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).

Caring Behaviors Inventory-24: translation, cross-cultural adaptation, and psychometric testing for using in nurses and patients.

BACKGROUND: To measure caring behaviors, it is necessary to have an instrument adapted based on the contextual culture. This study aimed to translate Caring Behaviors Inventory-24 (CBI-24) into Persian and determine its psychometric properties. METHODS: This is a methodological study conducted to translate and then psychometrically test The CBI-24. The forward-backward translation was conducted using the World Health Organization (WHO) model and Wild et al. (2005) approach. The face, content, and construct validity of the inventory were assessed using cognitive interviews (10 nurses and 10 patients), expert panel deliberations (10 experts), and the exploratory and confirmatory factor analyses (300 nurses and 300 patients), respectively. The reliability was determined using the internal consistency (300 nurses and 300 patients) and test-retest method (30 nurses and 30 patients). RESULTS: After translating the CBI-24 and combining its items, the forward translation was initially conducted and the final backward translation was then sent to the developer for confirmation. The final version of the inventory was prepared after the completion of cognitive interviews. The content validity index of all items was reported to be more than 0.8 and good. The Cohen's kappa coefficient of all items was also shown to be higher than 0.74 and excellent. The factor loading of all items except item 19 was above 0.3. Item 19 was removed since it caused the alpha value of the respectfulness dimension to be 0.32. The Cronbach's alpha and the correlation coefficient of the whole inventory were calculated to be 0.95 and 0.88, respectively. CONCLUSION: The Persian version of CBI-24 can be a suitable tool for measuring caring behaviors among patients and nurses.

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.

Workplace challenges and nurses recovered from COVID-19.

BACKGROUND: Although many studies have addressed COVID-19, the challenges faced by nurses in their workplace after recovering from this disease have not been investigated. As the backbone of the health system and at the forefront of the fight against COVID-19, nurses are exposed to serious risks of infection and even death. They may also face numerous challenges in their workplace after recovering from COVID-19. It is therefore ethically recommended that the problems of these nurses be solved to increase their job satisfaction and encourage them to remain in their profession. OBJECTIVES: The present research was conducted to determine the workplace challenges faced by nurses who had recovered from COVID-19. METHODS: This qualitative study was conducted using the interpretive phenomenological approach proposed by van Manen. The data collected through 17 in-depth semi-structured interviews with 14 eligible nurses at different occupational levels were analyzed using the six steps proposed by van Manen. These nurses had also recovered from COVID-19. ETHICAL CONSIDERATIONS: This study was approved by the Ethics Committee of Urmia University of Medical Sciences (IR.UMSU.REC.1399.318). FINDINGS: Four themes and 20 subthemes extracted from analyzing the data explained the challenges faced by the nurses after their return to work. The themes included declined ethical values (four subthemes), infected nurses, forgotten patients (three subthemes), gradually leaving the job (six subthemes), and corona phobia (seven subthemes). CONCLUSION: The present findings can be used to lay the foundations for adopting humanitarian policies in health organizations in terms of ethical care provision during future pandemics.

Spiritual Self-care in Stroke Survivors: A Qualitative Study.

Self-care and quality of life challenges significantly affect post-stroke life. Stroke patients look for strategies to improve their performance and cope with their new situation. The aim of this study was to explore spirituality in self-care from the perspective of stroke survivors in the northwest of Iran. Purposive sampling is done on 15 participants through Semi-structured interviews of obtained data through conventional content analysis approach. Two categories of "spiritual self-care" as the main theme included "supplication" comprising subcategories of "worship and prayer", "resort" and "trust" and "religious beliefs" with subcategories of "divine providence" and "divine blessing". Based on results of this study, Spirituality increases motivation for self-care and adaptation, reduces stress and helps patiently manage diseases as realities.

The organisational and managerial challenges experienced by nurses recovered from COVID-19: A phenomenological study.

AIM: This study was conducted to discover the organisational and managerial challenges of nurses recovered from COVID-19. BACKGROUND: Nurses, who are at the front line of fighting against COVID-19, face numerous organisational and managerial challenges that impose a burden on their already heavy burden of infection. Working in challenging situations can affect the quality of nursing care. METHODS: This qualitative study was conducted through an interpretive phenomenological approach. To collect the data, 18 semistructured interviews were held with 15 recovered nurses, which were then analysed using van Manen's method. RESULTS: The data analysis led to the extraction of four themes: nurses as victims of organisational prejudice, a profession surrounded by problems, insufficient sources for dealing with COVID-19 and post-COVID-19 development. CONCLUSION: This study showed the organisational and managerial challenges of recovered nurses from COVID-19. Although these nurses had positive experiences, they needed eliminating organisational prejudice, minimizing concerns and sufficient resources to deal with the crisis. IMPLICATIONS FOR NURSING MANAGEMENT: It is believed that these results can be used as a guide to nurse managers to improve the experience of recovered nurses from COVID-19 by treating all employees with equal kindness, considering to their problems and minimizing burden by actively providing resources.

The effect of knowledge brokering on nurses' empathy with patients receiving cardiac care: a study protocol.

BACKGROUND: Hospitalization could be an unpleasant experience for patients with cardiovascular disease leading to some negative emotional reactions. These emotions can be managed by nursing empathy. There are different methods for improving empathy, but some evidence indicates a dramatic drop in nurses' empathy. In this study, we aim to provide a protocol for investigating the effect of knowledge brokering on nurses' empathy with patients receiving cardiac care. METHODS: This study protocol is developed based on SPIRIT checklist with an experimental design. The study population are nurses working in cardiac wards of three educational hospitals in western Iran, Khorramabad. The quota sampling method is used. The sample size is 100 individuals. The samples will be assigned to two intervention and comparison groups using stratified random allocation method. Permuted block randomization is used in each stratum. To prevent contamination between participants; firstly, the measurements of the comparison group is done. Knowledge brokering intervention is performed in 7 stages based on Dobbins' knowledge translation framework 2009. Monica's Empathy Construct Self-Rating Scale is used for measuring empathy. Statistical analyses are performed using SPSS (SPPS Inc. Chicago, Il, version 21). P value below 0.05 is considered as statistically significant. DISCUSSION: To our knowledge, there is no similar study using an experimental design to examine the efficacy of a knowledge brokering method to improve humanistic knowledge. It helps nurses to improve their empathy in caring relationships.

Impact of hot stone massage therapy on sleep quality in patients on maintenance hemodialysis: A randomized controlled trial.

BACKGROUND: Many patients on maintenance hemodialysis experience sleep disorders. This problem is related to depression, anxiety, hospitalizations, chronic medical conditions, decreased quality of life, and increasing mortality rate in patients on maintenance hemodialysis. The objective of this research is to determine the impact of massage therapy by hot stone on quality of sleep in patients on maintenance hemodialysis. MATERIALS AND METHODS: This was a randomized controlled trial conducted on 60 patients on maintenance hemodialysis. They were assigned via random allocation process into two groups of study: intervention group (n = 30), or control group (n = 30). Patients in the experimental group received massage therapy by hot basalt stone for 12 séances. During the massage therapy, each of five basalt stones were placed at the sites of the fifth, fourth, third, second, and first chakra. Control group received their treatment as usual without any massage therapy. Using Pittsburgh Sleep Quality Index (PSQI), the global score and its components were computed in both groups of study, two times (before the intervention and 1 month after the intervention). RESULTS: Although there were not any baseline differences between the two groups of study for the mean of global PSQI score (P = 0.92) before the study, the mean of global PSQI score in the intervention group, after the intervention decreased to 5.7 ± 3.06, but in the control group sleep quality increased to 10.7 ± 3.6. The difference between the mean of global score of PSQI among two groups of study after the massage therapy was statistically significant (P < 0.001). CONCLUSION: Applying massage therapy by hot stone in hemodialysis patients may contribute in enhancing their quality of sleep.

Effects of supportive-expressive discussion groups on loneliness, hope and quality of life in breast cancer survivors: a randomized control trial.

PURPOSE: Evaluation of the effect of supportive expressive discussion groups on loneliness, hope and quality of life in breast cancer survivors. METHODS: A randomized control trial including breast cancer patients who had completed chemotherapy and randomly allocated into two groups: intervention (n = 41) and control (n = 40). The intervention consisted of twelve weekly 90-min sessions for groups of six to eight breast cancer survivors. Data were obtained pre-to -post the intervention and at 8-week follow-up. The data were analyzed using a repeated-measures analysis of variance (ANOVA). RESULTS: The findings revealed a significant reduction in loneliness scores (F = 69.85, p < 0.001), promotion in total hope (F = 20.8, p < 0.05) and enhancement in quality of life from pre- to post-intervention, and then over the 8-week follow-up period in the intervention group, while scores of control participants did not show this pattern during the study. The strongest effects were found for global quality of life (effect size) = 0.59), for future perspectives (effect size = 0.51), emotional functioning (effect size = 0.35) and social functioning (effect size = 0.31). CONCLUSION: The intervention was effective on loneliness, hope and quality of life in the intervention group. The intervention needs further evaluation in a larger study and with other cancer types. Copyright © 2016 John Wiley & Sons, Ltd.

Self-esteem and optimism in patients with major depression disorder: a cross-sectional study.

Background: Depressive disorders are common mental illnesses characterized by persistent feelings of sadness, hopelessness, and loss of interest in activities. Self-esteem refers to the appraisal of one's worth and personality, whereas optimism reflects a positive attitude and the expectation of positive outcomes. Therefore, the present study aims to determine the average self-esteem and optimism of patients with depression in 2022. Methods: The present study is a single center and prospective descriptive-analytical study in which 121 patients out of 154 participants with major depression using convenience sampling were studied. Recruitment started on 10 June 2022 and ended on 12 July 2022. Data were collected using a demographic questionnaire, the Rosenberg Self-Esteem Scale (RSES), and the Revised Life Orientation Test (LOT -R). Data analysis was performed using statistical tests and the Pearson correlation coefficient with SPSS software version 21. Results: The mean and SD of patients' self-esteem scores were 14.68±1.30, and the mean and SD for optimism scores were 9.90±1.68. Pearson correlation analysis showed that educational level had a significant inverse relationship with patients' self-esteem scores (r=-0.009, P=0.03), and sex had a significant relationship with patients' optimism scores (r=0.175, P=0.008). Conclusion: Considering the importance of self-esteem and optimism in the recovery and return to society of patients with major depression, it is necessary to take measures to strengthen and increase self-esteem and optimism in these patients.

Effect of Resilience-based Group Therapy Intervention on Coping in Mothers of Children with Cancer: A Randomized Clinical Trial.

BACKGROUND: Cancer is the second most common cause of mortality after cardiovascular diseases (CVDs). Resilience is one of the best strategies for coping with diseases in patients with cancer. This study was aimed to determine the effect of resilience-based group therapy intervention on coping in mothers of children with cancer. MATERIALS AND METHODS: This randomized clinical trial was carried out on 48 mothers of children with cancer in Shahid Motahhari Hospital of Urmia, Iran, in 2017. Samples were randomly divided into two groups in Excel. The data were collected using a demographic questionnaire, the General Health Questionnaire (GHQ-28), and the Coping Health Inventory for Parents (CHIP). Analysis of variance (ANOVA) was used to compare the two groups at three different times. All p values of less than 0.05 were considered significant. RESULTS: A significant difference was observed in the mean scores of integration between the intervention group and control group (F1, 47 = 426.41, p < 0.001); the mean (standard deviation) of the integration score in the intervention and control groups was 40.80 (2.54) and 18.04 (3.05), respectively. Moreover, there was significant difference between the two groups in terms of the mean scores of social support and health status perception (F1, 47 = 176.59, p < 0.001). The mean (standard deviation) of social support and health status perception scores in the intervention group was 39.88 (2.81) and 22.72 (5.91) and in the control group was 16.87 (4.19) and 10.95 (2.01), respectively. CONCLUSIONS: Resilience-based group therapy intervention can be an effective strategy for coping with childhood cancer among mothers of children with cancer.

Effect of lifestyle interventions on diabetic peripheral neuropathy in patients with type 2 diabetes, result of a randomized clinical trial.

OBJECTIVES: Diabetic peripheral neuropathy (DPN) is the most common and troublesome complication of diabetes leading to great morbidity and resulting in a huge economic burden for diabetes care. Over half of people with diabetes develop neuropathy. Also, DPN is a major cause of reduced quality of life due to pain, sensory loss, gait instability, fall-related injury, and foot ulceration and amputation. The aim of this study was evaluating the effects of lifestyle interventions on diabetic neuropathy severity in diabetes type 2 outpatients. METHODS: This clinical trial conducted on 74 patients with DPN that divided with random allocation into intervention or control group. The lifestyle interventions applied in the intervention group beginning four educational sessions on lifestyle that emphasize strategies for lowering blood sugar, increasing physical activity, promoting weight loss, prudent diet, and foot caring. Each session was lasted for1.5 hour. Then patients followed for 12 weeks. During this period, they received counseling on mentioned lifestyle interventions. DPN severity in both groups measured using modified Toronto Clinical Neuropathy Score (mTCNS) at the beginning of study and at the end of counseling for 12 weeks. RESULTS: Comparing differences of mean of DNP severity before and after lifestyle intervention between two groups of study, there was a significant difference (p<0.001). DNP severity in control group had not any change or it increased in some participants, but DNP decreased in intervention group, after applying lifestyle intervention. CONCLUSION: Lifestyle interventions can contribute to reducing DPN severity, and consequently decreasing neuropathic pain.

Effect of applying reflexology massage on nitroglycerin-induced migraine-type headache: A placebo-controlled clinical trial.

OBJECTIVES: Nitroglycerin (NTG)-induced migraine-type headache is the most prominent side effect of nitrate therapy. Therefore, the aim of this study was to clarify the effectiveness of reflexology massage on intravenous NTG-induced headache in coronary care unit (CCU) inpatients. METHODS: This was a randomized clinical trial. The study sample included 75 patients that were randomly divided into three groups: control, intervention, and placebo groups. The intensity of baseline headache in patients who received NTG was measured by the numeric rating scale for pain (NRS Pain). Patients in the intervention group received reflexology massage two times for 20 min (at 3-h interval), wherein the upper part of patient's both foot thumbs, which is the reflection point of the head, was massaged. In the placebo group, an unspecified point on the foot (heel), which was not related to the head, was massaged. Patients in the control group did not receive any massage. RESULTS: No baseline differences existed among the three groups for the mean pain scale score (p=0.66) before the study; but the difference between the groups after the application was statistically significant (p=0.000). CONCLUSION: Reflexology massage can reduce the intensity of NTG-induced headache.

Effects of Peer-Facilitated, Video-Based and Combined Peer-and-Video Education on Anxiety Among Patients Undergoing Coronary Angiography: Randomised controlled trial.

OBJECTIVES: Coronary angiography can be stressful for patients and anxiety-caused physiological responses during the procedure increase the risk of dysrhythmia, coronary artery spasms and rupture. This study therefore aimed to investigate the effects of peer, video and combined peer-and-video training on anxiety among patients undergoing coronary angiography. METHODS: This single-blinded randomised controlled clinical trial was conducted at two large educational hospitals in Iran between April and July 2016. A total of 120 adult patients undergoing coronary angiography were recruited. Using a block randomisation method, participants were assigned to one of four groups, with those in the control group receiving no training and those in the three intervention groups receiving either peer-facilitated training, video-based training or a combination of both. A Persian-language validated version of the State-Trait Anxiety Inventory was used to measure pre- and post-intervention anxiety. RESULTS: There were no statistically significant differences in mean pre-intervention anxiety scores between the four groups (F = 0.31; P = 0.81). In contrast, there was a significant reduction in post-intervention anxiety among all three intervention groups compared to the control group (F = 27.71; P <0.01); however, there was no significant difference in anxiety level in terms of the type of intervention used. CONCLUSION: Peer, video and combined peer-and-video education were equally effective in reducing angiography-related patient anxiety. Such techniques are recommended to reduce anxiety amongst patients undergoing coronary angiography in hospitals in Iran.

Efficacy of Self-Hypnosis in Pain Management in Female Patients with Multiple Sclerosis.

Pain is common in patients with multiple sclerosis. This study evaluated self-hypnosis for pain control in that population. A randomized clinical trial was conducted on 60 patients, who were assigned to either a control group or to a self-hypnosis group, in which patients performed self-hypnosis at least 10 times a day. All patients were trained to score the perceived pain twice daily on a numerical rating scale and also reported the quality of pain with the McGill Pain questionnaire. Repeated-measures analysis showed a significant difference between the groups; pain was lower in the self-hypnosis group but was not maintained after 4 weeks. Self-hypnosis could effectively decrease the intensity and could modify quality of pain in female patients with multiple sclerosis.

Fatigue, Sleep Quality, and Disability in Relation to Quality of Life in Multiple Sclerosis.

BACKGROUND: Quality of life (QOL) is impaired in multiple sclerosis (MS) in part due to physical disability. MS-associated fatigue and poor sleep are common and treatable features of MS that affect QOL. We assessed the association between fatigue, sleep quality, and QOL in people with MS. METHODS: Cross-sectional data were collected from 217 patients with MS. Health-related QOL (MS Quality of Life-54), fatigue (Fatigue Severity Scale [FSS]), and sleep quality (Pittsburgh Sleep Quality Inventory [PSQI]) were assessed. Expanded Disability Status Scale scores were also provided by a qualified neurologist. RESULTS: The mean ± SD age of the 217 patients was 32.6 ± 8.6 years, and 79% were female. One hundred fifty-two patients (70.0%) were classified as poor sleepers based on PSQI scores; 122 (56.2%) had significant fatigue based on FSS results. The mean ± SE physical (PCS) and mental (MCS) health composite scores of the MSQOL-54 were 40.12 ± 1.27 and 43.81 ± 1.61, respectively. There was a strong statistically significant positive correlation between PCS scores and MCS (r = 0.58), FSS (r = 0.49), and PSQI (r = 0.52) scores. MCS scores were strongly correlated with FSS (r = 0.53) and PSQI (r = 0.35) scores. Age exhibited statistically significant negative correlations with PCS (r = -0.21) and MCS (r = -0.58) scores, and was statistically significantly correlated with FSS (r = 0.23) and PSQI (r = 0.21) scores. Expanded Disability Status Scale scores were strongly correlated with FSS scores. CONCLUSIONS: These findings support screening of fatigue severity and sleep quality and their effects on QOL.