محمدعلی ذاکری

Medication adherence is one of the most significant factors in optimally controlling cardiovascular disease.

The aim of this study was to determine the effect of Health Belief Model (HBM)-based education on medication adherence of cardiovascular patients.

In this quasi-experimental study, participants were 45 patients discharged from CCU ward of Ali Ibn Abitalib Hospital in 2020, Rafsanjan, Iran. Participants allocated into intervention or control group by simple randomization. For five weeks, the intervention group received weekly medication adherence educational package using a mobile phone application, through the WhatsApp messenger. The control group received routine care. Data collected using demographic questionnaire and Morisky Drug Adherence scale as well as the researcher-made HBM questionnaire, before and three months after the intervention. The data were analyzed by descriptive and inferential statistics and independent samples t-test, chi-square test and repeated measures ANOVA.

The drug adherence scores of the patients in the intervention group (6.63 ± 1.71) significantly increased than control group (5.29 ± 1.85) three months later (P = 0.006). Moreover, the mean score of the components of the HBM included perceived benefits, perceived self-efficacy and perceived barriers were significantly increased in the intervention group (P < 0.001)

Health Belief Model-based education through WhatsApp Messenger promote the drug adherence of cardiovascular patients, through improving self-efficacy, improving the understanding of the benefits as well as reducing perceived barriers. Therefore, utilizing this method may be a practical solution toward enhancing the drug adherence of cardiovascular patients.

Caring behaviors are crucial in intensive care units (ICU) because patients in these wards require high levels of care. Effective communication with patients is one of the most important factors in the caring behaviors of nurses working in ICUs. This study aimed to evaluate the effect of therapeutic communication skills training on the caring behaviors of ICU nurses. This experimental pre-test/post-test study was carried out on 105 nurses working in ICUs of hospitals affiliated with Yazd University of Medical Sciences in Iran in 2019. Nurses were randomly assigned into control (52 nurses) and intervention (53 nurses) groups. A two-day therapeutic communication training workshop was conducted for the participants. Data were collected using a demographic information questionnaire and caring behaviors questionnaire before and one month after the intervention. The findings showed no significant difference between the control and intervention groups regarding the nurses' caring behaviors in the pretest (P=0.148). However, after the implementation of the training program, a significant difference was observed in the mean scores of caring behaviors between the two groups. In the control group, the mean scores of caring behaviors decreased significantly after the intervention (P=0.001); whereas, the mean scores of the intervention group increased significantly after the intervention (P=0.001). According to the results, ICU nurses' training in therapeutic communication skills had a positive effect on their caring behaviors. Therefore, we suggest the authorities prepare and implement educational packages of therapeutic communication skills as a coherent program for other nurses. As a result, the caring behaviors and the quality of care can be improved for patients.

Takotsubo cardiomyopathy (TC) is characterized by transient systolic dysfunction, presenting with electrocardiographic (ECG) changes and mimicking acute coronary syndrome (ACS). Studies have shown that 95% of patients have changes in ECG. ECG changes in TC syndrome may be similar to myocardial infarction )MI(. ECG changes can be seen in the form of ST-segment elevation or deep T-wave inversion. TC can be considered a special form of ACS. TC is not a benign entity, and conduction abnormalities can occur. The acute phase can be predicted based on decreased EF and arrhythmia. Different treatments are used in the acute phase of TC, depending on the hemodynamic condition. Our case elucidates the importance of age, female gender, symptoms, such as stress and emotion, clinical manifestations, ECG characteristics, and echocardiography in TC. This paper describes a case of TC from a hospital affiliated to Rafsanjan University of Medical Sciences. The case was a 75-year-old woman with no history of cardiovascular diseases who has been admitted to the hospital with myocardial infarction.

Information about COVID-19 patients must be studied meticulously to control the COVID-19 pandemic more effectively. This study aimed to evaluate the clinical and epidemiological features of COVID-19 patients in Rafsanjan County.

In this descriptive study, data of 3,212 patients referred to the Ali-Ibn Abitaleb Hospital in Rafsanjan County, Iran were recorded. Collected data included demographic information (age, sex, etc.), information about the method of referral to the hospital, contact history, previous history of infections, clinical symptoms associated with the disease, and data on comorbidities. Data were analyzed using a chi-square test and logistic regression coefficients.

The three common clinical symptoms were fevers (46%), muscular pain (44.6%), and coughs (34%). The most common comorbidity was hypertension (7.9%), and the case fatality rate was 10.8%. Besides, the death ratio in confirmed patients was significantly higher than that in suspected cases (P < 0.001). The chance of death in men was 16% higher than Women's (OR = 1.166). The chance of death in people with cancer and in people with reduced levels of consciousness was 9.1 and 5.5 times, respectively, higher than that in patients without comorbidity (P < 0.001).

Most of the features of our patients resembled those reported in previous research. The results of this study can contribute to healthcare policymaking for this disorder.

Nurses are front-line health-care workers for patients with severe Coronavirus disease (COVID-19) symptoms. The aim of this study was to determine the resiliency of nurses and its relationship with secondary traumatic stress (STS) in pandemic conditions. This cross-sectional study was performed on 233 nurses working in a medical center providing services to patients with COVID-19 in southeast Iran from May to August 2020. Data were collected using demographic questionnaire, Connor-Davidson Resilience Scale (CD-RISC) and The Secondary Traumatic Stress Scale (STSS). Pearson correlation coefficient was used to determine the relationship between variables and data were analyzed through SPSS22. The mean STS score of nurses was 40.82 ± 11.7. The results showed a significant relationship between STS score and Job satisfaction. The mean score of resilience was 60.91± 17.1 in nurses. The resiliency score showed significant difference based on work experience and exposure to COVID-19 disease. The results of correlation test showed that the overall stress score was significantly related to all aspects of resilience except trust (p < 0.05).  Also, based on the multiple regression model, positive acceptance (one of the dimensions of resilience) and exposure to COVID-19 disease were the predictors of STS.  The results showed that there is a significant and inverse relationship between resiliency score and STS. Therefore, according to the present conditions, it is recommended to design programs to improve resilience and reduce stress of nurses during COVID-19 pandemic.

The professional quality of life (ProQOL) and occupational burnout are two central factors related to nurses' job performance. Nurses' job performance might be affected by work stress and compassion. In the present study, the association of ProQOL of nurses with burnout, depression, anxiety, and stress was investigated.

In this descriptive study, 282 nurses were invited to help with the survey. Demographics Scale, Maslach Burnout Questionnaire, Depression, Anxiety and Stress Scale (DASS-21), and ProQOL Questionnaire were used to collect the data.

Most participants have an average degree of compassion satisfaction (CS) (63.2%) and compassion fatigue (CF) (57.1%). Also, most nurses had low scores for occupational burnout (39.3%). A significant negative correlation was found between CS with CF (p < 0.001). Occupational burnout (p = 0.019), anxiety (p = 0.015), and depression (p < 0.008) subscales had a significant negative correlation with CS. There was a significant correlation between the CF and subscales of occupational burnout, anxiety, stress, and depression (p < 0.001). The CF predicted 18% of variance in CS (R2 = 18%) (p < 0.001). The CS, depression, and occupational burnout predicted 25% of variance in CF (R2 = 25%) (p < 0.001).

In this study, the CS, depression, and occupational burnout were important variables affecting the level of CF. Healthcare service leaders and nurse managers should make efforts promoting emotional wellbeing among nurses. Therefore, future studies need to pay more attention to the CF and its associated factors.

The Coronavirus (COVID-19) pandemic can have many adverse personal and professional consequences for physicians and medical students. Therefore, the present study aimed to investigate the psychological consequences of the COVID-19 disease in physicians and medical students during the pandemic.

Using the census method, this cross-sectional study was conducted on 132 physicians and medical students working in Rafsanjan hospitals, Kerman province, Iran, from May to August 2020. General Health Questionnaire (GHQ-28), Generalized Anxiety Disorder 7-item (GAD-7), and Impact of Event Scale (IES) were used to collect data. The data were analyzed using SPSS 22, and descriptive and inferential statistics (Chi-square and Multiple logistic regression) methods were applied.

More than half of the participants were female and married. According to GHQ, fifty-one and a half of the participants had psychological disorders. Based on the results, 24.2% of the participants had GAD, and 33.3% had PTSD. The results also showed that only occupation significantly correlated with psychological disorders (P = 0.01). The risk of psychological disorders in medical students was 2.38 times higher than among physicians (OR= 2.38, 95% CI= 1.11- 5.10, P = 0.026).

Physicians and medical students were faced too much stress in the COVID-19 pandemic. They were at great risk of mental health disorders and the psychological consequences of COVID-19 due to their job condition. Managers and health policymakers need to take the necessary mental health interventions to reduce such risks.

Self-management is considered an important factor for change of behavior and health care to reduce disability in patients with myocardial infarction (MI). Continuous care model (CCM) is a plan that improves knowledge, practice, and attitude of patients toward health care. This study aimed to investigate the effect of CCM on self-management in patients with MI.

This study was a controlled trial conducted on patients with MI, admitted to cardiac care units in one of the eastern cities of Iran. 82 eligible patients were selected and randomly assigned into two groups of CCM and control. In the intervention group, 4 to 6 educational sessions (1 to 2 hours) with a follow up period were conducted. The mean score of self-management was assessed in both groups at the beginning of the study, after training and after follow-up of the model.

Mean score of self-management significantly decreased in both intervention and control groups immediately after the implementation of CCM and follow up of the study (P < 0.001). Considering that in the questionnaire, the lower score indicates a better situation, there was a significant difference between the two groups at different times regarding self-management score. After the study, the self-management score in the follow-up care group was significantly lower than that of the control group.

Implementation of CCM is recommended to improve self-management skills in patients with MI, and further studies are needed in other chronic patients.

Obesity and overweight in children and adolescents have become a global problem in recent years. Adolescence increases the likelihood of obesity in adulthood and associated illnesses. Nowadays, health literacy is one of the greatest determinants of the health. This study was conducted to evaluate the correlation between body mass index (BMI) and health literacy in high school students.

In this descriptive‑analytical study, 430 high school students were enrolled in a multi‑stage random method in Yazd city in the center of Iran. The data were collected through The Health Literacy Measure for Adolescents and calculate BMI with measurement of height and weight of adolescents. The data were then analyzed using SPSS 25 and descriptive and inferential statistics (Chi‑square and multivariate regression).

The results showed that the mean score of BMI (21.76 ± 3.76) was in a normal range. The score of health literacy was at the borderline level (58.44 ± 13.79). BMI was not significantly correlated with health literacy (P = 0.09). BMI was significantly different in terms of age, high school grade, school type, and health status. School type and health status predict 37% of the variance of BMI (R2 = 37%) and the best predictor was health status (P < 0.05).

The results of the present study showed that BMI was not correlated with health literacy and student health literacy was at the borderline level. It is necessary to carry out further studies on the causes and facilitators and the barriers to increasing health literacy. Furthermore, educational interventions are needed to prevent the increase of BMI in adolescents and identify determining factors.

Dear Editor, Prevention is the best strategy to reduce infection. The widespread novel infectious diseases have been diagnosed and controlled with delay [1]. The rapid spread of COVID-19 has exposed nurses, the frontline caregivers, to such an infection. All medical centers and hospitals have paid particular attention to the education and educational methods to prevent nurses' infection. This education has been important for nurse managers. Studies have shown that nursing education programs on infection control measures have led to significant advances in nurse knowledge and practice, significantly affecting infection control [2-4]. In the study of Gaikwad et al., the educational intervention has had a significant impact on the development of nurses' knowledge about infection control measures (pre-test score: 3.94 ± 2.3 vs. post-test score: 15.33 ± 2.4) [4].  According to Gomarverdi et al., nurse adherence to the standard precautions has increased from 19.87 ± 4.44 at pre-test to 29.20 ± 5.00 and 28.40 ± 4.37 at two- and six-week post-test, respectively [3]. Also, Yousef et al. show statistically significant improvement in the nurses' infection control measures (48.93 ± 16.67 vs. 113.37 ± 10.61) and total knowledge (80.70 ± 18.48 vs. 174.83 ± 18.37) after the educational program [2]. Implementing a nursing education program can help nurses be prepared for critical situations such as COVID -19 disease. Ghanbari et al. show that the nursing education program against natural disasters improves the knowledge, attitude, practice, and readiness of nurses [5]. Also, Gresh et al. have shown that online education for 135 nursing students and 15 clinical instructors in COVID-19 disease improve factors, including assessment and analytic, policy development/program planning, communication, cultural competency, community dimensions of practice, public health sciences, financial planning/ evaluation/management, and leadership /system thinking skills [6]. In the prevalence of COVID-19 disease, some hospitals have used educational content involving personal protective equipment (PPE), hand hygiene, ward disinfection, medical waste management, patient-care device sterilization, and occupational exposure management. Nurses should know how to use PPE by continuing education in practice and theory. PPE includes highly recommended equipment to protect nurses. PPE plays a very important role in reducing the infection of nurses, and education has a significant effect on its proper use. Some hospitals have used recorded educational videos, the details of which have been made available to nurses in social groups such as WeChat [7]. Such measures have increased the information of nurses and prevented the transmission of COVID-19 disease to them. Nurse managers can increase the quality of education by monitoring and assessing the educational feedback in practice before nurses contact patients. One of the important issues in the correct and principled learning of nurses is to study the factors affecting the quality of their continuing education, which significantly, in turn, affects their protection. Health care providers, especially nurses, are under high psychological pressure due to the high risk of infection, unsuitable equipment against infection, isolation, burnout, as well as being away from family. These conditions can cause many psychological problems for nurses, thus affecting their decisions and participation in medical care [8]; they can also affect the education of nurses. To relieve the psychological pressure of nurses, head nurses in some hospitals and medical centers share the necessary information about the equipment and resources with them in regular meetings and talk about emergency assistance in critical situations. Psychotherapists can help in the case of symptoms of anxiety or insomnia in nurses [7]. Also, psychological intervention teams are required to reduce the psychological damage of COVID-19 among the nursing staff. Further, a wide range of psychological services, including psychotherapeutic counseling and brochures, are needed [9] to train nurses. These measures can indirectly play an important role in the observance and avoidance of occupational exposures, helping nurses cope with potential stress and depression and increasing their satisfaction. They identify the psychological problems of nurses and improve their condition, motivating them to involve in personal protection, follow precautionary instructions, and participate in continuing education. To motivate nurses and encourage them to follow safety principles, some support groups, not the health care system, present safety tips in the form of motivational sentences in different hospital wards. The approval and encouragement by the hospital manager and government, the preparation of infection control instructions, specialized equipment, and facilities for COVID-19 infection management are among the factors potentially encouraging health care workers to implement and consider precautionary measures [10] to pave the way for nurses to participate in the education. Nurses experience more anxiety and stress because they deal with ill patients and difficult working conditions [11, 12], affecting their strength and concentration on learning, thus the quality of their training. Therefore, education should be done at appropriate times and according to the psychological dimensions of nurses. Managers' attention to the mental state, the training of stress coping strategies, and specialized education to control infection can protect nurses against the COVID-19 epidemic.

Investigating information on the causes of death of patients is an undeniable necessity for health policy and disease control at the level of human societies. This study aimed to perform an epidemiological study on patient mortality in Ali Ibn Abitaleb Hospital in Rafsanjan, Southeastern Iran, 2019.

In this descriptive study, 260 patients who died during March to September, 2019 were reviewed. Data were collected from patientschr('39') records using a pre-designed checklist. Data were analyzed using t-test and one-way analysis of variance.

The highest proportion of death was due to internal diseases (38.8%). The mean duration of hospitalization in the emergency ward was 7.14 hours and in other wards was 180.36 hours. The mean time from admission to initial visit was 57.91±29.16 minutes, to death was 185.20 hours, and to Cardiopulmonary Resuscitation (CPR) time was 29.82±19.29 minutes. The cause of death in various groups of patients was significantly different based on their age and the duration of being admitted in hospital (P <0.001). 

Our findings suggested the importance of controlling and preventing internal diseases in the population from that patients referred to this hospital. More investigation on the duration of hospitalization in the ward (by assessing the association between complications due to prolonged hospital stay and mortality) can play an effective role in preventing long-term hospitalization deaths.