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Objective: The present study aimed to determine the prevalence and severity of moral distress (MD) and itsassociated factors among emergency department nurses.Methods: This cross-sectional study was conducted in 2023 on 172 nurses from the emergency departments ofmedical training centers affiliated with Mazandaran University of Medical Sciences. The census method wasused to collect the data, which included demographic variables and Corley’s MD questionnaire. The Data wereanalyzed using SPSS software (version 22), using an independent T-test, analysis of variance (ANOVA), andmultiple regressions.Results: Out of 172 nurses, 60.5% were women, with an average age of 32.52±6.88 years. The resultsdemonstrated an average MD score of 69.73±25.68. In terms of frequency and intensity, around 53.5% ofthe participants experienced MD at a low level (0-72), while the remaining 46.5% reported experiencing itat a medium level (14-73). A significant association was found between MD and age (p=0.037), workplacehospital (p=0.005), and history of mental disorders (p=0.005). Furthermore, linear regression analysis revealeda statistically significant association between MD, marital status, and occupational type (p

Objective: This study evaluated the occupational burnout (OB) and spiritual well-being (SWB) of emergencynurses as well as the associations between these variables.Method: This cross-sectional study was conducted in six hospitals and emergency medical centers affiliated withArdebil 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±6.4years. The mean of existential well-being and religious well-being was 40.3±8.7 and 41.0±9.2, respectively. Theresults indicated that moderate (P=0.007) and severe (P

Introduction: Pain experienced during the insertion of a catheter into the arteriovenous fistula (AVF) and restless legs syndrome (RLS) are prevalent issues among Hemodialysis (HD) patients. The primary objective of this systematic review and meta-analysis was to consolidate the findings from randomized clinical trial (RCT) studies examining the impact of aromatherapy with lavender on the pain associated with AVF catheter insertion and RLS in HD patients. Methods: A systematic search was conducted on PubMed, Web of Science, Scopus, Cochrane, Embase, ClinicalTrials.gov, and Google Scholar search engine from inception to August 1, 2022, using keywords extracted from Medical Subject Headings, such as “Aromatherapy”, “Lavender”, “Arteriovenous fistula”, “Pain”, “Restless legs syndrome”, and “Hemodialysis”. Results: Finally, eleven articles were included in this systematic review and meta-analysis. The results showed that aromatherapy reduced the average pain of catheter insertion in AVF compared to the control group (Standard Mean Difference: -1.60, 95% Confidence Interval: -2.32 to -0.87, Z=4.32, I2:90.3%, P

Introduction: In the absence of timely treatment, the risk of rupture in patients with ectopic pregnancy (EP) increases, which is associated with extensive bleeding, complicated surgery, and maternal death. This study aimed to investigate the prevalence of rupture and its related factors among EP cases. Methods: A comprehensive, systematic search was conducted in electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as "Ectopic pregnancies", "Extrauterine pregnancies", and "Ruptured ectopic pregnancy" from the earliest to the 13th of December 2022. The CMA program, version 3, was utilized for analysis. The overall effect size was calculated using the sample size and the frequency of rupture in each of the studies. Heterogeneity was measured using the I2 statistics. Results: A total of 5,269 women with EP participated in 17 studies. The pooled prevalence of rupture was 56.4% (95%CI: 44.9% to 67.2%; I2=98.09%; P

Background and Objectives: High workload, insufficient resources, and many stressors in the workplace have led to the imposition of physical and psychological pressures on nurses, which exposes them to death anxiety (DA). This systematic review aimed to assess the DA and factors associated with its in nurses during the COVID-19 pandemic. Material and Methods: An extensive search was conducted on Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) databases via keywords such asincluding "Death", "Death Anxiety", "Nurses", and "COVID-19", from December 2019 to November 10, 2021. Results: 818 nurses were enrolled in four papers. The mean age and work experience of nurses Nurses’ mean age and work experiences were 31.21 (SD=5.43) and 7.60 (SD=6.73) years, respectively. The mean DA of nurses during the COVID-19 pandemic was 7.30 (SD=2.23). Also, 31.05% of nurses had a high level of DADA level during the COVID-19 pandemic. Age, sex, work experience, working hours per week, childbearing, several patients needing end‑of‑life care, direct participation in resuscitation operations, cases of direct participation in resuscitation operations, cases of patient death, depression, mental health status, and life satisfaction were influential factors in DA nurses during the COVID-19 pandemic. Conclusion: Thus, nursing policymakers should pay special attention to these factors related to the use of nurses' health maintenance and promotion programs to increase the quality of nursing care for COVID-19 patients. Also, it is recommended that psychological and communication support be provided to nurses during the COVID-19 pandemic.

Background and Objectives: The implementation of Complementary and Alternative Medicine (CAM) has increased in recent decades. Due to the positive effects of CAM interventions, 5 to 74.8% of people use these treatments worldwide. However, implementing CAM-related clinical trials is associated with challenging issues. Failure to address these challenges can lead to poor quality of studies, publication of non-scientific findings, and ultimately disregard for human rights and ethics. This review aims to comprehensively review the literature focusing on methodological and ethical challenges for implementing CAM-related clinical trials. Material and Methods: This review of reviews was conducted via international databases, including PubMed/MEDLINE, Web of Science, and Scopus using keywords extracted from medical subject headings such as “Methods”, “Methodological Study”, “Methodological Studies”, “Ethics”, “Complementary Therapies”, “Complementary Medicine”, “Alternative Medicine”, “Clinical Trial”, and “review” from the earliest to May 1, 2022. Results: In general, challenging issues for the implementation of CAM-related clinical trials can be divided into two categories: 1) methodological and 2) ethical. Methodological challenges included: Risk of bias, Lack of knowledge of researchers, and Blinding. On the other hand, ethical challenges in clinical trial studies are divided into two categories: patients' rights and placebo use. Conclusion: Overall, the present study emphasizes the need for special attention to the quality of CAM-related clinical trials. Also, this study can pioneer the introduction of critical challenging issues in CAM-related clinical trials and provide appropriate suggestions for researchers to solve these issues in future studies.

Introduction: This systematic review and meta-analysis aimed to summarize the evidence regarding the impact of needle direction and distance of arteriovenous fistula (AVF) cannulation on KT/V (where k is the dialyzer urea clearance, t, the duration of dialysis, and V, the volume of distribution of urea) and access recirculation (AR) as hemodialysis (HD) adequacy criteria. Methods: A comprehensive systematic search was performed on international and domestic electronic databases from the earliest to June 4, 2022 using keywords. Analysis was performed in STATA software v.14. Results: Three randomized control trials (RCTs) and four non-RCT articles were included in the final review. Six studies reported the effects of direction, while four mentioned the effects of distances of AVF cannulation on outcomes of HD adequacy based on KT/V or AR. Results of three non-RCT studies showed that retrograde direction decreased KT/V more than antegrade direction (ES: 0.44, 95% CI: -0.38 to 1.27). Two non-RCT studies showed that antegrade decreased AR compared to the retrograde direction (ES: -0.64, 95%CI: -1.94 to 0.67). However, the results of two RCTs indicated uncertainty about this issue. Two of the four studies suggested that a distance of 5 cm or more in arterial and venous needles had greater adequacy than a distance of less than 5 cm. However, other studies did not confirm this finding. Conclusion: Overall comparison of the results qualitatively and quantitatively indicated uncertainty about the effects of direction and distance of AVF cannulation on HD adequacy outcomes. More studies with high-quality designs, such as RCTs, are required to better understand and adjudicate the effects of needle direction and distance of AVF cannulation on HD adequacy outcomes.

Introduction: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections affecting one-third of patients with mechanical ventilation. This study aimed to synthesize available evidence regarding the effect of treatment with povidone-iodine (PI) among adult patients admitted to intensive care units (ICUs) for the prevention of VAP. Methods: An extensive search was conducted in online databases, including PubMed, Web of Science and Scopus, from the earliest records until January 1, 2023. STATA software v14 was used for statistical analysis. Publication bias was assessed via funnel plot, Begg's and Egger's tests. A P-value less than 0.1 was considered statistically significant for publication bias value. Results: Four studies were included in the meta-analysis. Three studies showed rhat PI decreased VAP compared to the placebo group, but it was not statistically significant (RR: 0.61, 95%CI: 0.25 to 1.47, Z=1.10, P=0.27, I2:71.5%). One study compared the effect of PI with chlorhexidine on the rate of VAP, the difference between which was not statistically significant (RR: 1.50, 95%CI: 0.46 to 4.87, Z=0.67, P=0.50, I2:0). Two studies demonstrated that the use of PI intervention compared to placebo decreased the average length of stay in ICU; however, it was not statistically significant (WMD: -0.35, 95%CI:-3.90 to 3.20, Z=0.19, P=0.85, I2:0). Also, three studies showed that using PI had almost no effect on mortality rate compared to placebo (RR: 1.05, 95%CI: 0.66 to 1.53, Z=0.8, P=0.27, I2:29.0%).Conclusion: More rigorously designed randomized clinical trials and further evidence are required to make a better decision/comparison about using PI as a suitable choice for preventing VAP among adult patients admitted to the ICU.

Introduction: Burn patients undergo daily painful wound care procedures, including washing, debridement, and dressing. This systematic review and meta-analysis aimed to examine the effect of virtual reality (VR)-based interventions on pain during wound care in burn patients. Methods: A comprehensive systematic search was conducted on international electronic databases such as Scopus, PubMed, and Web of Science with keywords extracted from Medical Subject Headings such as "Virtual reality", "Virtual reality therapy", "Virtual reality exposure therapy", "Virtual reality immersion therapy", "Exergaming”, “Active-video gaming”, “Burns”, “Wound healings”, “Pain”, and “Pain management” from the earliest to May 6, 2022. The Joanna Briggs Institute (JBI) critical appraisal checklist was used to assess the quality of randomized control trials and quasi-experimental studies. Results: 1,293 patients with burns were included in 30 studies, and their mean age was 22.89 (SD=7.63) years. 70.72% of the participants were male, and 67.05% were in the intervention group. This meta-analysis showed that VR significantly decreased pain severity in the intervention group compared to the control group (standard mean difference (SMD): -0.70, 95%CI: -0.97 to -0.43, Z=5.05, P