financial support for nurses are essential to increase the quality of nursing care.

Does family-centred education improve treatment adherence, glycosylated haemoglobin and blood glucose level in patients with type 1 diabetes? A randomized clinical trial.

AIM: To investigate the effect of family-centred education on treatment adherence, glycosylated haemoglobin and blood glucose level in patients with Type 1 Diabetes Mellitus. DESIGN: Randomized controlled trial. METHODS: Sixty patients with Type 1 Diabetes Mellitus were randomly allocated into the intervention and control group. Data were collected using demographic and Modanloo Adherence to Treatment Questionnaires. The patients received 12 family-centred educational sessions in the intervention group. RESULTS: A significant difference was found in the mean score of treatment adherence between the two groups after the intervention (p < 0.001). The mean score of treatment adherence significantly increased in the intervention group after family-centred education. The mean score of Fasting Blood Glucose and Glycosylated Haemoglobin A1C significantly decreased in the intervention group after the intervention (p < 0.001). CONCLUSION: Relevant authorities need to consider family-centred education as one of the most important education methods in Type 1 Diabetes Mellitus patients. TRIAL REGISTRATION: IRCT20131112015390N4; August 21, 2020.

Surgical debridement and maggot debridement therapy (MDT) bring the light of hope to patients with diabetic foot ulcers (DFUs): A case report.

INTRODUCTION AND IMPORTANCE: Management of diabetic foot ulcers (DFUs), one of the complications of diabetes mellitus, can lead to death and amputation, and it is one of the most critical challenges for the patients and their families. CASE PRESENTATION: The present case report concerns a 72-year-old man with a 5-year history of uncontrolled type 2 diabetes mellitus. The patient had antibiotic-resistant DFUs on two phalanges of his left foot, which were completely gangrenous, and a superficial ulcer of 1 × 1 cm under his left foot. Despite the routine DFU care, the phalanges of his DFU were amputated. The patient was moved to our wound management team. DFU was treated and managed using surgical debridement and maggot debridement therapy. Ten sessions of Maggot Debridement Therapy (MDT) were conducted (one therapy session every 48 h). After three months, the patient's DFUs healed, and he was discharged from our service in good condition. CLINICAL DISCUSSION: DFU can lead to infection, amputation, and even patient death. Therefore, effective treatment methods are very important for managing DFUs. CONCLUSION: Using surgical debridement and MDT is a safe and effective approach to facilitate the healing of DFUs.

Job satisfaction and its relationship with burnout among nurses working in COVID-19 wards: A descriptive correlational study.

Objective: Nurses' feeling of Job satisfaction and burnout profoundly impact the quality of nursing care. COVID-19, due to its unknown nature and high contagiousness, can cause high levels of stress and tension and, finally, burnout in nurses, affecting their job satisfaction. Therefore, we aimed to determine the level of job satisfaction and its relationship with burnout among nurses working in COVID-19 wards. Methods: This is a descriptive correlational study in which a total of 251 nurses working in COVID-19 wards were enrolled using stratified random sampling. Data collection was conducted using the demographic questionnaire, the Minnesota Satisfaction Questionnaire (MSQ), and the Maslach Burnout Inventory (MBI). Data were analyzed using descriptive statistics and Pearson correlation coefficient. Result: The results showed that the majority of nurses (75.7%) had a low level of job satisfaction, 40.6% of nurses had a high level of emotional exhaustion (EE), 41.8% had a moderate level of EE, and 50.2% of nurses had a high level of depersonalization (DP). Furthermore, over half of nurses (55.8%) experienced reduced personal accomplishment (PA), and 27.5% had a moderate level of reduced PA. There was a statistically significant negative correlation between job satisfaction and EE (r=-0.394, p<.001). Moreover, job satisfaction negatively correlated with reduced PA (r=-5/590, p<.001). However, no statistically significant correlation was found between job satisfaction and DP (r=-0.122, p=.053). Conclusion: As most nurses reported low job satisfaction and high rates of burnout, nurse managers should consider appropriate measures to correct these factors. Such measures could also improve patient satisfaction and, ultimately, the efficiency of the health system.

Loneliness and academic performance mediates the relationship between fear of missing out and smartphone addiction among Iranian university students.

BACKGROUND: Fear of missing out (FoMO) can increase loneliness and smartphone addiction and decrease academic performance in university students. Most studies investigated the relationship between FoMO and smartphone addiction in developed countries, and no studies were found to examine this association in Iran. The mediating role of loneliness and academic performance in the relationship between FoMO and smartphone addiction is unclear. This study investigated the relationship between FoMO and smartphone addiction and the mediating role of loneliness and academic performance in this relationship in Iranian university students. METHODS: In this cross-sectional study, 447 students from Urmia University of Medical Sciences were investigated. Data were collected using demographic questionnaires, Przybylski's FoMO scale, Pham and Taylor's academic performance questionnaire, Russell's loneliness scale, and Kwon's smartphone addiction scale. Data were analyzed using SPSS ver. 23 and SmartPLS ver. 2. RESULTS: FoMO had a positive and direct association with smartphone addiction (ß = 0.315, t-value = 5.152, p < 0.01). FoMO also had a positive and direct association with students' loneliness (ß = 0.432, t-value = 9.059, p < 0.01) and a negative and direct association with students' academic performance (ß = -0.2602, t-value = 4.201, p < 0.01). FoMO indirectly associated with smartphone addiction through students' loneliness (ß = 0.311, t-value = 5.075, p < 0.01), but academic performance was not mediator of smartphone addiction (ß = 0.110, t-value = 1.807, p > 0.05). FoMO also indirectly correlated with academic performance through students' loneliness (ß =-0.368, t-value = 6.377, p < 0.01). CONCLUSIONS: FoMO can be positively associated with students' smartphone addiction, and loneliness is an important mediator of this association. Since smartphone addiction could harm students' academic performance, thus, healthcare administrators should reduce students' loneliness and improve their academic performance by adopting practical strategies to help students to manage their time and control their smartphone use. Holding self-management skills classes, keeping students on schedule, turning off smartphone notifications, encouraging students to engage in sports, and participating in group and family activities will help manage FoMO and loneliness.

The Relationship Between Professional Autonomy and Job Stress Among Intensive Care Unit Nurses: A Descriptive Correlational Study.

Background: Autonomy is an essential factor in the nursing profession. Nurses' autonomy can improve care quality, decrease mortality in patients, and attenuate job stress. This study aimed to investigate professional autonomy and its relationship with job stress among nurses working in Intensive Care Units (ICUs). Materials and Methods: This descriptive correlational study was conducted at Urmia nursing school in Iran in 2020. Three hundred ninety-eight nurses working at the ICUs entered the study. Data was collected using the Dempster Practice Behavior Scale (DPBS) and the Health and Safety Executive (HSE) questionnaire. Independent t-test and analysis of variance (ANOVA) were used to examine the relationship between demographics and study variables. Pearson's correlation coefficient was used to investigate the relationship between professional autonomy and job stress of nurses. Results: The mean (SD) of total professional autonomy and job stress score of nurses was, respectively, 102. 11(91. 88), and 115. 53(12. 42), indicating moderate autonomy and job stress. Professional autonomy had a significant positive correlation with job stress (r = 0.51, p < 0.001). It also had a significant positive correlation with work experience in ICU (r = 0.12, p = 0.014). Conclusions: ICU nurses have moderate autonomy and job stress, and their autonomy is a significant positive predictor of their job stress. University authorities are recommended to develop practical strategies to enhance nurses' autonomy and eliminate factors that cause job stress in ICU nurses in order to preserve nurses' health, improve the quality of nursing care, and increase patient safety.

Extensive excisional surgery; the last hope for a patient with human papillomavirus-associated severe head and neck squamous cell carcinoma: A case report.

INTRODUCTION AND IMPORTANCE: Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignant tumors of skin cancer. Most of these cancers occur on the head and neck. CSCC makes up the seventh most common type of cancer worldwide. The incidence of human papillomavirus (HPV)-associated head and neck squamous cell carcinoma became more prevalent, and HPV infection is mainly linked to head and neck squamous cell carcinoma (HNSCC). CASE PRESENTATION: A 57-year-old non-smoking man was admitted to Omid Hospital in Urmia, West Azerbaijan, Iran; there were extensive bleeding masses on his head and neck due to squamous cell carcinoma (SCC), and he has been diagnosed with HPV infection so accidentally. The operation room had prepared for excisional treatment and the masses had been removed as much as possible. Patient was referred to the wound care team to receive advanced treatment interventions. CLINICAL DISCUSSION: Incidence of HPV-associated HNSCC has been more noticeable recently, and HPV infection alone can be a distinct risk factor for metastatic HNSCC. Most patients with HPV positive have peripheral lymph node involvement. Radiation therapy and surgery can offer equally good long-term results in small initial head and neck tumors. Traditionally, advanced head and neck tumors managed surgically more advantageous. CONCLUSION: This case illustrates that history of HPV positive can be associated with a more severe and resistant type of HNSCC with poor treatment outcomes. Patients with HPV should be monitored regularly for HNSCC, and treatment should be started as soon as possible for a better result.