Short-term effect of dressing with Dermaheal ointment in the treatment of diabetic foot ulcer: A double-blinded randomized controlled clinical trial.

Background and Aims: Diabetic foot ulcers, a major cause of amputations in diabetics, could benefit from natural products as adjuncts to standard care, given the costs and adverse effects of typical therapies. This study aims to evaluate the short-term effects of dressing with Dermaheal ointment in the treatment of DFUs through a double-blinded randomized controlled clinical trial. Methods: This double-blinded, placebo-controlled trial included 50 patients with Wagner's ulcer grade I or II, randomly assigned to Dermaheal and placebo groups (received standard treatment and placebo ointment). The ulcer site was dressed daily for four consecutive weeks with either Dermaheal or placebo ointment. Ulcer healing score (using DFU healing checklist), ulcer size with transparent ruler and largest dimension of ulcer, and pain severity using numerical pain rating score (were recorded at five-time points, including baseline, and on weeks 1, 2, 3, and 4). Also, ulcer healing status was investigated at the trial ended in November 2021. Results: Both groups showed significant improvement in ulcer healing over 4 weeks (p time < 0.001), with more remarkable progress in the Dermaheal group (p group = 0.03). At the trial end, complete ulcer healing was also significantly higher in the Dermaheal group compared to the placebo group (56% vs. 12%, p = 0.002). Both groups exhibited a decrease in ulcer size (p time < 0.001). Considering the baseline ulcer size as a covariate, substantial changes in mean ulcer size were noted in the initial (p = 0.01), second (p = 0.001), third (p = 0.002), and fourth (p = 0.002) weeks of the intervention, showing a preference for the Dermaheal group. However, no significant between-group difference was observed in pain severity levels. Conclusion: Dressing with Dermaheal as a topical treatment shows promise in improving healing and reducing the size of diabetic foot ulcers. Further research is needed to confirm these findings' long-term efficacy.

Healing of diabetic foot ulcer with topical and oral administrations of herbal products: A systematic review and meta-analysis of randomized controlled trials.

This systematic review aimed to qualitatively synthesize recent randomized controlled trials (RCTs) regarding the effect of topical application and oral intake of herbal products on the healing of diabetic foot ulcer (DFU). Also, we sought to pool the obtained findings in a meta-analysis using a random-effects model, if RCTs were relatively comparable and homogenous. A comprehensive search was performed on five electronic data sources from their inception through 23 January 2024. The RCTs, without restriction on the country of origin, were included if they compared the effect of administering standard treatments and/or placebo (i.e. control condition) to applying standard treatments and/or herbal products in topical or oral routes (i.e. experimental condition). Out of 1166 retrieved records, 28 RCTs were included. Studies used different poly and single herbal formulations. Based on the meta-analysis, administration of standard care plus daily dressing of the ulcer site with olive oil for 28 days significantly increased the total ulcer healing score (3 RCTs; weighted mean difference [WMD] = 89.30; p < 0.001), raised frequency of complete ulcer healing (2 RCTs; risk ratio [RR] = 12.44; p = 0.039) and declined ulcer degree (3 RCTs; WMD = -22.28; p = 0.002). Also, daily use of the bitter melon leaf extract in oral form for 28 days significantly increased the total ulcer healing score (2 RCTs; WMD = 0.40; p = 0.001). Additionally, based on qualitative synthesis, the adjuvant use of herbal agents seems an intriguing choice to manage DFU. Nonetheless, considering the undesirable methodological quality of most studies and the high heterogeneity in administered herbal formulations, more robust trials are required to build a solid conclusion regarding the use of herbal products for healing DFU.

Is oral consumption of dates (Phoenix dactylifera L. fruit) in the peripartum period effective and safe integrative care to facilitate childbirth and improve perinatal outcomes: a comprehensive revised systematic review and dose-response meta-analysis.

BACKGROUND: Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes. METHODS: Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software. RESULTS: Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials. CONCLUSION: More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care. TRIAL REGISTRATION: PROSPERO Registration No: CRD42023399626.

Application of "Partnership Care Model" in chronically ill adults and children: A systematic review and dose-response meta-analysis of randomized controlled trials.

BACKGROUND: "Partnership Care Model (PCM)", which is the first partnership conceptual framework founded on the Iranian culture to control chronic diseases, has been recently used in different fields of nursing research with no levels of valid evidence to support its application. Therefore, this systematic review and meta-analysis sought to clarify the impacts of interventions developed based on PCM on quality of life (QoL), sleep quality, anxiety, and depression among adults and children with chronic diseases. METHODS: International data sources (e.g., PubMed, Web of Science, Scopus) and national databases (e.g., SID, MagIran, IranDoc, IRCT) were searched from 2001 to September 23, 2023, to find Randomized Controlled Trials (RCTs) on PCM-driven interventions for the experimental groups versus no intervention or standard care groups. The studies' methodological quality and evidence quality were rated utilizing the Cochrane risk of bias instruction and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were pooled by a random-effects approach employing STATA (vers. 11.2). RESULT: Eighteen RCTs, reported in 22 publications, were qualified. The PCM compared to the standard care significantly improved the QoL among both adults (10 effect sizes [ESs], mean difference [MD]: 3.17, P < 0.001) and children (4 ESs, MD: 4.45, P < 0.001). Likewise, the intervention enhanced adults' sleep quality (3 ESs, MD: 7.15, P < 0.001). The anxiety of adults and children was also significantly lower in the PCM group (4 ESs, MD: -4.52, P = 0.001; 2 ESs, MD: -4.04, P < 0.001, respectively). However, regarding depression, a significant effect of PCM was found only among children (3 ESs, MD: -7.99, P = 0.011). The methodological quality of the studies and the evidence quality were undesirable. CONCLUSION: The PCM had a promising influence on the caring of adults and children suffering from chronic diseases. However, additional high-quality RCTs are needed to generate a higher quality of evidence concerning the clinical benefits of the PCM. PROSPERO NO: CRD42021253790.

Development and assessment of validity and reliability of a checklist to evaluate the Circulating and Scrub Skills of Operating Room Novices (CSSORN checklist).

BACKGROUND: Assessment of circulating and scrub skills is an important issue in operating room (OR) programs. However, there is a lack of well-designed tools that are specifically developed for this purpose. Hence, this study aimed to develop and determine the validity and reliability of a checklist to measure the circulating and scrub skills of OR novices. MATERIALS AND METHODS: This cross-sectional methodological study was conducted among 124 OR technology students who were selected during three consecutive academic years (2019-2020 to 2021-2022). The developed checklist was evaluated with face validity, content validity (quantitative and qualitative), construct validity (known-groups validity), criterion-related validity (concurrent and predictive validities), internal consistency (Kuder-Richardson 20, KR-20), and inter-rater reliability (intra-class correlation coefficient, ICC). Known-groups validity was evaluated by comparing the difference between the checklist scores of first-semester and third-semester students using independent samples t-test. Additionally, concurrent and predictive validities were evaluated by ICC through measuring the correlation between the total score of checklist and grades of a multiple-choice test and two clinical apprenticeship courses, respectively. Data were analyzed in the Statistical Package for Social Sciences software. RESULTS: After reconciling the preliminary checklist in terms of face and content validities, a checklist with 17 sub-scales and 340 items called "Circulating and Scrub Skills of Operating Room Novices (CSSORN)" was developed. Regarding the known-groups validity, the third-semester students had higher scores compared to the first-semester students (p < 0.001 in most sub-scales). Besides, the total score of checklist showed a significant correlation with the criteria of concurrent and predictive validities (ICC = 0.64, ICC = 0.72; P < 0.001). The KR-20 for the entire checklist was 0.90 (range: 0.60-0.93). The ICC for inter-rater reliability was also 0.96 for the entire checklist (range: 0.76-0.99, P < 0.001 in all sub-scales). CONCLUSION: The CSSORN had appropriate validity and reliability to be used for measuring the circulating and scrub skills of OR novices. To shed light on the findings, further testing of this checklist on larger populations and in different contexts is suggested.

Using objective structured clinical examination (OSCE) for circulating and scrub skills of first-semester operating room technology students: Is it valid and reliable?

Objectives: This study aimed to determine the validity and reliability of an Objective Structured Clinical Examination (OSCE) developed for the summative assessment of the practical credit of the course titled "Principles and Techniques of Circulating and Scrub Persons' Practice." Methods: This applied descriptive study was conducted on 63 first-semester undergraduate Operating Room (OR) technology students. Totally, 17 circulating and scrub skills were incorporated in four 7-min OSCE stations. The content validity of the examination was assessed by an expert panel (n = 14). Additionally, its concurrent validity was evaluated by Intra-Class Correlation (ICC) through measuring the correlation between the total score of OSCE and grade point average, grades of the practical and theoretical credits of the course that were obtained by multiple-choice tests, and the total grade of the course (achieved by the grades of the practical and theoretical credits tests). The Inter-Rater Reliability (IRR) was also calculated by the correlation between the scores recorded by two examiners at each OSCE station using ICC. Meanwhile, the internal consistency across stations (item-total correlation) and across items within a station was determined by Cronbach's alpha (α). Results: The OSCE was deemed to fulfill the content validity criteria. The total score of OSCE showed a significant correlation with the concurrent validity criteria (ICC = 0.66-0.85, p < 0.001). Besides, the IRR was significant for the total score of OSCE as well as for the score of each station (ICC = 0.90-0.98, p < 0.001). Likewise, a good level of internal consistency was found across stations (α = 0.63-0.93) and across items within a station (α = 0.78-0.92). Conclusion: The developed OSCE had appropriate validity and reliability. Thus, it can be used to assess the circulating and scrub skills of first-semester OR technology students.

Application of Orem's theory-based caring programs among chronically ill adults: A systematic review and dose-response meta-analysis.

AIM: This study aimed to clarify the value of caring programs developed according to Orem's Self-Care Deficit Nursing Theory regarding quality of life and self-care as the primary outcomes and self-efficacy, anxiety, depression, and stress as the secondary outcomes among individuals aged 18-70 years with chronic diseases. BACKGROUND: Chronically ill patients need to receive appropriate self-care training, counseling, and support. In this regard, the use of caring programs developed based on theories is highly suggested. Orem's Nursing Theory is the most well-known theory that provides a structure to involve patients in their self-care activities. INTRODUCTION: Orem's Nursing Theory has been increasingly applied to guide practice for patients with chronic health conditions. However, recent trials have reported conflicting findings on the value of its application. METHODS: Eight information sources (e.g., Web of Science Core Collection, PubMed, and Scopus) and the International Clinical Trials Registry Platform were searched up to 30 March 2022. RESULTS: A total of 46 studies and 11 study register entries were eligible. Orem's theory-based interventions significantly improved the quality of life, self-care, and self-efficacy as well as significantly reduced anxiety and depression. However, the value of the interventions on stress was uncertain, as performing the meta-analysis was not possible. DISCUSSION: Orem's Nursing Theory can help nurses in different fields to dynamically and carefully evaluate patients' self-care ability and implement appropriate nursing measures tailored to their needs, interests, and problems. Considering the inconsistent evidence to support the empirical adequacy of this theory, high-quality reviews are essential. CONCLUSION: Orem's theory-based programs had a favorable effect on taking care of adults with chronic diseases. IMPLICATIONS: This study augments the previous reviews related to the applicability of Orem's Nursing Theory. Considering the undesirable evidence quality and the high between-study heterogeneity, further well-designed trials are required to draw an evidence-based conclusion.

Effects of Topical Application and Oral Intake of Rosa damascena on Acute Pain in Adults: A Systematic Review and Meta-analysis.

Objectives: To conduct a systematic review and meta-analysis of available studies regarding the effects of the traditional herb Rosa damascena (as topical application and oral intake) on the severity of acute pain in adults. Methods: A systematic search was performed on the following databases: Cochrane Central Register of Controlled Trials, PubMed, Scopus, Web of Science Core Collection, Embase, Cumulative Index to Nursing and Allied Health Literature, Scientific Information Database, and Magiran from inception to 20 March 2021. We included parallel-group and cross-over randomized controlled trials that compared the effects of any products containing R damascena in oral and topical administration forms to placebo, non-treatment, or conventional treatment. Two researchers independently performed the document screening and selection, data extraction, and risk of bias assessment. A random-effect model was used to pool the data. Results: From a total of 11 studies that met the inclusion criteria, four studies administered R damascena through topical application and seven by oral intake. Nine studies recruited only females. Ten studies had parallel-group design, while one adopted cross-over design. The oral intake of Rdamascena reduced pain severity non-significantly (standardized mean difference (SMD) = -0.55, 95% CI: -1.27-0.17; p =0.132). However, the topical application of this treatment had no pain-alleviating effect (SMD = 0.10, 95% CI: -0.75-0.96; p =0.814). One study reported mild allergic rhinitis as an adverse effect of the treatment. Risk of bias assessment revealed that three of the eleven studies had good methodological quality, six had fair quality, and two were of poor quality. Conclusions: This systematic review and meta-analysis suggests that the oral intake of R damascena may have a non-significant alleviating effect on acute pain severity in adults. However, its topical application has not shown pain-alleviating effect. More robust randomized controlled trials are needed for accurate estimation of the effects of oral and topical use of R damascena on the severity of different types of acute pain in adults.

Effects of light stroking massage with olive oil on acute pain severity and number of taken non-steroidal anti-inflammatory drugs among outpatients with extremities trauma: A double-blind, placebo-controlled superiority trial.

INTRODUCTION: Currently, analgesics are used to alleviate acute pain after trauma; however, these drugs cause some undesirable adverse effects. Hence, there is a need for nonpharmacological methods to reduce trauma-induced pain. This study investigated the effects of massage with olive oil on acute pain severity and number of taken non-steroidal anti-inflammatory drugs (NSAIDs) among trauma patients. METHODS: In this double-blind, placebo-controlled superiority trial, 42 outpatients who suffered from superficial injury in upper or lower extremities were randomly assigned to olive oil and placebo groups. Patients received a 5-min light stroking massage on the trauma site twice a day for nine consecutive days with 10 drops of either olive oil or placebo (liquid paraffin). Also, they received NSAIDs and applied cold and warm compresses on the trauma site. The pain severity (a 0-10 numerical pain rating scale) and the number of NSAIDs were recorded at four points of time, including before the intervention (baseline), and on the third, sixth, and ninth days of intervention. RESULTS: There was a significant difference between the study groups in mean ranks of the number of NSAIDs taken on the baseline and third days (P = 0.02, P = 0.009). Considering the number of NSAIDs taken during nine days as a covariate, a significant decrease in the pain severity was found in two groups during the nine days (Ptime< 0.001). However, pain reduction over time was more significant in the olive oil group (Ptime*group = 0.001). Also, mean changes in the pain severity compared to the baseline were significant on the sixth (P = 0.001) and ninth (P = 0.002) days of the intervention in favor of the olive oil group. CONCLUSION: Administration of light stroking massage with olive oil as a complementary method seems to be potentially effective in reducing the pain severity and use of NSAIDs among patients with trauma to the extremities.

Psychometric Properties of the Persian Version of Palliative Care Outcome Scale (POS) in Adult Patients With Cancer.

Background: Measuring the outcomes of palliative care plays an important role to improve the quality, efficiency, and availability of these services in patients with cancer. Using valid, reliable, and culturally appropriate tools has a considerable role to measure these outcomes. This study aimed to assess the psychometric properties of the translated version of the Palliative care Outcome Scale (POS). Methods: This methodological study was conducted in two outpatient clinics related to Shohada Tajrish and Baqiyatallah hospitals in Tehran in 2019-2020. The translation was done using the Forward-Backward approach after gaining permission from the developer. Face validity was tested with 10 patients with cancer through cognitive interviewing, as well as content validity with four experts. Construct validity was performed by (n = 203) exploratory factor analysis and confirmation (N = 150). To assess the reliability, internal consistency was assessed by using Cronbach's alpha coefficient, and relative stability was assessed using the interclass correlation coefficient (ICC). Furthermore, interpretability and ceiling and floor effects were assessed. Results: A total of 353 patients with cancer under palliative care were included in the study. Then, three psychological (30%), physical (12.25%), and social factors (12.08%) with a cumulative variance of 54.34% were extracted in exploratory factor analysis. Confirmatory factor analysis showed that the model has a good fit of information. Cronbach's alpha coefficient for scale was 0.719. Furthermore, the ICC was 0.812. The scale was interpretable, and ceiling and floor effects were 0%. Conclusion: Persian version of the POS was evaluated as a valid and reliable tool. Therefore, it can be used by the clinician to monitor the consequences of palliative care in Iranian cancer patients.

Comparison of Iran's nursing education with developed and developing countries: a review on descriptive-comparative studies.

BACKGROUND: Iran's nursing education has undergone significant modifications in the last decades, especially following the Islamic revolution and the Iran-Iraq war. This review outlined changing trends in Iran's nursing education and evaluate its status compared to other developing and developed countries. METHODS: Six international and two national electronic data sources were searched up to May 2021, using relevant keywords and terms. The studies were included if they addressed history, development, or evolutionary aspects of Iran's nursing education or evaluated its status by comparing it with developing or developed countries, using Bereday's model. To obtain more relevant information, the organizational documents of the Iranian Ministry of Health and Medical Education and the Iranian Ministry of Culture and Higher Education were searched. Of 753 evidence found in the initial search, 73 were considered eligible for this review. A systematic and unbiased data synthesis was performed and a narrative and tabulated summary was presented. RESULTS: The evolution in Iran's nursing education has resulted in the establishment of Bachelor, Master, and Ph.D. PROGRAMS: Iran's nursing education system plays an important role in fulfilling the healthcare system's mission, and it does not hold a dissatisfactory position in comparison with other developed and developing countries. However, this system is expected to be more versatile for the upcoming changes and advancements. CONCLUSION: Iran's nursing education has a moderate rating despite recent changes. Hence, this system has to be modified in some aspects by adopting experiences of other countries, with an appropriate and successful education system, to prepare future highly competent nurses.

Comparison of the effects of virtual training by serious game and lecture on operating room novices' knowledge and performance about surgical instruments setup: a multi-center, two-arm study.

BACKGROUND: Game-based training is increasingly implemented in different nursing fields, as it allows students to learn experientially, with the flexibility to regulate their training based on their personal progresses and abilities. This study aimed to compare the effects of virtual training by the "Playing with Surgical Instruments (PlaSurIn)" game and the lecture on the surgical instruments setup knowledge and performance of Operating Room (OR) novices. METHODS: This study was conducted on 51 s-semester undergraduate OR technology students taking the course "An Introduction to Surgical Instruments and Equipment." An additional virtual training session was held via a learning management system using two different methods. The students of the Game Training Group (GTG, n = 27) played individually with the "PlaSurIn" game during a week, while the students of the Lecture Training Group (LTG, n = 24) received the lecture-based training during a week. To measure knowledge, all the students participated in a theoretical test with 10 multiple-choice questions before and immediately after the training. They also participated in an Objective Structured Clinical Examination (OSCE) after the training, and their performance was evaluated by the remained time for setup completion and the scores, errors, and bonuses. RESULTS: The mean score of the theoretical test was significantly higher in the GTG than in the LTG after the training (p = 0.040). Additionally, the GTG participants had higher scores (p = 0.016), fewer errors (p = 0.001), and higher bonuses (p = 0.011) compared to the LTG ones. The remained time for setup completion was also significantly longer in the GTG than in the LTG (p < 0.001). CONCLUSION: Virtual training by "PlaSurIn" was superior to the lecture-based method for the enhancement of surgical instruments setup knowledge and performance amongst OR novices.

Effects of Aromatherapy with Lavender (Lavandula angustifolia MILL) on Post-Dural Puncture Headache: A Randomized Placebo-Controlled Trial.

Context: Lavender has been proposed as an analgesic agent for different types of headaches in complementary and alternative medicine. However, no documented trial has been performed to investigate the effects of lavender in managing post-dural puncture headache (PDPH). Objective: To evaluate the effects of aromatherapy using lavender essential oil in reducing the severity of PDPH. Design: Randomized, placebo-controlled clinical trial with parallel group design. Setting: Post-operative wards of Kamkar-Arab-Nia and Nekooei Hedayati Hospitals in Qom, Iran. Participants: Patients with PDPH caused by spinal anesthesia (n = 50). Intervention: Patients received 15-minute inhalations of either lavender oil or liquid paraffin as placebo, using the same protocol. Outcome Measures: The severity of headache was scored before (baseline) and five times after the intervention (immediately, 30, 60, 90, and 120 minutes after) using the visual analog scale. Also, dosage and frequency of the received Diclofenac and adverse effects of the intervention were recorded. Results: Both groups showed a reduction in headache scores post intervention. However, the headache scores between the groups was significantly different only immediately after the intervention in favor of lavender oil (difference: 1.60 ± 0.63, P = .015). Furthermore, it was observed that the mean changes of the headache scores compared to baseline were significant at each time interval in favor of the placebo group (P < .05), except immediately after the intervention. No significant difference was observed in diclofenac intake between groups (P = .440). Also, no adverse effects were found from the intervention. Conclusions: Aromatherapy with lavender oil was observed to reduce the severity of PDPH only immediately after the intervention, while only minimal effects were observed at successive time intervals. However, it is noted that the study was likely underpowered and further studies are recommended to better understand the effects of lavender oil on PDPH and compare its effects to other herbal products or pharmacological agents commonly used for managing headaches.

Effect of Rosa damascena on improvement of adults' sleep quality: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Recent studies have reported inconclusive results regarding the potential effects of Rosa damascena on sleep quality. Therefore, this review aimed to summarize the findings of parallel-group and cross-over randomized controlled trials (RCTs) on the effects of aromatherapy and oral intake of Rosa damascena on adults' sleep quality. METHODS: The electronic data sources of PubMed, Scopus, Web of Science Core Collection, Embase, CENTRAL, ProQuest, CINAHL, SID, and MagIran were searched from inception to June 30, 2021. Out of 1341 publications found in the initial search, 10 RCTs were considered eligible for this review. The Cochrane risk-of-bias assessment tool was used to evaluate the risk of bias. Sufficient data were statistically pooled by a random-effects model using Stata software (version 11.2); otherwise, a narrative summary was presented. RESULTS: Based on the systematic review, the inhalation and oral intake of Rosa damascena could improve some sleep-related outcomes. The pooled analysis of seven effect sizes revealed that inhalation aromatherapy with Rosa damascena significantly improved sleep quality (standardized mean difference: 2.24; 95% confidence interval: 1.01-3.48; P < 0.001). Most RCTs had fair methodological quality, and two RCTs reported the adverse effects of treatment, including headache, nausea, vomiting, and frequent sneezing. CONCLUSIONS: The administration of Rosa damascena seems to be a promising approach in complementary and alternative medicine for the improvement of adults' sleep quality. However, considering the fair methodological quality of most RCTs and reported adverse effects, it is required to perform further high-quality RCTs to draw an evidence-based conclusion on the use of Rosa damascena for the improvement of adults' sleep quality. PROSPERO NO: CRD42020211778.

Effects of Rosa damascena (Damask rose) on menstruation-related pain, headache, fatigue, anxiety, and bloating: A systematic review and meta-analysis of randomized controlled trials.

Recent studies have reported inconclusive results regarding the therapeutic effects of Rosa damascena on the outcomes of primary dysmenorrhea (PD) and premenstrual syndrome (PMS). Hence, this study is aimed to summarize the findings of randomized controlled trials (RCTs) regarding the effects of this treatment on menstruation-related pain as the primary outcome and menstruation-related headache, fatigue, anxiety, and bloating as the secondary outcomes. This study evaluated parallel-group and cross-over RCTs on aromatherapy, topical treatment, or oral intake of R. damascena products for the treatment groups versus placebo, nontreated, or conventional treatment groups. Seven electronic databases (Web of Science Core Collection, Scopus, Embase, CENTRAL, CINAHL, SID, and MagIran) and one search engine (PubMed) were searched from inception to January 15, 2021. Of 1468 trials found in the initial search, 983 potentially relevant articles were screened by title and abstract. After examining the full-text of 13 studies for compliance with the inclusion criteria, seven studies were considered eligible for this review. A random-effects model was used to pool the data; otherwise, a narrative summary was presented. The retrieved studies were conducted on females with PD or PMS, aged 18-35 years. The total sample size of the intervention and comparator arms was 276 and 272. The results showed that R. damascena had a nonsignificant alleviating effect on the menstruation-related pain (weighted mean difference [WMD]: -0.47; 95% confidence interval [CI]: -1.25, 0.31; P = 0.234). Such findings were also found for menstruation-related anxiety (WMD: -0.40; 95% CI: -0.91, 0.11; P = 0.125). However, the treatment significantly reduced the menstruation-related headache (WMD: -0.42; 95% CI: -0.74, -0.11; P = 0.008), fatigue (WMD: -0.48; 95% CI: -0.87, -0.09; P = 0.015), and bloating (WMD: -0.72; 95% CI: -1.21, -0.22; P = 0.005). Since R. damascena had no significant effects on menstruation-related pain and anxiety, further studies with improved methodological quality are suggested to evaluate the effects of the treatment on these symptoms, using different dosages and durations.

Rosa Damascena mill for treating adults' anxiety, depression, and stress: A systematic review and dose-response meta-analysis of randomized controlled trials.

Recent studies have reported conflicting findings on the antianxiety, antidepressant, and anti-stress properties of Rosa Damascena Mill (RDM). Therefore, the present systematic review and meta-analysis were conducted on the effects of RDM for treating anxiety, depression, and stress amongst adults. The online data sources of Cochrane Central Register of Controlled Trials, PubMed, Scopus, Web of Science, Embase, ProQuest, and Scientific Information Database were searched from inception to June 30, 2021. The randomized controlled trials (RCTs), which examined the effects of RDM (in any form of administration) on adults' anxiety, depression, and stress, were included. A random-effects model was applied to pool the data, and a total of 32 publications were included. The results of the meta-analysis revealed that administration of RDM significantly reduced state anxiety (effect size [ES]: 24, standardized mean difference [SMD]: -1.74, 95% confidence interval [CI]: -2.29, -1.20; p < .001), depression (ES: 7, SMD: -0.87, 95% CI: -1.47, -0.28; p = .004), and stress (ES: 4, SMD: -1.33, 95% CI: -1.98, -0.69; p < .001). However, the treatment had no significant effect on trait anxiety (ES: 6, weighted mean difference: -0.75, 95% CI: -1.93, 0.43; p = .214). The association between the total administration dosage and/or duration of RDM and the changes in state anxiety and depression was not dose-dependent. Most RCTs had a fair methodological quality based on the Cochrane risk of bias assessment tool. Besides, the quality of evidence ranged from very low to moderate according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Hence, further high-quality RCTs are needed to draw reliable conclusions regarding the use of RDM for treating adults' anxiety, depression, and stress.

"Playing with Surgical Instruments (PlaSurIn)" game to train operating room novices how to set up basic surgical instruments: A validation study.

BACKGROUND: Game-based training has been considered as an alternative modality to traditional training in different perioperative nursing fields. OBJECTIVES: To describe the adaptation and validation process of "Playing with Tweezers", a Portuguese game developed for novices to set up basic surgical instruments on the Mayo stand or a back table. DESIGN: A validation study with three phases of translation, reconciliation, and evaluation (face, content, and construct validity). SETTINGS: Several medical universities in Iran. PARTICIPANTS: Twelve students in a pilot translation test, 18 experts in the reconciliation phase, 20 experts in the face and content validity stages, and 120 students (72 novices, 26 intermediates, and 22 experts) in the construct validity stage. METHODS: Following "forward-backward" translation from Portuguese to English, the English version of the game was appraised in the reconciliation phase using a 57-item questionnaire. To test face and content validity of the final version of the game, a 30-item questionnaire addressing different aspects of the game was completed. The students' game performance (remained time for game completion, obtained score, and error) was compared to assess the construct validity. RESULTS: Minor differences were detected and resolved during the translation process. The English version of the game was reconciled in two sequential steps, and the final game called "Playing with Surgical Instruments (PlaSurIn)" was developed. All the items regarding the face validity received 80-100% of positive responses. Moreover, regarding the content validity, all of the evaluated items obtained a content validity index of 0.90-1.0. Compared to the novices, the experts and intermediates received higher scores (p < 0.001 in two cases) and fewer errors (p < 0.001, p = 0.007). The remained time for game completion was significantly longer for experts than the novices (p = 0.011). CONCLUSIONS: The "PlaSurIn", as a virtual training strategy, can prepare novices to set up basic surgical instruments.

Association of Total Nut, Tree Nut, Peanut, and Peanut Butter Consumption with Cancer Incidence and Mortality: A Comprehensive Systematic Review and Dose-Response Meta-Analysis of Observational Studies.

Data on the association of nut intake with risk of cancer and its mortality are conflicting. Although previous meta-analyses summarized available findings in this regard, some limitations may distort their findings. Moreover, none of these meta-analyses examined the dose-response associations of total nut intake with the risk of specific cancers as well as associations between specific types of nuts and cancer mortality. Therefore, this study aimed to summarize available findings on the associations of total nut (tree nuts and peanuts), tree nut (walnuts, pistachios, macadamia nuts, pecans, cashews, almonds, hazelnuts, and Brazil nuts), peanut (whole peanuts without considering peanut butter), and peanut butter consumption with risk of cancer and its mortality by considering the above-mentioned points. We searched the online databases until March 2020 to identify eligible articles. In total, 43 articles on cancer risk and 9 articles on cancer mortality were included in the current systematic review and meta-analysis. The summary effect size (ES) for risk of cancer, comparing the highest with lowest intakes of total nuts, was 0.86 (95% CI: 0.81, 0.92, P < 0.001, I2 = 58.1%; P < 0.01), indicating a significant inverse association. Such a significant inverse association was also seen for tree nut intake (pooled ES: 0.87, 95% CI: 0.78-0.96, P < 0.01, I2 = 15.8%; P = 0.28). Based on the dose-response analysis, a 5-g/d increase in total nut intake was associated with 3%, 6%, and 25% lower risks of overall, pancreatic, and colon cancers, respectively. In terms of cancer mortality, we found 13%, 18%, and 8% risk reductions with higher intakes of total nuts, tree nuts, and peanuts, respectively. In addition, a 5-g/d increase in total nut intake was associated with a 4% lower risk of cancer mortality. In conclusion, our findings support the protective association between total nut and tree nut intake and the risk of cancer and its mortality.

Effect of aromatherapy with Damask rose on alleviating adults' acute pain severity: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND PURPOSE: Although recent studies have investigated the analgesic activity of Damask rose using aromatherapy in different painful conditions, the results are inconclusive. Hence, this systematic review and meta-analysis aimed to clarify the effect of aromatherapy with Damask rose on adults' acute pain. MATERIAL AND METHODS: The online databases of MEDLINE/PubMed, Scopus, ISI web of science, Embase, ProQuest, CENTRAL, CINAHL, SID, and MagIran were searched up to August 10, 2020. The aim of this study was to find randomized controlled trials on the effect of aromatherapy with Damask rose in any form of administration (inhalation, vapor diffusion, and massage) on different types of acute pain in adults. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies. Moreover, the quality of the evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random effects model was applied to pool data using Stata. RESULTS: A total of 16 studies met the inclusion criteria, of which only one was not included in the meta-analysis. Pooled analysis revealed that aromatherapy with Damask rose reduced the pain severity significantly (WMD: -2.12; 95% CI [-2.85, -1.40]; P < 0.001). Inhalation aromatherapy (WMD: -2.39; 95% CI [-3.31, -1.48]; P < 0.001) and aromatherapy massage (WMD: -1.16; 95% CI [-1.57, -0.75]; P < 0.001) also had significant effects on pain reduction. The quality of evidence was low. CONCLUSION: Aromatherapy with Damask rose had a favourable effect on reducing the severity of acute pain in adults. However, there is insufficient evidence for the clinical benefits of aromatherapy with Damask rose due to the low-quality evidence. Accordingly, more high quality randomized clinical trials are needed to make an evidence-based conclusion.

The relationship between spiritual well-being and happiness among healthcare students: Application of the spiritual health questionnaire for the Iranian population.

OBJECTIVES: To investigate the relationship between spiritual well-being (SWB) and happiness in a sample of Iranian healthcare students, considering a culturally-adapted and a context-based measure of SWB. METHODS: In this descriptive-correlational study, 343 Muslim students of Qom University of Medical Science are studied from October 2017 to March 2018. Data collection tools were the culturally-adapted spiritual well-being scale (SWBS), the spiritual health questionnaire for the Iranian population (SHQ), and the Persian version of Oxford happiness inventory (OHI). RESULTS: Total scores of SWBS, SHQ, and OHI were in moderate (68.42 ± 12.76), high (193.74 ± 24.26), and moderate (37.95 ± 14.56) levels, respectively. Happiness had a significant positive correlation with all domains of SWBS and SHQ. Moreover, a significant proportion of happiness was determined by SWBS and SHQ. Also, some domains of SWBS and SHQ showed a significant correlation with age, gender, marital status, and academic major. CONCLUSION: There was a significant correlation between happiness and SWB, measured by SWBS and SHQ. Hence, it seems that both SWBS and SHQ are sufficiently sensitive to assess the relationship between happiness and SWB.