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Objectives: Futile medical care is considered as the care or treatment that does not benefit the patient. Staff of intensive care units experience moral distress when they perceive the futility of care. Therefore, this study aimed to determine the relationship between perceptions of nurses regarding futile medical care and their caring behaviors toward patients in the final stages of life admitted to intensive care units. Method: This correlation, analytical study was conducted with 181 nursing staff of the intensive care units of health centers affiliated to Mazandaran University of Medical Sciences, Mazandaran, Iran. The data collection tool included a three-part questionnaire containing demographic characteristics form, perception of futile care questionnaire, and caring behaviors inventory. To analyze the data, statistical tests and central indices of tendency and dispersion were investigated using SPSS, version 19. Pearson's correlation coefficient, partial correlation, t-test, and analysis of variance tests were performed to assess the relationship between the variables. Ethical considerations: The study was reviewed by the ethics committee of the Mazandaran University of Medical Sciences. Informed consent was obtained from participants. Results: Our findings illustrated that the majority of nurses (65.7%) had a moderate perception of futile care, and most of them (98.9%) had desirable caring behaviors in taking care of patients in the final stages of life. The nurses believed that psychosocial aspects of care were of utmost importance. There was a significant negative relationship between perception of futile care and caring behavior. Conclusion: Given the moderate perception of nurses concerning futile care, and its negative impact on caring behaviors toward patients, implementing suitable interventions for minimizing the frequency of futile care and its resulting tension seems to be mandatory. It is imperative to train nurses on adjustment mechanisms and raise their awareness as to situations resulting in futile care. [ABSTRACT FROM AUTHOR]

Background: Many patients undergoing hematopoietic stem cell transplant (HSCT) experience fatigue due to their disease process and its long period of treatment. Using nonpharmacological methods to help reduce their fatigue is a reasonable endeavor. The present study was conducted to investigate the effect of Benson's relaxation technique on fatigue levels in patients after HSCT. Materials and Methods: Thirty-seven patients were randomly selected to the intervention (n = 19) and control group (n = 18). In the intervention group, the participants performed Benson's relaxation exercises for 20 min twice per day over a period of 15 days. The data collection tools used included a demographic and medical information form and the Brief Fatigue Inventory, completed by both groups on three different occasions (upon admission and days 8 and 14 after the HSCT). The data obtained were analyzed in Statistical Package for the Social Sciences version-20 using statistical tests. Results: The results of the independent t-test showed no significant preintervention differences in fatigue levels between the two groups. On days 8 (t = 11.21, p < 0.001) and 14 after the transplant (t = 15.62, p < 0.001), a significant difference was observed in the mean level of fatigue between the two groups. Conclusions: These findings indicate that Benson's relaxation technique would improve fatigue in HSCT patients. [ABSTRACT FROM AUTHOR]

Fatigue is one of the main complaints of patients undergoing allogeneic and autologous hematopoietic stem cell transplantation (HSCT). Since nonpharmacological interventions are cost-effective and causes fewer complications, this study aimed to review the studies performed on the effects of nonpharmacological interventions on fatigue in patients undergoing HSCT during September 2016. MEDLINE, CINAHL, Scientific Information Database, IranMedex, PubMed, ScienceDirect, Scopus, Magiran, and IRANDOC databases were searched using Persian and English keywords. A total of 1217 articles were retrieved, 21 of which were used in this study. Exercise is known as an effective intervention in alleviating physical and mental problems of patients undergoing stem cell transplant. This review-based study showed that nonpharmacological methods such as exercise might be effective in decreasing fatigue in patients undergoing stem cell transplant. There is a multitude of studies on some of the complementary and alternative therapy methods, such as music therapy, yoga, relaxation, and therapeutic massage. These studies demonstrated the positive effects of the aforementioned therapies on reduction of fatigue in patients undergoing stem cell transplantation. All the investigated methods in this study were nonaggressive, safe, and cost-effective and could be used along with common treatments or even as an alternative for pharmacological treatments for the reduction, or elimination of fatigue in patients undergoing stem cell transplantation. Given the advantages of complementary and alternative medicine, conducting further studies on this issue is recommended to reduce fatigue in patients after stem cell transplantation. [ABSTRACT FROM AUTHOR]

Background and purpose: One of the main goals of nursing education is training appropriate and efficient nurses. The purpose of this study was to discover the perceptions of nursing students and their teachers about professional competency of academic staff. Materials and methods: In this qualitative content-analysis approach study, the data were collected through unstructured in-depth interviews [30 individual and 1 focusing (Focus Group) interviews]. The participants were chosen using purposeful sampling from Mazandaran University of Medical Sciences, Iran, during July 2012 to June 2013. Formal or conventional qualitative content analysis was performed. Results: 11 categories and 4 themes were achieved. The themes included making the theoretical training efficient and useful (with 4 subthemes), gaining qualificative nursing science and skills (with 4 subthemes), making the clinical education efficient and effective for students (with 8 subthemes), and making the evaluation logical and objective (with 3 subthemes). Conclusion: This study found four basic themes of professional competency of academic staff and the indicators related to these features according to nursing students and their teachers' viewpoints. These findings can be used for designing evaluation and assessment tools for professional competency of academic staff. [ABSTRACT FROM AUTHOR]

Background: Pain is a common phenomenon after surgery. Cardiac surgeries are no exception and patients generally experience acute pain after these surgeries. Inadequate pain management after cardiac surgery predisposes patients to many complications. Therefore, the aim of this study was to determine the effects of listening to preferred music on pain intensity after open heart surgery. Materials and Methods: This study was a randomized clinical trial (RCT) conducted in open heart intensive care unit (ICU) of a university hospital in Sari, Iran. A total of 60 patients who were scheduled to undergo open heart surgery were randomly allocated in two groups. Patients in the intervention group (n = 30) listened to their preferred music by headphones for 30 minutes, whereas those in the control group (n = 30) did not listen to music. Using a Numerical Rating Scale (NRS), pain intensity was measured among the patients before the intervention, and immediately, 30 minutes and one hour after the intervention. Data was analyzed by Chi-square test, student's t-test and repeated measures analysis of variance (ANOVA). Findings: Mean pain intensity in the intervention group before, immediately after, 30 minutes and one hour after the intervention were 5.8, 3.1, 2.5 and 2.4, respectively. Corresponding numbers in the control group were 4.7, 4.7, 4.8 and 4.9, respectively. Repeated measures ANOVA showed music to significantly reduce pain intensity (p = 0.0001) Conclusions: Music can be effective as a non-pharmacological, inexpensive, non-invasive and side effect free method for pain management after open heart surgery. [ABSTRACT FROM AUTHOR]

Background and purpose: The monitoring of the patients' hemodynamic status and vital signs is a routine practice in ICU and the use of a low-cost and soothing method to maintain stable physiological parameters is necessary. This study aimed at investigating the effect of music on the vital signs and SpO2 of patients after open heart surgery. Materials and methods: This study was a randomized clinical trial (RCT) conducted on 60 patients hospitalized in the open heart surgery ICU of Mazandaran Heart Center. Patients were randomly assigned into case and control groups. In the case group, the patients listened to the music, which they selected before, through headphones for 30 minutes, while headphones without playing any music were used for patients in the control group. Vital signs and SpO2 of the patients were assessed before the intervention, immediately, 30 and 60 minutes after the intervention. The data were analyzed using Chi-square; T -test and repeated measure statistical tests. Results: Findings showed that music led to a significant decrease in the rate of heart beat, systolic blood pressure, and mean arterial pressure and a significant increase in SpO2 rate (P<0.05) was also observed. But music had no significant effect on the respiratory rate and diastolic blood pressure (P>0.05). Conclusion: As a non-pharmacologic, inexpensive, non-invasive method and without any side effects, music can improve the vital signs of the patients after open heart surgery. [ABSTRACT FROM AUTHOR]

Background and purpose: Prevalence of over weight and obesity is increasing in the world. Those over weight are more susceptible to cardiovascular diseases than other individual's. Studies indicate that body fat distribution has a determining role in the identification of risk factors. Also, the relation between BMI, cardiac ischemic pains and exercise test condition in such patients, is in need further investigation. The aim of this study was to determine the relation between BMI with exercise tolerance test in patients with cardiac ischemic pains, who were referred to the Cardiac Center of Mazandaran Province, in Sari Township. Materials and methods: In this case control study considering the BMI in ischemic patients, 65 were selected as case and 65 persons as control using Tread mill and according to Bruce Protocol, results and tolerance test time was recorded. Independent T test was used for comparison of quantitative indexes mean, while x2 test using SPSS soft ware was used for comparison of the ratio of persons with the qualitative features. Results: Data indicated mean weight of 57.1 kg and height of 1.64m in the case group. Also, 58.5% had history of hyperlipidemia (Cholesterol higher than 200mg/dl) and 78.8% with history of blood sugar (higher than 120mg/dl (P<0.001). Even 63.6% had hypertension of 140/9o mm Hg. Our findings showed that BMI in the case and control groups were (26.95±3.94) and (25.95±3.49) respectively. Moreover, a significant relationship between high BMI with cardiac ischemic pains and exercise tolerance test (P<0.001) were demonstrated. Conclusion: Cardiac ischemic pains in individuals with high BMI is common. Exercise tolerance test as one of the non invasive and less expensive procedures, can be an indicator of cardiac ischemic disease. [ABSTRACT FROM AUTHOR]

Purpose: Hemodialysis is the common kidney replacement therapy in Iran. Doing an adequate and effective dialysis can improve patients' quality of life and reduce kidney failure complications. Additionally, dialysis quality is an important factor in reducing mortality in patients with chronic kidney failure. This systematic review has investigated the adequacy of dialysis in studies done on hemodialysis patients of Iran. Materials and Methods: All articles related to the dialysis adequacy in hemodialysis patients in English and Farsi (contemporary Persian) were identified by searching the related keywords in various electronic databases. According to the inclusion criteria, 21 studies were identified. The results were analyzed using Stata software version 11. Results: A number of 6677 patients had been enrolled in 21 studies that were chosen for this systematic review. Based on the random effects model, the overall dialysis adequacy (KT/V) (K: clearance of urea, T: duration of dialysis, V: distribution of urea) more than 1.2 and its confidence interval were 36.3% and 26.4-46.2, respectively. Also, based on random effects model more than 65% urea reduction ratio in all studies was 28.8% and the confidence interval was 14.4-43.3. Conclusion: KT/V and urea reduction ratio were much less desirable in hemodialysis patients and the dialysis quality was also undesirable. It seems that inadequate dialysis prescription, use of inappropriate filters, low pump speed (blood flow speed), and the short duration and few times of dialysis are the major causes of this inadequacy. [ABSTRACT FROM AUTHOR]

Background and purpose: Coma results from brain damage and patients in intensive care units (ICU) are often more at risk for sensory deprivation. This study compares the effects of familiar and unfamiliar voices on recovering the consciousness level in comatose patients. Materials and methods: This double blind clinical trial (patient and assessor) was performed in 45 traumatic comatose patients with Glasgow Coma Scale (GCS) ⩽8 within the age range of 15-75 years, admitted to ICU training centers affiliated to Mazandaran University of Medical Sciences. The subjects were randomly allocated into three groups. Group A was stimulated with a familiar voice, group B's auditory stimulation was done by the researcher introduced as a nurse) and no intervention was done for group C (control group). The interventions were conducted twice a day for 1-5 minutes. The level of consciousness was measured using the GCS scale. To analyze the data descriptive and inferential statistics (Logrank Test) were used. Results: In the day before the intervention the mean levels of GCS in groups A, B, and C were 6.40, 5.66, and 5.53, respectively. Logrank test revealed significant differences between the groups in the time to reach CGS= 15 which happened sooner in group A (P<0.0001). Conclusion: Familiar voice could highly influence the auditory level of patients in ICU. Therefore, auditory stimulation programs are recommended for comatose patients. [ABSTRACT FROM AUTHOR]

Background and purpose: Intense and prolonged exercises generate reactive oxygen species that leads to cell damage. It seems that using antioxidant supplements reduce exercise-induced oxidative stress. The purpose of this study was to determine the effect of omega-3 supplements on oxidative stress in elite karate athletes. Materials and methods: Sixteen elite male karate athletes were randomly divided into two groups, receiving Omega-3 supplements (experimental) and placebo (control). The subjects consumed 1200 mg omega-3 (720 mg EPA and 480 mg DHA) and placebo daily for four weeks. Both groups participated in increased karate training programs (three days a week for a month). Blood samplings were performed pre and post-training period to analyze oxidative stress index (malondialdehyde), antioxidative index (superoxide dismutases), and lipid profile (cholesterol and triglycerides). The student's ttest was used to analyze the data. Results: Taking omega-3 led to a significant reduction in resting malondialdehyde levels in experimental group (t= 2.38, P= 0.045) but there was no significant change in resting malondialdehyde for the placebo group (t= 0.708, P= 0.506). Also, the resting malondialdehyde levels were not significantly different between the experimental and placebo groups (t=2, P=0.065,). Superoxide dismutases rate had no significant increase in experimental and the placebo groups (t= 0.272, P= 0.792, t=1.39, P= 0.186, respectively). There was also no significant difference between the two groups (t=1.39, P=0.186). After four weeks cholesterol concentration was significantly lower in the experimental group (t=2.97, P=0.018) while this reduction was not significant in the placebo group (t=0.694, P=0.514). Also, the difference between the two studied groups was not significant (t=1.44, P=0.172). Concentration of triglyceride significantly decreased in both groups (t=0.835, P=0.428, t=1.38, P=0.217, respectively). There was no significant difference between the two groups (t=1.04, P=0.315). Conclusion: Omega-3 supplements increased the serum levels of antioxidant biomarkers and reduced the resting levels of lipid profiles in exercise-trained men, but it was not enough for exerciseinduced attenuation in oxidative stress. Therefore, more research is needed to draw accurate conclusions regarding the effects of omega-3 and exercise on oxidant/antioxidant factors on excersise-trained people. [ABSTRACT FROM AUTHOR]

Objective: This study evaluated the occupational burnout (OB) and spiritual well-being (SWB) of emergency nurses as well as the associations between these variables., Method: This cross-sectional study was conducted in six hospitals and emergency medical centers affiliated with Ardebil University of Medical Sciences (Ardebil, Iran), in 2020. Data were collected via socio-demographic, Spiritual Well-Being Scale (SWBS), and Maslach Burnout Inventory (MBI) questionnaires., Results: This study included 239 emergency department nurses. The mean age of the participants was 34.4±6.4 years. The mean of existential well-being and religious well-being was 40.3±8.7 and 41.0±9.2, respectively. The results indicated that moderate (P=0.007) and severe (P<0.001) personal accomplishment was a positive and significant predictor of the SWB in emergency department nurses., Conclusion: Proper planning and provision of suitable educational programs in the dimension of the SWB of nurses prevent the creation and continuation of OB and increase the self-efficacy and job satisfaction of emergency medical staff, resulting in better patient care., Competing Interests: None declared.

Fatigue is one of the main complaints of patients undergoing allogeneic and autologous hematopoietic stem cell transplantation (HSCT). Since nonpharmacological interventions are cost-effective and causes fewer complications, this study aimed to review the studies performed on the effects of nonpharmacological interventions on fatigue in patients undergoing HSCT during September 2016. MEDLINE, CINAHL, Scientific Information Database, IranMedex, PubMed, ScienceDirect, Scopus, Magiran, and IRANDOC databases were searched using Persian and English keywords. A total of 1217 articles were retrieved, 21 of which were used in this study. Exercise is known as an effective intervention in alleviating physical and mental problems of patients undergoing stem cell transplant. This review-based study showed that nonpharmacological methods such as exercise might be effective in decreasing fatigue in patients undergoing stem cell transplant. There is a multitude of studies on some of the complementary and alternative therapy methods, such as music therapy, yoga, relaxation, and therapeutic massage. These studies demonstrated the positive effects of the aforementioned therapies on reduction of fatigue in patients undergoing stem cell transplantation. All the investigated methods in this study were nonaggressive, safe, and cost-effective and could be used along with common treatments or even as an alternative for pharmacological treatments for the reduction, or elimination of fatigue in patients undergoing stem cell transplantation. Given the advantages of complementary and alternative medicine, conducting further studies on this issue is recommended to reduce fatigue in patients after stem cell transplantation., Competing Interests: There are no conflicts of interest.

Background: Sleep disorders and depression, accompanied by reduced quality of life and increased mortality are the most common psychological problems in dialysis patients. This study was conducted with the aim to investigate depression and sleep quality and their association with some demographic and clinical factors in hemodialysis patients., Method: This descriptive-correlative study was conducted on 310 patients undergoing hemodialysis in 8 centers in educational hospitals in Mazandaran University of Medical Sciences. Data collection tools included a demographic questionnaire, Beck Depression Inventory, and Pittsburg Sleep Quality Index (PSQI). Statistical analysis was conducted using Chi-Square test and regression model., Results: Results obtained showed 44.8% depression in patients. Significant relationships were found between depression and increased blood phosphorus (P=0.002) and urea (P=0.001). Poor sleep quality was observed in 73.5% of hemodialysis patients, which was found significantly related to aging (P=0.048), female (P=0.04), and reduced frequency of weekly hemodialysis (P=0.035)., Conclusion: Depression and poor sleep quality are two common factors in hemodialysis patients, but patients do not overtly show symptoms of these disorders., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this paper.