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Green hydrogen is currently eye-catching in terms of its production, storage and delivery to facilitate energy transition. In the present research, it is tried to demonstrate the capability of green hydrogen in blending with syngas (produced by biomass gasification) to feed an SOFC system in order to supply electrical power and heating for an existing educational building. Dynamic simulation has been performed in TRNSYS Software to calculate the hydrogen production annually at different scenarios. Effects of hydrogen concentration in the fuel mixture on the performance of the proposed CHP system are assessed. Results indicated that utilizing a reasonable roof area can offer approximately 10,000 kg H 2 and 70,000 kg H 2 per year in cases of grid-zero connected and grid 85% connected, respectively. It is revealed that increasing the hydrogen share in fuel mixture from 5% to 30% increases noticeably the hydrogen gas percentage at the SOFC anode inlet and outlet while it has a reverse effect on the H 2 O amount. In addition, the studied increment in hydrogen share could increase 18% of the net output power from the system. Finally, related to the CO 2 emission from the system, it is found that 58% reduction could be achieved by increasing the hydrogen share in the fuel blended. • A new CHP unit by utilisation of green hydrogen and syngas for an educational building is proposed. • Dynamic simulation results prove that grid-zero connected mode can provide 10T hydrogen annually. • Quality of syngas is enhanced by hydrogen injection revealing a positive effect on SOFC performance. • Increasing the share of green hydrogen in the final fuel would increase 18% of total power of the system. • 30% hydrogen injection to syngas can cut the total CO 2 emission from the system by up to 58%. [ABSTRACT FROM AUTHOR]

The impacts of pressure on the structural and electronic properties of CeIn3 have been calculated. The calculations are performed in the presence and the absence of spin-orbit interaction as well as GGA+U using density functional theory within the PBE-GGA approximation. It is shown that energy and density of states analyses are considerably influenced by the spin-orbit interaction. The spin and orbital magnetic moments of Ce are calculated under pressure up to 22 GPa. An almost linear relation is observed between the magnetic moment and the density of states of Ce-4 f at Fermi level. At ambient pressure, a good agreement between the values of the electric field gradients, EFG, and bulk modulus with experimental results is observed. The strongest anisotropy in charge distribution originates from In-5 p orbital, which has the main contribution to EFG. [ABSTRACT FROM AUTHOR]

Objective: Early integration of palliative care into home health care services is essential for cancer patients to improve their Quality of Life and reduce their health care costs. Thus, this study aimed to develop a home-based palliative care model for adult cancer patients in Iran., Methods: This is a health policy and systems research based on the World Health Organization guide. It consists of four phases; an integrative review, a qualitative study through individual semi-structured interviews ( n  = 37), and one focus group interview ( n  = 8), integrating these results in the third phase and generating model indicators. In the last phase, the evaluation of the importance of the indicators and the validation of the model were carried out during four classic Delphi rounds., Results: Barriers to home-based palliative care were extracted from the first phase, and then 22 categories in eight pillars emerged from the qualitative phase. The indicators created for the model from two phases were integrated in the third phase ( n  = 118). After the four-round of the Delphi, a conceptual model for home-based palliative care in cancer patients, including 92 indicators within eight pillars was created., Conclusions: Although this model was designed for our society, it can be utilized as a useful guide in other similar societies to design practical models and innovative programs to provide home-based palliative care in cancer patients. The application of the model in predicting different outcomes should be investigated in future trials., (© 2024 The Authors.)

Background: Breast cancer rates and the number of breast cancer survivors have been increasing among women in Iran. Effective responses from healthcare depend on appropriately identifying survivors' needs. This study investigated the experience and needs of breast cancer survivors in different dimensions., Methods: In this qualitative content analysis, semi-structured in-depth interviews were conducted from April 2023 to July 2023. Data saturation was achieved after interviewing 16 breast cancer survivors (BCSs) and four oncologists using purposive sampling. Survivors were asked to narrate their experiences about their needs during the survivorship. Data were analyzed with an inductive approach in order to extract the themes., Results: Twenty interviews were conducted. The analysis focused on four central themes: (1) financial toxicity (healthcare costs, unplanned retirement, and insurance coverage of services); (2) family support (emotional support, Physical support); (3) informational needs (management of side effects, management of uncertainty, and balanced diet); and (4) psychological and physical issues (pain, fatigue, hot flashes, and fear of cancer recurrence)., Conclusions: This study provides valuable information for designing survivorship care plans. Identifying the survivorship needs of breast cancer survivors is the first and most important step, leading to optimal healthcare delivery and improving quality of life. It is recommended to check the financial capability of patients and take necessary measures for patients with financial problems. Additionally, support sources should be assessed and appropriate. Psychological interventions should be considered for patients without a support source. Consultation groups can be used to meet the information needs of patients. For patients with physical problems, self-care recommendations may also be useful in addition to doctors' orders., (© 2024. The Author(s).)

Given the situation of cancer patients as vulnerable patients and the threat of COVID-19 in the society, integration of home-based palliative care services into the healthcare system is essential. The aim of this qualitative study was to explore the current barriers of integration of palliative care services from hospital to home for cancer patients during the COVID-19 Pandemic and to provide suggestions to resolve them. Semi-structured interviews were conducted with 25 stakeholders in the healthcare system, including health policy makers, healthcare providers, clinical home healthcare experts, home healthcare researchers, university faculty members, clergy, family caregivers, and cancer patients. Data were analyzed using directed content analysis method based on the World Health Organization Public Health Strategy for Palliative Care. Challenges were extracted in 4 main categories, containing education barriers (3 subcategories), implementation barriers (9 subcategories), policy barriers (5 subcategories), and drug availability barriers (2 subcategories). Based on the results, removing the barriers and establishing a strong infrastructure for home-based palliative care services is recommended in the healthcare system by concentrating on 4 essential factors, that is, utilizing a coordinating nurse during the process of patient's hospital discharge, establishment of connecting outpatient palliative care clinics to home healthcare centers, access to palliative care tele-medicine and development of a comprehensive and flexible home-based palliative cancer care model in our context., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Objectives: To achieve optimal survival care outcomes, all healthcare services must be tailored to patients' specific needs, preferences and concerns throughout the survival period. This study aimed to identify supportive care needs from the point of view of breast cancer survivors., Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting systematic reviews, a comprehensive search of PubMed, Web of Science and Scopus was performed. The inclusion criteria were studies published from inception to the end of January 2022, covering all stages of breast cancer. The exclusion criteria were mixed-type studies relating to cancer, such as case reports, commentaries, editorials and systematic reviews, as well as studies that assessed patients' needs during cancer treatment. Two quality assessment tools were used for the qualitative and quantitative studies., Results: Of the 13 095 records retrieved, 40 studies, including 20 qualitative and 20 quantitative studies, were retained for this review. Survivors' supportive care needs were classified into 10 dimensions and 40 subdimensions. The most frequently mentioned supportive care needs of survivors were psychological/emotional needs (N=32), health system/informational needs (N=30), physical and daily activities (N=19), and interpersonal/intimacy needs (N=19)., Conclusions: This systematic review highlights several essential needs for breast cancer survivors. Supportive programmes should be designed in order to take into consideration all aspects of these needs, particularly psychological, emotional and informational needs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: This study aimed to identify the perceptions of challenges in access to diabetes-related support resources among patients with type 2 diabetes and their family caregivers., Methods: This qualitative study was conducted with 18 patients with type 2 diabetes and nine of their family caregivers, using the conventional content analysis method, in 2020 in Lorestan Province, Iran. The participants were selected through purposive sampling and the process continued until the data was saturated. Thirty semi-structured interviews, carried out from February to April 2020, were used to collect the data; they were analyzed using Graneheim and Lundman's content analysis (2004)., Results: The study showed two main categories of structural challenges (subcategories: shortage of skilled professionals and defects in executive processes) and destructive inefficiencies (subcategories: service bottlenecks, uncertain support, and irresponsibility of medical team), indicating the dimensions of the participants' perceptions of barriers to support., Discussion: The findings of the study showed that barriers relating to the structure and function of healthcare organizations were among the most important challenges perceived by patients with diabetes when pursuing their care. However, there may be other barriers that have not been addressed due to the lack of support resources in deprived areas and the lack of awareness of patients.

Introduction: This study aimed to examine the impact of palliative care on the life quality of adults with advanced cancer., Methods: After a comprehensive and regular search using [MeSH] keywords in some important databases, 25 published randomised controlled trials (RCTs) involving 5160 adults with advanced cancer were selected and examined through meta-analysis., Results: Analysis of 36 reports in 1-3 months follow-up, and 19 reports in 4-7 months follow-up, showed that compared to usual care (g = 0.25; 95%CI: 0.1 to 0.41), palliative care had a significant impact on quality of life (QOL) (g = 0.1; 95%CI: 0.019 to 0.18) of advanced cancer patients. Also, based on the analysis of 15 reports on outpatients (g = 0.27; 95%CI: 0.04 to 0.4), 10 reports of early (g = 0.27; 95%CI: 0.029 to 0.52), and 8 reports of end-of-life (g = 0.24; 95%CI: 0.06 to 0.47) palliative care in 4-7 months follow-up, a significant impact on life quality was shown. However, in four reports, the impact of palliative care on health related quality of life in ≥10 months follow-up (g = 0.19; 95%CI: -0.03 to 0.42) was not significant., Conclusion: Systematic QOL assessment with valid tool in palliative care setting would establish quality assurance and could further develop the application of this pretty new discipline in oncology care worldwide., (© 2022 John Wiley & Sons Ltd.)

Background: Adherence to ethical principles is a requirement for palliative care delivery to children and a main concern of healthcare providers. Physicians usually face ethical challenges during their daily practice in hospitals and need adequate skills and the ability to identify and manage them. This study sought to explore the ethical challenges of palliative care from the perspectives of pediatricians., Methods: This qualitative study was conducted between April and July 2019 using the content analysis approach. Participants were fifteen pediatric medical residents, specialists, and subspecialists purposively recruited from pediatric hospitals in Tehran, Iran. Data were collected using in-depth semi-structured interviews and were analyzed using Graneheim and Lundman's approach to conventional content analysis. Trustworthiness was ensured through the four criteria proposed by Guba and Lincoln., Results: Participants' experiences of the ethical challenges of palliative care for children were grouped into two main categories, namely "bewilderment in dealing with children and their families" (with two subcategories) and "conflicts in decision making" (with three subcategories). The final five subcategories were: (a) inability to effectively communicate with children and their families, (b) inability to tell the truth about the disease, (c) physician-parent conflicts, (d) parent-child conflicts, and (e) physician-physician conflicts., Conclusion: The main ethical challenges of palliative care from the perspectives of Iranian pediatricians are the inability to effectively communicate with children and their families, the inability to tell them the truth, and the inability to manage physician-parent, parent-child, and physician-physician conflicts. Identification and management of these challenges may help improve the quality of pediatric palliative care in Iran. Further studies are needed to confirm these findings in other settings., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zahedi, Kadivar, Khanali Mojen, Asadabadi, Tajalli, Ilkhani, Barasteh, Elahikhah and Larijani.)

Rationale/aim: Falls can have severe consequences particularly for older patients with cancer undergoing ambulatory care. The aim of the study is to identify the predictors of falls in older patients receiving cancer ambulatory care and evaluate the accuracy of the final multivariable model in detecting older patients with falls., Method: A retrospective study was conducted on 300 older patients aged 60 years and above that were referred for ambulatory care in three oncology clinics based at hospitals in Tehran, Iran. Participants completed a questionnaire comprising demographic, history of falls, and cancer-related factors. Logistic regression was used to determine risk factors associated with falls., Results: A total of 35.3% of the older patients with cancer had experienced a fall in the 6 months following the start of their ambulatory care. The most important predictors of falls include the fourth stage of cancer (odds ratio [OR]: 6.47, 95% confidence interval [CI]: 3.20-13.08, p < 0.001), fear of falling (OR: 5.64, 95% CI: 2.58-12.33, p < 0.001), use of hearing (OR: 2.38, 95% CI: 1.07-5.29, p = 0.033) and visual aids (OR: 2.36, 95% CI: 1.12-5.01, p = 0.025), and the number of visits to the doctor (OR: 1.10, 95% CI: 1.01-1.21, p = 0.035)., Conclusions: The results indicate that a reduction in falls is possible by introducing strategies to improve care for older patients in the advanced stage of cancer, eliminating the causes of fear of falling, examining and improving vision and hearing, and identifying and addressing the underlying causes of visits to the doctor., (© 2021 John Wiley & Sons Ltd.)

Background: Cancer is one of the most common diseases and it has many physical and psychological consequences. Women with cancer are more likely to suffer from sexual dysfunction (SD) than healthy women., Objective: To estimate the overall prevalence of SD in women with cancer., Materials and Methods: The international databases Google Scholar, Embase, PubMed, Web of Science, and Scopus were searched for related articles without any time limitation. The keywords "Neoplasia", "Tumor", "Cancer", "Malignancy", "Female Sexual Function Index", "FSFI", and "female sexual dysfunction" along with their combinations were used in the search. Inconsistencies in the data were examined using the I 2 test. The data were analyzed using the meta-analysis method and the random-effects model in the Stata software., Results: The analysis of 24 articles with a sample size of 5483 women showed that the prevalence of SD in women with cancer was 66% (95% CI: 59-74%). The highest and lowest prevalence were in Africa and Europe, respectively (75%; 95% CI: 66-83% vs. 43%; 95% CI: 26-60%, respectively). There was no relationship between the prevalence of SD and the mean age of the women, sample size, yr of publication, or quality of articles., Conclusion: SD is highly prevalent in women with cancer. African and American women with cancer have a higher average SD prevalence than Asian and European ones., Competing Interests: The authors declare that there is no conflict of interest., (Copyright © 2022 Hosseini et al.)

Abstract: Autism is a type of neurodegenerative disorder, caused by genetic and environmental factors. Children with autism spectrum disorder (ASD) have symptoms of attention deficit and behavioral problems. Child's sleep pattern has a significant effect on mood. Sleep problems are more common in children with ASD. The current study aimed to investigate the effect of non-pharmacological approaches on the improvement of sleep disturbances in patients with ASD., Materials & Methods: We systematically searched PubMed, EMBASE, Web of Science, Scopus, and Science Direct to identify relevant articles published from January 2009 to May 2019. All original articles from observational and interventional studies were reviewed. The CONSORT Statement and Strengthening the Reporting of Observational Studies in Epidemiology(STROBE) checklist were used to assess the quality of selected papers., Results: Reviewing 18 eligible articles according to the CONSORT checklist(for interventional studies) and STROBE (for descriptive studies) demonstrated that behavioral interventions, such as cognitivebehavioral therapy, bedtime fading with response cost, and functional behavioral assessment, physical activity such as aerobic exercise, swimming, and aquatic exercise and weighted blankets can improve sleep disturbances., Conclusion: Restlessness, tantrums, increased stereotypic activities, and reducedlearning level and speaking power in children with autism were. caused by poor sleep quality and sleep deficiency, which may affect other dimensions of life. Non- pharmacological approaches to sleep disturbances could improve both sleep quality and quality of life of children with ASD with no adverse effect., Competing Interests: The authors declare no conflict of interests.

Background: Quality of life (QOL) is one of the effective factors in promoting the health of diabetic patients. In recent years, the role of peer support in the optimal management of diabetes has gained increasing attention. However, contradictory results have been reported from the effectiveness of this method. This study aimed to investigate the effect of peer support on the QOL among type 2 diabetic patients in deprived areas., Materials and Methods: This study was a randomized clinical trial conducted on 80 patients with T2D referring to the diabetes Clinic in Aligoudarz in Iran. Participants were randomly assigned into two groups of 40 patients. Intervention group received a peer Supportive-educational program for 3 months and the control group received routine clinic care. Diabetes QOL brief clinical inventory was used to collect the data. This questionnaire was completed three times at the beginning of the study, immediately after the 3-day training, and after 3 months of peer supportive intervention. The SPSS software (v. 18.0) was used to analyze the data through the Generalized Estimating Equations., Results: There was no significant difference in mean QOL between the two groups before the intervention ( P = 0.891) and immediately after the education ( P = 0.076). However, after 3 months of intervention, the intervention group showed a significant improvement in mean QOL compared to those in the control group ( P < 0.001)., Conclusion: Peer support program can improve the QOL in type 2 diabetic patients in deprived areas. Therefore, this method can be recommended to improve care and educational programs in these patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

Background: Pain is a common and unpleasant feeling among patients in intensive care units. Therefore, the use of proper pain management methods, such as non-pharmacological interventions, is a priority in intensive care units., Objective: This study aimed to ascertain the extent of the use of non-pharmacological pain management methods by intensive care unit nurses in Iran and to identify the obstacles that hindered the use of these methods., Material and Methods: This study used a descriptive cross-sectional design which involved a convenience sample of 224 nurses who worked in 16 intensive care units across northern Iran. Data were collected using the non-pharmacological pain management questionnaire and a researcher-developed checklist of the obstacles that hindered the use of non-pharmacological pain management methods., Results: A moderate number of ICU nurses used non-pharmacological pain management methods (55.8 %). The most common method used by nurses was repositioning (M = 2.72), while methods such as acupuncture and reflexology were used less frequently. Furthermore, the most common obstacles to the use of non-pharmacological pain management methods were nurses' fatigue (M = 2.92) and multiple responsibilities (M = 2.91). Demographic variables such as age, gender, educational level, and work experience were not significantly associated with the use of non-pharmacological pain management methods., Conclusions: Due to factors such as fatigue, multiple responsibilities, a heavy workload, and an insufficient number of nurses per shift, the rate of utilization of non-pharmacological pain management methods among intensive care unit nurses in Iran was low. Furthermore, most of the participants in this study had not attended courses on non-pharmacological pain management., (Copyright © 2021. Published by Elsevier Ltd.)

Objectives: Transitional care program refers to the health care continuity during transferring from one health care setting to another or to home. This is an essential program for cancer patients and reduces the risk of unnecessary hospital admissions as well as the complications of the disease. The aim of this study was to develop a transitional cancer care program from hospital to home in the health care system of Iran., Methods: This study is a health policy and system research. It was conducted in four stages from October 2019 to January 2020. The first stage was a qualitative study. The qualitative data were collected through semi-structured interviews with 24 participants and a focus group with eight experts. In the second stage, a literature review of transitional care models was carried out. The initial version of the transitional cancer care program was developed based on the qualitative results and the literature review in the third stage. The validity and feasibility of the program were assessed using the Delphi study in the fourth stage., Results: Six major categories were extracted from the qualitative results, consisting of "integrated services for the continuity of care", "holistic care", "care standardization", "the use of telemedicine", "the transparency of rules" and "the care process provision". Using these results and extracted the three common models of transitional care, the initial program was developed in three phases of pre-discharge, post-discharge, and transitional care with six protocols. The content validity of the program (98.7%) and its feasibility (95.8%) were approved by experts in the Delphi rounds., Conclusions: It is necessary to revise hospitals' discharge program, and home health care center's plan for admission and delivering health care services for cancer patients. Also, a pilot program is necessary to find the system advantages and disadvantages., .

Aim: Family caregivers have limited abilities that make them vulnerable to the care needs of patients. Therefore, it seems necessary to evaluate their caring ability. The aim of this study was to design an instrument for assessing the caring ability of family caregivers of cancer patients., Methods: This was a sequential exploratory mixed-method study, carried out in two qualitative and quantitative phases. The concept of caring ability and its dimensions were explained using conventional content analysis in the qualitative phase. The research participants included 41 family caregivers of cancer patients and professional caregivers who were selected using purposeful sampling method until reaching data saturation. The scale items were designed using the results of the qualitative phase of the study, as well as the review of relevant literature. In the quantitative phase, the scale was validated using content and face validity, construct validity, as well as internal consistency and stability., Results: The primary item pool was prepared in 108 items. Content validity was determined using CVR with a cut-off point (0.62), CVI with a cut-off point (0.8) and kappa coefficient (κ) (>0.75). The validity of 72 items was confirmed. Then, the overlapping items were merged and eventually the 45-item scale entered the face validity stage and five items with an impact factor < 1.5 were omitted. Results of KMO = 0.904 and Bartlett = 6184.012 (p < 0.001) justified the need for factor analysis. Scree plot indicates five factors with eigenvalues above 1 and 67.7% of the total variance, including 'Effective role play, Fatigue and Surrender, Trust, Uncertainty, and Caring ignorance'. Reliability of the 31-item instrument indicated a Cronbach's alpha coefficient of 0.93 and ICC of 0.94., Conclusions: Caring abilities scale (CAI) of family caregivers of patients with cancer is a valid and reliable instrument that can assess caregivers' caring ability., (© 2020 Nordic College of Caring Science.)

Background: There are various definitions and tools for Information Need (IN), Learning Need (LN) and Educational Need (EN) which are used interchangeably in the patient education., Objective: Clarifying the definitions of IN, LN and EN as well as comparing item generation methods and the dimensions of the available tools to be used appropriately., Methods: We searched PubMed/Scopus/Embase/Science Direct databases from 1960 to 2019. Two reviewers selected studies and extracted data independently., Results: We identified 22 tools comprised of 14 IN, 5 LN and 3 EN tools. The Patient Learning Needs Scale (PLNS) was the only general tool. The content of tools includes anatomy, physiology, diagnostic tests, symptoms, treatments, medications, diet, activity and self-care. No difference was found between EN/LN/IN tools in terms of item generation and dimensions according to their concept definitions. Seven tools assessed all 7 domains of patient education components., Conclusion: The EN, LN and IN are different concepts, but using these concepts in the tools is not based on their definitions and they have been used interchangeably. IN and LN tools were more complete and comprehensive., Practical Implications: The findings of this review can help researchers and clinicians to use EN, LN and IN tools more appropriately., (Copyright © 2020 Elsevier B.V. All rights reserved.)

One of the most frequent symptoms in postmenopausal women is sleep disturbance. This study aimed to determine the relationship between sleep quality and lifestyle factors in postmenopausal women. Postmenopausal women (n = 252) in Ahvaz, Iran with an age range of 45-55 years, were enrolled from April to December 2015. The study tools included the Lifestyle Questionnaire (LSQ) and Pittsburgh Sleep Quality Index. The LSQ contains 10 lifestyle factors: physical health, physical activity, weight control and nutrition, psychological health, spiritual health, social health, medications and narcotics avoidance, illness prevention, accident prevention, and environmental health. Data were analyzed using, chi-square, Pearson correlation coefficients, analysis of variance, and multiple linear regressions. In unadjusted analyses, physical health, physical activity, nutrition, mental health, spiritual health, social health, and medication and narcotics avoidance scores were significantly higher in women without sleep disruption than in those with light and moderate sleep disruption ( p < .001). Adjusting for confounding factors, sleep disruption was directly related to duration since the final menstrual period ( p < .001), and inversely related to physical health ( p = .04) and spiritual health ( p = .028). Lifestyle factors were related to sleep disruption in postmenopausal women. Policymakers should consider education on healthy lifestyles for women.

Introduction and Hypothesis: The treatment and mental support of patients with Mayer-Rokitansky-Küster-Hauser syndrome are very important. Many of these patients seek treatment to improve their sexual relationships and the quality of their sexual life. This systematic review sought to evaluate the sexual satisfaction of patients with MRKH syndrome following various types of vaginoplasty and non-surgical procedures over the past 10 years., Methods: A systematic review of studies published in English during 2008-2018 was performed. Electronic databases and valid sites, including PubMed, EMBASE, Science Direct, Cochrane Library, SCOPUS, Ovid, and ProQuest, were searched for articles published from the beginning of 2008 to February 2018. Literature restricted to women with Mayer-Rokitansky-Küster-Hauser syndrome who underwent vaginoplasty surgery or a non-surgical technique was reviewed. Of 195 papers identified, 45 articles were analyzed. All studies that reported sexual and functional outcomes following various vaginoplasty procedures and non-surgical procedures were selected., Results: Greater vaginal length and higher sexual satisfaction were observed following surgical procedures than after non-surgical techniques. A range of complications was reported following the use of different surgical approaches. The Female Sexual Function Index (FSFI) was the most commonly applied tool to measure sexual satisfaction, but its results were not always in agreement with the findings of other research tools. Finally, women who underwent surgical techniques had higher sexual activity levels than those who received non-surgical procedures., Conclusion: The reviewed studies highlighted the need for further quantitative and qualitative research on the sexual performance and outcomes of patients with MRKH syndrome., Registration Number: None.

Background: A child's cancer not only affects the child in question, but also their family members and even closes relatives and friends. The nature of this disease is such that, while imposing a high level of care workload on the family, it also affects various family aspects including personal, familial, and social interactions and relationships, as well as family functioning. This study aims to describe family interactions in childhood leukemia., Methods: This study was an exploratory descriptive study, conducted on 58 participants (40 family members and 18 members of the health team), with purposeful sampling and semi-structured interviews-63 personal interviews and four group interviews-in the research context of the Cancer Hospital in Isfahan, 2016-2017. Data analysis in this study was carried out with qualitative content analysis using the Graneheim method., Results: In the data analysis, four main categories and 13 subcategories were revealed. The first category, changes in roles, included the subcategories of super caregiver mother, supportive super father, role shift, self and others' forgetfulness, and confusion in roles and tasks; the second category, changes in interpersonal relationships, included the subcategories of changes in spousal relationships, changes in parent-child relationships, and changes in relationships between children; the third category, changes in social interactions, included the subcategories of changes in relationships with relatives, changes in relationships with peers, changes in relationships with the therapy team, and changes in interaction with supportive social networks; and the fourth category, changes in relationship with God, included the subcategories of spiritual bond and spiritual illness., Conclusion: Regarding the findings of this study, it is expected that health system policymakers in the country, while striving to strengthen the positive aspect of changes in family relationships and interactions, will develop and execute operational, comprehensive, and society-based plans in order to eliminate the barriers and problems of relationships within the family, as well as in relation to the larger community, taking into consideration the family's cultural and social beliefs.

Background: One of the lithotripsy complications is urinary tract infection (UTI) and sepsis after extracorporeal shock wave lithotripsy (ESWL). The aim was to study the prophylactic effect of antibiotics on UTI after ESWL., Methods: This randomized double-blind clinical trial was carried out on 600 patients admitted to Babol Clinic hospital in 2014-2015. Patients were randomly divided into treatment group (receiving 200 mg ofloxacin and control group (receiving placebo. The effect of prophylactic antibiotics on the incidence of bacteriuria after ESWL and the impact of variables such as gender, age, urolithiasis size and location and underlying diseases in the incidence of UTI after ESWL were evaluated., Results: Totally, 67 of the population had positive urine cultures. Twenty-nine (10.13%) of them were in the treatment group (n=286) and 38 (13.01%) of them were in the control group (n=292). All 67 patients had asymptomatic bacteriuria. Escherichia coli and proteus were the grown microorganisms in most samples. The mean age of sample population was 44.8±23, and 67.16% of patients with positive urine culture were older than 45 years., Conclusions: The results indicated that prophylactic antibiotics prior to ESWL in patients with urinary calculi and negative urine culture had no significant decrease in urinary tract infection after lithotripsy. It is better that the use of prophylactic antibiotics is limited to patients with risk factors., Competing Interests: None declared.

Background: Aphasia is a common outcome of Cerebrovascular Accident (CVA) in which clinical interventions have limited effectiveness. Some evidence suggests that noninvasive stimulation of the brain can have beneficial effects in the treatment of CVA induced aphasia. In patients with motor aphasia, repetitive Transcranial Magnetic Stimulation (rTMS) is used to facilitate long-term improvement in speech ability. Since identifying effective methods for treating CVA induced aphasia can be very important in subsequent decision-making and treatment interventions, the objective of this study was to evaluate the effect of low-frequency TMS in Broca's area in the right hemisphere on the treatment of CVA induced motor aphasia. Methods: This clinical trial enrolled 24 patients with a clinical diagnosis of motor aphasia caused by CVA using convenient sampling. In this study, the effect of stimulation of Broca's area in the right hemisphere was examined by low-frequency rTMS (one Hz) on aphasia caused by CVA. To conduct verbal fluency test in patients, their correct responses to the selected images before and after rTMS during a certain time were recorded and compared by non-parametric Wilcoxon test using SPSS16 and the significance level was considered <0.05. Registration ID of this research in IRCT is IRCT2014052417814N1. Results: The study findings suggested a significant difference between Wilcoxon test results of patients before and after rTMS (z= -4.401), and it was found that using low-frequency rTMS in the right hemisphere was effective on improving dysarthria in the study population with 95 percent confidence interval (p<0.001). Conclusion: According to the findings, low-frequency rTMS has the potential to be considered as a treatment for patients with nonfluent aphasia caused by CVA.

Background: The experience of caring for a family member with cancer is associated with several care-related problems and challenges for the caregiver. The comprehensive and in-depth understanding of the trials and tribulations of caregiving can be a step towards resolving the problems faced by family caregivers of these patients., Aim: The present study aimed to explore challenges faced by Iranian family caregivers of cancer patients., Materials and Methods: The present qualitative study was conducted through in-depth semi-structured interviews held with 21 family caregivers of cancer patients selected through purposive sampling. Interviews continued until saturation of data. All interviews were recorded, transcribed and analysed through conventional content analysis., Finding: The codes extracted from interviews produced four main themes, including 'confusion', 'uncertainty', 'disintegration' and 'setback', which collectively caused suffering for family caregivers., Conclusion: Care provided in an atmosphere of suffering and discontent diminishes caregiver's quality of life and quality of patient care. Health planners should therefore consider the challenges and sufferings faced by family caregivers and should seek to obviate them through appropriate plans., (© 2017 Nordic College of Caring Science.)

Background: Aphasia is a common outcome of Cerebrovascular Accident (CVA) in which clinical interventions have limited effectiveness. Some evidence suggests that noninvasive stimulation of the brain can have beneficial effects in the treatment of CVA induced aphasia. In patients with motor aphasia, repetitive Transcranial Magnetic Stimulation (rTMS) is used to facilitate long-term improvement in speech ability. Since identifying effective methods for treating CVA induced aphasia can be very important in subsequent decision-making and treatment interventions, the objective of this study was to evaluate the effect of low-frequency TMS in Broca's area in the right hemisphere on the treatment of CVA induced motor aphasia. Methods: This clinical trial enrolled 24 patients with a clinical diagnosis of motor aphasia caused by CVA using convenient sampling. In this study, the effect of stimulation of Broca's area in the right hemisphere was examined by low-frequency rTMS (one Hz) on aphasia caused by CVA. To conduct verbal fluency test in patients, their correct responses to the selected images before and after rTMS during a certain time were recorded and compared by non-parametric Wilcoxon test using SPSS16 and the significance level was considered <0.05. Registration ID of this research in IRCT is IRCT2014052417814N1. Results: The study findings suggested a significant difference between Wilcoxon test results of patients before and after rTMS (z= -4.401), and it was found that using low-frequency rTMS in the right hemisphere was effective on improving dysarthria in the study population with 95 percent confidence interval (p<0.001). Conclusion: According to the findings, low-frequency rTMS has the potential to be considered as a treatment for patients with nonfluent aphasia caused by CVA.

This qualitative study was conducted to investigate the spiritual challenges faced by Iranian family caregivers of patients with cancer. The findings showed, 2 main themes, including "spiritual crisis" and "spiritual coherence", and 6 classes, including "spiritual distress", "disappointment," "faith and trust in God," "praying," "inner peace," and "transcendence."

Aim: To provide a literature review of nursing curricula relating to care for children with disabilities., Background: Children with disabilities do not receive adequate attention in nursing curricula for children., Introduction: The best approach to promoting the standard of care delivery to children with disabilities is to improve the quantity and quality of training among health professionals., Methods: We conducted the review using three databases, CINAHL, MEDLINE and ProQuest, between the years 1990 and 2015. The review commenced in 2012 and was updated in 2015. Seventy-eight studies were initially identified., Results: Out of 78 retrieved articles, only six research articles contained all the keywords 'education', 'disability' and 'curriculum'; no articles contained all the keywords 'nursing education, 'children with disabilities' and 'curriculum'., Discussion: Five themes have been generated from the literature review relating to disability content within nursing curricula, namely: overloaded curriculum, gaps in the contemporary curricula, lack of faculty expertise, problems with teaching methods and focus on the medical model., Conclusion: There was a paucity of evidence for the way that disability was presented in the nursing curricula for children., Implications for Nursing and Health Policy: Improving the provision of care delivery to children with disabilities should be paid adequate attention in nursing curricula for children. Additionally, there is a need for policy-makers to identify the best coverage of nursing curricula, as well as the most effective nurse training methods that enhance knowledge and clinical skills relating to the care of children with disabilities., (© 2015 International Council of Nurses.)

Congenital myasthenic syndromes (CMSs) are a heterogeneous group of genetic disorders affecting neuromuscular transmission. The agrin/muscle-specific kinase (MuSK) pathway is critical for proper development and maintenance of the neuromuscular junction (NMJ). We report here an Iranian patient in whom CMS was diagnosed since he presented with congenital and fluctuating bilateral symmetric ptosis, upward gaze palsy and slowly progressive muscle weakness leading to loss of ambulation. Genetic analysis of the patient revealed a homozygous missense mutation c.2503A>G in the coding sequence of MUSK leading to the p.Met835Val substitution. The mutation was inherited from the two parents who were heterozygous according to the notion of consanguinity. Immunocytochemical and electron microscopy studies of biopsied deltoid muscle showed dramatic changes in pre- and post-synaptic elements of the NMJs. These changes induced a process of denervation/reinnervation in native NMJs and the formation, by an adaptive mechanism, of newly formed and ectopic NMJs. Aberrant axonal outgrowth, decreased nerve terminal ramification and nodal axonal sprouting were also noted. In vivo electroporation of the mutated MuSK in a mouse model showed disorganized NMJs and aberrant axonal growth reproducing a phenotype similar to that observed in the patient's biopsy specimen. In vitro experiments showed that the mutation alters agrin-dependent acetylcholine receptor aggregation, causes a constitutive activation of MuSK and a decrease in its agrin- and Dok-7-dependent phosphorylation.

During the last decade, sporadic combination of multiple sclerosis (MS) and myasthenia gravis (MG) has been reported repeatedly. Although these are anecdotal, they are important enough to raise concerns about co-occurrence of MG and MS. Here, we present a case of an MS patient who developed an MG crisis. She had received interferon for relapsing remitting MS. Interestingly, she developed an MG crisis 4 years after the diagnosis of MS. MS and MG have relatively the same distribution for age, corresponding to the younger peak of the bimodal age distribution in MG. They also share some HLA typing characteristics. Furthermore, some evidences support the role of systemic immune dysregulation due to a genetic susceptibility that is common to these two diseases. The association may be underdiagnosed because of the possible overlap of symptoms especially bulbar manifestations in which either MG or MS can mimic each other, leading to underestimating incidence of the combination. The evidence warrants physicians, especially neurologists, to always consider the possibility of the other disease when encountering any patients either with MS or MG. Anecdotal and sporadic reports of combination of multiple sclerosis (MS) and myasthenia gravis (MG) have been raised concerns about co-occurrence of them.

Menstrual patterns differ even in nongenital tuberculosis. Our objective is to determine whether nongenital tuberculosis makes menstrual dysfunction, before and sustain after treatment. Menstrual patterns were compared in women with pulmonary or extrapulmonary but nongenital tuberculosis with healthy nursing students and also with themselves, before and after treatment in a retrospective cohort study. Subjects were selected by convenient nonrandomized sampling but control groups were selected by random allocation among volunteers of nursing students. Case and control subjects were matched in age group. Menstrual patterns including amount, duration, interval, cessation of period, any menstrual irregularity, and pelvic pain were evaluated. Among 100 cases of proven tuberculosis, 90 patients had pulmonary and 10 cases had extrapulmonary tuberculosis. Secondary amenorrhea (P < or = .001, RR: 22), spotting during menstrual period (P < or = .0001, RR: 4.5), decreasing in amount (P < or = .001, RR: 7.8), shorter duration of menstrual period (P < or = .001, RR: 12), and pelvic pain (P < or = .001, RR: 8.6) were more prevalent and significantly different in the cases compared to control subjects (with CI:95% and P < .001), but excessive or prolong vaginal bleeding was not observed. Menstrual disorders occur even in nongenital tuberculosis, but it is manifested with cessation or decrease in menstrual bleeding flow and period.

Objective: Concerning prevalence of carpal tunnel syndrome (CTS) and the difficulties with electromyography (EMG) and nerve conduction studies (NCS), this study was designed to evaluate the power of somatosensory evoked potential (SSEP) in CTS diagnosis among Iranian patients., Patients and Methods: SSEP was performed on 100 asymptomatic hands of 50 healthy participants (40 female, age range 38-59 years) and on 61 hands of 46 patients (39 female, age range 34-58 years). Mean difference between N(20) latency of the middle finger and the wrist (median nerve innervation) as well as N(20) latency of the third finger and the fifth finger (ulnar nerve innervation) were measured. Using receiver operating characteristic (ROC) curve analysis, the upper limits of these variables were defined as 6.0 and 1.5 ms, respectively. Higher amounts in either of these variables were considered as positive SSEP for diagnosis of CTS. Measures of accuracy for SSEP were measured getting clinical diagnosis by two separate neurologists as the reference standard. In the patients' group who underwent both techniques of SSEP and EMG-NCS, kappa statistic as the agreement coefficient between two procedures was calculated., Results: Sensitivity, specificity, and likelihood ratios for positive and negative results of SSEP in diagnosis of CTS were 70.4%, 91.0%, 7.83 and 0.32, respectively. Sensitivity of EMG-NCS in diagnosis of CTS was measured as 81.9%. Measure of agreement between two procedures (kappa) was calculated as 0.42., Conclusion: This study showed that positive results of SSEP might have a role in diagnosis of CTS. However, larger studies to demonstrate diagnostic power of SSEP in comparison with EMG-NCS seem necessary.