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Background & aim: Some studies have called into question medical students' competency in neonatal resuscitation. Therefore applying standard training methods has been recommended. This study compared the effect of Structured Clinical Instruction Module (SCIM) and video-assisted Instructor -led training (ILT) in accelerating and retention of students’ knowledge and skill in neonatal resuscitation.Methods: In this experimental study 48 nursing and midwifery students of Mashhad University of Medical Sciences, Mashhad Iran, who did not attended in any related education, were allocated in SCIM, VT and control group through stratified randomization. In SCIM group, after lecture, six groups of students rotated through six stations, trained and practiced under supervision of six instructors. In VT group after lecture an instructional video presented then students repeated the video and discussed its content with each other and instructor. Before, after and one month following workshops all students participated in an OSCE to assess their cognitive, technical and behavioral skills. Paired t-test and One-way ANOVA were used for data analysis.Results: In post-test, both groups of SCIM and VT had better performance than control group (p

Background: The Emergency Severity Index (ESI) may not recognize high-risk patients with heart failure (HF) efficiently.Aim: 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.Method: 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.Results: 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.

Background: 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. Aim: The purpose of the present study was to investigate the effect of mirror therapy on AV fistula cannulation-related pain severity in hemodialysis patients. Method: 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. Results: 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 Implications for Practice: Mirror therapy could be effective in reducing AV fistula cannulation-related pain severity in hemodialysis patients.

Background: Several complications may occur in patients after coronary artery bypass grafting (CABG) leading to decreased self-efficacy. Rehabilitation training is the best method for reducing the complications and increasing self-efficacy. Various educational techniques lead to different rehabilitation results and levels of self-efficacy. Improving these measures requires the selection of the most appropriate educational technique. Aim: This study aimed to compare the effect of two media-based and face-to-face cardiac rehabilitation training methods on self-efficacy in patients undergoing CABG. Method: This clinical trial was conducted among 60 patients, who were randomly assigned into two groups, in Imam Reza Hospital, Mashhad, Iran, 2017. Cardiac rehabilitation training program was implemented face-to-face or using a researcher-made multimedia upon admission, discharge, at the start of cardiac rehabilitation, and at the end of the 10th session for half-hour. A researcher-constructed questionnaire on self-efficacy was completed by the participants in the mentioned stages. Data analysis was performed in SPSS software, version 16. Results: The mean ages of the participants in the face-to-face and multimedia groups were 56.0±8.1 and 57.5±7.3 years old, respectively. No significant difference was observed in the self-efficacy scores of the patients upon admission (P=0.36). However, there was a significant difference between the groups at the post-intervention stage (P

Patients with end-stage renal disease (ESRD) encounter various challenges following kidney transplantation, which should be managed appropriately. These problems can be partly controlled by considering spirituality as one of the care components. Regarding this, the aim of this study was to investigate the relationship between coping and spiritual health in the renal transplant recipients. This descriptive correlational study was conducted on 169 patients referring to the Organ Transplantation Center at Montasserieh Hospital in Mashhad, Iran. The study population was selected through convenience sampling method. The data were collected using demographic characteristics form, Renal Transplant Coping Scale by Valizadeh et al. (2015), and Spiritual Health Questionnaire developed by Khorashadizadeh et al. (2015). The mean scores of coping and spiritual health were 321.2±15.3 and 123.3±6.2, respectively, which were desirable. There was a significant linear relationship between coping and spiritual health mean scores (P˂0.001, r=0.37). Based on the findings, the reinforcement of spiritual beliefs in patients could be a strategy to promote their coping level.

Background: Neglecting the pain assessment in intensive care unit (ICU) patients with decreased level of consciousness (LOC) can lead to inappropriate pain management. Implementation of a pain management protocol may contribute to avoiding such negligence. Aim: This study aimed to determine the effect of using a pain monitoring protocol on the pain intensity of ICU patients with decreased LOC. Method: This clinical trial was conducted on 60 nurses and 120 patients in the surgical ICUs of Imam Reza and Ghaem hospitals, Mashhad, Iran, 2016. The nurses in the intervention group were trained about pain management protocol in three 20-minute sessions (each session for 10 nurses). Before and after two weeks of training, the patients' pain intensity was monitored using the Nonverbal Pain Scale (NVPS) for three months during the resting-state, suctioning, and dressing change. The patients in the control group received routine nursery care. Data analysis was performed using independent and paired t-tests in the SPSS software version 22. Results: The nurses in the intervention and control groups had a mean age of 38.1±6.4 and 41.2±7.1 years, respectively. The results of independent t-test demonstrated no difference between overall pain intensity (P=0.08), pain intensity during resting-state (P=0.11), suctioning (P=0.23), and dressing change (P=0.06) scores among two groups before the intervention, however after the intervention, there was a significant reduction in the intervention group in comparison to the control group in all mentioned aspects (P

Background: Chest compression with adequate depth and number is one of the main indicators of high-quality cardiopulmonary resuscitation (CPR). Nevertheless, no proper counting technique is suggested to provide sufficient number of massages. Aim: To compare the effects of three techniques of chest compression counting on the quality of CPR and rescuer fatigue. Method: Inthis clinical trial, 30 rescuers (divided into three groups) performed all the three techniques of chest compression counting (without counting [common], alternate [counting from 1 to 10], and continuous [counting from 1 to 100]) in 90 different resuscitation events at Ghaem Hospital of Mashhad, Iran, in 2015. Rescuer fatigue was evaluated using visual analogue scale to evaluate fatigue, and quality of massage was evaluated by the level of end-tidal CO2 (ETCO2); massage was calculated in minutes. Data was analyzed in SPSS using ANOVA and Friedman test. Results: The mean age of the rescuers was 30.6±6.8 years. Based on Kruskal-Wallis test results, common, continuous, and alternate techniques were in descending order of fatigue level, and the common, alternate, and continuous techniques were in descending order of number of massages. In addition, according to ANOVA, the highest ETCO2 levels were observed in the alternate, continuous, and common techniques, respectively; the difference between the techniques was significant (P

Background: Postoperative pulmonary complications (PPC) are of the major reasons for death. Prolonged mechanical ventilation (PMV) and delayed extubation are leading to the incidence of more seriously complications. The effect of hyperinflation has not been investigated in control of these complications in patients who have been weaned from mechanical ventilation and are undergoing T-tube support. Aim: Investigation of MHI effect on oxygenation of patients following abdominal surgery and T-tube support. Method: This clinical trial was performed on 40 patients undergoing abdominal surgery and T-tube support hospitalized in intensive care units of hospitals in Mashhad, Iran, in 2015-2016. The participants were divided randomly into two experimental and control groups. In the experimental group, MHI technique was performed using Mapleson circuit for three twenty-minute periods. The control group received routine hospital care. The two groups were compared for PaO2, PaCO2 and SpO2 before intervention, 5 and 20 minutes after intervention. Data were analyzed using SPSS software. Results: The mean age was 66.7±8.3 and 67.5±9.0 years in experimental and control groups, respectively. In intergroup comparison using independent t-test, the mean PaCO2, PaO2 and SpO2 had no significant differences in the experimental group before the intervention. However, the means SpO2 and PaO2 at 5 and 20 minutes after intervention were significantly higher in the experimental group (p

Background & aim: Neonatal resuscitation training is mandatory for the staff providing maternity and neonatal services in order to ensure competence during the academic period. This study was conducted to assess the neonatal resuscitation skills of nursing and midwifery students. Methods:In this study, the skills of 48 nursing and midwifery students were assessed, using Objective Structured Clinical Examination (OSCE), which consists of seven “stations”, lasting 28 minutes. In station 1, students’ knowledge was assessed. In stations 2-7, students’ skills in the initial steps of resuscitation, positive pressure ventilation, intubation, chest compression, medication prescription and management of cardiopulmonary resuscitation were assessed. Time management and students’ re-evaluation of the infant were also assessed. The total score of OSCE was calculated to be 236. Also, students’ self-evaluation regarding their competence in neonatal resuscitation and their satisfaction with OSCE were evaluated, using two self-structured questionnaires. Results: The mean score of students’ skills in neonatal resuscitation was 97.85±23.15 out of 236. On average, students obtained 38%, 49%, 20% and 72% of the total score in the initial steps of resuscitation, positive pressure ventilation, intubation and chest compression, respectively. Also, the students obtained 45%, 29% and 56% of the total score in prescribing medications (drug dosage and route of administration), management skills in advanced resuscitation and knowledge on neonatal resuscitation, respectively. Students’ self-confidence was lower than half of the optimal score, and their satisfaction with OSCE was high. Conclusion: The students’ skills in neonatal resuscitation were lower than expected. As competence in this area is of high significance for the improvement of neonatal outcomes, holding training workshops through applying novel training methods is recommended.