The Effect of Resistance Exercises Using an Elastic Band on Balance and Fear of Falling in Older Adults With Diabetic Peripheral Neuropathy: A 16-week Randomized Controlled Trial.

OBJECTIVE: The current study aimed to investigate the effect of resistance training using an elastic band on balance and fear of falling in older adults with diabetic peripheral neuropathy. DESIGN: The study was a clinical controlled trial with a repeated measure design. SETTING: Iranian Diabetes Foundation of Mashhad. PARTICIPANTS: The participants were 51 older adults with diabetic peripheral neuropathy and balance impairment (N=51). INTERVENTIONS: Participants were randomly assigned to 2 groups; 1 group received balance training using an elastic band and the other group just received balance training. MAIN OUTCOME MEASURES: The main outcomes were balance and fear of falling that were measured using Berg Balance Scale and a short version of the Fall Efficiency Scale-International, respectively. RESULTS: The results showed that balance resistance training with and without using an elastic band significantly enhances balance and reduces fear of falling in diabetic older adults suffering from balance issues. However, balance resistance training using an elastic band had a significantly better effect on the balance and fear of falling in the participants. The best results were obtained after week 12 (48 sessions of balance training). CONCLUSION: Balance rehabilitation programs may include an elastic band in balance resistance training for 12 weeks (3-4 sessions a week) for enhancing balance in diabetic older adults suffering from balance impairment.

Estimation of type 2 diabetes risk score using diabetes risk test in Neishabour-Iran.

BACKGROUND: Preventing diabetes and identifying patients who are at risk for it is very important. This study was conducted to estimate the risk score of type 2 diabetes among adults living in Neishabour city in 2020. MATERIALS AND METHODS: This descriptive-analytical study was performed on 1000 people aged 25 years and older living in Neishabour (Iran) using a multi-stage sampling method. The data collection instrument included the American Diabetes Association Diabetes Risk Test (DRT), which is a screening instrument to assess the risk of type 2 diabetes. Data analysis was carried out using SPSS ver. 18, using independent t-test, Chi-squared, Fisher's Exact test, Mann-Whitney, path analysis, and regression of generalized estimating equation model at 95% confidence interval. RESULTS: The mean age of the subjects was 43.87 years (SD = 0.419) and 50.7% (n = 507) were female and the rest were male (n = 493). The risk of developing type 2 diabetes was high in 18.4% (n = 184) of the subjects. And the average risk of diabetes in people was 2.76 (SD = 0.057) out of 10 points. There was no significant relationship between gender and gestational diabetes with the risk of diabetes, but there was a significant relationship between age over 40 years, history of hypertension, family history of diabetes, lack of physical activity, and being overweight with the risk of type 2 diabetes. CONCLUSION: Approximately, one-fifth of the subjects had a high risk of developing type 2 diabetes. Therefore, the use of a simple and practical instrument such as DRT can be suitable for screening and early detection of Prediabetic state and type 2 diabetes.

The effect of comprehensive individual motivational-educational program on medication adherence in elderly patients with bipolar disorders: An experimental study.

BACKGROUND: The number of older adults with bipolar disorder is increasing and medication non-adherence is a major problem that negatively impacts the course of bipolar disorder. This study aimed to determine the effect of a comprehensive individual motivational-educational program on medication adherence in elderly patients with bipolar disorder. MATERIALS AND METHOD: An experimental study with pretest-posttest repeated measures with a control group was conducted on two groups of 62 elderly people with bipolar disorders hospitalized at Ibn Sina Hospital in Mashhad, Northeast Iran, 2019. For the elderly in the intervention group, a comprehensive motivational-educational program was administered for one month (four 30-45 minute sessions), and for the elderly in the control group, routine clinical care was performed. Medication adherence in both elderly groups was measured before, immediately after, one and two months after the intervention. Data were analyzed by SPSS statistical software (version 16) using descriptive statistics and independent t-test, Mann-Whitney, paired t-test, repeated measures analysis of variance (ANOVA), and Chi-square tests. RESULTS: The mean age of elderlies in the intervention and control groups were 69.03 ± 5.75 and 68.50 ± 6.73 years, respectively. Regardless of the groups to which the patients were assigned, a significant difference in medication adherence scores was observed during the study period (time effect; P < 0.001). Also, the medication adherence score was significantly lower in the intervention group, compared to the control group (group effect; P < 0.001). Also, there was a group time interaction between the medication adherence score and the time of evaluation (P < 0.001). CONCLUSION: The results of the present study confirm the positive effect of a comprehensive educational-motivational program on improving medication adherence in elderly patients with bipolar disorder.

Cooling spray or lidocaine spray and needle insertion pain in hemodialysis patients: an open-label cross-over randomized clinical trial.

BACKGROUND: The needle insertion pain to perform hemodialysis is the main challenge and a common problem that requires pain management techniques for patients' comfort. AIM: This study aimed to compare the effects of cooling and lidocaine sprays on needle insertion pain in hemodialysis patients. METHODS: In this randomized cross-over clinical trial study, the hemodialysis patients were selected through convenience sampling according to inclusion criteria and randomly assigned to three intervention groups using the block randomization method. Each patient received three interventions in a cross-over design: Cooling spray or 10% lidocaine spray or placebo spray. There was a 2-week wash-out time between each intervention. The pain score was measured four times for each patient by the Numerical Rating Scale. RESULTS: Forty-one hemodialysis patients were included. The results showed a significant interaction between time and group (p < 0.05), so only observations of time 1 with adjustment for baseline values were used to evaluate the effect of the intervention. Patients receiving cooling spray reported 2.29 less pain score on average compared to placebo (B=-2.29, 95% CI: -4.17 to -0.43; p < 0.05); Also, patients receiving cooling spray reported a 1.61 lower pain score than those receiving lidocaine spray, but this difference was not statistically significant (95% CI: -0.26 to 3.48; p > 0.05). CONCLUSION: The cooling spray was effective in reducing the needle insertion pain. Although it was impossible to compare the pain scores at different times and following different interventions, the present study results can help supplement the existing knowledge regarding cooling and lidocaine sprays.

Signs, Symptoms, and Side-Effects Presented by Different Types of COVID-19 Vaccines: A Prospective Cohort Study.

The concern about post-COVID-19 vaccine complications still remains. In addition, the evidence on Sinopharm, Sputnik V, Covaxin, and, in particular, COVIran Barekat, as well as comparisons between them by dosage after post-vaccination, is scarce. This study aimed to investigate and compare the prevalence of self-reported post-vaccination signs and symptoms following the first and second doses of different types of COVID-19 vaccines. Research design and methods: This prospective cohort study was conducted on more than 1500 health professionals who had received at least one dose of any type of Sputnik V, Sinopharm, Oxford AstraZeneca, Covaxin, and COVIran Barekat vaccines in Iran. The survey questionnaire was sent to participants online, 28 days after receiving each dose of the vaccine. Results: About 73% of health professionals reported at least one post-vaccination sign or symptom, developing mostly within the first 12 h (69.9%) and lasting up to 12 h (59.0%). Pain and tenderness at the injection site, fever, and muscle pain were the most common post-vaccination signs and symptoms in all vaccines, which were significantly higher in the Oxford AstraZeneca vaccine (p < 0.001) for both the first and second doses. The incidence rate of all post-vaccination signs and symptoms was significantly higher in the first dose than in the second dose (p < 0.05). Conclusion: The Oxford AstraZeneca vaccine showed the highest incidence rate, onset, and lasting time of signs and symptoms in both doses; however, they were not life-threatening. The onset time of signs and symptoms was significantly higher for the COVIran Barekat and Oxford AstraZeneca vaccines in both the first and second doses.

Using Mirror Therapy to Optimize the Efficacy of Balance Programs for Older Adults With Poststroke Balance Impairment.

PURPOSE: Poststroke rehabilitation is an inevitable element of the treatment for stroke survivors. This study aimed to investigate the effect of balance training with mirror therapy in older adults with poststroke balance impairment. DESIGN/METHODS: The study adopted a two-arm randomized clinical trial and included 38 older adults with poststroke balance impairment. The intervention group received balance exercises with mirror therapy, whereas the control group received the same balance exercises without mirror therapy (a nonreflective plate was used instead). The patient outcome, the balance score, was measured using the Berg Balance Scale. Analysis of covariance was used for statistical analysis. RESULTS: Results showed that balance exercises combined with mirror therapy were significantly more effective than balance exercises without mirror therapy in improving balance in the stroke survivors ( p < .001). CONCLUSION: Mirror therapy combined with regular balance exercises is an effective and practical method for enhancing balance in older adults suffering from balance impairment. CLINICAL RELEVANCE: Balance training combined with mirror therapy may be included in the rehabilitation programs of older adults with poststroke balance impairment.

The impact of laughter yoga on depression and anxiety among retired women: a randomized controlled clinical trial.

Recently, laughter yoga (LY) has been introduced for managing depression and anxiety. This study aimed to investigate the impact of LY on depression and anxiety among retired women in city of Bojnurd, Iran, 2018. Sixty-six retired women were randomly assigned to intervention and control groups. Intervention group received LY twice weekly for 8 weeks; control group had their routine daily activities. Depression and anxiety levels were measured at study initiation, week 4, and week 8 in both groups. Results showed significant difference in the pattern of depression (p <.001) and anxiety (p <.001) scores within and between groups. LY could be an effective intervention in reducing depression and anxiety among retired women.

Evaluation of the Impact of Handoff Based on the SBAR Technique on Quality of Nursing Care.

BACKGROUND: Effective communication, including the complete and accurate transfer of information and the prevention of misrepresentation and misinterpretation of patient-centered data during handoff, can enhance the quality of patient care and safety. PURPOSE: This study was aimed at evaluating the impact of bedside handoff using the Situation, Background, Assessment, Recommendation (SBAR) technique, on the quality of nursing care. METHODS: The Quality Patient Care Scale (QUALPACS) was completed by the patient while nurses performed a verbal bedside shift handoff and after receiving education on the purpose and proper use of the SBAR communication tool. RESULTS: The mean age of subjects was 51.29 ± 8.02 years. We found a significant increase in the mean score of QUALPACS dimensions, namely psychosocial (P < .001), physical (P < .001), and communication (P < .001) after SBAR implementation. CONCLUSIONS: Findings suggest that using the SBAR handoff technique increases the quality of nursing care in all QUALPACS dimensions.

The Effect of Self-Management Educational Program on Pain Intensity in Elderly Patients with Knee Osteoarthritis: A Randomized Clinical Trial.

BACKGROUND: Osteoarthritis is one of the chronic diseases that greatly affect the health and life quality of individuals. AIM: This study aimed to determine the effect of self-management educational program on the pain intensity of the elderly patients with knee osteoarthritis. METHODS: In a randomised clinical trial, a total of 82 elderly patients with knee osteoarthritis were randomly divided into intervention and control groups. The intervention group received six sessions of self-management group education, while the control group received only the routine care during this period. In both groups, patients' pain intensity, with a visual analogue scale (VAS), were assessed before, immediately after and eight weeks after the start of the study. RESULTS: The mean pain intensity scores of the intervention and control groups were not significantly different before the intervention (P = 0.9), but after the intervention, the mean pain intensity score in the intervention group (3.61 ± 2.36) was significantly lower than that of the control group (4.93 ± 2.00), (P < 0.0001). CONCLUSION: Implementation of a self-management program for the patients with knee osteoarthritis is useful in reducing their pain intensity and can be used as one of the effective methods for their empowerment.

The Effect of Tai Chi Exercise on the Risk and Fear of Falling in Older Adults: a Randomized Clinical Trial.

BACKGROUND: Falling and fear of falling are among the most common problems of the elderly, which can cause illness, isolation, dependency and reduced quality of life in elderly. Exercise is recommended to prevent falling injuries in the elderly. AIM: This study aimed to examine the effect of Tai Chi exercise on the risk and fear of falling in older adults. MATERIALS AND METHODS: In this randomized clinical trial, a total of 60 male and female elderly were randomly divided into two groups: Tai Chi exercise and control (daily activities) groups. Tai Chi exercise protocol in the intervention group consisted of 3 sessions per week for 10 weeks. The risk and fear of falling were assessed in subjects by using standardized questionnaires, including Berg's Balance Scale and Fall Efficacy Scale-International (FES-I) before initiating the protocol, at the end of 4th, 8th weeks and at the end of exercise period. RESULTS: Two groups were matched in terms of age, gender, education, and body mass index. Baseline values of risk of falling and fear of falling were not significantly different between the two groups (P>0.05). The score of fear of falling at the end of 4th, 8th weeks and at the end of exercise period was significantly different between the two groups (P<0.05) and it decreased in the intervention group, but the risk of falling reduced after 8 and 10 weeks in the intervention group (P<0.001). CONCLUSION: Performing Tai Chi exercises for at least four weeks could reduce fear of falling and reduce the risk of falls in older adults after 8 weeks.

Directed qualitative content analysis: the description and elaboration of its underpinning methods and data analysis process.

Qualitative content analysis consists of conventional, directed and summative approaches for data analysis. They are used for provision of descriptive knowledge and understandings of the phenomenon under study. However, the method underpinning directed qualitative content analysis is insufficiently delineated in international literature. This paper aims to describe and integrate the process of data analysis in directed qualitative content analysis. Various international databases were used to retrieve articles related to directed qualitative content analysis. A review of literature led to the integration and elaboration of a stepwise method of data analysis for directed qualitative content analysis. The proposed 16-step method of data analysis in this paper is a detailed description of analytical steps to be taken in directed qualitative content analysis that covers the current gap of knowledge in international literature regarding the practical process of qualitative data analysis. An example of "the resuscitation team members' motivation for cardiopulmonary resuscitation" based on Victor Vroom's expectancy theory is also presented. The directed qualitative content analysis method proposed in this paper is a reliable, transparent, and comprehensive method for qualitative researchers. It can increase the rigour of qualitative data analysis, make the comparison of the findings of different studies possible and yield practical results.

Effect of Oral Health Care Program on Oral Health Status of Elderly People Living in Nursing Homes: a Quasi-experimental Study.

BACKGROUND: Oral health of elderly people plays a major role in their overall health and quality of life, and is an integral part of personal care. AIM: The aim of this study was to evaluate the effect of implementing the oral health care program (OHCP) on oral health status of elderly people resident in nursing homes. MATERIALS AND METHODS: This quasi-experimental study was carried out using a pretest-posttest design on 101 elderly people (46 in the intervention group and 55 in the control group) resident in two randomly selected nursing homes in Mashhad, Iran. In the intervention group, the OHCP was carried out by caregivers for 8 weeks. The control group received routine care. Using the oral health assessment tool, the oral health status of elderly people was assessed in both groups at three times; onset of the study, 4th, and 8th week after the start of the study. RESULTS: The oral health status of the elderly people in both groups was not statistically significantly different at baseline, but it changed significantly at the 4th, and 8th weeks (p<.001). CONCLUSION: The implementation of the OHCP for elderly people resident in nursing homes may improve their oral health status after 4 weeks. It is recommended that OHCP be included in care plans of all nursing homes to improve the elderly people's oral health status.

Oral versus written feedback delivery to nursing students in clinical education: A randomized controlled trial.

BACKGROUND: Feedback delivery is deemed as a key element during a students' clinical education. It keeps students on track to meet their goal and increase students' motivation and confidence. OBJECTIVE: The aim of this study was to compare the quality of feedback delivery in oral versus written feedback delivery to nursing students in clinical education. METHODS: A randomized controlled trial was conducted between February and August 2012 in the city of Bojnurd in Iran. Using purposive sampling, last semester's nursing students (n=44) had been randomly assigned to oral and written feedback delivery groups. Three Instructors received orientation and training on methods of feedback delivery before study initiation. Then, they gave necessary oral and written feedback to the students. Clinical settings of the study included coronary care, surgical, and neonatal units of hospitals. Data collection tools were quality of feedback delivery, students' satisfaction questionnaire and students' reactions checklist. Data were analyzed using SPSS version 11.5 with chi-square test and the t-test. RESULTS: Most of the students (52%, n=23) were male. There were no significant differences between the scores of quality of oral and written feedback delivery (p>0.05). The study did not show a difference of satisfaction level between the oral and written feedback groups. The relationship between students' reactions and feedback type at the confidence level of 90% was significant, so that students who received oral feedback showed more severe reactions as compared to the written feedback group. CONCLUSION: According to the results, the type of feedback is not an important factor in clinical education quality and satisfaction level. They may achieve a better outcome by focusing on the other aspects of quality of feedback delivery rather than feedback type. TRIAL REGISTRATION: The trial was registered at the Iranian Registration Center for Clinical Trials with the Irct id: (IRCT: 201111128076N1). FUNDING: North Khorasan University of Medical Sciences (permission no. 89/p/209).

Gastric Residual Volume: Rethinking the Threshold.

There are many challenges related to enteral feedings of the mechanically ventilated patient. Among the most often debated issues is the threshold for gastric residual volume before further feeding. This brief article considers the factors to be considered and reviews current thinking on the topic.

Is Nurses' Professional Competence Related to Their Personality and Emotional Intelligence? A Cross-Sectional Study.

INTRODUCTION: Nurses' professional competence is a crucial factor in clinical practice. Systematic evaluation of nurses' competence and its related factors are essential for enhancing the quality of nursing care. This study aimed to assess the nurses' competence level and its possible relationship with their personality and emotional intelligence. METHODS: Using a cross-sectional survey design, three instruments including Nurse Competence Scale, short form of Schutte Self Report Emotional Intelligence Test, and the short 10-item version of Big Five Factor Inventory, were administered simultaneously to a randomized stratified sample of 220 nurses working in hospitals affiliated to Mashhad University of Medical Sciences. Data analysis was performed using SPSS 11.5. RESULTS: Majority of nurses rated themselves as "good" and "very good", with the highest scores in "managing situations" and "work role" dimensions of nurse competence. A relatively similar pattern of scores was seen in competence dimensions, personality and emotional intelligence, among male and female nurses. Emotional intelligence and personality scores showed a significant relationship with nurses' competence, explaining almost 20% of variations in nurse competence scores. CONCLUSION: Iranian nurses evaluated their overall professional competence at similar level of the nurses in other countries. Knowledge about the nurses' competence level and its related factors, including personality and emotional intelligence, may help nurse managers in enhancing nurses' professional competence through appropriate task assignments and conducting in-service educational programs, thus improving the health status of patients.

Women's Sexual Issues After Myocardial Infarction: A Literature Review.

BACKGROUND: Sexual activity after myocardial infarction (MI) is a concern for patients and often a challenge for health care professionals to address. It is widely recognized that most patients, of both sexes, report sexual problems or concerns after MI. However, there are reported differences between men and women. Women with sexual concerns may seek less help from health care providers and are more inclined to conceal them because of cultural barriers. OBJECTIVE: The aim of the current study is to present a comprehensive review of the literature describing women's sexual issues after MI. METHOD: A systematic search of the relevant literature was performed within international databases, including PubMed/Medline, Scopus, ScienceDirect, and ProQuest, as well as Google Scholar using relevant keywords. Also, Persian electronic databases such as Magiran, Scientific Information Databases, and Iran Medex were searched from the inception to October 2014. Articles focusing on the sexual issues after MI only in women, as well as articles on both sexes where women's results could be separated, were included in this review. RESULTS: A total of 8 articles were included in the final dataset. The main themes of women's sexual concerns after MI were "loss or decrease of sexual activity," "dissatisfaction of sexual relationship," "doubt about resumption time of sexual activity," "fear of reinfarction or sudden death during sexual activity after MI," "knowledge deficit regarding sexual activity after MI," and "poor performance of health care providers in sexual counseling." DISCUSSION: The results of this review demonstrate that women's post-MI sexual activity is affected by many concerns. The concerns may be a knowledge deficit related to not receiving necessary consultation on this topic. Nurses, as first-line care givers, can provide appropriate consultation and education for patients post-MI. As a result, breaking taboo imposed by cultural barriers, personal assumptions, or lack of confidence on giving sexual consultation may ultimately help patients to improve their quality of life.

Timeliness: The authors' vested right but the editors' last concern.

.

Conflict management styles among Iranian critical care nursing staff: a cross-sectional study.

BACKGROUND: Conflict among nurses has been recognized as an extremely important issue within health care settings throughout the world. Identifying the conflict management style would be a key strategy for conflict management. OBJECTIVE: The aim of this study was to evaluate the prevalence of conflict management styles and its related factors among Iranian critical care nursing staff. METHODS: In a descriptive cross-sectional study, a total of 149 critical care nurses who worked in the critical care units of 4 teaching hospitals in Sari (Iran) were evaluated. A 2-part self-reported questionnaire including personal information and Rahim Organizational Conflict Inventory II was used for data collection. RESULTS: Although Iranian critical care nurses used all 5 conflict management styles to manage conflict with their peers, the collaborating style was the most prevalent conflict management style used by them, followed by compromising, accommodating, avoiding, and competing. Male gender was a predictor for both compromising and competing styles, whereas position and shift time were significant predictors for compromising and competing styles, respectively. DISCUSSION: Based on the results of this study, nurse managers need to take these factors into account in designing programs to help nurses constructively manage unavoidable conflicts in health care setting.