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).

Assessment of frequency and types of drug interactions in intensive care units: a cross-sectional study.

Background: Drug interactions can cause adverse reactions, from treatment inefficiency to serious treatment complications in the patient. Due to the complexity of drug therapy and the simultaneous use of several drugs and different drug groups, patients hospitalized in intensive care units are exposed to more drug interactions. Therefore, this study was conducted to investigate the frequency of drug interactions in patients hospitalized in the ICU. Methods: In this cross-sectional study, the files of 300 patients hospitalized in the ICU were examined. Drug interactions were determined using Lexicomp software and the book drug iteration facts. Data analysis was done using SPSS 21 software. Findings: The findings showed that there were a total of 1121 cases of interference. Two hundred thirty-one (77%) patients had moderate interference, 94 (31.3%) patients had mild interference, and 67 patients (22.3%) had severe interference. One hundred eight patients had B-type interference, 223 C-type interference, 116 D-type interference, and 6 X-type interference, so most of the interactions are C-type interference. One hundred eighty-six patients had pharmacokinetic interference and 201 patients had pharmacodynamics interference. The highest interaction was between two drugs, heparin and aspirin with 58 cases. Conclusion: This study highlights the alarming frequency and types of drug interactions observed in ICU. The high prevalence of drug interactions emphasizes the need for improved medication management and vigilance in these critical care settings. Polypharmacy and certain drug combinations were identified as major contributing factors to the occurrence of drug interactions, which calls for regular medication reviews and cautious prescribing practices.

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.

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.

Single and Combined Use of Benson Relaxation Technique and Oxygen Therapy on Chemotherapy-Induced Nausea and Vomiting in Gastric Cancer Patients.

BACKGROUND: Nausea and vomiting are the most common complications of chemotherapy encountered by cancer patients. To alleviate these complications and reduce patients' problems, it is necessary to use complementary methods. OBJECTIVE: The present study aimed to investigate the effect of single and combined use of the Benson relaxation technique and oxygen therapy on chemotherapy-induced nausea, vomiting, and retching in patients with gastric cancer. METHODS: This is a single-blind, four-arm, 2 × 2 factorial-design randomized clinical trial, in which a total of 100 patients with gastric cancer were enrolled and assigned to four groups of relaxation therapy, oxygen therapy, combined therapy, and control (n = 25 in each group) using simple random allocation. The intervention program included the application of Benson relaxation technique, supplemental oxygen therapy, and a combination of both. The control group merely received routine care. Data were collected using the Rhodes Index of Nausea and Vomiting Form 2 (INV-2). RESULTS: The results of the Kruskal-Wallis H test showed that there was a statistically significant difference in the mean scores of nausea, vomiting, retching, and acute phase between the four groups (p = 0.001). However, there was a statistically significant difference only in the mean score of retching in this regard for the delayed phase (p = 0.02). CONCLUSION: Overall, the single use of Benson relaxation technique and the combined use of this technique and oxygen therapy were shown to be more effective in managing chemotherapy-induced nausea and vomiting.

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 COVID-19 patients' educational needs assessment questionnaire (COPENAQ): development and psychometrics.

BACKGROUND: Despite the importance of assessing COVID-19 patients' educational needs, there is currently no standard tool for a comprehensive assessment of these needs. The present study was aimed at developing a questionnaire to assess the educational needs of COVID-19 patients and determining its psychometric properties. METHODS: This study was conducted using an exploratory sequential mixed methods design in 3 stages. At the first stage, patients' educational needs were explained and determined using conventional content analysis so that a total of 15 COVID-19 patients were first selected using purposive sampling and then interviewed. At the second stage, the questionnaire items were developed using the qualitative findings and a review of valid sources related to the study subject. At the third stage, the psychometric properties of the questionnaire were determined using internal consistency reliability and the face, content, and construct validities. RESULTS: The mean content validity ratio and the content validity index were obtained to be 0.94 and 0.92, respectively. The internal consistency was evaluated using Cronbach's alpha, which was measured to be 0.97. Based on the exploratory factor analysis, the questionnaire was developed with 36 items in four subscales of "disease recognition and treatment follow-up", "prevention of infection transmission", "medication regimen", and "psychological and physiological needs". The results of confirmatory factor analysis also showed appropriateness and approval of the structural model obtained from the questionnaire. CONCLUSION: This questionnaire was found to have the necessary psychometric criteria (validity and reliability) so that it can be applied to assess the educational needs of COVID-19 patients and provide better and more effective patient education for them.

Burn self-stigma: A hybrid concept analysis.

AIM: As burn self-stigma has not been addressed fully, the purpose of current study is to analyze dimensions of the concept using literature and lived experiences in burn survivors. METHODS: Using hybrid concept analysis method, we investigated self-stigma in three phases (i.e. theoretical, fieldwork, and final analytical phase). In the first phase we reviewed the literature using PubMed, SCOPUS, Web of Science, Cochrane Library, OVID, SID and Google Scholar. Thirteen semi-structured interviews with burn survivors were conducted during the fieldwork phase. Two extra interviews with health care providers were undertaken for the aim of data triangulation. Textual content analysis and inductive content analysis were used to analyze the data of the first and second phases of this study, respectively. The findings of both phases were combined in the final analytical phase and a comprehensive definition was emerged. RESULTS: We assigned all our findings into three content areas (i.e. antecedents, properties and consequences), which are dimensions of self-stigma. In final analytical phase antecedent, properties and consequences of the concept were formed in one (society's misconception about burns), three (negative definition of self, emotional responses, and behavioral responses), and three (negative individual effects, negative social effects, and negative familial effects) categories, respectively. Based on these categories and their corresponding subcategories, a comprehensive definition of the concept was presented. CONCLUSION: Burn self-stigma is a state in which burn survivors experience unfavorable thoughts and feelings about themselves as a result of society's misconceptions about them. They give emotional and behavioral responses that define them in a negative way. In the end, the burn survivor's individual, familial, and social dimensions are significantly impacted.

The effect of guided imagery on the quality and severity of pain and pain-related anxiety associated with dressing changes in burn patients: A randomized controlled trial.

Pain and anxiety caused by burn dressing change are one of the major issues in burn patients. In this regard, guided imagery as a complementary method can be effective in reducing the levels of anxiety and pain. This method is the process of creating mental images and using sensory features through the individual's imagination and memory that facilitate the achievement of desired therapeutic outcomes. Therefore, this study was aimed at determining the effect of guided imagery on the quality and severity of pain and pain-related anxiety associated with dressing change in burn patients. This is a single-blinded randomized controlled trial in which a total of 70 burn patients were enrolled using convenience sampling and randomly allocated to two groups of intervention and control (n = 35 in each group). Each patient in the intervention group received four sessions of guided imagery during four consecutive days (one session a day) using a headphone. Then in both groups, the level of pain was assessed after the dressing change and the level of pain-related anxiety was assessed before the dressing change (between the end of the intervention and the initiation of dressing change). Data were collected using a demographic questionnaire, the Visual Analog Scale (VAS), the short-form McGill Pain Questionnaire (SF-MPQ), and the Burn Specific Pain Anxiety Scale (BSPAS). Data were first entered into the IBM SPSS Statistics for Windows, version 25.0 and then analyzed using repeated-measures Analysis of Variance. The repeated measures ANOVA indicated the mean score of the quality and severity of pain and pain-related anxiety differed statistically and significantly after the intervention (during the four sessions) compared to before it (baseline) in the intervention group (p < 0.001). The independent-samples t-test indicated a statistically significant difference in the mean scores of the quality and severity of pain and pain-related anxiety between the two groups (p < 0.001). This difference was found to be significant from the second session onwards (p < 0.001). Medical staff, including physicians, nurses and other healthcare professionals, are responsible for developing strategies to manage complications of burn injuries. Considering the effectiveness of guided imagery in reducing anxiety and pain in burn patients, it is recommended to use this method of complementary medicine to manage stress, anxiety, and pain in these patients.

Society, family, and individual characteristics as double-edged swords in the social reintegration of Iranian female survivors from unintentional severe burns: a qualitative study of enablers and barriers.

BACKGROUND: Reintegrating to society is a significant challenge during burn survivors' rehabilitation. AIM: This study aims to describe what Iranian female survivors from unintentional severe burns experience as enablers and barriers of social reintegration (SR). METHODS: Fourteen adult female burn survivors whose burns were unintentional participated in this qualitative study. Data were gathered through semi-structured face-to-face or telephone interviews and analyzed using inductive content analysis. RESULTS: Thirteen subcategories and six categories were emerged. Categories and subcategories of enablers content area were as follows: positive impact of society on SR (normal treatment of society, instrumental support), positive impact of family on SR (magnifying personal abilities assets, empathy and emotional support), and positive impact of personal characteristics on SR (coping with others stares, right to have a normal social life). Categories and subcategories of Barriers content area were as follows: negative impact of society on SR (being questioned in public, incorrect judgment about intent of burns, burns as a contagious disease), negative impact of family on SR (embarrassment of appearing in public with the survivor, family mistrust), and negative impact of intra-personal factors on SR (exaggeration of the post-burn changes, being over-sensitive to the others looks). From the deep interpretation of the data two overarching themes were emerged: "acceptance of the new normal by the society and the individual" and "being encompassed by misconceptions and mistreatments". CONCLUSIONS: Society, family and the individual characteristics have a dual role to play in the success of social reintegration in Iranian female unintentional burn survivors.

Rapid and Low-Cost Culture-Based Method for Diagnosis of Mucormycosis Using a Mouse Model.

Prompt and targeted antifungal treatment has a positive impact on the clinical outcome of mucormycosis; however, current diagnostic tools used in histopathology laboratories often fail to provide rapid results. Rapid culture-based strategies for early diagnosis of Mucorales infections, which may influence treatment decisions, are urgently needed. Herein, we evaluated a microculture assay for the early diagnosis of mucormycosis in an immunocompetent murine model of disseminated infection, by comparing it with traditional diagnostic methods. The assay specificity was assessed using blood (n = 90) and tissue (n = 90) specimens obtained from mice infected with Rhizopus arrhizus using different inoculum sizes [1 × 104, 1 × 105, and 1 × 106 colony forming units (CFUs)/mouse] and blood (n = 15) and tissue specimens (n = 15) from uninfected mice. Surprisingly, 26 of 90 (28.9%) blood samples revealed positive results by microculture, whereas all blood samples were negative when assayed by conventional culture. The overall positive conventional culture rate for the mouse tissue (kidney) samples was 31.1% (28/90). The calculated sensitivity for kidney microculture was 98.8% [95% confidence interval (CI) 96.6-100], with an assay specificity of 100%. Hence, the microculture assay may be useful for rapid culturing and diagnosis of mucormycosis caused by R. arrhizus directly in blood and tissue samples. Hence, this method may allow for the timely administration of an appropriate treatment.

Hypnosis for reduction of background pain and pain anxiety in men with burns: A blinded, randomised, placebo-controlled study.

INTRODUCTION: 'Background pain' and 'pain anxiety' are among the numerous problems of patients with burns. Non-pharmacological and pharmacological interventions have been used to reduce background pain and pain anxiety. This study compared the effectiveness of hypnosis and 'neutral hypnosis' (as a placebo in the control group) in decreasing the background burn pain and pain anxiety of adult male survivors with burns. DESIGN: This is a blinded, randomised, placebo-controlled study. METHODS: Sixty men with burns were included in the minimisation method (30 individuals in the intervention group and 30 individuals in the control group). Four hypnotherapy sessions were performed every other day for each participant in the intervention group. Four neutral hypnosis sessions were performed every other day in the control group. Burn pain and pain anxiety of the patients in both groups were measured at the end of the second and fourth sessions. Repeated measures ANOVA was used for data analysis. RESULTS: There was no significant difference between the groups in the reduction in background pain intensity. There was a significant reduction in background pain quality and pain anxiety in the intervention group during the four hypnosis sessions. After two hypnotherapy sessions, a significant reduction was observed in the level of background pain quality and pain anxiety of participants. CONCLUSION: Hypnosis is effective in reducing background pain quality and pain anxiety of men with burns.

Novel restricted access to vasectomy in Iran: addressing changing trends in vasectomy clients' characteristics over 16 years in northwestern Iran.

OBJECTIVES: This study is designed to evaluate the popularity of vasectomy in Iran. The study was conducted to calculate the frequency of vasectomy over time, to compare vasectomy users' characteristics with the general population and whether these characteristics have changed over time. STUDY DESIGN: A cross-sectional study of 7864 men undergoing vasectomy in a 16-year period was conducted in Urmia, Iran. Comparative statistics described differences between vasectomy users and nonusers. The data were analyzed separately in two 8-year periods, 1996-2003 and 2004-2011. The time period did not involve 2012, the year which vasectomy became outlawed in the whole country. RESULTS: During the study period, the contraceptive prevalence rate of vasectomy increased from 0.1% to 3.35%. Vasectomy users were predominantly older, better educated, had more children and more urban residents than the general male population (p<0.001). Over time, men who underwent vasectomy tended to be younger, have well-educated wife and rural resident (p<0.05). CONCLUSIONS: This study highlighted a dramatic rise in the use of vasectomy between 1996 and 2011 in Iran. While the characteristics of vasectomy users versus general population were different, especially in age, education, resident area, number and sex of their children, there were significant changes from two 8-year study time periods.

Longitudinal standards for growth velocity of infants from birth to 4 years born in West Azerbaijan Province of northwest Iran.

OBJECTIVES: Growth velocity is an important factor to monitor for appropriate child growth. This study presents the growth velocity of infants based on length, weight, and head circumference. METHODS: The subjects of this study were 308 neonates (160 boys and 148 girls) born in West Azerbaijan Province of northwestern Iran who were followed from birth for 4 years. The weights and lengths of the subjects were recorded at birth, 1, 2, 4, 6, and 9 months, and 1, 1.5, 2, 3, and 4 years of age, while the head circumferences were measured just up to 1.5 years of age. In this study, the Lambda-Mu-Sigma (LMS) method using LMS Chartmaker Pro (Institute of Child Health, London, UK) was utilized to obtain growth velocity percentiles. RESULTS: After obtaining growth velocity charts for weight, length, and head circumference (5th, 50th, and 95th percentiles), the researchers could deduce that there was a sharp decrease in the velocity growth charts from birth to 2 years of age but these charts remained relatively stable up to 4 years for both sexes. Growth velocities for the length and weight of boys in the present sample are slightly but not significantly greater than those in girls through the first months of infancy and there was no significant difference between girls and boys up to 4 years. CONCLUSIONS: This paper provided the first local growth velocity standards of length, weight, and head circumference for infants by analyzing longitudinal measurements produced for West Azerbaijan Province, which should be updated periodically. It seems that there has been a significant difference between the growth velocity of infants in northwestern Iran and southern Iran within the past few years.