seyed reza mazlom

Many patients with advanced cardiovascular disease need Coronary Artery Bypass Graft (CABG) surgery, indicating the importance of cardiac rehabilitation. Our study explored the combined efficacy of simulation (using demonstration and return‑demonstration approach) with music on post‑Open Heart Surgery (OHS) outcomes.

This randomized, controlled trial was conducted at Imam Reza Hospital, Mashhad, Iran, on 90 patients awaiting OHS. The participants were allocated to 3 groups: education via simulation, education via simulation enhanced by instrumental music, and conventional instruction. Evaluations were performed pre‑education and 2‑days post‑surgery using the activity measure for post‑acute care (AM‑PAC) “6‑Clicks” Questionnaire, 18‑item Nursing Outcomes Classification (NOC) index, and State‑Trait Anxiety Inventory (STAI). JASP software (JASP Team, 2023, Version 0.17.3) was employed for statistical analyses, using RM‑ANOVA and ANCOVA test.

The results revealed a significant effect in immediate post‑intervention and 2‑day follow‑up periods across all outcome measures (all p < 0.05), except for activity. Post hoc tests demonstrated substantial variations in effect sizes between intervention and control groups. Both intervention groups had significantly greater impact than the control group, particularly the composite group, showing heightened effects in state and trait anxiety and respiratory scores (p < 0.05).

The combined use of the simulation with rhythmic music in phase one cardiac rehabilitation notably improved post‑surgical outcomes, outperforming the method without music. This approach shows promise as an effective instructional strategy in cardiac rehabilitation stages.

Given the heightened impact of post-COVID-19, active involvement in the rehabilitation process, particularly in respiratory rehabilitation, is essential for these patients. This study addresses the urgent need for developing and evaluating remote respiratory rehabilitation methods post-COVID-19, focusing on enhancing patients’ quality of life and pulmonary function.

The study aimed to investigate how respiratory telerehabilitation influences pulmonary function and the quality of life in this patient population.

In this randomized controlled clinical trial, 60 COVID-19 patients from two major hospitals in Mashhad were evaluated during 2021 - 2023. The control group received a training booklet and an incentive spirometer, while the intervention group participated in a telerehabilitation program. This program involved four-week daily respiratory rehabilitation exercises conducted online using the Skyroom platform. At the end of each session, the patient’s fatigue and shortness of breath were assessed using the Borg Rating of Perceived Exertion (RPE) Scale and the number of physical exercises completed. All patients completed the Quality of Life (QOL) Questionnaire and undertook the 6-MinuteWalk Test (6MWT). Heart rate, respiratory rate, blood oxygen saturation (SPO2), maximum inspiratory pressure (MIP), fatigue, and shortness of breath were measured on the day of discharge and two and four weeks post-discharge. Covariance (ANCOVA) and repeated measures analysis of variance (RMANOVA) were analyzed for data analysis.

In both baseline-adjusted and fully-adjusted ANCOVA models, the results indicated a significant intervention effect after 4 weeks for MIP (73.43 ± 5.77), SPO2 (96.90 ± 1.21), Borg scale score (9.77 ± 1.59), andMWT6(455.90 ± 37.70), (all P< 0.0001), with significantly higher changes observed in MIP, SPO2, Borg Scale score, and MWT6 after 2 weeks as well as after 4 weeks in the intervention group than the control groups. Also, in both models, the results indicated a significant intervention effect after 2 weeks as well as 4 weeks for physical functioning, role physical, vitality, social functioning, role emotional, Physical Health Scale score, and total SF36 score (60.37 ± 6.93) (P < 0.001).

Using bidirectional audio and video communication in the telerehabilitation of COVID-19 patients significantly improved their pulmonary functionandQOL. Basedonthese findings, it isrecommendedthat thismethodbe considered as an integralcomponentin rehabilitation programs for COVID-19 patients.

Considering that a decline in sexual satisfaction after assisted reproductive treatment failure can cause a decrease in the overall quality and satisfaction of life, the present study was conducted to compare the effect of sexual counseling based on EX-PLISSIT and BETTER models on the sexual satisfaction of infertile women following the failure of assisted reproductive technologies.

Methods & Materials: 

This randomized clinical trial, conducted in 2022, involved 66 infertile women who had experienced unsuccessful assisted reproductive treatments and were referred to the Milad Infertility Center of Imam Reza (AS) Hospital in Mashhad, Iran. The participants were divided into two intervention groups – EX-PLISSIT and BETTER – and received individual sexual counseling across four weekly sessions, comprising two face-to-face and two virtual sessions. Data were collected using the Sexual Satisfaction Scale for Women (SSSW) and subsequently analyzed using SPSS software version 25, through chi-square, independent t-tests, Mann-Whitney, and Wilcoxon tests.

After the intervention, there were no statistically significant differences in the total scores of sexual satisfaction and its components between the two groups (P>0.05), with the exception of relational anxiety (P=0.021). Intra-group comparisons revealed a significant increase in the total scores of sexual satisfaction and its components within each group after the intervention, as compared to before the intervention (P<0.05).

Sexual counseling utilizing the EX-PLISSIT and BETTER models was found to be an effective, affordable, and side-effect-free method in enhancing sexual satisfaction among infertile women after the failure of assisted reproductive methods, particularly by addressing relational anxiety.

The purpose of this study was to evaluate the effect of threshold inspiratory muscle training (IMT) on the duration of weaning in intensive care unit (ICU)?admitted patients.

This randomized clinical trial enrolled 79 ICU?admitted, mechanically ventilated patients in 2020–2021 in Imam Reza Hospital, Mashhad. Patients were randomly divided into intervention (n = 40) and control (n = 39) groups. The intervention group received threshold IMT and conventional chest physiotherapy, while the control group only received conventional chest physiotherapy once a day. Before and after the end of the intervention, the strength of inspiratory muscles and the duration of weaning were measured in both the groups.

The duration of weaning was shorter in the intervention group (8.4 ± 1.1 days) versus the control group (11.2 ± 0.6 days) (P < 0.001). The rapid shallow breathing index decreased by 46.5% in the intervention group and by 27.3% in the control group after the intervention (both P < 0.001), and the between?group comparison showed a significantly higher  eduction in the intervention group than control group (P < 0.001). Thepatients’ compliance after the intervention compared to the 1st day increased to 16.2 ± 6.6 in the intervention group and 9.6 ± 6.8 in the control group (both P < 0.001), and the between?group comparison showed a significantly higher increase in the intervention group than control group. The maximum inspiratory pressure increased by 13.7 ± 6.1 in the intervention group and by 9.1 ± 6.0 in the control group (P < 0.001). Furthermore, the weaning success was 54% more probable in the intervention group than control group (P < 0.05).

The results of this study showed the positive effect of IMT with threshold IMT trainer on increased strength of respiratory muscles and reduced weaning duration.

PCOS is a common endocrine disorder of reproductive age with high morbidity that its prevalence ranging from 5.6% to 26%. The aim of this study was to evaluate the prevalence of PCOS in Iranian adolescent girls aged 14-19 years based on adults and adolescents’ criteria.

This cross-sectional study was carried out with 650 high school adolescent girls in Mashhad city, north-east of Iran. PCOS was defined as the presence of three or two of the three features including oligo/amenorrhea, clinical or biochemical hyperandrogenism, and polycystic ovaries. Descriptive statistics, chi-square, and ttest were used to analyze the data through SPSS vs 22 (SPSS Inc., USA) and the significance level was set at p≤0.05.

The mean age of adolescent girls was 16.73±3.4 years. The prevalence of PCOS using Rotterdam, National Institutes of Health (NIH), Androgen Excess– PCOS Society (AES), European Society of Human Reproduction and Embryology (ESHRE)/American Society for Reproductive Medicine (ASRM) (2012), and Endocrine Society Clinical Practice (2013) criteria was 4.2%, 3.6%, 3.6%, 0.7%, and 3.6%, respectively.

The rate for prevalence of PCOS calculated based on Rotterdam, NIH, AES, and Endocrine Society (2013) criteria was higher in comparison to ESHRE/ ASRM (2012) criteria. According to the results of our study, in order to prevent overestimation of this syndrome’s prevalence in the adolescents due to its overlap with signs of pubertal development, all above-mentioned three criteria should be considered together, which is in line with the recommendations proposed by Carmina et al. and ESHRE/ASRM working group.

The Emergency Severity Index (ESI) may not recognize high-risk patients with heart failure (HF) efficiently. This study aimed to compare the diagnostic validity and mistriage rates of the ESI plus the Capnometer (Capno) and ESI alone among dyspneic patients with HF. This quasi-experimental group (random assignment) study was conducted within April 2019-February 2020. Patients were randomly assigned to the ESI+Capno and ESI groups. Triage levels, resources used, disposition and door to an electrocardiogram, and physician visit were compared among patients admitted to the Cardiac Care Unit (CCU), the Cardiac Unit (CU), or discharged from the ED. Interobserver agreement (Kappa) was used to assess the reliability of the ESI. In this study, 65 HF patients were assigned to the ESI+Capno (n=36) and ESI (n=29) groups. The undertriage rates were 0% and 10% and the overtriage rates were 10% and 31% in the ESI+Capno and ESI groups, respectively. Sensitivity, specificity, and accuracy to recognize high-risk HF patients were 100%, 60%, and 90% for the ESI+Capno group and 62.5%, 42.86%, and 48.36% for the ESI group.Implications for Practice: The addition of Capno to the ESI increased the validity of triage decisions to recognize high-risk HF patients, compared to the ESI alone. It is recommended that decisions regarding triage HF patients be made after that an End-tidal Co2 is considered into the decision-making process.

Considering the importance of report writing and its problems, different teaching methods can be used to improve nurses’ knowledge and performance, among which is peer teaching. This study aimed to determine the effect of peer teaching on the quality of report writing based on the nursing process.

This quasi‑experimental study examined 60 nurses working in the surgical and cardiac wards of Razavi Hospital in Mashhad during 2019. These wards randomly assigned to intervention (n </em>= 30) and control (n </em>= 30) groups. For 2 weeks, report writing teaching was implemented for the intervention group based on the nursing process through peer teaching. The control group routinely performed report writing. At the beginning and end of the study, we reviewed nursing reports of both groups using a valid and reliable checklist. Data were analyzed using two‑way analysis of variance with repeated‑measures analysis of variance.

Before the intervention, there was no significant difference between the two groups in terms of scores of report writing quality in structure, content dimensions, and the total scores (p </em>> 0.05). After the intervention, the mean score changes were significantly higher in the structure (Mean Difference (MD) = 4.99, 95%CI: 1. 26–8.72, p </em>< 0.010), content (MD = 8.11, 95%CI: 4.91–11.31, p </em>< 0.001), and the total quality of report writing (MD = 7.54, CI: 4.56–10.53, p </em>< 0.010) in the intervention group than the control group.

Peer teaching improved the nurses’ quality of report writing. The teaching planners are recommended to use this method to train nursing staff.

After abdominal surgery, the patients who are separated from mechanical ventilation and provided with oxygen therapy via a T-piece are at risk for respiratory complications. Therefore, they need additional respiratory support. This study aimed to evaluate the effects of manual hyperinflation (MHI) on pulmonary function after weaning.

This randomized clinical trial included 40 patients who had undergone abdominal surgery and were receiving oxygen via a T-piece. Patients were selected from the intensive care units (ICU) of two hospitals in Mashhad, Iran. The subjects were randomly allocated to intervention (MHI) and control groups. Patients in the MHI group were provided with three 20-minute MHI rounds using the Mapleson C, while the control group received routine cares. Tidal volume (Vt), Rapid Shallow Breathing Index (RSBI), and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) were measured before the intervention, as well as 5 and 20 minutes after the intervention. Atelectasis prevalence was assessed before and 24 hours after the intervention. Data were analysed by SPSS software version 13.

At baseline, there were no significant differences between the groups regarding Vt, RSBI, P/F ratio, and atelectasis rate. No significant difference was also found between the groups regarding atelectasis rate 24 hours after the intervention. However, at both posttests, Vt, RSBI, and P/F ratio in the MHI group were significantly better than the control group.

In patients with artificial airway and spontaneous breathing, MHI improves pulmonary function.

Undergraduate education should be able to establish the basic level of clinical competence to care for and maintain patient safety in novice nurses. Examining the clinical competencies of novice nurses from the perspective of nursing managers can identify aspects of the competency of novice nurses that need to be improved.

The present study is a cross-sectional descriptive study that was conducted to evaluate the clinical competence of novice nurses from the perspective of their head nurses in selected teaching hospitals of Mashhad University of Medical Sciences in 2020. 100 novice nurses working in three major teaching hospitals Mashhad participated in this study. Data were collected using a clinical competency evaluation and a demographic information form. The Creighton Competency Evaluation Questionnaire was completed by the head nurses. Stata software version 14.1 and descriptive and robust regression indices were used to analyze the data.

The results showed that the mean age of participants was 24.23±1.72 and their mean clinical competence from the perspective of head nurses was 59.55 ± 16.26 equal to 65% of total score. Using robust regression, the relationship between competence and the studied variables was investigated and there was no significant relationship with any of the variables (p>0/05).

 Improving the competence of nurses to increase the quality of pateint care is one of the main program of nursing managers.The clinical competence of novice nurses in the dimensions of patient assessment and clinical judgment from the perspective of head nurses had the lowest score that should be planned to improve it. Considering that there was no significant relationship between contextual variables and variables such as interest in the profession, the duration of work experience with clinical competence, it needs further study on the validity of competency assessment from the perspective of head nurses.

Background & The complications of cesarean section (CS) are greater than vaginal delivery in most cases and will be increased in repeat cesarean section. Therefore, women are not keen to choose vaginal birth after cesarean section (VBAC). The present study was conducted to explore why women with previous cesarean section do not choose VBAC. This qualitative content analysis was performed on 13 women with previous cesarean section as well as 12 health care providers, who were selected from Om-Albanin hospital in Mashhad, Iran. Data was collected through semi-structured individual interviews and two focus group with women and health care providers. The interviews were recorded, transcribed and analyzed using Graneheim and Lundman’s conventional method of content analysis (2004). The trustworthiness of data was verified by Lincoln and Guba’s criteria. The main category of "feeling of loneliness, inability and fear of VBAC" was emerged from three sub-categories including "non-supportive sociological perspectives", "inefficient care” and "psychological fear of childbirth". The mothers had conflict in choosing VBAC due to emotional, social, and care system issues. Therefore, comprehensive supports including cultural interventions for vaginal birth in order to correct women’s beliefs and enhance their knowledge as well as planning a supportive and special care system for women with previous CS will help them in decision making for VBAC. Planning for these strategies and evaluating their effectiveness are suggested.

Clinical competence is the ability to perform professional tasks and coordinate cognitive, communication and psycho-motion skills in patient care, and empathy is one of the factors influencing clinical competence. Given the role of clinical competence in the quality of midwifery care, this study aimed to determine the effect of empathy skill training on clinical competence in midwifery students.

This randomized clinical trial study was conducted on 73 midwifery students and 438 pregnant women in 2015. A clinical competence questionnaire was used to assess the clinical competence of the students, which was completed in two ways by self-assessment and researcher assessment (after reviewing the studentchr('39')s performance for 3 times). Data were analyzed by chi-square test, independent t-test and paired t-test using the SPSS software version 16.

There was no significant difference between the two groups in the mean score of clinical competence in the ways of self-assessment and assessment by the researcher before the intervention (P>0.05). Results from the post-intervention showed that there was significant difference between the two groups. However, the clinical competence score by the researcher assessment in the intervention group was significantly higher than in the control group (P<0.05). Also, the difference in the mean scores of the self-assessment of clinical competence before and after the intervention between the two groups was not significant (P>0.05), but the difference in the mean scores of the researcher assessment of clinical competence before and after the intervention between the two groups was significant (P<0.05).

Empathy skill training is an effective way to increase the clinical competence of students.

Hand burns are among the most destructive types of burns, imposing significant limitations on the performance and occupation of individuals. Accordingly, this injury induces many negative effects on the quality of life (QOL) of patients. Therefore, the goal of the present study was to assess the effect of a self-care educational mobile application on the QOL of victim patients with hand burns.

The present randomized controlled trial included 60 burn victims admitted to the Burn Center of Imam Reza hospital, Mashhad, Iran. The intervention group used the hand burn self-care application upon their admission up to 2 months after their hospital discharge while the controls only received the ordinary training presented in the burn center. All patients completed the Burn-Specific Health Scale-Brief (BSHS-B) questionnaire before and 2 months after the intervention. Finally, data were analyzed using an independent t test, along with chi-square and Mann-Whitney U tests in SPSS 21.

Two months after using the hand burn self-care application, the total mean score for the QOL of burn victims increased from 80.4±17.9 to 182.5±15.6 and 74.8±15.3 to 122.4±19.7 in the intervention and control groups, respectively (P<0.001).

According to our results, using the self-care burn mobile application can improve the QOL of burn victims. Consequently, the use of this tool can be proposed as part of the treatment and rehabilitation procedures for these patients.

Multimedia learning can be recommended for cardiopulmonary rehabilitation to reduce respiratory complications following open-heart surgery (OHS). Furthermore, flipped learning may reinforce the effects of education via further feedback.

This study aimed to compare the effects of flipped teaching versus multimedia-based teaching on postoperative physical activity in patients undergoing OHS.

This controlled randomized clinical trial was conducted on a total of 60 patients admitted to an intensive care unit and a cardiac-surgical ward in northeastern Iran in 2019. In the multimedia learning group, a tutorial video was displayed three times a day at different stages, namely preoperation, 1-2 days after the surgery, and 2-3 days postsurgery. The flipped learning group was also subjected to the same tutorial with the potential to be displayed on smartphones. Then, the 6-Clicks instrument was completed to assess the basic mobility function. The data were analyzed in the IBM SPSS Statistics software (version 25) using the Mann-Whitney U and Friedman tests.

The groups were homogenous in terms of demographic characteristics. The mean duration of physical activity was not significantly different in the study groups at the preoperative stage (P=0.87), 2 days postoperation (P=0.09), and 5-6 days after surgery (P=0.10). Based on the inter-group comparison, the mean score of physical activity was significantly different between the groups receiving flipped (P<0.001) and multimedia (P<0.001) learning.

The same as multimedia learning, flipped learning is able to improve physical activity in patients following OHS.

Receiving the news of a loved one’s death can cause extreme anxiety reactions. Breaking death news according to the setting, patient perception, invitation, knowledge, empathy, and strategy (SPIKES) protocol could be effective in alleviating this anxiety. This study aimed to determine the effect of using the SPIKES protocol for delivering the news of patient mortality to the deceased’s family members on their anxiety symptoms. This non-randomized controlled intervention study was carried out on the 60 families of the patients who died in Imam Reza Hospital of Mashhad, Iran. The subjects (i.e., next of kin or close family members) were divided into two groups of 30 cases. In the control group, the nurse conveyed the news of death using her routine method. In the intervention group, this task was performed according to the SPIKES protocol. After delivering the news, the nurse assessed the level of anxiety in the recipient of the news by filling out an inventory of visual symptoms of anxiety. The Mann-Whitney U test showed that the mean anxiety score in the intervention group (31.2±11.7) was significantly lower than that of the control group (63.4±18.1) (p <0.001). Since the findings revealed that the SPIKES protocol reduced the level of anxiety in the recipients of bad news, it is essential to apply this protocol in nurse education and training courses in Iran.

Anxiety and depression are among the most important and common problems in patients admitted to the intensive care unit open-heart (ICU-OH). While the family plays a vital supportive role in decreasing these complications, patients are deprived of this supportive source during the important post-operative days due to visiting restrictions at these wards.

Therefore, this study aimed to evaluate the role of online video visitations on the anxiety and depression of patients at ICU-OH.

This randomized clinical trial was carried out among 66 patients at ICU-OH of Imam Reza Hospital in Mashhad, Iran. The subjects were selected by the convenience sampling method and were randomly allocated to the intervention and control groups. Data were collected using a demographic characteristics checklist and HADS. In the intervention group, online video visitations with the family were carried out three times in the morning, evening and night on the second and third days of hospitalization in ICU-OH. In the control group, patients received the routine care of the ward and had no visitations with their families. Data were collected before the surgery, as well as 24 and 48 hours after admission to the ICU-OH. In addition, data analysis was performed in SPSS using independent t-test, Mann-Whitney U test, paired t-test, and Chi-square test.

No significant difference was observed between the intervention (7.8 ± 2.2) and control (8.3 ± 2.3) groups regarding the mean anxiety score 24 hours after the intervention (P = 0.416). However, the mean anxiety scores 48 hours after the intervention were 6.1 ± 2.3 and 7.7 ± 2.6 in the intervention and control groups, respectively, showing a significant decrease in the intervention group, compared to the control group (P = 0.010). However, the mean depression scores 24 and 48 hours after the intervention were estimated at 8.0 ± 2.0 and 7.1 ± 2.0, respectively, demonstrating no significant difference from the control group (P = 0.933 and P = 0.269).

According to the study results, online video visitations decreased anxiety in patients at ICU-OH. Therefore, it is recommended that this method be used as an alternative to in-person meetings of patients at this ward.

Lifestyle and behaviors of human beings are major factors in cardiovascular diseases. Therefore, a discharge program based on Self-determination Theory could improve the lifestyle of the patients. This study aimed to determine the effect of this program on the lifestyle and readmission of patients with heart failure. This clinical trial was performed on 60 patients with heart attack in a city in north-east of Iran, during 2018-19. The participants were selected by convenience sampling method and divided randomly into intervention and control groups. Subsequently, the intervention group was subjected to a 12-week SDT-based discharge program. However, the control group received the routine program. The data were collected using a demographic characteristics form, the Health-Promoting Lifestyle Profile II questionnaire, and the readmission questionnaire. Moreover, the data were analyzed in SPSS software (version 20) using the Chi-square, independent t-test, paired t-test, and Wilcoxon. In total, 20.0% and 46.7% of the subjects in the intervention and control groups were re-hospitalized, respectively. The Chi-square showed a significant difference in this regard (P=0.028).The results also showed a significant increase in the lifestyle score of the patients at post-test stage, in the intervention group (164.6±16.9), compared to the control group (119.1±17.2) (P<0.001). Furthermore, the mean score of various lifestyle subscales significantly increased in the intervention group, compared to the control group, three months after discharge (P<0.01). Implications for Practice: The design and implementation of a SDT-based discharge program could be included in the nursing care program as an effective method to create and maintain health-promoting behaviors.

Infertility affects women more profoundly than men, even when the male partner is the cause of infertility. Therefore, identifying the coping strategies of women in confrontation with their husbands' infertility is very important.

This study aimed to explore women’s coping strategies following the diagnosis of infertility in their husbands.

This qualitative study was performed on 18 women whose husbands were diagnosed with infertility. The subjects were selected from those who referred to Milad Fertility Clinic and public health centers in Mashhad, Iran, through purposive sampling within 2014-2016. The data were collected by conducting semi-structured interviews. Data analysis was manually carried out using conventional content analysis.

The main theme emerged from the content analysis was the attempts to overcome the threat, including two categories, namely emotional coping and active coping. Emotional coping included strategies like attributing infertility to herself and others, selective disclosure, religious coping, seeking emotional support, as well as being considerate and offering verbal support to the spouse. active coping consisted of strategies namely attempting to verify the diagnosis, accepting infertility, searching for information, adhering to medical and surgical treatments, trying fertility superstitions, using alternative medicine, and changing lifestyle. Implications for Practice: Women may use a diverse set of coping strategies to adapt to their husbands’ infertility. A deep perception of these strategies is critical for controlling and managing the consequences of this diagnosis, designing interventions to strengthen preferred actions and strategies, as well as facilitating women’s coping with the infertility crisis of their spouses.

Menstrual hygiene education in adolescence is an important factor to prevent fertility problems. The present study aimed to compare the effect of menstrual hygiene education based on peer and small group teaching methods on hygiene behaviors in female adolescents. This randomized controlled clinical trial was performed on 90 high school students in 2018. Three high schools in Mashhad, Iran, were allocated to three groups by drawing lots. The peers and small groups were provided with educational content within a month and over four sessions, respectively. Moreover, the control group received routine education. The data were collected by a researcher-made questionnaire before and after the intervention and analyzed by SPSS software (version 16) using the analysis of variance, as well as Chi-square and Kruskal-Wallis tests. According to the Kruskal-Wallis test, the three groups were homogeneous regarding age (P=0.12). Furthermore, the mean scores of hygiene behaviors in the intervention groups (after the intervention) were significantly higher than in the control group (P<0.001) and higher in the peers than in the small groups (P<0.001). It is recommended to employ peer teaching on menstrual hygiene by health planners.

In view of the contradictory results for the use of cold tubes for the purpose of enhancing nasogastric tube insertion success there is a pressing need for further research in this area. This study aimed to determine the effect of using cold versus regular temperature nasogastric tube on successful nasogastric tube insertion for patients referring to toxicology emergency department.

This study is a clinical trial with two groups design of 65 patients admitted to toxicology emergency department who were divided into two groups by random allocation. Nasogastric tubes used in the intervention group had been stored in a refrigerator at 2°-8° C while the ones employed in the control group had been maintained at the room temperature of 22-28° C. Nasogastric tube insertions in both groups were done by the investigator according to standard methods. The data were analyzed using SPSS ver. 13.

The placement of nasogastric tube was done in the first attempt with 27 (%84.4) of the subjects in the control group and 33 (%100.0) in the intervention group. The chi-square test results showed that the frequency of the number of attempts for gastric intubation in subjects between the two groups was statistically significant.

Cooling gastric tubes reduces the time required for nasogastric intubation. Thus, it is suggested that the gastric tubes be cooled before the application of the procedure so as to reduce complications, increase patient comfort and save nurses time.

One of the most common disorders during pregnancy is sleep disorders and the most common is it insomnia. One of the ways that may correct sleep disorders is training. Therefore, the present study was conducted to compare the education based on continuous care model and Telehealth on the severity of insomnia in pregnant women.

This clinical trial study with random multistage sampling was conducted on three groups of 91 pregnant women referring to health centers in Mashhad city in 2017. Intervention was conducted for 12 weeks for groups of continuous care model and Telehealth, and usual care of health centers was done for control group. Data collection tool was an insomnia severity index (ISI) that was completed before intervention, immediately after that and 4 weeks after the intervention. Data were analyzed using SPSS software, Descriptive statistics and statistical tests were used.

The results of the statistical tests showed that the three groups was matched in terms of age, gestational age, number of children, number of pregnancies, mother's education and pregnancy status (P <0.05). There was no significant difference in severity of insomnia before the study in all three groups (P = 0.235); there was a significant difference immediately after intervention and 4 weeks after it in all three groups (P <0.001).

Training based on continuous care model and Telehealth, both lead to reduce pregnant women insomnia. Therefore, Given that the telehealth method is cheaper and easier, this method can be used to improve the sleep disorders in pregnant women.

Caring for a patient with Parkinson's disease (PD) imposes a high burden of care on caregivers due to its chronic and progressive nature. Implementation of an empowerment program leads to self-control and adoption of preventive behaviors. This study investigated the effect of a family-centered empowerment model on the burden of care among the caregivers of the elderly with PD. The present randomized controlled clinical trial was performed on 60 caregivers and elderly people with PD referring to the Neurology Clinic of one of the two large hospitals of Mashhad, northeast Iran, in 2018. In the intervention group, the family-centered empowerment model consisted of four steps, including perceived threat, problem-solving, educational participation, and evaluation, in four training sessions. Before and 1.5 months after the training sessions, both groups completed the Zarit Burden Interview questionnaire. The control group also received routine care. The data were analyzed by SPSS software (version 16) using paired t-test, independent t-test, Wilcoxon test, and Mann-Whitney U test. The two groups were homogeneous regarding demographic findings. The difference in pre and postcare burden scores decreased 25.1±13.9 and 0.6±3.1 in the intervention and control groups, respectively. Independent t-test showed a significant difference (P<0.001). Intragroup comparison by paired t-test in the intervention group showed a significant difference between the total care burden score before and after the intervention (P<0.001). Implications for Practice: Using the empowerment model focusing on the management of care programs leads to reducing the burden of care and improving the role of caregivers. Therefore, it is recommended to implement family-centered empowerment programs for the caregivers of patients with chronic diseases.

It is generally accepted thatcancer affects the concept of mental well-being by changing the physical, psychological, spiritual, and social dimensions of the patient's life. Laughter yoga as one of the complementary therapies may promote mental well-being in patients undergoing chemotherapy.

This study aimed to determine the effect of laughter yoga on the mental well-being of cancer patients undergoing chemotherapy.

This randomized controlled trial was conducted on 69 cancer patients undergoing chemotherapy at Reza Medical Center, Mashhad, Iran, in 2018. The intervention group was subjected to four 20-30 min sessions of laughter yoga prior to chemotherapy. On the other hand, the control group received routine self-care training. The mental well-being scores were measured using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) before and after the laughter yoga sessions. Data were analyzed in SPSS software (version 20) using an independent t-test, Mann-Whitney test, Wilcoxon test, and repeated measures ANOVA.

According to the results,the mean age values of the patients were 49.0±9.6 and 45.2±12.6 years in the intervention and control groups, respectively. Regarding the independent t-test results, the mean post-test WEMWBS score in the intervention group (50.0±8.9) was significantly higher than that in the control group (47.9±10.4, P=0.004). Moreover, the repeated measures ANOVA showed a significant increase in the mean post-test WEMWBS score in the intervention group (P<0.001).
Implications for Practice: Laughter yoga can promote the mental well-being of patients undergoing chemotherapy; therefore, its clinical applications are recommended in this study.

Brain injury is one of the most common traumas and the most important cause of death in traumatic events. Ventilated patients are susceptible to pressure ulcers caused by endotracheal tube fixation (ETF). The aim of the present study is to compare three methods of ETF (band, adhesive and holder) on the incidence of pressure ulcers in patients with head injury.
Methods & Materials: This randomized clinical trial was performed in a hospital in Mashhad in 2017. A total of 108 hospitalized patients with head trauma were included in the study by convenience sampling. The patients were randomly divided into three groups of ETF using holder, band and adhesive. In three groups, the incidence of pressure ulcers caused by fixation method was assessed at 6, 12, 18, and 24 hours after the intervention. The grade of ulcer was measured by pressure grading scale (EPUAP/NPUAP). The data were analyzed using the SPSS software version 16.

The incidence of pressure ulcers at 6, 12, 18, and 24 hours after the intervention was significantly different in the three groups (P<0.05). At six and 12 hours after the intervention, the three groups had a grade one ulcer. However, after 18 hours, 10% in the adhesive group and band group and 24 hours after the intervention, 25% in the band group and 12.1% in the adhesive group had a grade 2 pressure ulcer, but this amount was 0% in the holder group.

Use of holder rather than adhesive and band for ETF in mechanically ventilated patients causes less pressure ulcers.

Hemodialysis patients experience pains induced by cannulation of an arteriovenous (AV) fistula. The effect of mirror therapy on patients’ pain severity has not been investigated in individuals living with hemodialysis. The purpose of the present study was to investigate the effect of mirror therapy on AV fistula cannulation-related pain severity in hemodialysis patients. This study was conducted on 30 hemodialysis patients admitted to two hospitals in Mashhad, Iran, during 2018. Pain severity was measured using the Visual Analogue Scale for pain. The mean pain scores in the control session (pre-intervention phase), non-adaptive phase (immediately after looking in the mirror), and adaptive phase (ten minutes after looking in the mirror) were 4.8±1.1, 3.9±1.1, and 2.6±1.22, respectively. The results showed a statistically significant difference between the given sessions (P<0.001). Mirror therapy could be effective in reducing AV fistula cannulation-related pain severity in hemodialysis patients.

Self-efficacy of medication use and pharmaceutical knowledge are important factors for medical treatment completion. This study aimed to determine the effect of self-administration of medication program on pharmaceutical knowledge and satisfaction of patients with cardiovascular diseases. This randomized clinical trial was conducted on 60 patients with cardiovascular diseases (CVD) in Imam Reza hospital in Mashhad during 2018. Self-efficacy was examined using the standard scale of self-efficacy for appropriate medication use. Moreover, pharmaceutical knowledge was examined using the standard scale for the measurement of patients’ knowledge level before and after the intervention. Patients’ satisfaction with the medication use manner was also evaluated at the time of discharge from the hospital. Data were analyzed in SPSS software (Version 20). According to the results, the mean ages of patients in the intervention and control groups were 40.9±8.6 and 44.4±8.5, respectively. In the pre-test, the self-efficacy and pharmaceutical knowledge scores obtained from independent t-tests and Mann-Whitney U test were homogeneous. However, self-efficacy scores in the post-test were 32.0±3.3 and 24.7±3.1 in the intervention and control groups, respectively. The mean satisfaction of patients with medication use manner was significantly higher in the intervention than that in the control group (P<0.001). Implications for Practice: The self-administration of medication program in qualified patients with CVD can improve medication use and pharmaceutical knowledge. Therefore, the application of these programs is suggested improving medication compliance.