فهرست مطالب مختار محمودی

The triage system of the emergency department prioritizes patients to receive medical care, and errors in prioritizing patients can have serious consequences. This study aims to evaluate the Performance Emergency Severity Index in the triage of trauma patients referred to the emergency department of Ashayer Shohada Khorramabad Hospital in 2023.

The current cross-sectional study was conducted using an available sampling method on 375 trauma patients referred to the emergency department. First, the reliability of the Emergency Severity Index (ESI) triage was calculated by examining the agreement between observers (inter-rater reliability) and Cohen's kappa statistical test. Then, to validate the levels of severity, in the absence of a gold standard, the outcome of trauma patients was used as an alternative marker. Researchers compared the results of nurse's triage for each of the outcomes, and based on this comparison, the validity of ESI triage was evaluated in terms of heavy and light triage. The obtained data were analyzed using STATA-17 software, and the chi-square test was used to validate the triage. A value of P<0.05 was considered statistically significant.

The findings of the present study showed that the percentage of patients assigned to levels one; two, three, four, and five were 2.94, 15.2, 61.6, 12.53, and 7.73, respectively. Kappa calculated from the inter-rater agreement for ESI triage was determined to be 0.7. The ESI triage system generally had an error in 23.2% of the performed care prioritization.

According to findings, ESI triage has high inter-rater reliability in performance. In terms of validity however, it needs a serious review, and most of the trauma patients are placed at the level of three ESI triages, and a large collection of undifferentiated patients is created, which weakens the main purpose of triage.

Due to the high mortality of patients admitted to the intensive care unit, the provision of high quality nursing care, especially for patients admitted to these wards, is of great importance, so the quality of death and dying in these wards is necessary. The aim of this study was to determine the quality of dying and death from the perspective of nurses working in intensive care units.

The present study was performed cross-sectional in the teaching hospitals of Kurdistan University of Medical Sciences. The research samples in this cross-sectional study were 105 nurses working in intensive care units who were selected by census. Data collection tools included two sections: demographic information, Quality of Dying and Death Questionnaire (QODD).

The results of the present study showed that the mean and standard deviation of the quality of dying and death variable were 37.15±13.47 and below the mean. Among the items related to the quality of death, the highest average was related to receiving appropriate sedation during the stay in the intensive care unit (5.80±2.41) and being touched or hugged by loved ones (4.90±2.78) and the lowest average quality of care was related to having a spiritual ceremony before the patient's death (2.12±2.59) and having one or more visits to a religious or spiritual counselor (2.24±2.66). There was a statistically significant relationship between the quality of dying and death and the history of passing training courses related to dying and death (P=0.03).

It is recommended to hold training courses related to quality dying and death care criteria for personnel working in intensive care units, as well as to evaluate the quality of mortality care from the perspective of the families of patients admitted to the intensive care unit.

It is clear that The Covid-19 pandemic has disrupted an education system like other areas of society. The current research aimed to investigate faculty members' and medical students’ perceptions towards E-learning challenges during the Covid-19.

This qualitative study was performed by purposive sampling among students (N=16) and faculty members (N=6) in Sabzevar University of Medical Sciences in 2020. After obtaining informed consent from the participants, all semi-structured interviews were recorded one by one, handwritten, and analyzed by qualitative content analysis. To assess the accuracy and reliability of data was confirmed from various methods. 

From the data analysis, two main themes include "turmoil in the organization" (with the main classes of technical concerns, time concerns, and educational alienation) and "organizational uncertainty" (with the main classes of fundamental inconsistency and managerial inconsistency) were extracted.as virtual educational challenges.

Based on the result, there are challenges of management and organization in relation to managers' emphasis on the importance of e-learning and the issue of supporting these training. Paying attention to the challenges and obstacles in e-learning can greatly improve the quality of higher education.

Swap as one of the new methods of international trade can have a great impact on solving the country's economic problems. This contract has become widespread in the field of international trade. But no research has been done on its advantages and disadvantages in Iran. The present article examines the issue using library resources and answers the question: What are the benefits of swap contracts? And what effect can it have on the country's economic development? It concludes that the swap can prevent the negative impact of price changes on the value of assets and cover the risk of commodity, currency and interest rate fluctuations. Swaps reduce the cost and time of moving goods and currency, and boost the country's transportation, eliminating intermediary currency and using the national currency, and making sanctions ineffective. So the swap has a very positive effect on economic development, but there are also criticisms of it, which is that this contract increases crude sales and reduces domestic production and the value of the national currency. But the important point is that in addition to economic benefits, swaps have significant benefits in political convergence. Communicating with countries around the world through swaps provides political and security benefits, as well as access to the consumer markets for the sale of Iranian goods.

The Pender’s health promotion model is a framework used for determining health-promoting lifestyle behaviors in people with chronic diseases. This study aims to investigate the effect of educational intervention based on the Pender’s health promotion model on the lifestyles of patients with diabetic foot ulcers.

In this clinical trial conducted in 2019, 74 patients were selected based on inclusion criteria by convenience sampling and allocated into two groups, the intervention and control, using the randomized block method. Both groups completed the demographic characteristics- and the Health-Promoting Lifestyle Profile Questionnaires. Data obtained were analyzed using SPSS 16, using descriptive & comparative statistical methods, including independent t-test, paired t-test and ANCOVA.

After the intervention, a significant increase was observed in the average score of the intervention group in all lifestyle dimensions (P<0.001). Comparing the changes in the average scores of lifestyle and its dimensions in both groups 50 days after the intervention, an increase was observed in the average scores of lifestyle and its dimensions in the intervention group, compared to those in the control group (P<0.001).

Educational intervention based on the Pender’s health promotion model can promote the lifestyles of patients with diabetic foot ulcers, results of which can be used in educational interventions aimed at patients with diabetic foot ulcers to change their lifestyles.

The use of swap contracts as a new method of trade has become internationally widespread and results tosome important advantages such as reduction of shipping costs, time saving in movement of the goods and elimination of export and import risk. The increasing significance and prevalence of such contracts, give rise to some questions including: what are the nature and characteristic of the swap contract in the Iranian legal system? Is there any similar concept to the swap contract in our domestic law? The present article considers similar legal concepts in response to the questions and comes to the conclusion that swap is an innominate contract under Article 10 of the Iranian Civil Code based on party autonomy. Despite undeniable similarities with barter contract, swap has a particular nature,the subject matter of the contract usually consists of fungible goods and includes special obligations based on mutual agreement of the parties as a general rule. Accordingly, the swap contract has its own specific characteristics, which have been examined in detail.

Regarding the importance of nursing education promotion, there is a need to use methods that have the ability to create knowledge and skills in students. This study aimed to assess the effect of education (problem base learning, cooperative training and routine approach to clinical education) on critical care nursing student's clinical learning, anxiety and satisfaction.
This quasi-experimental study performed in the intensive care unit (ICU) of Amir Al Moemenin hospital in Arak, Iran, during 2015-2017. The subjects were 60 nursing students who were selected via Fixed blocked randomization method and randomly were allocated into three groups (60 subjects). After the administration of pretest, students in control group were educated using common method; in one of the experimental groups, the cooperative learning and for other experimental group, problem- based learning was used for 9 days. Then, the three groups completed the questionnaires at the end of education again. Finally, data were analyzed using SPSS version 16 (analysis of variance, Chi-square, Kruskal-Wallis, Wilcoxon, Fisher).
The mean total score of the learning was significantly difference among three groups after the intervention. after intervention, the mean of learning was in problem based solving and collaborative learning higher than usual method. There was no significant difference between means of satisfaction and anxiety in three teaching methods.
It seems that two methods of problem-based learning and cooperative training enhanced clinical skills of students. Therefore, it is recommended to use these two methods to enhance students’ clinical learning.

Myocardial infarction is one of the main causes of death and disability in the world. Adherence of therapeutic regimen is an important caring option in these patients. This study has been conducted to determine the effect of family-centered education on laboratory index of patients after acute myocardial infarction.
This clinical trial was performed between October and March 2014 in CCUward of Amirkabir hospital of Arak. Research samples were 60 patients with 30-70 years old who had been selected by convenience method after the first heart attack and randomly assigned into two groups: control (patient-centered education: 30 individuals) and intervention (family-centered education: 30 individuals). On admission, blood sugar and blood lipids (Chol, TG, HDL, LDL) were examined. Theneducation to patients was done in the intervention group associated with close family member through computers in three domains (diet, pharmaceutical regimen and exercise program) in three sessions of 30-45 minutes and the same educational content were taught to the patient (without family members) in the control group. Three months after the intervention, all aforementioned items were recorded again in two groups and, finally, data were analyzed using independent t-test and Chi-square test.
The results indicated that laboratory indexincluding blood sugar (P=0.03), blood lipids (P=0.0001) in the family-centered group was better than patient-centered group. However, there was not a significant difference between the two groups in aforementioned items before the intervention (P> 0.05).
According to the findings of this study, it seems that family-centered education model improves laboratory index of the patients with myocardial infarction. It is recommended that the educational interventions for the patients with myocardial infarction to be done with the participation of the family.

Musculoskeletal disorders are one of the most common causes of occupational injuries in nursing. The purpose of this study was to evaluate the effect of education of occupational safety on knowledge and improvement of employee performance during moving patients in intensive care units of hospitals.
This study is an educational trial and was accomplished in Amiralmomenin and Vali-e-Asr educational hospitals in Arak. 60 subjects (nurses, health workers and services) were randomly divided into intervention and control groups. In both groups, the rates of musculoskeletal disorders are assessed. Then intervention group was trained for safety instructions during moving patients, but the control group was not. Data analysis was performed using SPSS software version 20.
Results showed that before intervention, both groups based on demographic characteristics and musculoskeletal disorders did not have significant different (P> 0.05). In intervention group a significant difference between knowledge level of before (12.73± 6.61) and after the intervention (88± 19.27) was seen (P 0.05).
The results showed that increasing the knowledge level of nurses and health workers about correct transportation of patients in intensive care units have had a surprisingly effectiveness on their knowledge levels and performances.

Aims: The installation of intravenous catheter is an unpleasant and painful experience for many patients. Then, it is necessary to provide new methods to either reduce or remove pain in the patients’ injection point. The aim of this study was to investigate the effects of positioning (either sitting or lying) during the installation of intravenous catheter on pain level and the following anxiety in the patients.
Instrument & In the two-blinded clinical trial study, 60 patients hospitalized in the internal wards of Arak Amir-Al-Momenin Hospital were studied in 2015. The subjects selected via available method were divided into two groups including sitting and supine groups based on the simple random allocation. The pain severity and anxiety severity indices were investigated in both groups before and after the venipuncture based on the visual analogue scale (VAS). Data was analyzed by SPSS 20 software using Chi-square, paired-T, and independent T tests.
Findings: Mean scores of anxiety before the venipuncture in both groups were not significantly different (p>0.05). Nevertheless, after the venipuncture, mean anxiety score and mean pain score in sitting group were significantly more than supine group (p=0.0001). In addition, mean scores of anxiety before and after the venipuncture in the supine group were significantly different (p=0.0001). However, no significant difference was observed between the scores before and after the venipuncture in sitting group (p>0.05).
During the installation of intravenous catheter, the supine position can reduce the pain level and the following anxiety in the patients compared to the sitting position.

Lipid disorders of the most important factors involved in the development and progression of cardiovascular lesions, The aim of this study was to evaluate the role and use of a combination of honey and apple cider vinegar on blood lipids in patients with hyperlipidemia is.
This study was clinical trial and its demonstrate in in Amiralmomenin and Vali- Asr hospital. 30 samples were selected that For one group before and after the intervention by ethical satisfaction. For subsequent investigations, levels of blood lipids are measured at the beginning of and 4 weeks after the intervention for the participants in groups using blood tests, in the intervention group administered one tablespoon each honey and apple vinegar in a glass containing 200cc water twice a day in addition to their usual lipid-lowering drugs. After 4 weeks, levels of blood lipids were measured in groups and were analyzed by SPSS v.20.
after intervention, result shown that TG Min & Sd before 314.13(79.8) and after164.56(42.9), CHOL(Min & Sd before 256.8(58.13) and after137.7(31.26), LDL Min & Sd before 185.4(48.6) and after120.43(25.07), have significant difference with group, and HDL) Min & Sd before 43.30(10.6) and after64.03(16.1), increased after intervention.
This study demonstrated that a combination of honey and apple vinegar is very effective role in reducing bad fats and good fats increase in patients with high blood fat.

Regarding the importance of nursing education promotion, there is a need to use methods that have the ability to create knowledge and skills in students. This study aimed to assess the effect of education (inquiry, bedside education and routine approach to clinical education) on critical care nursing student's clinical learning.
This quasi-experimental study performed in the intensive care unit (ICU) of Valiasr hospital in Arak, Iran, during Octobers to March 2014. The subjects were 60 nursing students who were selected via census method and randomly were divided into three groups of 20 subjects. After the administration of pretest, students in the control group were educated using common method; in one of the experimental groups, the inquiry-based method and the other group, bedside method were used for education for 10 days. Then, the three groups completed the questionnaires at the end of education again (posttest). Finally, data were analyzed using ANOVA, paired-t and independent-t tests.
The mean total score of the clinical skills and cognitive domain was significantly difference among the three groups after the intervention (F = 136.75, degree of freedom = 2, P = 0.0001). After testing the homogeneity hypothesis of variances and using Games-Howell post-hoc tests, the total scores of training in bedside and inquiry-based education were significantly more than the routine training after the intervention (P It seems that two methods inquiry-based and bedside education enhanced clinical skills of students. Therefore, it is recommended to use these two methods of clinical educating to enhance students’ clinical learning.

The studies on animal models have shown positive effects of Kelussia odoratissima on different health problem cases including digestive disorders. However, there has been no research on the effectiveness of Kelussia odoratissima on peptic ulcers in humans. In this study, "the effect of Kelussia odoratissima on the rate of improvement in patients with peptic ulcer" has been investigated.
The present study was a Randomized clinical trial which is done in March- September, 2015 in Amir Al-Momenin Hospital in Arak, Iran. The subjects were 60 patients with peptic ulcer, selected by simple random sampling and acquiring their informed consents. After taking written informed consent, they were divided into two groups randomly: the control group (administering prescribed medicines) and the intervention group (administering medicines along with Kelussia odoratissima powder). One month after intervention, the types of peptic ulcers were determined by follow-up endoscopy. Finally, the data was analyzed using SPSS v. 16 and statistical independent samples t-test and Fisher’s exact test.
The two groups were homogenous in terms of demographic features. The findings showed that the groups were not significantly different regarding the type of peptic ulcers (p= 0.91) before intervention; but one month after intervention, the highest frequency in the control group was related to the ulcers Type II and III, and the lowest frequency to the ulcers Type I, while the highest frequency in the intervention group was related to the ulcers Type I and the lowest frequency to the ulcers Type III and higher. Accordingly, Fisher’s exact test showed a significant difference between the two groups (p=0.008).
Given the results of the present study, it seems that administering Kelussia odoratissima powder along with the medicines effective for treating stomach ulcers has a positive effect on patients with peptic ulcer.

One of the most important needs of hospitalized patients in intensive care units is patients visiting by their family members, but it is very limited in these units. The aim of this study was to determine the effect of increased visiting to patients’ time on pain and level of consciousness of hospitalized patients in intensive care units. In this clinical trial, 60 hospitalized patients in intensive care units of Vali-Asr Hospital in Arak City, Iran, in 2013-2014 were selected by convenience sampling method and were randomly assigned into intervention and control groups. Each visiting was done for 10 minutes, 3 times a day (9- and 12am and 15pm) in the intervention group and for 10 minutes once a day (15pm) in the control group. Then patients’ pain and level of consciousness was measured before, during, and after 10 and 30 minutes of visiting by family. Data was analyzed in SPSS 20 software using Chi-square, paired T, independent T, and repeated measure ANOVA tests. There was no significant difference between pain and level of consciousness between 2 groups before intervention (p>0.05). There was no significant difference between the means of pain and level of consciousness before and 30min after the visiting at 15pm in control group (p>0.05). There were significant differences between the means of pain before and 30min after visiting at 9am, 12am and 15pm in intervention group (p<0.05), but no significant differences were seen in the level of consciousness (p>0.05). Increasing the time of visiting to patients decreases the pain of the hospitalized patients in intensive care units.

Weaning from mechanical ventilator due to the direct effect on patient’s physiologic indices is very risky action and if it is unsuccessful, it can lead to re-intubation of patient. The aim of the current study was to compare the effect of two weaning methods from mechanical ventilation “SBT” method with “SIMV” on physiological indices of ventilated patients.
In this clinical trial study, 44 intubated patients in intensive care units of one of the hospital in Arak in 2014 were selected through convenience sampling and then were randomly allocated into two intervention and control groups (each group 22 persons). In intervention group SBT method and in control group SIMV were used as weaning method from ventilation. Data collection was done thorugh using physiological indices and GCS score before, during and after the intervention Data were analyzed by using SPSS 20, paired T-test, independent T-test, repeated measures ANOVA and Greenhouse-Geisser.
In SBT group, the means of systolic blood pressure was (107.90 ± 5/2), heart rate (70.27 ± 7.2), respiration rate (14.90 ± 1.06) had significant reduction after intervention (from 9 to 12 Am) (p The results showed that “SBT” method leads to improvement of systolic and diastolic blood pressure, heart rate, Pao2, O2sat and level of consciousness of patients in intervention group. It is recommended to apply of this weaning method in intensive care unit.

Due to the growing complexities of health care, the use of methods that improve the ability to think critically, decision-making and problem-solving in nursing is mandatory. This study aimed to determine the effect of inquiry-based learning on student's performance skills, satisfaction and clinical environments. This study was carried out with the aim of determining the effect of inquiry-based teaching on student's operational skills and satisfaction in clinical environments.
This clinical trial was conducted in the ICU unit of Valie Asr hospital of Arak in 2014. A total of 40 nursing students were selected through census method and randomly divided into two 20-member groups. After the pre-test, students in the control group and those in the intervention group received conventional (traditional) and inquiry-based training for 10 days, respectively. At the end of training, both groups took post-test. Finally, independent and paired-t and chi-square tests and using SPSS.V16 software were analyzed.
The results showed that there was no significant difference between the two groups in clinical skills prior to training. But after the intervention, the intervention group scores in the areas of clinical skills such as arterial blood sample preparation (P=0.0001), connection to ventilator (P =0.0001), suction (P =0.0001), tube feeding stuffs (P =0.001) and skin care (P =0.001) were significantly higher than in the control group. Satisfaction points in the intervention group with a mean of 12/75±16/76 was significantly higher than those of the control group with a mean of 7/51 ± 10/06 was (P=0.042).
Inquiry-based training, compared to the usual method, leads to an improvement in clinical skills and the satisfaction of nursing students. Hence, it seems that this educational method is effective and beneficent for teaching clinical reasoning and practical procedures.

Symptoms and complications of menopause affect menopausal women’s quality of life. In order to control these symptoms and improving their quality of life, this study was done to evaluate the effect of Glycyrriza glabra on quality of life in postmenopausal women. This Randomized clinical trial was carried out between Octobers to March 2014 at Arastoo clinic in Arak. Samples were 60 postmenopausal women which were selected by convenient method and after obtaining informed consent were randomly allocated into two groups. The first group received three Glycyrriza glabra tablets (containing 380 mg extract) three times daily for one month at morning, noon and night. The second group received placebo. Quality of life was investigated by Menopause Quality of Life Questionnaire (MENQOL) before and one month after the intervention. Data was analyzed under SPSS V.16 using Chi-square, ANOVA, and Mann-Whitney tests. Both groups were similar in terms of demographic characteristics. Results indicated that before the intervention there was no significant difference among the two groups in total quality of life (p=0.001), and vasomotor (p=0.181), psychosocial (p=0.145), physical (p=0.711) and sexual (p=0.51) dimensions. But one month after the intervention there was significant difference among the two groups in total quality of life (p=0.001), and vasomotor (p=0.001), psychosocial (p=0.001) and physical (p=0.001) dimensions. According to the results, consuming Glycyrriza glabra was effective in improving quality of life in menopausal women.