Designing and psychometric properties of the hospitalized patients' spiritual needs questionnaire (HPSNQ) in the medical-surgical hospital setting.

BACKGROUND: The evaluation of spiritual requirements in patients can facilitate the delivery of spiritual care as an essential element of holistic healthcare. The objective of this research was to develop and evaluate the psychometric properties of a questionnaire on patients' spiritual needs in medical-surgical hospital settings. METHODS: This research utilized an exploratory sequential design, involving the creation of a pool of items through both inductive and deductive methods. The questionnaire's psychometric properties were then assessed using various techniques, such as face and content validity, item analysis, construct validity, internal consistency, stability, confirmatory factor analysis, and the Gradual Response Model of Samejima. The data analysis was conducted using MPLUS software, version 5.1. RESULTS: The study's results showed that a four-factor structure (interpersonal connectedness, relationship with God, transcendence, and peaceful environment) with 43 items was successfully extracted through exploratory factor analysis. The confirmatory factor analysis supported the findings of the exploratory factor analysis. The Cronbach's alpha coefficients for the scale and factors ranged between 0.83 and 0.95. Furthermore, the interclass correlation coefficients for the scale and factors were between 0.89 and 0.96. CONCLUSIONS: The questionnaire designed in this study is a reliable and valid instrument that can be utilized by healthcare, educational, and research institutions to evaluate the spiritual needs of patients in medical-surgical hospital settings.

How to prepare nursing students for mental health clinical engagement: a qualitative study.

BACKGROUND: Since clinical experience is challenging, identifying the factors influencing the learning process and acquiring clinical competence in mental departments is essential. Limited studies have investigated students' concerns regarding attending this clinical setting and how they are mentally and academically prepared. AIM/QUESTION: Explaining the various aspects of nursing students' preparation to attend the mental clinical environment. METHODS: This qualitative study was conducted on bachelorette nursing students and college professors using in-depth, semi-structured interviews. Inductive content analysis was used for data analysis, and Lincoln and Guba's criteria were used for the rigor of the data. RESULTS: The participants' viewpoints regarding how to prepare nursing students to enter mental clinical settings can be summarized in 4 categories: "understanding the students' concerns" "understanding the students' expectations" "the necessity of the students' mental preparation" and "preparing the scientific materials needed to attend in a mental ward". CONCLUSION: Nursing students have fears and worries about entering mental departments and have expectations of themselves and their instructors. To help students deal with these concerns, psychological and educational preparations should be provided, among which the role of new educational technologies can be mentioned.

Hsa-miR-3658 down-regulates OCT4 gene expression followed by suppressing SW480 cell proliferation and migration.

The pluripotency factor, OCT4 gene is a stemness marker that is involved in the tumorigenicity of different cancer types and knowing about molecular mechanisms of its regulation is crucially important. To date, a few microRNAs (miRNAs) are known to be regulators of OCT4 gene expression. Looking for the novel miRNAs which are capable of regulating OCT4 gene expression, our bioinformatics analysis introduced hsa-miR-3658 (miR-3658) as a bona fide candidate. Then, RT-qPCR results indicated that miR-3658 expression is decreased in colorectal cancer (CRC) tumor tissues, compared with normal pairs. Furthermore, RT-qPCR and western blot analysis showed that the OCT4 gene has been down-regulated following the miR-3658 overexpression. Consistently, dual-luciferase assay supported the direct interaction of miR-3658 with the 3'-UTR sequence of OCT4 gene. Unlike in HCT116 cells, overexpression of miR-3658 in SW480 cells brought about growth inhibition, cell cycle arrest and reduced cell migration, detected by flow cytometry, and scratch test assay. Overall, these findings demonstrated that miR-3658 as a tumor suppressor miRNA exerts its effect against OCT4 gene expression, and it has the potential of being used as a prognostic marker and therapeutic target against colorectal cancer.

Attitude of nursing students following the implementation of comprehensive computer-based nursing process in medical surgical internship: a quasi-experimental study.

BACKGROUND: The nursing process is the core and the standard of practice in nursing profession. Nowadays, the use of information technology in the field of nursing processes, education and practice has been emphasized. Since nurse's attitudes towards clinical information systems are considered as an indicator of the success rate of information systems, and nurse's attitudes about the nursing process can affect their execution of the process. So the purpose of this study was to evaluate nursing students' attitudes towards the nursing process software. METHODS: In this quasi-experimental study, 160 undergraduate nursing students (terms 4-8) in Tabriz University of Medical Sciences were selected by convenience sampling. To evaluate the effectiveness of nursing process software in this study, Mazlom and Rajabpoor (IJME 14(4):312-322, 2014) a questionnaire consisting of 21 components based on a five-point Likert scale was completed by students after using the software. Data were then analyzed by SPSS 19 software. RESULTS: The mean score of students' attitude toward nursing process software was high (80.70 ± 5.58). The nursing students' highest scoring attitudes were respectively related to "Effectiveness of software in prioritizing patient care and problems", "Completeness of patient's electronic information compared to handwritten mode" and "Software's effectiveness in saving your time". The lowest scoring attitudes towards the software was respectively related to the "feeling of fairness in labor division", "the effectiveness of the software in determining your workload" and "the feeling of satisfaction in labor division". There was a statistically significant relationship between gender and age, and student's attitude toward nursing process software. CONCLUSIONS: According to the results and analysis of nursing student's attitudes toward nursing process software, the use of such software would be welcomed by students. It seems that changing policies in the educational and clinical substructure of nursing in order to develop, adapt and use the nursing process software is an important responsibility for nursing authorities to consider. Providing educational and clinical technology equipment, periodic evaluation of software by stakeholders and promoting the use of this software, can be fundamental steps in operationalizing the findings of this research.

Using Newly Developed Software to Enhance the Efficiency of the Nursing Process in Patient Care: A Randomized Clinical Trial.

The nursing process is a systematic decision-making method of problem-solving that increases the quality of patient care. Implementation of modern technology in nursing can reduce documentation time, make nursing care safer, and improve the quality of patient care. This study aimed to determine the effectiveness of applying newly developed nursing process software on the efficiency of the nursing process in patient care. In this randomized clinical trial, 80 nursing students were randomly allocated into intervention (n = 40) and control (n = 40) groups. The student in the intervention group used the software to care for patients for two semesters. Students in the control group used routine hospital protocol to care for their patients. Modified Brooking nursing process measuring scale was used to evaluate the effectiveness of software before and after the intervention. The results showed a statistically significant difference in the mean efficiency score of the nursing process in the two groups after the intervention (P < .001). Using nursing process software leads to increasing the efficiency of the nursing process in patient care. Thus, providing executive support and electronic resources with relevant training for nursing students can be beneficial in students' education and be a practical application of the nursing process in caring for patients.

Iranian nurses' views on barriers to moral courage in practice: A qualitative descriptive study.

BACKGROUND: Nursing is a caring profession. Due to the nature of their work, nurses need to have the moral courage to deliver safe nursing care. Research results have reported a low level of moral courage in the majority of nurses. The current study aimed to identify the barriers to show moral courage in Iranian nurses. METHODS: This study was qualitative research that was conducted using conventional content analysis. Data was gathered using in-person, semi-structured, in-depth interviews. Interviews were conducted from March to September 2020. Purposeful sampling was used and sampling was continued until data saturation was reached. Participants were 19 nurses working in hospitals in Iran. RESULTS: According to data analysis, six categories and three themes were extracted. Themes are "organizational failure", "deterrent personal identity" and "defeated professional identity". CONCLUSIONS: The results of this study revealed the barriers to show moral courage which were usually overlooked in previous quantitative studies. It appears that the elimination of these barriers is an effective step in the improvemalet of nurses' competencies. The results of this study can be helpful in the developmalet of programs to address the factors affecting nurses' moral courage.

Potential drugs used in the antibody-drug conjugate (ADC) architecture for cancer therapy.

Cytotoxic small-molecule drugs have a major influence on the fate of antibody-drug conjugates (ADCs). An ideal cytotoxic agent should be highly potent, remain stable while linked to ADCs, kill the targeted tumor cell upon internalization and release from the ADCs, and maintain its activity in multidrug-resistant tumor cells. Lessons learned from successful and failed experiences in ADC development resulted in remarkable progress in the discovery and development of novel highly potent small molecules. A better understanding of such small-molecule drugs is important for development of effective ADCs. The present review discusses requirements making a payload appropriate for antitumor ADCs and focuses on the main characteristics of commonly-used cytotoxic payloads that showed acceptable results in clinical trials. In addition, the present study represents emerging trends and recent advances of payloads used in ADCs currently under clinical trials.

Efficient synthesis of new functionalized 2-(alkylamino)-3-nitro-4-(aryl)-4H-benzo[g]chromene-5,10-dione.

Structurally diverse benzo[g]chromenes were conveniently synthesized by one-pot, multi-component reaction of N-alkyl-1-(methylthio)-2-nitroethenamine (derived from the reaction of nitroketene dithioacetal with various amines), aromatic aldehydes and 2-hydroxy-1,4-naphthoquinone in CH3CN at room temperature within 10-25 min, without any catalyst. The notable advantages of the protocol are mild reaction conditions, absence of catalyst, very short reaction time, simple purification process involving no chromatographic process, compatibility with various functional groups and excellent product yields.

Saline vs. dextrose for local anesthetic dilution in brachial plexus block: A randomized study.

Higher sodium ions in saline diluted local anesthetic may reduce the anesthetic action of the drug as injected around the nerves. However, the impact of local anesthetic dilution agents on the quality of peripheral nerve blockades has not yet been widely investigated. This study was aimed at evaluating the impact of lidocaine dilution with normal saline vs dextrose 5% on onset time of supraclavicular approach to brachial plexus block. Sixty American Society of Anesthesiologists class 1or2 patients, scheduled for elective upper extremity surgeries under sono-guided supraclavicular block were randomly assigned to receive lidocaine 2% diluted with either dextrose 5% or normal saline. At the end of lidocaine injection, sensory and motor blocks were evaluated at 5 min intervals for 30 min in the areas innervated by median, radial, ulnar and musculocutaneous nerves. Block onset time and number of patients with complete sensory or motor blockade were similar in both groups. Lidocaine diluted with either normal saline or dextrose 5% produces comparable sensory and motor block onset time and success rate in ultrasound guided supraclavicular block.

Design, synthesis, and biological evaluation of novel 4-oxobenzo[d]1,2,3-triazin-benzylpyridinum derivatives as potent anti-Alzheimer agents.

Novel 4-oxobenzo[d]1,2,3-triazin derivatives bearing pyridinium moiety 6a-q were synthesized and screened against acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE). Most of the synthesized compounds showed good inhibitory activity against AChE. Among the synthesized compounds, the compound 6j exhibited the highest AChE inhibitory activity. It should be noted that these compounds displayed low anti-BuChE activity with the exception of the compound 6i, as it exhibited BuChE inhibitory activity more than donepezil. The kinetic study of the compound 6j revealed that this compound inhibited AChE in a mixed-type inhibition mode. This finding was also confirmed by the docking study. The latter study demonstrated that the compound 6j interacted with both the catalytic site and peripheral anionic site of the AChE active site. The compound 6j was also observed to have significant neuroprotective activity against H2O2-induced PC12 oxidative stress, but low activity against ß-secretase.

Synthesis of (E)-2-amino-N'-benzylidenehexahydroquinoline-3-carbohydrazide.

A one-pot, multi-component protocol for the synthesis of a new class of functionalized quinoline carbohydrazide derivatives via reaction of various anilines, dimedone, aromatic aldehydes, and cyanoacetohydrazide is described. The reactions are completed in the presence of catalytic amount of piperidine, respectively, in melt conditions and then in ethanol/water (1:1) as green solvent at 80 °C. Mild conditions, green medium, short reaction times, simple workup and purification process with no chromatographic technique, and good yields are the main advantages of this method.

Presence: the cornerstone of spiritual needs among hospitalised patients.

BACKGROUND: An important part of the spiritual needs of patients is 'presence'. The increased demand for holistic care has led to increased attention on 'presence' and its quality. AIMS AND OBJECTIVE: Given the importance of understanding the phenomenon of presence in order to promote the spirituality dimension among hospitalised patients, this study aimed to describe the lived experience of hospitalised patients in the context of presence. RESEARCH METHODS: This was a descriptive phenomenological qualitative study carried out on 12 admitted patients in general hospital settings. The data were collected through individual and semi-structured interviews. The Colaizzi method was used for analysing and interpreting the data, while the criteria of the Guba and Lincoln method were used to ensure the trustworthiness of these data. RESULTS: The experience of hospitalised patients concerning 'presence' appeared in the form of three main themes: 'multidimensional connection', 'receiving support' and 'dignity'. During hospitalisation, patients need to experience effective connection with the transcendent and individuals, and receive various types of comprehensive support, such that their and others' dignity is preserved. Patients considered that 'presence' was beyond 'being' and able to provide them with comfort. CONCLUSIONS: Patients' need is very important in the field of presence. In the social and religious context of Iran, in which both supernatural and human aspects of presence are emphasised, it seems that healthcare teams, health authorities and policymakers must provide an appropriate supportive environment in terms of providing a healing presence in its different dimensions.

Patients' perception of dignity in Iranian general hospital settings.

BACKGROUND: Dignified care is one of the main objectives of holistic care. Furthermore, paying attention to dignity as one of the fundamental rights of patients is extremely important. However, in many cases, the dignity of hospitalized patients is not considered. Dignity is an abstract concept, and comprehensive studies of the dignity of Iranian patients hospitalized in general hospital settings are limited. OBJECTIVE: The aim of this study was to explore the concept of dignity from the perspective of patients hospitalized in general hospital settings in Iran. RESEARCH DESIGN: This study takes a qualitative approach. Data were gathered using individual, semi-structured interviews. Qualitative content analysis was the method used to analyse and interpret the data. The criteria suggested by Guba and Lincoln were used ensure the trustworthiness of the study. PARTICIPANTS AND RESEARCH CONTEXT: A total of 14 hospitalized patients in general hospital settings in Shiraz participated in this study. ETHICAL CONSIDERATIONS: The Research Ethics Committee of the Shiraz University of Medical Sciences approved the protocol of the study and the ethical principles were followed throughout. FINDINGS: The findings of this study revealed four main themes - 'respectful atmosphere', 'patient privacy', 'preservation of authority' and 'receiving attention' - and 10 categories. DISCUSSION: Patients need to be hospitalized in a respectable environment in which their privacy is preserved and paid attention, providing them with sufficient authority in terms of medical decisions and their life-related issues. The dignity of hospitalized patients will be preserved under these conditions. CONCLUSION: Patients hospitalized in general hospital settings need to retain their dignity. This can contribute to the optimal therapeutic outcomes for them. Therefore, it is suggested that a cultural, professional and institutional background, in which all components of the patient's dignity are protected and emphasized, should be provided.

The relationship between nursing instructors' clinical teaching behaviors and nursing students' learning in Tabriz University of Medical Sciences in 2016.

Background: Clinical teaching is at the core of the nursing profession. However, clinical teaching may not empower students to gain clinical competency and skills. In this context, the performance of instructors is one of the main determinants of effective clinical teaching. Therefore, the present study aimed to determine the relationship between nursing instructors' clinical teaching behaviors and students' learning. Methods: This descriptive, correlational study was conducted with 267 nursing students selected through convenience sampling. The data were collected using the Nursing Clinical Teacher Effectiveness Inventory, developed by Knox and Morgan. The questionnaire included two parts: the extent to which nursing instructors used teaching behaviors and the effectiveness of these behaviors on students' learning. The data were entered into the SPSS statistical software, version 19, and were analyzed using descriptive and inferential statistics and the Pearson's correlation coefficient. Results: The results showed a significant positive relationship between the extent to which nursing instructors used teaching behaviors and the effectiveness of these behaviors on students' learning (P = 0.001). In terms of the utilization of teaching behaviors, the highest average rates were related to the dimensions of interpersonal relations and teaching abilities, while the lowest average rates were found for the evaluation dimension. With regard to the effectiveness of these teaching behaviors on learning, the dimensions of teaching ability and evaluation gained the highest and lowest average rates, respectively. Discussion: Instructors' capabilities have to be improved regarding the effective utilization of some behaviors related to evaluation, personal characteristics, and nursing competency. In this respect, the use of comprehensive teaching programs can be quite beneficial.

Experimental verification of a conserved intronic microRNA located in the human TrkC gene with a cell type-dependent apoptotic function.

Tropomyosin receptor kinase C (TrkC) is involved in cell survival, apoptosis induction and tumorigenesis. We hypothesized that, similar to p75(NTR) receptor, some of the diverse functions of TrkC could be mediated by a microRNA (miRNA) embedded within the gene. Here, we experimentally verified the expression and processing of two bioinformatically predicted miRNAs named TrkC-miR1-5p and TrkC-miR1-3p. Transfecting a DNA fragment corresponding to the TrkC-premir1 sequence in HEK293t cells caused ~300-fold elevation in the level of mature TrkC-miR1 and also a significant downregulation of its predicted target genes. Furthermore, endogenous TrkC-miR1 was detected in several cell lines and brain tumors confirming its endogenous generation. Furthermore, its orthologous miRNA was detected in developing rat brain. Accordingly, TrkC-miR1 expression was increased during the course of neural differentiation of NT2 cell, whereas its suppression attenuated NT2 differentiation. Consistent with opposite functions of TrkC, TrkC-miR1 overexpression promoted survival and apoptosis in U87 and HEK293t cell lines, respectively. In conclusion, our data report the discovery of a new miRNA with overlapping function to TrkC.

Practice of Iranian Adolescents with Hemophilia in Prevention of Complications of Hemophilia.

BACKGROUND: Prerequisite for management of a chronic disease involves knowledge about its complications and their prevention. Hemophilia in adolescents influences all the aspects of their lives and thier performance. OBJECTIVES: The present study aimed to determine the performance of Iranian hemophilic adolescents in prevention of disease complications. PATIENTS AND METHODS: In this descriptive-analytical study, 108 adolescents with hemophilia were selected through convenience sampling. Their performance in preventing the complications of hemophilia was evaluated by sending a semi-structured questionnaire to their addresses throughout Iran. Then, the data was analysed using the Statistical Package for Social Sciences (SPSS) software (v. 13) and descriptive and interferential statistics were used. RESULTS: Overall, 32.1% of the participants controlled bleeding during the 1(st) hour. Inaccessibility of coagulation products was mainly responsible for inhibiting timely and proper bleeding control. In order to relieve bleeding associated pain, only 39.0% of the adolescents used analgesics. On the other hand, 19.8% of the subjects used nonpharmacological methods to relieve pain. The majority of the adolescents did not participate in sport activities (65.4%) others allocated less than 5 hours a week to physical activities (70.5%). In addition, the participants did not have favorable dietary patterns, exercise habits, and dental care. The results showed a significant relationship between the adolescents' preventive practice with coagulation disorders and utilization of pharmacological pain relief methods. Also, significant relationships were found between severity of the disease; participating in physical activities, number of hours of physical activities; and disease complications. CONCLUSIONS: Iranian adolescents did not exhibit favorable practices towards complication prevention.

Temporal relationships between changes in depression and suicidal ideation: A mediation analysis in a randomized double-blinded clinical trial.

OBJECTIVES: There is a considerable debate regarding the possible dependence between depression and suicidal ideation treatments. The present study used a novel mediation approach in a randomized comparison of pharmacotherapy and combined therapy to explore whether depressive symptoms mediate the association between treatment and suicidal ideation and whether it depends on the treatment condition. DESIGN: This study is a randomized, controlled, parallel group (1:1), clinical trial using a novel mediation approach for longitudinal data. Latent difference score modelling was utilized to investigate whether changes in depressive symptoms drive subsequent changes in suicide ideation. METHOD: Participants were 94 depressive suicidal outpatients who were assessed regarding depressive symptoms and suicidal ideation over the course of an experiment (0-2-7 months). Direct and indirect associations between (change in) depressive symptoms and (change in) suicidal ideation were explored using Pearson's correlations and latent difference score model. RESULTS: The results showed that depression treatment affects not only suicidal ideation directly but also its influence on suicidal ideation occurs via improvement in depressive symptoms. It was found a more significant effect of combining pharmacotherapy and PPT (in comparison with the pharmacotherapy alone) on the early and late improvements of suicidal ideation (Δ 0-2 and Δ 2-7) via the early improvement of depressive symptoms (Δ 0-2). CONCLUSIONS: The findings indicate that changes in depressive symptoms preceded changes in suicidal ideation. Our results highlighted that improving depressive symptoms could be a primary target in treating patients with depression experiencing suicidal thoughts.

The effect of mobile-based logotherapy on depression, suicidal ideation, and hopelessness in patients with major depressive disorder: a mixed-methods study.

Major depressive disorder is one of the most common psychiatric disorders in the world. It is essential to study and use effective, available, and affordable psychotherapy methods along with drug therapy to manage the symptoms of this disease. Therefore, the current study aimed to determine the effect of mobile phone-based logotherapy on depression, suicidal ideation, and hopelessness in patients with major depressive disorder by using a mixed-methods approach. In the first phase of this mixed-methods study, 70 patients completed the quantitative phase (control group = 35, intervention group = 35). The intervention group received an 8-week mobile-based logotherapy program via WhatsApp (one 180-min module per week) combined with sertraline, while the control group received just sertraline plus education about pharmacotherapy. Data was collected before, immediately after the intervention, and 3 months later using the Beck depression inventory short form items (BDI-13), the Beck hopelessness scale (BHS), and the Beck scale for suicide ideation (BSSI). Then, a qualitative study on the intervention group was conducted to explain the findings of the quantitative phase. The repeated measure MANOVA revealed a significant interaction effect of time and group on the set of dependent variables (F(6,63) = 25.218, P < 0.001). Qualitative analysis confirmed the efficacy of sertraline plus mobile-based logotherapy on depression, suicidal ideation, and hopelessness in the intervention group. Three key themes extracted from the participants' experiences of mobile-based logotherapy were "efficient instruction", "user-friendly intervention" and "constructive change". Mobile-based logotherapy through WhatsApp was an effective psychotherapy method for decreasing depression, hopelessness, and suicidal ideation in patients with major depressive disorder. It is suggested that educational, institutional, and technological infrastructure for providing and using mobile-based logotheapy for patients with major depressive disorder be considered in the mental health care system.

Positive imagery in depressive suicidal patients: A randomized controlled trial of the effect of viewing loved ones' photos on mood states and suicidal ideation.

According to research, it has been suggested that individuals who are affected by depression could potentially engage in the creation and experience emotional advantages relating to positive events directed towards the past or future, with the condition that they are provided with suitable mental imagery techniques. The main aim of this study was to assess the impact of utilizing positive imagery, specifically through the utilization of photographs featuring loved ones, on mood states and suicidal ideation among individuals diagnosed with depression and exhibiting suicidal tendencies. This randomized, double-blind, controlled crossover trial was conducted among 78 hospitalized depressive patients at three psychiatric services between April and August 2019. The patients participated in four individual picture-viewing sessions on four consecutive days. The four categories of pictures were included: loved ones, neutral faces of strangers, natural landscapes, and optical illusions. Directly prior to and immediately following the observation of the visual stimuli (photographs), the Brunel Mood Scale (BRUMS) and the Beck Scale for Suicide Ideation (BSSI) were completed by the patients. Repeated measures ANOVAs conducted in this study revealed a significant main effect of time on ratings of tension, depression, fatigue, vigor, calmness, and happiness (P values < 0.001). Additionally, statistically significant interactions were identified between picture category and time in relation to the variables of tension, depression, fatigue, vigor, calmness, and happiness (P values < 0.001). The analysis did not reveal a significant main effect of time on ratings of anger, confusion, and suicidal ideation (P values > 0.05). Likewise, the interaction between picture category and time did not yield significant results for the variables of anger, confusion, and suicidal ideation (P values > 0.05). The positive imagery procedure using the presentation of loved ones' photos showed beneficial effects on the mood states of depressed patients. The findings of this study suggest that incorporating a greater emphasis on positive imagery within the context of clinical depression may offer potential advantages. This highlights the potential for novel opportunities in the treatment of depression. Trial registration: The study has been registered in the Iranian Registry of Clinical Trials (registration number: IRCT20180808040744N1; first registration date: December 22, 2018; website: https://en.irct.ir/trial/33186).

Performance evaluation of buildup bolus during external radiotherapy of mastectomy patients: treatment planning and film dosimetry.

A buildup bolus is used during the post-mastectomy radiotherapy (PMRT) to overcome under-dosage issues in the chest wall. The current study is aimed at evaluating the performance of a bolus in dose enhancement through both film dosimetry and treatment planning approaches. Twenty patients were enrolled in current research. The received dose by the skin at the lateral and medial regions of the chest wall in the presence and absence bolus was evaluated. Film dosimetry results showed that the presence of the bolus can averagely increase the skin dose by about 80% (P value < 0.001) and 92% (P value < 0.001) in lateral and medial regions, respectively. No significant difference was observed between the measured and treatment planning system (TPS)-calculated dose values in the presence of bolus. The presence of the bolus can considerably increase the absorbed dose by superficial chest wall regions. The TPS shows a favorable performance in superficial dose calculations in the presence of the buildup bolus. Hosseini et al.: demonstration of implemented research in the current study.