The state of clinical education and factors affecting effective clinical education: the point of view of nursing and midwifery students.

BACKGROUND: Clinical education is the basis of education in medical sciences. Clinical education, as the essence of education in nursing and midwifery, promotes social health, improves health care, and reduces mortality. Considering the position of nursing and midwifery, investigating the views of students in this field can be an effective step in improving clinical education. Therefore, the present study was conducted to investigate the status of clinical education and the factors affecting effective clinical education from the point of view of nursing and midwifery students. METHODS: A descriptive-analytical study was conducted among nursing and midwifery students at Qazvin University of Medical Sciences in 2022-2023. Using available sampling, 242 students were included in the study. Students were included in the study if they completed at least one unit of in-person internship. Refusing to continue the study for any reason and having a practical nurse certificate were the criteria for exclusion from the study. The data collection tools included a demographic information questionnaire, a questionnaire to assess the status of clinical education, and a questionnaire on factors affecting effective clinical education. The data were analysed with descriptive and inferential statistics and SPSS 20 software. RESULTS: The mean age of the participants in this study was 21.66 ± 2.25. A total of 180 (74.4%) of the participants were women, and the rest were men. The results showed that the general condition of clinical education is at an average level (103.16 ± 19.21). It was also found that the clinical education status of midwifery students was better than that of nursing students, and this difference was significant (p = 0.003). Among the fields of clinical education, the highest score belonging to the field of objectives and planning was reported on the average level (34.39 ± 6.66). Among the factors affecting effective clinical education, the highest score was given to the field of personal characteristics of the student (33.97 ± 5.99). The results showed that there is a significant relationship between the grades of the general state of clinical education with the academic semester (p = 0.001) and interest in the field of study (p < 0.040). CONCLUSIONS: Based on the findings of the present study, clinical education is at an average level. Among the factors affecting effective clinical training, the field of personal characteristics of the student is more effective in clinical training. Providing educational facilities according to the number of students, using modern teaching methods, and determining and communicating the duties of professors and students can help to improve clinical education.

Time indicators of pre-hospital emergency missions in Qazvin province in 2021-2022.

BACKGROUND: Pre-hospital emergency has a crucial role in providing timely care for patients. In this system, seconds and minutes mean the difference between life and death. Considering the importance of the role of pre-hospital emergency in providing services to different patients and the necessity of continuous evaluation of this system, the present study was conducted to investigate time indicators in pre-hospital emergency missions. METHODS: This cross-sectional study was conducted in 2022 in Qazvin province, Iran. The research population was all the calls made to pre-hospital emergency bases in Qazvin province The required information, including time indicators and demographic characteristics of the patient, was obtained using the electronic registration system (Asayar). Data were Analysis using descriptive statistics and SPSS 20 software. RESULTS: Out of the 35,943 patients admitted to the hospital, 20,915 were male while the remaining were female. The mean age of the patients was 44.09 ± 21.82 years. Accidents (29.41%) were the most common reason for contacting the pre-hospital emergency. In all transfer missions, the mean delay time (0:02:23 ± 0:03:33), response time (0:15:02 ± 0:09:42), the time on the scene (0:18:33 ± 0:11:10), total run time (0:54:02 ± 0:25:20), transport time (0:20:25 ± 0:16:49), round trip time (1:32:43 ± 1:08: 43). CONCLUSIONS: The findings of the present study provided valuable information about the variety and number of missions in a pre-hospital emergency. The results showed that some indicators are within the standard range and some indicators are far from other regions of the country and the world. Increasing the number of bases, increasing the number of ambulances, and Implementation of continuous training courses for personnel can improve time indicators and increase the quality of service to different types of patients.

The Effect on Flexibility and a Variety of Performance Tests of the Addition of 4 Weeks of Soleus Stretching to a Regular Dynamic Stretching Routine in Amateur Female Soccer Players.

The purpose of this study was to investigate the effects of 4 weeks of soleus stretching on ankle flexibility and dynamic balance, as well as selected monitoring and performance tests in soccer. Forty-five healthy female soccer players were randomly divided into a regular stretching group, a regular stretching group with soleus stretching, and a control group. Dynamic stretching protocols were performed for 4 weeks during three sessions per week as part of routine exercises. The regular group stretched three muscle groups (i.e., gastrocnemius, quadriceps, and hamstrings), while the regular + soleus group also stretched the soleus muscle. Before and after the stretching intervention, the ankle range of motion test, Y-balance test, drop jump test, dynamic knee valgus test, and Illinois Agility Running Test were performed. Ankle ROM, Y-balance, and DJ significantly improved in both intervention groups compared to controls. Only the regular + soleus group showed improvement in the Illinois Agility Running Test. Additionally, athletes performing the additional soleus stretching had greater improvements in ankle ROM and DJ but not in DKV or Y-balance. The results showed that adding soleus stretching into regular protocols can provide benefits for female soccer players in terms of performance parameters.

Relationship between spiritual intelligence and lifestyle with life satisfaction among students of medical sciences.

BACKGROUND: Young people are the main resources of any country and entering university is considered a sensitive period in their lives. Satisfaction with life is one of the indicators of successful adaptation to life. Lifestyle and spiritual intelligence can complement and give meaning to this variable. The present study was conducted to investigate the relationship between spiritual intelligence and lifestyle with life satisfaction in students of Medical Sciences. METHODS: This descriptive-analytical study was conducted among the students of Qazvin University of Medical Sciences in 2017. One hundred thirty-nine students were included in this study. Data collection tools were the King's spiritual intelligence scale, Miller-Smith lifestyle assessment inventory, satisfaction with life scale (Diener), and demographic information checklist. To analyze the data, descriptive and analytical tests such as independent T-test and one-way analysis of variance and SPSS version 22 software were used. The significance level of all tests was considered less than or equal to 0.05. FINDINGS: In the present study, 108 were women and the rest were men. 49.6% of students were under twenty years old. The results of this research showed that there is a significant negative relationship between lifestyle and life satisfaction (r = -.33) and a significant positive relationship between spiritual intelligence and life satisfaction (r = .27) (p < 0.05). The mean scores of students in life satisfaction were 22.49 ± 5.92, lifestyle was 49.15 ± 8.35, and spiritual intelligence was 51.59 ± 11.43. CONCLUSIONS: The findings of the present study showed the important role of spiritual intelligence and lifestyle in students' life satisfaction. These findings can be used by administrators and policymakers in formulating interventions and providing a suitable context to improve students' life satisfaction.

Investigating the role of predictive death anxiety in the job satisfaction of pre-hospital emergency personnel during the COVID-19 pandemic.

BACKGROUND: Pre-hospital emergency staffs as the frontline forces fighting against COVID -19 have been affected by this pandemic. Today, the occupational and mental health of these individuals is particularly important to the health care system. Death anxiety is one of the inevitable things in this job, and not paying attention to it can cause unwanted effects such as changing the level of job satisfaction of the personnel. The purpose of this study was to determine the role of predictive death anxiety in the job satisfaction of pre-hospital emergency personnel during the COVID-19 pandemic. METHODS: This cross-sectional descriptive study was conducted among pre-hospital emergency staffs in Qazvin Province, Iran in 2021-2022. Among the bases chosen by the census method, 198 samples were included in the study by the available method. Data collection tools included the Demographic Checklist, Templer's Death Anxiety scale, and the Minnesota Job Satisfaction Questionnaire. The data were analyzed with descriptive and inferential statistics and SPSS 20 software. RESULTS: The mean age of the samples was (33.14 ± 6.77). 167 persons were male and the others were female. The average job satisfaction and death anxiety of the personnel were 55.07 ± 11.50 and 8.18 ± 1.96, respectively. Pearson's correlation coefficient between the two variables was r = -0.126 And a null correlation coefficient hypothesis has been confirmed with p-value = 0.077. CONCLUSIONS: The results showed a high level of death anxiety and average job satisfaction. Although these two variables do not have a significant relationship with each other, considering that they do not have the appropriate level, it needs more investigation and consideration.

Unnecessary ultrasonography as supplier-induced demand in diagnosis of primary breast cancer in Iran: A cross-sectional study.

BACKGROUND: Supplier-induced demand (SID) refers to the concept that healthcare providers may deliver services that are not medically necessary to patients. An estimation of the extent to which this event has occurred can be insightful for policymaking and guiding health and insurance systems. This study aimed to investigate the extent of SID when performing a diagnostic ultrasonography for primary breast cancer patients and its relationship with socioeconomic factors in Iran. METHODS: Data were obtained using questionnaires from 334 patients referred to the Cancer Research Center. To identify the patients who were candidates for undergoing a necessary diagnostic US, we employed the international clinical guidelines with confirmation of our expert panelists. With their assistance, a comprehensive index was created to screen those 'most probably affected by SID'. RESULTS: 55.9% had undergone an unnecessary diagnostic ultrasonography, and thus were most probably affected by SID. A significant association between socioeconomic factors (education, occupation, and supplemental health insurance) and SID was confirmed (p value ≤ 0.001, 0.002, and 0.039, respectively). CONCLUSION: This study supports the SID hypothesis and the unnecessary demand for diagnostic ultrasonography in primary breast cancer. Also, our evidence indicates imposing excessive costs that can positively influence the policymakers' decision-making in the healthcare systems.

Psychosocial Adjustment to Illness and Its Relationship with Spiritual Wellbeing in Iranian Cancer Patients.

BACKGROUND: The aim of this study was to investigate the psychosocial adjustment to illness and its relation with spiritual health in cancer patients. METHODS: This study was conducted in 2019 in Iran. It was a descriptive study with a sample of 124 cancer patients. Data were collected using two questionnaires of the psychosocial adjustment to illness scale (PAIS) with 46 questions and the Paloutzian and Ellison spiritual health scale with 20 questions. RESULTS: The mean age of the participants in this study was 52.4 ± 13.2 (range 18 to 87 years). The mean months of life with cancer were 16.5 months. The mean score of psychosocial adjustment to illness was 30.7 ± 15.5. The mean score of spiritual wellbeing in the studied patients was 71.4 ± 17.1. The results of the Pearson correlation test showed a significant inverse relationship between the mean score of psychosocial adjustment to illness and the mean score of spiritual wellbeing (p > 0.001, rr = -.355). CONCLUSION: Cancer patients in this study had relatively good psychosocial adjustment with their illness. Spiritual wellbeing can increase psychosocial adjustment to illness in this group of patients.

Effects of BCc1 nanoparticle and its mixture with doxorubicin on survival of murine 4T1 tumor model.

Background: Our previous findings showed that BCc1, a nanoparticle designed based on nanochelating technology, can be considered a new anti-cancer nanoparticle if confirmed by complementary studies. Goal: In the present study, we investigated the effects of the BCc1 nanoparticle alone on some gene expressions influencing the apoptosis pathway, and also the effect of the mixture of BCc1 nanoparticle and doxorubicin on survival. Method: Using an in vitro study, the effects of the BCc1 nanoparticle on Bax, Bcl2, p53, Caspase7 and p21 gene expressions were assessed after a 24-h treatment using real-time PCR in MCF-7 and MEFs; in addition, using an in vivo study, 4T1 tumor-bearing female Balb/c mice were treated with different doses of the BCc1 nanoparticle and doxorubicin alone and together and then their mean and median survival was evaluated. Result: The results showed that the BCc1 nanoparticle increased gene expressions of RB, p53, Caspase7, p21, and Bax and decreased gene expressions of Bcl2 in MCF-7 significantly, but no change was observed in MEFs expressions. The findings revealed that the BCc1 nanoparticle, when used orally, had the highest mean and median survival time. A mixture of a high dose of the BCc1 nanoparticle (1 mg/kg) and a low dose of doxorubicin (0.1 mg/kg) showed synergistic effects on enhanced life span, while doxorubicin dose was prescribed approximately 50 times less than the murine applicable dose (5 mg/kg). Conclusion: Our results demonstrated that the BCc1 nanoparticle not only has the potential to become a novel nanomedicine for cancer therapy, but it can also provide the basis of a new medicine for cancer management when mixed with a lower applicable dose of doxorubicin.

A randomized, double-blind, placebo-controlled investigation of BCc1 nanomedicine effect on survival and quality of life in metastatic and non-metastatic gastric cancer patients.

BACKGROUND: Currently, the main goal of cancer research is to increase longevity of patients suffering malignant cancers. The promising results of BCc1 in vitro and vivo experiments made us look into the effect of BCc1 nanomedicine on patients with cancer in a clinical trial. METHODS: The present investigation was a randomized, double-blind, placebo-controlled, parallel, and multicenter study in which 123 patients (30-to-85-year-old men and women) with metastatic and non-metastatic gastric cancer, in two separate groups of BCc1 nanomedicine or placebo, were selected using a permuted block randomization method. For metastatic and non-metastatic patients, a daily dose of 3000 and 1500 mg was prescribed, respectively. Overall survival (OS) as the primary endpoint and quality of life (measured using QLQ-STO22) and adverse effects as the secondary endpoints were studied. RESULTS: In metastatic patients, the median OS was significantly higher in BCc1 nanomedicine (174 days [95% confidence interval (CI) 82.37-265.62]) than in placebo (62 days [95% CI 0-153.42]); hazard ratio (HR): 0.5 [95% CI 0.25-0.98; p = 0.046]. In non-metastatic patients, the median OS was significantly higher in BCc1 nanomedicine (529 days [95% CI 393.245-664.75]) than in placebo (345 days [95% CI 134.85-555.14]); HR: 0.324 [95% CI 0.97-1.07; p = 0.066]. The QLQ-STO22 assessment showed a mean difference improvement of 3.25 and 2.29 (p value > 0.05) in BCc1 nanomedicine and a mean difference deterioration of - 4.42 and - 3 (p-value < 0.05) in placebo with metastatic and non-metastatic patients, respectively. No adverse effects were observed. CONCLUSION: The findings of this trial has provided evidence for the potential capacity of BCc1 nanomedicine for treatment of cancer. Trial registration IRCTID, IRCT2017101935423N1. Registered on 19 October 2017, http://www.irct.ir/ IRCT2017101935423N1.

Testing random effects in linear mixed-effects models with serially correlated errors.

In linear mixed-effects models, random effects are used to capture the heterogeneity and variability between individuals due to unmeasured covariates or unknown biological differences. Testing for the need of random effects is a nonstandard problem because it requires testing on the boundary of parameter space where the asymptotic chi-squared distribution of the classical tests such as likelihood ratio and score tests is incorrect. In the literature several tests have been proposed to overcome this difficulty, however all of these tests rely on the restrictive assumption of i.i.d. measurement errors. The presence of correlated errors, which often happens in practice, makes testing random effects much more difficult. In this paper, we propose a permutation test for random effects in the presence of serially correlated errors. The proposed test not only avoids issues with the boundary of parameter space, but also can be used for testing multiple random effects and any subset of them. Our permutation procedure includes the permutation procedure in Drikvandi, Verbeke, Khodadadi, and Partovi Nia (2013) as a special case when errors are i.i.d., though the test statistics are different. We use simulations and a real data analysis to evaluate the performance of the proposed permutation test. We have found that random slopes for linear and quadratic time effects may not be significant when measurement errors are serially correlated.