aliasghar jesmi

Pain is a persistent concern and a common symptom in critically ill patients. It is an increasingly unpleasant experience in patients discharged from the intensive care units (ICUs). 

This study aims to evaluate the correlation of pain intensity with the acute physiology and chronic health evaluation (APACHE II) score, the Ramsay sedation scale (RSS) score, and some ventilation parameters in patients under mechanical ventilation admitted to the ICU. 

This cross-sectional study was conducted on 40 intubated patients under mechanical ventilation at the trauma ICU of a hospital in Sabzevar, Iran, from November 2020 to May 2021. The samples were selected using a convenience sampling method. Data were collected using the critical-care pain observation tool (CPOT), APACHE II, RSS, and a form surveying demographic and ventilation parameters. Data analysis was performed using descriptive statistics, Spearman’s correlation test, and Mann-Whitney U test. The significance level was set at 0.05.

Among participants, 87.5% were male (n=35) and 12.5% female (n=5). Their mean age was 42.80±17.12 years, ranged 18-83 years. The CPOT score at rest (r=0.78) and during suctioning (r=0.72) was significantly correlated with the APACHE II score (P=0.001). It also had a significant association with the RSS score at rest and during suctioning and position change (P=0.001), surgical diagnosis (P=0.002 at rest, P=0.001 during suctioning), and using sedatives (P=0.001 at rest, P=0.001 during procedure). However, no significant correlation was observed between the CPOT score and ventilation parameters. Pain intensity was significantly different among patients with and without a history of addiction (r=0.68, P=0.015 at rest; P=0.002 during suctioning).

Given the correlation of the pain intensity with the APACHE II and RSS scores in patients under mechanical ventilation, these factors should be considered by healthcare planners to promote the quality of care and effective management of pain in these patients admitted to ICUs.

One of the main complications of diabetes is psychological problems, such as reduced stamina and psychological well-being. The use of muscle relaxation is a simple, safe, and non-pharmacological method. Therefore, the present study was designed to investigate the effect of Jacobson's muscle relaxation technique on psychological well-being and resilience in patients with type 2 diabetes.

The current study is a two-group randomized clinical trial with a pre-test and post-test design conducted on 40 patients with type 2 diabetes at the Khayyam Diabetes Clinic in 2021. Eligibility criteria included minimum literacy, acceptable hearing, and speaking ability, age between 25 and 65 years, no history of relaxation training, type 2 diabetes for at least 6 months, no smoking and no alcohol, ability to use a computer, poor psychological well-being and resilience (psychological well-being score equal to or less than 63, resilience score equal to or less than 50), and no definite psychiatric disorders. Exclusion criteria included: special medical conditions (such as hospitalization or medical inability to continue treatment), withdrawal from the research, death, unwillingness to cooperate, incomplete completion of questionnaires by members, and failure to perform sedation for more than 4 sessions. The samples were selected using the available methods and then randomly allocated with permutation blocks to two intervention and two control groups. The relaxation technique was then practiced at home by the intervention group once a day for 8 weeks. Rif's psychological well-being questionnaire and Connor's resilience questionnaire were completed by the intervention and control groups at the beginning and end of the intervention. Data were analyzed using the Shapiro-Wilk test for normality, Fisher's exact test, chi-square, and analysis of covariance using SPSS 25 software.

The results of the research showed that the two groups were homogeneous in terms of gender, marriage, age, education, history of chronic diseases, history of neuro medications, insulin history, exercise history, peer history, dietary compliance, income, and occupation and there was a statistically significant difference. There was no difference in these variables between the two groups (P>0.05). The results of the covariance test show that the means of the experimental and control groups are the same in terms of patient resilience (P=0.49, eta=0.02). Therefore, it can be concluded that there is no significant difference between the experimental and control groups in terms of patient endurance, controlling for the effect of pre-test means. Also, the means of the experimental and control groups differ in psychological well-being (P=0.00, eta=0.44). Therefore, It can be concluded that there were statistically significant differences between the groups. More specifically, there was a significant difference between the experimental and control groups in terms of psychological well-being, controlling for the effect of pre-test means.

 Results of the study showed that muscle relaxation training was an effective, practical, and inexpensive method of improving and preventing psychological problems in people with diabetes in the intervention group compared with the control group.

Chronic kidney disease is one of the public health issues in the world. Imbalances in the gut microbiome contribute to the progression of multiple diseases, including chronic kidney disease. The consumption of probiotics and synbiotics in treating various diseases has progressed significantly. 

The present study investigates the effects of synbiotic supplements on the intestinal microbiome, resulting in improving fatigue and sleep quality of end-stage renal disease patients undergoing hemodialysis.

The study was a double-blind, randomized, placebo-controlled clinical trial. A total of 52 patients with end-stage renal disease undergoing hemodialysis were included in the research and, through permuted block randomization, assigned to the synbiotic group (28 patients) and the placebo group (24 patients). The intervention group received 500 mg of synbiotic (Lactocore) twice a day for eight weeks, and the control group received a placebo for the same period. The patients were evaluated with the Chalder fatigue and Pittsburgh sleep quality questionnaires at the beginning, the fourth week of the study, and at the end of the study. Demographic variables were analyzed using the chi-square test, Fisher exact test, or independent sample t-test, as appropriate. The repeated measures test was used because the outcome variable has been measured three times in each group.

The samples, consisting of 26 males (50%) and 26 females (50%), were randomly allocated to the placebo (n=24, 46.16%), 12 males and 12 females, and the synbiotic supplement (n=28, 53.84%), 14 males and 14 females, groups. The result showed regular use of a synbiotic supplement for 8 weeks did not show a change in the amount of fatigue and sleep quality reported in patients receiving the synbiotic supplement considering the effect of time and group compared to the placebo group.

In general, the 8-week consumption of synbiotic supplements in the intervention group compared to the control group did not significantly affect the fatigue and sleep quality of patients undergoing hemodialysis treatment. However, further studies with larger sample sizes and longer duration are suggested.

Brain injury and coma after trauma are major health problems all over the world as the hemodynamic indicators of patients fluctuate and their clinical conditions deteriorate. Consequently, the demand for professional care will increase. Accordingly, this study aimed to explain the experiences of people caring for comatose patients with head injury. The present study was conducted using a conventional qualitative content analysis approach. The participants were selected through purposive sampling and the sampling process continued until data saturation. A total of 17 nurses and 3 head nurses working in the intensive care units (ICUs) of Sabzevar University of Medical Sciences in 2022 participated in the study. Data analysis led to the identification of three main categories and nine subcategories including clarification of needs (understanding patients’ needs based on symptoms, intensive vision, application of care knowledge), continuous care to facilitate transition (skilled and quality care, progress monitoring, continuity in care and teamwork), and empathic support (living in the patient’s world, therapeutic relationship, and conscience-oriented actions. As a result, “targeted care” was detected as the main theme of the study. According to the results of the current study, in order for nurses to perform targeted care to get patients out of critical situations as quickly as possible, first a detailed examination is required to identify the patients’ needs and problems. Then, continuous nursing care with comprehensive support should be provided to the patients. The results of this study can instill motivation in care and improve its quality, ultimately leading to patient-centered nursing and treatment.

The high prevalence of hypertension worldwide and its severe effects on various body organs are major health concerns in every community. The present study aims to evaluate the effects of telenursing on the management of self-care behaviors in patients with chronic hypertension.

This randomized clinical trial was conducted on two groups with a pretest-posttest. The sample population included 82 patients with hypertension referred to comprehensive urban and rural health service centers in Garme City, Iran who were initially selected via two-stage cluster sampling and allocated into two groups of intervention and control by permuted block randomization (six patients in each block). Data were collected using a demographic questionnaire, the hypertension self-care profile, and phone follow-up, which were completed at the beginning of the study. The patients received a two-hour training session. The intervention group was followed up (telenursing) for three months, and the control group received routine care. After the intervention, the self-care questionnaire in patients with chronic hypertension was completed by both groups. Data were analyzed with SPSS software, version 25 using the Mann-Whitney U test, paired t-test, and the analysis of covariance (ANCOVA).

Telenursing increased the mean score of a healthy diet by 1.3 units (P=0.04) and the score of disease management by 1.19 units (P=0.004). However, the intervention had no significant effects on weight (P=0.09), supervision of the awareness of food labeling (P=0.38), and medication regimen (P=0.62). 

According to the results, it is recommended to use this method to manage the disease and dietary habits of patients with chronic hypertension.

In relation to mental health, self-efficacy indicates that a person with high Self-efficacy has the ability to change their negative mental states, in other words, strong self-efficacy beliefs bring peace and can be an appropriate predictor for mental health. Therefore, the current research was conducted to investigate the effect of virtual training of relaxation methods on self-efficacy and mental health of medical students of Sabzevar University of Medical Sciences during the outbreak of the Covid 19.

The present study is an intervention type that was conducted by random method based on double replacement blocks in 2019 on 26 samples (14 in the intervention and 12 in the control group) from undergraduate students of anesthesiology and operating room. The criteria for entering the study included not suffering from mental disorders and taking psychoactive drugs, as well as willingness to participate in the study. Checklist of demographic characteristics and standard questionnaires of mental health and self-efficacy were completed in both groups before and after the intervention.

The results of the study showed that there was no statistically significant difference between self-efficacy (P-Value >0/05) and mental health (P-Value >0/05) of students in both groups before and after the intervention.

The findings of the present study showed that Benson's relaxation technique had no effect on students' self-efficacy and mental health, so other relaxation methods can be used.

This study was performed aimed to compare the effect of isometric exercises and lidocaine 2% on pain relief during intravenous propofol injection.

This randomized clinical trial (RCT) study was performed in 2020 on 106 patients who were candidates for general anesthesia for different surgical treatments in Neyshabur 22 Bahman Hospital. The subjects were randomly allocated into three groups by permuted block randomization. Group A received propofol 1% with 40 mg lidocaine 2%, group B received pure propofol 1%, and group C completed 5 cycles of isometric exercises before injection of 1% pure propofol. Data collection tools consisted of a demographic information questionnaire and Ambesh four-point scale. Data were analyzed by SPSS software (version 16) and Fisher’s exact test, Mann-Whitney U test, and analysis of variance (ANOVA). P<0.05 was considered statistically significant.

The majority of patients underwent general surgery. There was no significant difference between pain intensity in groups A and C, but group B reported significantly higher pain intensity than the intervention groups (P<0.001).Implications for Practice: The use of both lidocaine 2% and isometric exercises reduces the pain intensity of propofol injection. Therefore, the use of these two methods is recommended.

The outbreak of coronavirus disease 2019 (COVID-19) in early 2020 has affected reperfusion time in patients with ST-segment elevation myocardial infarction (STEMI) across the globe.

The present study aimed to assess the effect of the COVID-19 pandemic on the treatment management of STEMI.

This quantitative cross-sectional descriptive-analytical study investigated medical records of all patients (n=279) with STEMI who were consecutively admitted to Heshmatieh Hospital in Sabzevar city and underwent Primary Percutaneous Coronary Intervention (PPCI) in the last 9 months of 2019 (from April to December) as "Pre-pandemic group" (n=161) and the same period in 2020 as "post-pandemic group" (n=118). The data collection tools were a demographic information form and a checklist for recording treatment information.

The average times from the symptom onset to first medical contact (FMC) and from FMC to the commencement of PPCI were significantly increased in the post-pandemic group, compared to those in the pre-pandemic group (870.50±1397.48 versus 348.80±399.20 min and 73.23±91.87 versus 52.68±27.46 min, respectively). The mean length of stay was reduced after the intervention in the post-pandemic group. Despite the reduction in the number of STEMI patients’ referrals in the post-COVID-19 pandemic period, the comparison of the referral of patients by month showed no significant difference between the two study groups before and after the COVID-19 pandemic.Implications for Practice: The COVID-19 pandemic caused treatment delay and reduced hospital stay among STEMI patients. The results of this study can be used to inform the community and better manage time-dependent diseases, such as STEMI, in the future.

Acceptance of individuals and the use of technology by users are an important factor.

This study is aimed to investigate the acceptance of the hospital information system (HIS) among the educational hospitals. Setting and Design: Educational hospitals of Mazandaran University of Medical Sciences, cross‑sectional study.

This study conducted in 2018. Census sampling method was used, and the sample of this study was 400 nurses, physicians, and paramedical staff. In this study, the unified theory of the acceptance and use of technology (UTAUT) questionnaire was used for data collection. Statistical Analysis Used: The present study has been analyzed using structural equation modeling.

The results demonstrated that the behavioral intention (BI) to use HIS was predicted by performance expectancy (β = 2.08, P < 0.05), effort expectancy (β = 3.73, P < 0.01), and social influence (β = 6.83, P < 0.01). Furthermore, use behavior was predicted by facilitating conditions (β = 2.96, P < 0.01) and BI (β = 8.15, P < 0.01). These antecedents, respectively, determined 61% and 59% of the variance of BI and use behavior (R2 = 0.61, 0.59).

The results of this study showed that the acceptance of HIS, directly and significantly influenced by the UTAUT model.

Context: 

Communicating with intubated patients is one of the main challenges for nurses.

This study aimed to evaluate the effect of education on function and communication skills of nurses with intubated patients. Setting and Design: This quasi-experimental study with pretest–posttest design was carried out. Statistical Analysis Used: The data analyzed using Mann–Whitney test Wilcoxon, and Spearman’s correlation coefficient at significance level less than 0.05 and study power of 80%.

The research instruments were the nurse–patient relationship checklist and communication skill questionnaire.

The mean ± standard deviation of communication function and verbal and nonverbal skills of nurses showed a significant difference (P = 0.039 and P < 0.001).

The training of communication skills with intubated patients to the nurses improves their function and communication skills.

Spinal muscular atrophy (SMA) is a neuromuscular disease which, in addition to physical disability, causes psychological and social problems for patients and their families. If physiological and mental disorders continue to persist for a long time, it leads to serious deterioration in the patient’s physical condition, influences the treatment process, and prevents the outcome of the therapies. The aim of this study was to explore the lived experiences of patients with SMA. Setting and Design: In this qualitative study, a total of six participants (five patients and one patients’ wife)
were selected by purposive sampling method. Data were collected by semi‑structured interview. Eleven interviews were conducted and analyzed by Colaizzi’s descriptive phenomenological approach. Statistical Analysis Used: Data were analyzed by One Note soft ware version 14.0 with Colaizzi’s descriptive phenomenological approach. Two main themes – “tragic life” and “vague future” – emerged from data analysis. They had four categories including “physical and psychological problems,” “limitations and lost opportunities,” “concerns,” and “uncertain future.” These patients experienced a lot of physical and psychological impairments in their life. They have many concerns and lost some opportunities. Therefore, policymakers and authorities should support these patients for participating as an effective members in the society, consequently their feeling improve by getting independent.

Clinical reasoning is considered as a process of applying knowledge and experience in a clinical setting to solve a problem. There are many types of clinical reasoning, each with a special application. Reasoning involves the process of cognition, thinking, and meta-cognition. In nursing, clinical reasoning is considered as one of the components expected by nurses with experience and efficiency (1). Clinical reasoning tests are composed of: Key feature test, clinical reasoning problem, patient problem management, comprehensive integrated puzzle and script concordance (2). The most common type is the "patient problem management" test (3.4). This test consists of a clinical scenario and some choices about history taking, clinical exam, assessment and diagnosis. Since this test has a low reliability so it needs a plenty of time to achieve optimal reliability. The common form of this test needs 90 minutes to be answered. In many cases, the scoring of this test is attributing to the ability of data collection, rather than decision-making, and has a close relationship with the knowledge assessment test (4). At a conference at Cambridge University in 1989, Page stated that to solve clinical problems, all the symptoms and elements do not have the same value and few elements are important in the diagnosis and resolution of a clinical problem (5). The medical consulting center conducted many studies for the substitution of the KF test with the PMP test. The PMP test uses elaborated and expanded scenarios which consisted of detailed subjects. It is possible to use a real situation or to omit and change some patient information. Scenarios should be enriched and consist of many important pieces of information to depict a patient's real life (6). It’s time consuming. KF test is suitable for assessing the ability of students in data collection and emphasizes the elements in which students tend to make mistakes (7). This test has a description (a description of a clinical situation) and some choices. The signs and symptoms are presented in such a way as to avoid giving guidance and clue to the student in the following sections. After the description of the clinical problem, there are usually answers (options) (8-11). Choices are 10-15 and up to the correct choices can reach 20 in some cases, depending on the number of correct answers, the number of options is changed (12,13). KF tests are so enriched that the students should integrate their information and make a decision. So it can assess the decision-making ability. It has a high reliability because of many issues. Content validity of this test increased because of paying attention to the key elements. Canada Medical Consulting Center from 1992, Maastricht University since 1993 and Australia University since 1996 have been using the KF test for evaluating the clinical decision making of medical student at general, specialized and fellowship levels. The University of Toronto also uses this test to assess the first and second year students (14). The results of the study by Zimany et al (2017) on evaluating the clinical judgment of 59 midwifery students using "Key Feature test" and the conventional "multiple-choice questions" showed that the average score of the test with key features was 10.9 out of 20, and the mean score the multiple-choice test was 8.88. The authors, based on the difficulty index, the discrimination ability of the test and the Cronbach's alpha coefficient, suggested that clinical reasoning cannot be measured with multiple-choice questions. Therefore, the use of innovative evaluation tools in clinical domains is recommended by using the key features (KF) test. (15). The researcher (as a clinical mentor) has a new experience in applying KF test to assess clinical decision-making skills in junior nursing students for post-test in urology ward. A sample question is mentioned below. Since it was a priority to make nursing students interested in an innovative type of clinical evaluation test, the result of the correct answer to this test has not had any effect on the end-point score. Although, in general, each of the three correct answers had a score, choosing more options would result in a lack of consideration for the rating for the individual. No negative rating was used.
A 52-year-old man with fever and shivering and productive cough that had started from 24 hours ago came to the hospital. At the time of being admitted, his blood pressure was 110 / 70mmhg, temperature was 38.8 and pulse rate was 110 PPM (tachycardia). What is your nursing priority? (3 choices)
1. Wearing mask for preventing infection transmission
2. Wet sponges for temperature decreasing
3. Acetaminophen for temperature decreasing
4. Connecting the oximeter pulse to the patient's finger
5. Cardiac monitoring
6. Recommendation for plenty of fluid intakes
7. Applying supplement oxygen with face mask
8. IV insertion
9. Reducing patient coverage
10. Complete bed-rest
11. High-protein diet
This test is used for the student of medicine in many levels for evaluating decision-making skills but there is no evidence for applying this test to nursing students. It seems clinicians are not able to assess the clinical judgment of a nursing student in subjects such as nursing diagnosis, prioritizing nursing care and modalities. Nursing and Midwifery Development Offices are expected to promote the culture of using tests that measure higher levels of thinking, and apart from conducting research studies, provide solid evidence for the effectiveness of the test with key features in nursing.

Meningitis is an important health issue. As crowded areas is a predisposing factor to the meningitis disease, thus, the aim of this study was to survey the effect of education by lecture and pamphlet methods on soldiers’ knowledge about meningitis disease. This research is a Quasi-experimental study with a before and after design which was conducted among the air defense soldiers of Semnan. The sampling method in this study was census and the data gathering instrument was a self-made questionnaire. At first, the knowledge about meningitis disease among soldiers was measured. After on, training was conducted by presence education methods and distribution of educational pamphlet. At the end the questionnaires were given to the research samples. The obtained data were entered into SPSS 21 and were analyzed by using paired t-test, and descriptive statistics including mean and standard deviation. The total score of knowledge about meningitis disease among soldiers before training was 36.3± 3.94 and after training was 65.76±3.57. Actually the paired t-test showed a significant difference between the training score of soldiers knowledge about meningitis before and after trainings (P = 0.001). According to the results of this study, educational interventions causes an increase in the knowledge of soldiers in regards to the meningitis disease. On the other hand, as all the men have to pass a military service period, this period is considered a great time to increase their knowledge.

Personnel job satisfaction, facilities and welfare are among the most important factors affecting quality of service. To date, no study has been done in the field of Emergency medical service (EMS) personnel satisfaction regarding facilities and welfare in Iran. Therefore, the present study was designed to evaluate the level of satisfaction among EMS personnel regarding facilities and welfare.
In the present cross-sectional study, 68 of the EMS personnel of Northern Khorasan, Iran, were selected by simple randomization and their level of satisfaction was evaluated using a 23-question questionnaire. Afterwards, their satisfaction level was divided into 2 groups of desirable and non-desirable and the findings were reported as frequency and percentage.
The lowest satisfaction level regarding facilities were reported to be linked to the physicians being out of reach (14.7%), presence of help (27.0%), comfortableness of nurse’s chair (29.8%), and ability of patients’ bed to be positioned (32.3%). Minimum satisfaction regarding welfare was also seen concerning the time of receiving their wage (4.4%) and place for rest (5.9%). Based on the classifications done, only 22 (32.4%) of the personnel were satisfied with the facilities and 5 (7.4%) were satisfied with the welfare conditions.
The findings of the present study showed that satisfaction rate of the EMS personnel regarding facilities and welfare is low. All the factors leading to this decrease in satisfaction level of the personnel could be prevented and relieved, therefore intervention in these regards can improve satisfaction rate among the personnel.