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In this paper, we propose the problem of connectivity maintenance for a group of robots that are connected with wireless communication. The communication between the agents is modeled by a fading channel, and the exchange of information is possible at permissible distances. The distributed controller is designed to maintain the global connectivity of the network communication graph. On the other hand, obtaining the best communication quality between agents is the definition of good network connectivity. Therefore, the Laplacian matrix is defined as a weighted graph according to the communication parameters. Initially, the controller uses the supergradation algorithm to remake the network Laplacian matrix for having a bigger second eigenvalue. While each agent in the network only has access to the neighbor's information. The control algorithm uses a multi-agent estimator to find the eigenvector corresponding to the second small eigenvalue. The formation problem has been considered in the second step after the reference topology has been obtained. Because of the nonlinear dynamics of the agents, the sliding mode controller has been used for this purpose. This robust controller could be a suitable choice due to the modeling uncertainty and sensor measurement uncertainty. Finally, an example of multi-agent robots is provided to evaluate the algorithm.

Actuator saturation and time delay are practical issues in practical control systems, significantly affecting their performance and stability. This paper addresses, for the first time, the stabilization problem of fractional-order (FO) nonlinear systems under these two practical constraints. Two primary methodologies are employed: the vector Lyapunov function method, integrated with the M-matrix approach, and the second one is the Lyapunov-like function method, which incorporates diffusive realization and the Lipchitz condition. An optimization framework is proposed to design stabilizing controllers based on the derived stability conditions. The proposed methods are validated numerically through their application to the FO Lorenz and Liu systems, demonstrating their effectiveness in handling actuator saturation and time delay.

Sliding mode control is a robust controller against modeling imprecisions and external disturbances, successfully employed to the dynamic positioning of autonomous underwater robot. In order to improve the performance of the whole system, the discontinuity in the control law must be smoothed out to avoid the undesirable chattering and unwanted ripples. One of the disadvantages of conventional sliding mode is great vulnerability in the presence of noise. However, noise and some initial condition causing undesirable chattering phenomenon and unwanted ripples in the control input. This paper describes the development of a depth control system for autonomous underwater robot. In this paper we used the sliding surface term and its derivation with adaptive gains in control law instead of the sign function with fixed gain. The proposed controller has been designed to solve great vulnerability of sliding mode control at the presence of noise. For contrast one of factors causing chattering, big controller gain, the gain of controller adapted according to state condition and uncertainties. Due to in the proposed controller there is no sign function, so our controller is not vulnerability to noise. Using this controller, ripples and unexpected sharp peak of the input control signal were canceled and control signal was smoother than conventional sliding mode controller with boundary layer. The stability and convergence properties of the closed-loop system are analytically proved using Lyapunov stability theorem. Simulation results are presented in order to demonstrate the control system performance.

A higher-order sliding approach to control a bioreactor model is proposed by non-commensurate fractional equations. The model outputs by the help of a controller reached the desired values and track them. According to existing conditions and chattering reduction, a high-order sliding mode has been chosen to design the controller. The purpose of the paper is to choose proper sliding surfaces. Here, for a better conclusion, a comparison has been made between the high-order sliding mode and the standard sliding mode. High-order sliding mode controllers have been taken in accordance with the structure of integer order system. Thus, in order for the system to apply more precise calculations, it should somehow turn to integer order. The sliding surfaces have been selected so appropriately that we can benefit from the structure of integer order controllers for fractional order system. The sliding surface in both controllers has also been the same so as to provide conditions for comparison. Finally, simulation results indicate that the high-order sliding mode controller has a great impact on chattering reduction.

Abstract Cross‐backstepping control for a type of uncertain non‐strict‐feedback non‐linear systems with time‐varying partial state constraints is the main subject of this work. Non‐strict‐feedback non‐linear systems are partitioned into two strict‐feedback non‐linear subsystems: constrained subsystem and unconstrained subsystem. An integral barrier Lyapunov function (IBLF) is used in each step of the backstepping design for the constrained subsystem to guarantee the boundedness of the fictional or actual state tracking errors. The effect of uncertainty is reduced using a hybrid cross‐backstepping sliding mode control (SMC) technique. The algorithm employs a systematic approach to developing control laws for non‐linear systems with matched and unmatched uncertainties. The simulation results of the proposed controller are juxtaposed with those of the cross backstepping with the time‐varying barrier Lyapunov function (TVBLF). The results demonstrate the overall better performance of the proposed method.

The robust adaptive leader-follower formation control of uncertain unmanned surface vehicles (USVs) subject to stochastic environmental loads is investigated in this paper. The stochastic additive noises are included in the kinematics which stands for the un-modeled dynamics and uncertainty. The disturbances induced by waves, wind and ocean currents in the kinetics are also separated into deterministic and stochastic components. A comprehensive model including kinematics and kinetics of each USV agent is then derived as stochastic differential equations including standard Wiener processes. Thus, the problem formulation is much more challenging and practical since both the exogenous disturbances and kinematics states are defined by stochastic differential equations. In order to guarantee that all the tracking errors converge to a ball centered at the origin in probability, quartic Lyapunov functions synthesis, dynamic surface control (DSC) technique, the projection algorithm, and neural networks (NNs) are employed. Finally, the simulation experiments quantify the effectiveness of proposed approach.

The paper introduces a novel adaptive fuzzy fractional-order (FO) fast terminal sliding mode control procedure for a class of nonlinear systems in the presence of uncertainties and external disturbances. For this purpose, firstly, using fractional calculus, a new FO nonlinear sliding surface is proposed and then, the corresponding FO fast terminal sliding mode controller (FOFTSMC) is designed to satisfy the sliding condition in finite time. Next, to eliminate the chattering phenomenon, a fuzzy system is constructed to design a continuous switching control law. The finite-time stability of the proposed adaptive fuzzy FOFTSMC (AFFOFTSMC) is proved using the concept of Lyapunov stability theorem. Finally, to illustrate the effectiveness of the proposed AFFOFTSMC, three examples are given as case studies. The numerical simulation results confirm the superiority of the proposed controller, which are the better robust performance, faster convergence, finite-time stability of the closed-loop control system, and a chattering free control effort compared to other mentioned control methods.

The knee hybrid exoskeleton is a system that aids in the rehabilitation of patients with mobility disorders. It comprises a powered exoskeleton and functional electrical stimulation, which moves the knee joint by stimulating the muscles. However, electrical stimulation of muscles can lead to muscle fatigue. For the first time, this article investigates the regulation of muscle fatigue by controlling muscle activation. To control muscle activation, an innovative adaptive controller for FES is designed. The adaptation law is designed utilizing a time-varying estimation of the muscle activation time parameter. The proportional-integral controller is designed to regulate the knee joint angle utilizing an electrical motor. The proportional-integral controller gains are calculated using an optimization method. A cooperative control structure is presented to use the electrical motor and functional electrical stimulation simultaneously. The muscle activation error is uniformly ultimately bounded, and its boundedness is proven through Lyapunov analysis; the error bound is also determined. The simulation results showed knee joint angle regulation and muscle fatigue regulation. The proposed control method results were compared with those based on model predictive control and switching control, which showed significant improvement in the joint angle error and muscle fatigue. The proposed method is appropriate for practical implementation based on the obtained results.

Lyapunov's theorem is the basic criteria to establish the stability properties of the nonlinear dynamical systems. In this method, it is a necessity to find the positive definite functions with negative definite or negative semi-definite derivative. These functions that named Lyapunov functions, form the core of this criterion. The existence of the Lyapunov functions for asymptotically stable equilibrium points is guaranteed by converse Lyapunov theorems. On the other hand, for the cases where the equilibrium point is stable in the sense of Lyapunov, converse Lyapunov theorems only ensure non-smooth Lyapunov functions. In this paper, it is proved that there exist some autonomous nonlinear systems with stable equilibrium points that despite stability don’t admit convex Lyapunov functions. In addition, it is also shown that there exist some nonlinear systems that despite the fact that they are stable at the origin, but do not admit smooth Lyapunov functions in the form of V(x) or V(t,x) even locally. Finally, a class of non-autonomous dynamical systems with uniform stable equilibrium points, is introduced. It is also proven that this class do not admit any continuous Lyapunov functions in the form of V(x) to establish stability.

Nowadays, sea wave energy is widely regarded as an energy source that is clean, renewable and highly available for power extraction. The subject of extracting the maximum power from sea waves in Iran is of great importance due to access to the Caspian Sea and the Persian Gulf. Moreover, there is a need for resources with no air pollution besides providing a part of the country's power demand without costly infrastructure, so this research field is highly interesting although has rarely been addressed so far. The main purpose of this paper is to use an appropriate control strategy to improve the performance of point absorbers. In this scheme, to consider high uncertainty in the parameters of the power take-off system in different atmospheric conditions and improve controller performance, a new improved black hole algorithm is introduced to tune fuzzy controller parameters. The proposed method is then implemented for tuning the fuzzy controller parameters in order to obtain the maximum power capture of wave energy converters. Compared to particle swarm optimization and conventional black hole algorithm, the results of the proposed method indicate enhancements in reference velocity tracking and absorbed power. Finally, some simulations are performed and the proposed controller is implemented for the wave spectrum of the Persian Gulf waters, so the performance of the proposed controller is evaluated.

In this paper, a novel optimal control design method by discontinuous quadratic Lyapunov function and continuous quadratic Lyapunov function for 2-dimensional piecewise affine systems via semi-definite programming and LMI constraints is proposed.In fact, for designing optimal control we use from two different criteria. At the first, an upper bound for a quadratic cost function for a stable closed-system is obtained. Then after, considering a state-feedback control approach, not only sufficient conditions for the stability of the closed-loop system but also the upper bound of the cost function are obtained. The optimization problem is formulated as a semi-definite programming with bilinear constraints (BMI). Some variables in BMIs are searched by genetic algorithm, so the bilinear constraints are converted to linear constraints and the controller coefficients are calculated. The effectiveness of the proposed method is verified by numerical examples. The simulation results show that discontinuous quadratic lyapunov functions are more efficient that continuous quadratic lyapunov functions.

This paper investigates the stabilization problem of an autonomous Linear Time Invariant (LTI) switched system with interval uncertainty and unstable subsystems. It is proved that the system would be stable by using a common Lyapanov function whose derivative is negative and bounded by a quadratic function within activation regions of each subsystem. First, a sufficient condition for the stability of an Linear Time Invariant switched system with interval uncertainty, based on the convex analysis and interval set theoretical approach, is presented and proved. Moreover, conservatism in the stability robustness bound is obtained. Then, a switching control law is designed to shift the Linear Time Invariant switched system among subsystems to ensure the decrease of the Lyapanov function within the state space. Finally, in order to decrease the switching frequency and to avoid chattering, the switching law is modified. Two examples are included to demonstrate the effectiveness of the theoretical findings.

Introduction: In this paper, a novel complexity measure is proposed to detect dynamical changes in nonlinear systems using ordinal pattern analysis of time series data taken from the system. Epilepsy is considered as a dynamical change in nonlinear and complex brain system. The ability of the proposed measure for characterizing the normal and epileptic EEG signals when the signal is short or is contaminated with noise is investigated and compared with some traditional chaos-based measures. Materials and Methods: In the proposed method, the phase space of the time series is reconstructed and then partitioned using ordinal patterns. The partitions can be labeled using a set of symbols. Therefore, the state trajectory is converted to a symbol sequence. A finite state machine is then constructed to model the sequence. A new complexity measure is proposed to detect dynamical changes using the state transition matrix of the state machine. The proposed complexity measure was applied to detect epilepsy in short and noisy EEG signals and the results were compared with some chaotic measures. Results: The results indicate that this complexity measure can distinguish normal and epileptic EEG signals with an accuracy of more than 97% for clean EEG and more than 75% for highly noised EEG signals. Discussion and Conclusion: The complexity measure can be computed in a very fast and easy way and, unlike traditional chaotic measures, is robust with respect to noise corrupting the data. This measure is also capable of dynamical change detection in short time series data.

Abstract Background Although previous studies have linked emotional intelligence to nurses’ job performance, research lacks how moral intelligence and occupational stress mediate this relationship. Addressing this gap is essential for improving nursing care outcomes. This study aims to determine the mediating effect of moral intelligence and occupational stress in this relationship among Iranian nurses. Methods This descriptive cross-sectional correlational study was conducted in Urmia Teaching Hospital from February to April 2022. Six hundred and twenty-one nurses were recruited using quota sampling. Data were collected using a demographic questionnaire, Lenik and Kiel’s Moral Intelligence Questionnaire (LK-MIQ), Siberia Schering’s Emotional Intelligence Questionnaire (SS-EISQ), Patterson’s Job Performance Questionnaire (P-JPQ), and the Nursing Stress Scale (NSS). Data were analyzed using IBM SPSS ver. 23 and Smart-PLS ver. 3.0. Results The effect of emotional intelligence on job performance was positive, direct, and weak (β = 0.099, t-value = 2.285, p = 0.023). Emotional intelligence had a negative, direct, and weak effect on moral intelligence (β = − 0.257, t-value = 4.754, p = 0.000) and a negative, direct, and moderate effect on occupational stress (β = − 0.316, t-value = 6.482, p = 0.000). Moral intelligence mediates the relationship between emotional intelligence and occupational stress (β = 0.0842, 95% CI: 0.0532, 0.1194). However, the mediating role of occupational stress between emotional intelligence and job performance was not supported (β = 0.003, 95% CI: − 0.0139, 0.0184). Conclusion Moral and emotional intelligence should be key criteria for selecting nursing staff and managers to create a safe, low-stress environment that boosts nurses’ job performance. Healthcare managers should promote nurses’ emotional intelligence by offering practical courses for enhancing nurses’ self-awareness, self-management, social awareness, and relationship management skills. It is essential to support moral intelligence by organizing educational classes that improve their integrity, responsibility, compassion, and forgiveness.

Abstract Background Although previous studies have linked professional autonomy to nurses’ job performance, research lacks how job satisfaction and organizational commitment mediate this relationship. Addressing this gap is essential for improving nursing practice outcomes. This study aims to determine the mediating effect of job satisfaction and organizational commitment in this relationship among Iranian nurses. Methods This descriptive-correlational study was conducted in Urmia teaching hospitals from October 2022 to June 2023. Four hundred twenty nurses were recruited using quota sampling. Eligible participants were selected non-randomly from predetermined numbers at four hospitals, and recruitment continued until the required sample size was achieved. Data were collected using demographic questionnaires, the Varjus Professional Autonomy Scale, the Porter Organizational Commitment Questionnaire, the Minnesota Satisfaction Questionnaire, and the Paterson Job Performance Questionnaire. Data were analyzed using SPSS ver. 23 and SmartPLS ver. 3. Results Professional autonomy had a positive, direct, and strong effect on nurses’ job performance (β = 0.708, t-value = 9.867, p

Background: Healthcare systems and hospitals encounter numerous challenges in the organ donation process.Objectives: This study aims to elucidate the organizational challenges associated with organ donation.Methods: A qualitative content analysis was conducted from February to September 2023. Purposive sampling and semi-structured interviews were employed with 14 family members and staff involved in the organ donation process in northwestern Iran. Data were analyzed using conventional content analysis based on the approach proposed by Lundman and Granheim.Results: The analysis revealed the overarching theme of "organizational challenges of organ donation," which encompassed five categories and twenty-three codes. The categories identified were "Insufficient Resources", "Insufficient Cultural Development", "Professionals Who Waste Opportunities", "Low Organizational Sensitivity", and "Depreciated Human Resources".Conclusion: Medical and healthcare organizations play a crucial role in the organ donation process; however, they face significant challenges in this area. To facilitate and expedite organ donation, it is essential to allocate more funding, provide appropriate media platforms, enhance training and cultural development, and improve the management of human resources involved in the organ donation process.

Abstract Background Platelets are critical in maintaining homeostasis and immune response in burn patients. The concentration of platelets decreases in burn patients, and any intervention that increases serum platelet concentration can prevent serious consequences and patient death. The present study aimed to assess the impact of skin graft surgery on burn patients’ platelet counts. Methods In this non-randomized clinical trial, 200 burn patients were investigated. The patients were recruited from the surgical ward of Imam Khomeini Teaching Hospital during the first six months of 2021. After completing the checklist, patients underwent skin graft surgery. Blood was taken from the patients during surgery in the operating room and on the third and fifth day after the surgery to check platelets. Data analysis was conducted using SPSS software (ver. 22.0). Results Most patients (63.5%) were male, and 73 (36.5%) were female. One hundred eighty-one patients (90.5%) had deep burns, and 19 (9.5%) had superficial burns. The mean burns percentage in the patients was 19.3 ± 15.4%, the lowest was 2%, and the highest was 90%. The most common burns were caused by flame (42%) and boiling water (30.5%). The patients’ outcomes revealed that 6% gained complete recovery, 86.5% partial recovery, 2.5% showed transplant rejection, and 5% died. Mean platelet levels in deceased patients had an upward trend. The mean platelet counts of patients were elevated during surgery (289,855 ± 165,378), decreased three days after surgery (282,778 ± 317,310), and elevated again five days after surgery (330,375 ± 208,571). However, no significant difference was found between the mean platelet counts during surgery, the third and fifth days after surgery in patients undergoing skin grafts (P = 0.057). Conclusions This study suggests that skin graft positively increases the patient’s platelets. Further studies are needed to confirm the findings and elucidate the mechanism. Iranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N8 & 06/01/2024).

Key Clinical Message Maggots in a wound (“myiasis”) cannot be considered maggot therapy (therapeutic myiasis) unless, at a minimum, the species is known to be safe and effective, and the maggots have been properly disinfected. Documenting treatment details is critical and allows us to determine the cause of problems, if they arise.

Stevens-Johnson Syndrome (SJS) is a severe and rare adverse drug reaction associated with significant morbidity and mortality. Although SJS is commonly triggered by multiple drugs, non-steroidal anti-inflammatory drugs (NSAIDs), including diclofenac, have been frequently implicated. A middle-aged woman, who is 50 years old, has a prior medical record of high blood pressure, type 2 diabetes, and has recently suffered from a pulmonary embolism. She was later admitted to the intensive care unit (ICU), where she was ultimately diagnosed with Steven Johnson syndrome. Careful drug selection, close monitoring of patients with predisposing factors, and prompt identification of adverse events are crucial to prevent severe drug reactions.

Abstract Background Depression is one of the most common mental disorders that leads to anxiety, sleep disturbances, and suicidal thoughts. Due to the high cost of treatment and the reluctance of many patients to seek medical help, major depressive disorder (MDD) is becoming more prevalent. Therefore, alternative methods like smartphone applications can help prevent and improve depression symptoms. The present study aimed to determine the effect of the newly developed Yara smartphone application on anxiety, sleep quality, and suicidal thoughts in patients with MDD. Methods This randomized controlled trial with a pretest-posttest design was conducted on Iranian patients with MDD in 2022. Sixty-four patients were recruited using convenience sampling and randomly assigned to two control and intervention groups. The intervention was conducted using the Yara smartphone application for three months. Data were collected using the Spielberger State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI), and Beck Scale for Suicidal Ideation (BSSI). Data were first entered into IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA) and then analyzed using descriptive and analytical statistics. Results There was no statistically significant difference in the mean score of anxiety and sleep quality between the intervention and control groups before the intervention (p ≥ .05). However, this difference in the mean score of anxiety and sleep quality was statistically significant in the two groups after the intervention (p < .05). The results showed no statistically significant difference in the mean score of suicidal thoughts between the two groups before and after the intervention (p ≥ .05). The use of the Yara smartphone application had a significant positive effect on anxiety and sleep quality in depressed patients (p < .001). At the same time, it had no significant effect on suicidal thoughts (p ≥ .05). Conclusion Considering the positive effect of using the Yara smartphone application on reducing anxiety and improving sleep quality in depressed patients, this application can help alleviate the problems of depressed patients alongside existing treatment methods. Thus, this application is recommended for this group of patients in psychiatric clinics and departments. The Yara application's effectiveness was not approved on suicidal thoughts in this study so that further investigation would be necessary. Trial Registration Iranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N7).

Abstract Background Nurses’ Job performance could be affected by occupational stress. Previous studies reported contradictory results in this regard. Factors such as moral and emotional intelligence could impact occupational stress. However, the extent of any mediating effect is unclear. Thus, this study aimed to determine the effect of occupational stress on nurses’ Job performance and the mediating impact of moral and emotional intelligence. Methods This cross-sectional study was conducted in Urmia teaching hospitals (Imam Khomeini, Motahari, Taleghani, Kosar, and Seyed al-Shohada Hospitals). Six hundred twenty-one nurses were selected using quota sampling from February 2022 to April 2022. Data were collected using demographic questionnaires, the Nursing Stress Scale, Paterson’s Job Performance Questionnaire, Siberia Schering’s Emotional Intelligence Standard Questionnaire, and Lennik and Keil’s Moral Intelligence Questionnaire. Data were analyzed using SPSS ver. 23 and SmartPLS ver. 2. Results Occupational stress had a positive, direct, and minor effect on nurses’ job performance (β = 0.088, t-value = 2.245, p

Background: Among leukemia patients, sleep disruptions are prevalent and can profoundly affect their overall quality of life. Acupressure and foot reflexology, modalities rooted in traditional Chinese medicine, have garnered attention for their potential to address sleep disturbances and mitigate associated symptoms. Methods: This research utilized a randomized controlled trial with a pretest-posttest design involving 102 leukemia patients admitted to Imam Khomeini Hospital in Urmia. Participants were randomly allocated to 3 groups: acupressure (n = 34), reflexology (n = 34), or control (n = 34). Prior to the intervention, patients completed a demographic survey and the Pittsburgh Sleep Quality Index (PSQI) for baseline assessments. Acupressure involved stimulation of the SP6 point twice daily for 10 minutes over 4 weeks, while reflexology entailed daily 10-minute sessions with sweet almond oil on the soles for the same duration. The control group received standard care without additional interventions. Following the 4-week intervention period, post-intervention evaluations were conducted using identical measurement tools. Results: The findings underscored the efficacy of both acupressure and foot reflexology in significantly improving sleep quality within the intervention groups ( P .05). Subsequently, pairwise comparisons adjusted with Bonferroni corrections revealed significant disparities in sleep quality between the acupressure and reflexology groups compared to the control group ( P

Abstract Aims To investigate nurses' experiences of adhering to professional values in clinical settings. Design A qualitative study with a conventional content analysis approach. Methods This study was conducted from January 2021 to March 2022. Semi‐structured interviews were conducted with 12 nurses working in different wards of five public and private hospitals in West Azerbaijan of Iran. Data were analysed using the conventional content analysis approach proposed by Graneheim and Lundman (Nurse education today, 24, 2004, 105) Results “Barriers to nurses' professional values” emerged as the main category of Iranian nurses' experiences in adhering to professional values. Three subcategories of barriers were revealed: “nurses' challenges,” “professional suppressors” and “poor working conditions.” Conclusion Barriers in clinical settings can overshadow nurses' professional performance and disrupt their adherence to professional values. Nursing managers must pay attention to nurses' challenges, their professional suppressors and poor working condition to help them promote their professional performance in clinical settings. Thus, nursing managers should not neglect the continuous education of nurses to assist them in increasing their clinical skills by holding practical and theoretical workshops. Improving the working conditions and clinical atmosphere by recruiting a capable workforce and applying psychological and financial support for nurses are essential to increase the quality of nursing care.

Abstract Background The unprecedented increase in the nurses’ workload is one of the issues affecting the quality and safety of patient care in the Intensive Care Units (ICUs). The electronic nursing handover can share sufficient, relevant, and necessary data about patients with greater efficiency and accuracy and prevent their information from being deleted. Therefore, this study aimed to determine and compare the effect of the Electronic Nursing Handover System (ENHS) on patient safety in General ICU and COVID-19 ICU. Method This is a quasi-experimental study conducted during an 8-month period from 22 to 2021 to 26 June 2022 using a test-retest design. A total of 29 nurses working in the General and COVID-19 ICUs participated in this study. Data were collected using a five-part questionnaire consisting of demographic information, handover quality, handover efficiency, error reduction, and handover time. Data analysis was conducted in IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA) using the chi-squared test, paired t-test, and Analysis of Covariance (ANCOVA). Results The results showed that the mean scores of handover quality and efficiency, reduction of clinical error, and handover time in the electronic handover were significantly higher than those obtained in the paper-based method. The results showed that the mean score of patient safety in the COVID-19 ICU was 177.40 ± 30.416 for the paper-based handover and 251.40 ± 29.049 for the electronic handover (p = .0001). Moreover, the mean score of patient safety in the general ICU was 209.21 ± 23.072 for the paper-based handover and 251.93 ± 23.381 for the electronic one (p = .0001). Conclusion The use of ENHS significantly improved the quality and efficiency of shift handover, reduced the possibility of clinical error, saved handover time, and finally increased patient safety compared to the paper-based method. The results also showed the positive perspectives of ICU nurses toward the positive effect of ENHS on the patient safety improvement.

Abstract Aim To investigate the effect of family‐centred education on treatment adherence, glycosylated haemoglobin and blood glucose level in patients with Type 1 Diabetes Mellitus. Design Randomized controlled trial. Methods Sixty patients with Type 1 Diabetes Mellitus were randomly allocated into the intervention and control group. Data were collected using demographic and Modanloo Adherence to Treatment Questionnaires. The patients received 12 family‐centred educational sessions in the intervention group. Results A significant difference was found in the mean score of treatment adherence between the two groups after the intervention (p

Testicular trauma is a rare but significant condition that can result in severe damage to the testicles. In some cases, when the trauma is extensive and irreparable, orchiectomy, which refers to the surgical removal of one or both testicles, may be necessary. A 45-year-old man experienced testicular trauma as a result of a sporting event. Upon examination, it was determined that the trauma had caused severe damage to the affected testicle, leading to compromised blood supply and persistent pain. The presence of compromised blood supply was assessed through a combination of clinical evaluation and diagnostic imaging (scrotal ultrasound). The imaging findings indicate reduced blood flow to the testicle. Considering alternative treatment options and potential complications, the medical team decided to proceed with orchiectomy. Orchiectomy is a significant surgical procedure performed as a last resort when other treatments are not viable or when complications such as infection or severe pain are present. The decision to perform orchiectomy depends on the extent of the testicular trauma and the patient's overall health. It has implications for fertility and hormone production, with the remaining testicle typically compensating for the functions of the removed testicle. Prompt medical intervention is crucial in evaluating the severity of the injury and determining the appropriate course of treatment. Orchiectomy should be considered when the testicle is extensively damaged and irreparable, making testicular trauma resulting in the need for orchiectomy a complex and challenging situation.

Abstract Background Fear of missing out (FoMO) can increase loneliness and smartphone addiction and decrease academic performance in university students. Most studies investigated the relationship between FoMO and smartphone addiction in developed countries, and no studies were found to examine this association in Iran. The mediating role of loneliness and academic performance in the relationship between FoMO and smartphone addiction is unclear. This study investigated the relationship between FoMO and smartphone addiction and the mediating role of loneliness and academic performance in this relationship in Iranian university students. Methods In this cross-sectional study, 447 students from Urmia University of Medical Sciences were investigated. Data were collected using demographic questionnaires, Przybylski's FoMO scale, Pham and Taylor's academic performance questionnaire, Russell's loneliness scale, and Kwon's smartphone addiction scale. Data were analyzed using SPSS ver. 23 and SmartPLS ver. 2. Results FoMO had a positive and direct association with smartphone addiction (β = 0.315, t-value = 5.152, p 0.05). FoMO also indirectly correlated with academic performance through students' loneliness (β =—0.368, t-value = 6.377, p

Background: Autonomy is an essential factor in the nursing profession. Nurses' autonomy can improve care quality, decrease mortality in patients, and attenuate job stress. This study aimed to investigate professional autonomy and its relationship with job stress among nurses working in Intensive Care Units (ICUs). Materials and Methods: This descriptive correlational study was conducted at Urmia nursing school in Iran in 2020. Three hundred ninety-eight nurses working at the ICUs entered the study. Data was collected using the Dempster Practice Behavior Scale (DPBS) and the Health and Safety Executive (HSE) questionnaire. Independent t-test and analysis of variance (ANOVA) were used to examine the relationship between demographics and study variables. Pearson's correlation coefficient was used to investigate the relationship between professional autonomy and job stress of nurses. Results: The mean (SD) of total professional autonomy and job stress score of nurses was, respectively, 102. 11(91. 88), and 115. 53(12. 42), indicating moderate autonomy and job stress. Professional autonomy had a significant positive correlation with job stress (r = 0.51, p < 0.001). It also had a significant positive correlation with work experience in ICU (r = 0.12, p = 0.014). Conclusions: ICU nurses have moderate autonomy and job stress, and their autonomy is a significant positive predictor of their job stress. University authorities are recommended to develop practical strategies to enhance nurses' autonomy and eliminate factors that cause job stress in ICU nurses in order to preserve nurses' health, improve the quality of nursing care, and increase patient safety.

Abstract Background End-Stage Renal Disease (ESRD) is the final and permanent stage of Chronic Kidney Disease (CKD). Hemodialysis (HD) is the most common treatment for CKD. To have desirable therapeutic outcomes, patients have to adhere to a specific therapeutic regimen that reduces the hospitalization rate and side-effects of HD. The present study aimed to determine the effects of the patient education program and nurse-led telephone follow-up on adherence to the treatment in hemodialysis patients. Methods This is a randomized controlled trial in which a total of 66 patients were recruited using convenience sampling and then randomly assigned to two groups of control (n = 33) and intervention (n = 33). Data were collected using a demographic questionnaire, the laboratory results record sheet, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which included four dimensions of HD attendance, medication use, fluid restrictions, and diet recommendations. The intervention group received a patient education program and nurse-led follow-up services through telephone communication and the Short Message Service (SMS) for 3 months. All participants filled in the questionnaire before and after the intervention. Data were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA). Results The results showed a significant difference in the mean scores of HD attendance, medication use, fluid restrictions, and diet recommendations between the two groups immediately, 1 month, and 3 months after the intervention (p

Abstract Background Patient safety is a top priority for any health care system. Most universities are looking for teaching methods through which they would be able to enhance students’ clinical decision-making capabilities and their self-centered learning to ensure safe and quality nursing care. Therefore, this study aimed to determine the effect of patient safety education through problem-based learning (PBL) on nursing students’ knowledge, attitude, and perceptions toward patient safety. Methods This randomized, controlled trial was conducted from September 2019 to January 2020. A total of 78 fourth-year nursing students participated in this study. The participants were randomly assigned to either the intervention group or the control group. In the intervention group, the educational materials were presented to the students using the PBL method during eight sessions of 45–60 min. In each control group, nursing students received eight education sessions through lectures and discussing the same educational content. Data were gathered 1 month after the intervention using demographic information and knowledge, attitudes, and perception questionnaires. Data were analyzed in SPSS ver. 22.0 using descriptive (mean and standard deviation) and inferential (chi-square test, independent t-test, paired t-test, and analysis of covariance (ANCOVA)) statistics. Results The results indicated that the difference in the mean scores of knowledge, attitudes, and perceptions of the nursing students about patient safety was statistically significant between the two groups after the PBL education (p = 0.001). The mean scores of students’ knowledge, attitude, and perceptions of patient safety increased significantly in the intervention group. Conclusions Implementing patient safety education through PBL positively affects knowledge, attitudes, and perceptions of patient safety among nursing students. Thus, the research team recommended the PBL method to be used by nursing professors to improve nursing students’ clinical skills and cognitive abilities to ensure safe patient care. Trial registration IRCT20190925044881N1 ; October 17, 2019.

Abstract Background Suicide-attempts have increased across the world and have become higher among females. There has been a high prevalence of self-immolation in Iran, mostly young married women admitted to the burn centers. This study aimed to explore the factors and experiences of self-immolation in Iranian married women to develop prevention strategies to prevent the personal, social, and economic impacts of suicide and suicide attempts. Methods A qualitative descriptive approach using open-ended, in-depth, face-to-face interviews was conducted in a purposive sample of 16 married Iranian women aged 16–40 years in the burn centers in Urmia city, a place in northwest Iran. Conventional content analysis was used to analyze the data. Results Three themes emerged from the data, including (1) antecedents of self-immolation, (2) suicidal ideation method, and (3) pathway to recovery. Each of these themes is supported by sub-themes. Conclusions The study highlights the demand for health professionals to support self-immolation survivors to continue their normal lives. According to survivors’ needs, a comprehensive supportive program is recommended to support their pathways to recovery in all its complexities. Health professionals should also not forget that the survivors’ family also will need help to overcome this trauma. A family counseling program may also be provided.

Background: Clinical self-efficacy (CSE) plays a pivotal role in safe and quality nursing care delivery. Clinical Belongingness (CB) is a major factor in the clinical practice of nursing students. Objective: This study aimed to assess CSE and CB and their relationship among nursing students. Methods: This descriptive, correlational study was conducted in 2019 in the Faculty of Nursing and Midwifery of Urmia University of Medical Sciences, Urmia, Iran. Participants were 216 eligible 3rd- and 4th-year nursing students. Data were collected using a demographic questionnaire, the Belongingness Scale-Clinical Placement Experience, and the Self-Efficacy in Clinical Performance Questionnaire. The Pearson correlation analysis, the independent-sample t-test, the one-way analysis of variance, and the linear regression analysis were performed for the data analysis. Results: The total mean scores of CSE and CB were, respectively, 134.02 ± 20.62 and 121 ± 16.79, indicating moderate CSE and high CB. CB had significant positive correlation with CSE and was a significant predictor of it (P < 0.05). Conclusion: Nursing students have high CB and moderate CSE, and their CB is a significant positive predictor of their CSE. University authorities are recommended to develop clear strategies to improve nursing students' CSE through improving their CB.

Background: Diaper dermatitis (DD) is a prevalent skin disease in children, which causes child discomfort and parental concern. This study aimed to compare the effects of aloe vera ointment with routine treatment on the severity of DD in hospitalized children. Materials and Methods: This double-blinded randomized clinical trial was carried out on 60 children aged less than two years admitted to Tabriz pediatric hospital in Iran from February to June 2017. Using convenience sampling method, the patients were assigned into two equal groups (n=30 in each) of intervention and control. The intervention group received routine combination treatment, whereas the control group received aloe vera ointment. The patients were examined on the first, third, and sixth days of the study. Data analysis was performed using SPSS software (version 22) and descriptive and analytical statistics. Results: The severity of DD in both groups improved on the sixth day compared to the first day. In comparison, no significant difference was observed between the two groups regarding the severity of dermatitis (P>0.05). Conclusion: Herbal products cause fewer side effects than chemical products and seem to have significant pharmacological effects on the skin. Thus, aloe vera ointment appears to help treat DD and, with further studies, may emerge as a possible therapeutic option.

Abstract Background Chronic nonhealing wounds are very expensive to treat and debilitating, and they reduce health-related quality of life. Scalp necrosis is very rare due to its rich vascularity. However, any post-traumatic wounds with secondary infection can lead to scalp necrosis. Case presentation We report a case of a 77-year-old Azerbaijani man with a history of diabetes who had a car accident and sustained a scalp wound. He underwent reconstructive surgery for the scalp wound. The wound became infected, and scalp necrosis developed following the surgery. There was no progress in wound healing in spite of conventional wound therapy. We combined maggot debridement therapy with negative-pressure wound therapy and amniotic membrane grafting for 7 months. Necrotic tissues began to be eliminated after the second use of larva therapy, and the wound became free of necrotic tissues with clear increase of granulated tissues after four treatments with maggot debridement therapy. Then, we applied negative-pressure wound therapy and amniotic membrane grafting to accelerate wound healing and improve wound closure. The patient’s scalp wound recovered well, and he was discharged to home in good condition. Conclusions Medical and wound care teams can benefit from this combination therapy when dealing with nonhealing necrotic wounds.

Introduction: Nursing education plays a pivotal role in patient safety in complicated healthcare environments, and problem-based learning (PBL) is an educational method that has gained a remarkable reputation in higher education. Objectives: The present study aimed to assess the effects of nursing education through the PBL method on patient safety-based communication skills in nursing students. Patients and Methods: This quasi-experimental study was performed on 78 fourth-year nursing students. The participants were divided into intervention (n=43) and control (n=35) groups. In the intervention groups, the educational content based on the PBL method was provided in eight sessions (45-60 minutes each). Data were collected using demographic and patient safety-based communication skills questionnaires. Results: No significant difference was observed in the mean score of patient safety-based communication skills in the control groups after the intervention (P=0.162). However, the intervention groups had significantly higher scores after the educational sessions (P=0.001). Conclusion: The implementation of the PBL method affected the patient safety-based communication skills of the nursing students. Thus, it is recommended that conventional teaching methods be replaced by PBL to improve the clinical and cognitive capabilities of nursing students.

Abstract Background Needlestick and sharps injuries (NSIs) are critical occupational risk among health care workers (HCWs), which is extremely worrying due to the potential risk of transmitting bloodborn pathogens (BBPs). This study was carried out to evaluate the prevalence of NSIs among Iranian HCWs. Methods In this systematic review and meta-analysis, the key terms percu* injur*, needle* stick injur*, needlestick* injur*, or sharp* injur* were searched in the Scientific Information Database (SID), MagIran, IranMedex, Google Scholar, Science Direct, PubMed, and Scopus. A prefabricated checklist, including variables: first author, publication year, study population, sample size, gender, total prevalence of needlestick in each gender, type of questionnaire, region, and type of hospitals, was used to extract data from the selected articles included which were published between 2003 and 2016. Results The analysis showed that the prevalence of NSIs in the Iranian HCWs was 42.5% (95% CI 37–48). Moreover, the prevalence of NSIs was more in women (47%; 95% CI 36–58) compared to men (42%; 95% CI 26–58). Conclusion Given the high prevalence of NSIs, it is necessary to supply safe needles and instruments, hold training programs focused on new methods of using sharp objects safely, observe safety principles and standards, reinforce the practical skills of personnel, and pay more attention to reporting and improving occupational behaviors like avoiding needle recapping in order to reduce the prevalence of NSIs and consequently reduce potential risk of transmission of BBPs.

BACKGROUND: Patients' satisfaction is a fundamental factor in the quality of nursing care. The emergence of the novel Coronavirus Disease 2019 (COVID-19) and the highly contagious virus can affect nursing care by increasing the number of care-seekers. This study aimed to determine the patients' satisfaction and related factors in patients with COVID-19 hospitalized in Taleghani Hospital, Urmia-Iran, in 2020. MATERIALS AND METHODS: This descriptive, correlational study was conducted on 196 patients with COVID-19 hospitalized in Taleghani Hospital, Urmia. Purposive convenient sampling was used to recruit participants. Study participants completed Patient Satisfaction Instrument and demographics questionnaires. Data were analyzed with the SPSS software version 25.0. RESULTS: The majority of patients (68.9%) were moderately satisfied with nursing care. Based on Pearson Correlation Analysis, only residential status had a significant inverse relationship with satisfaction level in patients with COVID-19 (r = −0.0238, P = 0.001). CONCLUSIONS: The patients' satisfaction with nursing care was mostly at a moderate level. Thus, there is a need to educate health personnel and nurses in particular and motivate them to have active participation in achieving patients' satisfaction with COVID-19. Notably, only the institutes that take patients' satisfaction as a top priority can succeed in a competitive market of health services.

Introduction: Team-based learning is one of the active learning approaches in which independent learning is combined with small group discussion in the class. This study aimed to determine the impact of team-based learning in nervous system examination knowledge of nursing students. Methods: This quasi-experimental study was conducted on 3rd grade nursing students, including 5th semester (intervention group) and 6th semester (control group). The traditional lecture method and the team-based learning method were used for educating the examination of the nervous system for intervention and control groups, respectively. The data were collected by a test covering 40-questions (multiple choice, matching, gap-filling and descriptive questions) before and after intervention in both groups. Individual Readiness Assurance Test (RAT) and Group Readiness Assurance Test (GRAT) used to collect data in the intervention group. In the end, the collected data were analyzed by SPSS ver. 13 using descriptive and inferential statistical tests. Results: In team-based learning group, mean and standard deviation was 13.39 (4.52) before the intervention, which had been increased to 31.07 (3.20) after the intervention and this increase was statistically significant. Also, there was a statistically significant difference between the scores of RAT and GRAT in team-based learning group. Conclusion: Using team-based learning approach resulted in much better improvement and stability in the nervous system examination knowledge of nursing students compared to traditional lecture method; therefore, this method could be efficiently used as an effective educational approach in nursing education.

This study aimed to evaluate the effectiveness of family involvement in patient education on hypertension (HTN) management. This single-blind randomized, parallel group controlled trial was conducted in Sayyed-Al Shohada hospital in Urmia. One hundred participants who met inclusion criteria were selected by convenience sampling and randomly allocated into control, patient-oriented, family-oriented and patient and family-oriented groups. Interactive educational interventions were given to three intervention groups for four months. The control group received routine care. The Hill-Bone Compliance to High Blood Pressure Therapy Scale and a mercury manometer were used to collect data. Data was analyzed using SPSS V20. The results showed a significant difference in the mean scores of the medical treatment compliance (primary outcome) and blood pressure (BP) among four study groups after the intervention (p

Background: Metabolic syndrome (MetS) is the major risk factor for development of type 2 diabetes and cardiovascular diseases in different populations. The aim of this study was to evaluate the prevalence of MetS among Iranian population. Methods: Thirty-four cross-sectional studies were analyzed with a sample of 83227 people. National and international English electronic databases (PubMed, Google scholar, Web of Science, Science Direct, and Scopus) and Persian language databases (SID, Medlib, Iran medex, Magiran, Medlib, and IranDoc) were used to search the articles published on MetS in Iranian population from Jan 2005 to May 2016. The MetS diagnosis was performed according to the ATP-III, NCEP/ATP-III, IDF and WHO criteria. Results: The overall weighted prevalence of MetS was 31% (95% CI: 28-35). According to ATP III criteria, total and gender-stratified prevalence of MetS in women and men were 29% (95% CI: 22-36), 37% (95% CI: 26-48) and 29% (95% CI: 23-36), respectively. Total prevalence of MetS based on NCEP/ATP III criteria was 29% (95% CI: 24-35) that the prevalence was 24% (95% CI: 18-30) and 35% (95% CI: 25-44) in men and women, respectively. According to the IDF and WHO criteria, total prevalence of MetS were 38% (95% CI: 32-43) and 30% (95% CI: 7-53), respectively. Conclusion: The findings demonstrate an emerging high prevalence of MetS in total and in particular among Iranian women population. Therefore, to minimize the risk of cardiovascular events in Iranian population, screening and early detection of risk factors for MetS are required.

Background and Objective: Restless legs syndrome (RLS) is a sensorimotor disorder that causes sleep deprivation. RLS is characterized by discomfort in the legs and severe desire to move them during sleep. Different prevalence rates about RLS are reported in Iran. This systematic review and meta-analysis was performed to estimate the prevalence of RLS in Iran. Materials and Methods: By searching the national and international databases such as Scientific Information Database (SID), MagIran, Google Scholar, IranMedex, Science Direct, PubMed and Scopus, 30 articles published between 2005 and 2014 were found. The results of the studies were combined using the random-effects model in the meta-analysis. Heterogenei-ty among studies was assessed using the I2 index and P value less than 0.05 were considered as statistically significant. Data were analyzed using STATA software version 11.2. Results: In studied articles, 8459 participants were entered into meta-analysis and the prevalence of RLS was esti-mated as 30% (95% CI: 24%-36%). According to the meta-regression diagram, the prevalence of RLS decreased by increasing the sample size and the year of study, indicated possible rising of the prevalence, but these changes were not statistically significant. The prevalence of RLS in patients with kidney disease (45%; 95% confidence interval: 33% to 57%), patients with diabetes (35%; 95% confidence interval: 22% to 49%), and patients with neurological disease (33%; 95% confidence interval: 10% to 57%) was more than other groups. Conclusion: Given the high estimated prevalence of RLS in this study, it is recommended to identify at-risk indi-viduals and provide educational materials for them.

Background: There is not enough studies to determine the frequency of using the prophylaxis against deep venous thrombosis (DVT) based on the American College of Chest Physician's (ACCP) guidelines in Iran. Thus, providing such statistics is essential to improve thromboprophylaxis in hospital. The present study aimed to determine the frequency of using the prophylaxis against DVT based on ACCP guidelines in patients hospitalized in surgical wards in one of teaching hospital in Ilam, Iran. Methods: In a cross-sectional, the samples were selected among medical records of patients who were hospitalized and underwent surgery in surgical wards of the hospital from April 2012 to September 2013. Type of prophylaxis was determined based on ACCP guidelines. After reviewing inclusion and exclusion criteria, patients' data were extracted from medical records based on required variables. Results: In reviewing 169 qualified samples, 46.2% (78 patients) were women. Of these, 132 patients were at risk of DVT and needed prophylaxis, only 39 patients (29.5%) received prophylaxis. Thromboprophylaxis based on ACCP guidelines had been fully implemented only in 30 cases (22.7%) of patients with the risk of DVT. The highest thromboprophylaxis was in the intensive care unit (46.6%) and neurosurgery (37.5%), and the least rate was in urology (0%). Conclusions: As the results of this study, there are differences between clinical practice and the ACCP guidelines recommendation in prophylaxis against DVT. Thromboprophylaxis has not been implemented based on ACCP guidelines in more than 75% of patients with the risk of DVT. Thus, new strategies are needed to implement thromboprophylaxis against DVT in Iranian hospitals.