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Masoume Rambod,1,2 Nilofar Pasyar,1,2 Mahsa Mokhtarizadeh3 1Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 2School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran; 3Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IranCorrespondence: Nilofar Pasyar Email npasyar@sums.ac.irBackground: Hemodialysis patients deal with some psychological and social problems. These problems may be the predictors of hope. This study aimed to determine the psychosocial, spiritual, and biomedical predictors of hope in hemodialysis patients.Methods: This cross-sectional study was conducted on 350 hemodialysis patients in hemodialysis centers affiliated to Shiraz University of Medical Sciences. Adult Hope Scale, Depression Anxiety Stress Scales, Personal Resources Questionnaire-85, Spiritual Well-Being Scale, and biomedical markers were used for data collection. The data were entered into the SPSS 22 software and were analyzed using Pearson’s correlation coefficient and linear regression analysis.Results: The mean score of hope was 28.54 (SD=5.27). The mean scores of depression, anxiety, and stress were 17.87 (SD=7.62), 13.12 (SD=3.47), and 12.99 (SD=3.88), respectively. The mean scores of social support and spiritual well-being were 126.35 (SD=17.53) and 74.02 (SD=5.84), respectively. The means of biomedical markers including interdialytic weight gain, urea nitrogen, creatinine, phosphate, sodium, and potassium were 2.10 (SD=1.04), 51.55 (SD=13.10), 6.98 (SD=2.48), 4.71 (SD=1.08), 139.32 (SD=4.91), and 4.87 (SD=0.93), respectively. The results revealed a significant association between hope and depression, anxiety, stress, social support, and spiritual well-being (p< 0.05). In addition, stress (β=− 0.14, p=0.01), anxiety (β=− 0.20, p=0.002), and social support (β=0.49, p< 0.001) were the predictors of hope.Conclusion: The hemodialysis patients reported moderate levels of hope, social support, anxiety, and depression. In addition, most of them adhered to dietary and fluid restrictions. Considering the association between hope and social support, spiritual well-being, anxiety, depression, and stress, using some interventions regarding the mentioned variables might increase hope among hemodialysis patients.Keywords: hemodialysis, hope, anxiety, depression, spirituality, social support

Nilofar Pasyar,1,2 Masoume Rambod,1,2 Mostafa Jowkar3 1Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 2Nursing Department, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran; 3Student Research Committee, Shiraz University of Medical Sciences, Shiraz, IranCorrespondence: Masoume RambodNursing Department, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Zand St., Nemazee Sq., Shiraz 7193613119, IranTel +98 71 3647 4254Fax +98 71 3647 4252Email rambodma@yahoo.comIntroduction: Providing social support for patients under hemodialysis treatment can reduce their psychological, social, and physical problems. The present study aimed at determining the effect of peer support on hopefulness in patients under hemodialysis.Methods: This clinical trial with a pre/posttest design was conducted on 128 patients who had referred to the hemodialysis centers of Shiraz University of Medical Sciences in 2019. The patients were randomly divided into an intervention and a control group. The patients in the intervention group were supported by their peers for eight weeks and were provided with the usual care, but the controls were only provided with the usual care. The data were collected using Snyder Hope Scale. Then, the data were entered into the SPSS software, version 18 and were analyzed using independent t-test and paired t-test.Results: At baseline, the participants in both groups were similar with respect to the mean scores of hope and its subscales (p> 0.05). However, there was a significant difference between the two groups in terms of hope and its subscales eight weeks after the intervention (p< 0.001).Conclusion: The results confirmed the effect of peer support on increasing hope among the patients under hemodialysis. Peer support in informational, emotional, instrumental, and spiritual forms could create a positive incentive and increase hope among the patients.Clinical Trial Number: This clinical trial has been registered in the Iranian Registry of Clinical Trials (IRCT20190126042498N1).Keywords: hope, chronic kidney failure, hemodialysis

Background & Aims : quality of sleep could be useful in health promotion and improvement of quality of life in student. Some psychosocial factors such as social support might affect the quality of sleep. Accordingly, the aim of this study was to determine the relationship between perceived social support and quality of sleep in nursing students. Material & Methods : It was a descriptive correlational study. Eighty seven nursing students of Shiraz University of Medical Sciences recruited by census, during school year of 2010-2011. The Persian versions of the "Personal Resources Questionnaire 85 (PRQ85)" and "Pittsburgh Sleep Quality Index (PSQI)" were used to evaluate the participants’ perceived social support and sleep quality. Data were analyzed using SPSS-PC (v. 15) by chi-square test, and Spearman’s rho correlation coefficients. Result : Most of the students had high levels of perceived social support (% 49.4) and poorer quality of sleep (% 61.0). Statistically significant relationships were found between social support and financial status ( c 2 =7.74, p=0.02) and place of residence ( c 2 =9.19, p=0.007). Third and fourth year nursing students had poorer sleep quality. In addition, there were a statistically significant relationship between perceived social support and quality of sleep in nursing students (r =-0.33, p= 0.01). Conclusion : Considering the relationship between social support and sleep quality among nursing students, managers of the nursing school and families could improve their sleep quality by providing the required social support. Received: 22 Oct 2012 Accepted: 4 Jan 2013

Background and Objectives: Recognition of the risk factors of childhood cancer has been important. However, there is little identification about these risk factors. The aim of this study was to determine the risk factors of cancer in children under14 years old.Methods: The present study has been a case-control study of 14-year-old children. 98 childhood cancer cases and 100 controls were matched on age and sex. Data were collected using a questionnaire with some of the known and suspected risk factors of cancer via the parent, and were analyzed with two independent samples t–tests, chi–square and logistic regression models.Results: In this study, low- educational status in mothers and fathers increased risk of childhood cancer (p

Abstract There is growing interest in discovering interpretable, closed‐form equations for subgrid‐scale (SGS) closures/parameterizations of complex processes in Earth systems. Here, we apply a common equation‐discovery technique with expansive libraries to learn closures from filtered direct numerical simulations of 2D turbulence and Rayleigh‐Bénard convection (RBC). Across common filters (e.g., Gaussian, box), we robustly discover closures of the same form for momentum and heat fluxes. These closures depend on nonlinear combinations of gradients of filtered variables, with constants that are independent of the fluid/flow properties and only depend on filter type/size. We show that these closures are the nonlinear gradient model (NGM), which is derivable analytically using Taylor‐series. Indeed, we suggest that with common (physics‐free) equation‐discovery algorithms, for many common systems/physics, discovered closures are consistent with the leading term of the Taylor‐series (except when cutoff filters are used). Like previous studies, we find that large‐eddy simulations with NGM closures are unstable, despite significant similarities between the true and NGM‐predicted fluxes (correlations >0.95). We identify two shortcomings as reasons for these instabilities: in 2D, NGM produces zero kinetic energy transfer between resolved and subgrid scales, lacking both diffusion and backscattering. In RBC, potential energy backscattering is poorly predicted. Moreover, we show that SGS fluxes diagnosed from data, presumed the “truth” for discovery, depend on filtering procedures and are not unique. Accordingly, to learn accurate, stable closures in future work, we propose several ideas around using physics‐informed libraries, loss functions, and metrics. These findings are relevant to closure modeling of any multi‐scale system.

Abstract Earth system models suffer from various structural and parametric errors in their representation of nonlinear, multi‐scale processes, leading to uncertainties in their long‐term projections. The effects of many of these errors (particularly those due to fast physics) can be quantified in short‐term simulations, for example, as differences between the predicted and observed states (analysis increments). With the increase in the availability of high‐quality observations and simulations, learning nudging from these increments to correct model errors has become an active research area. However, most studies focus on using neural networks, which while powerful, are hard to interpret, are data‐hungry, and poorly generalize out‐of‐distribution. Here, we show the capabilities of Model Error Discovery with Interpretability and Data Assimilation (MEDIDA), a general, data‐efficient framework that uses sparsity‐promoting equation‐discovery techniques to learn model errors from analysis increments. Using two‐layer quasi‐geostrophic turbulence as the test case, MEDIDA is shown to successfully discover various linear and nonlinear structural/parametric errors when full observations are available. Discovery from spatially sparse observations is found to require highly accurate interpolation schemes. While NNs have shown success as interpolators in recent studies, here, they are found inadequate due to their inability to accurately represent small scales, a phenomenon known as spectral bias. We show that a general remedy, adding a random Fourier feature layer to the NN, resolves this issue enabling MEDIDA to successfully discover model errors from sparse observations. These promising results suggest that with further development, MEDIDA could be scaled up to models of the Earth system and real observations.

Follicular dendritic cell sarcoma (FDCS) is a rare type of sarcoma that originates from the stromal component of the germinal center of the B-follicle. Its presentation and prognosis vary, as it can be nodal or extranodal, localized or multifocal, and can be fatal in 20% of cases. Due to its rarity, FDCS diagnosis requires a high level of suspicion. Most cases have been reported in Europe or the United States, and no cases have been previously reported in individuals of Iranian descent. This case report describes a 33-year-old Iranian man with no significant medical history who presented with a palpable nodule in the neck and odynophagia. Magnetic resonance imaging revealed a mass with heterogeneous enhancement in the parapharyngeal space. Pathological examination confirmed FDCS, likely localized to a parapharyngeal lymph node with no extranodal involvement. The patient underwent radiation therapy and remained disease-free 28 months after diagnosis.

Purpose: To describe the relationship between perceived social support and the quality of life in hemodialysis patients from an Islamic cultural background in Iran. Design: A cross-sectional, correlational design was used. Data were collected in hemodialysis units affiliated to Iran University of Medical Sciences. Two hundred and two Muslim hemodialysis patients were selected by census during 2007. Methods: The Persian versions of the Personal Resources Questionnaire 85 (PRQ-85) Part II and the Ferrans and Powers Quality of Life Index–dialysis version were used. The data were analyzed using chi-square test and Spearman's rho correlation coefficients. Findings: There were a statistically significant relationship between perceived social support and health-functioning ( r= .65, p≤ .05), socioeconomic ( r= .67, p≤ .05), psychological-spiritual ( r= .63, p≤ .05), and family subscales of quality of life ( r= .51, p ≤ .05). Total quality of life was also significantly correlated with perceived social support ( r= 0.72, p= .00). Conclusions: Perceived social support is associated with quality of life in Iranian hemodialysis patients. Clinical Relevance: It is important to reflect on the impact of culture and religion of Iran on quality of life of hemodialysis patients and their perceived social support. [ABSTRACT FROM AUTHOR]

Background: CD14 is a key molecule in innate immunity that mediates cell activation and signaling in response to endotoxin and other bacterial wall-derived components. CD14 protein exists in soluble (sCD14) and membrane-bound forms. The correlates of sCD14 in persons undergoing long-term hemodialysis (HD) therapy are not known. We hypothesized that increased sCD14 levels in HD patients are associated with proinflammatory cytokine activation and increased mortality.Study Design: Cohort study.Setting& Participants: 310 long-term HD patients who participated in the Nutritional and Inflammatory Evaluation in Dialysis (NIED) Study, a cohort derived from a pool of more than 3,000 HD outpatients during 5 years in 8 DaVita maintenance dialysis facilities in the South Bay Los Angeles, CA, area.Predictors: sCD14 levels in serum.Outcomes: 33-month mortality.Results: Mean sCD14 level was 7.24 +/- 2.45 microg/mL. Tumor necrosis factor alpha level was the strongest correlate of sCD14 level (r = +0.24; P < 0.001), followed by interleukin 6 level (r = +0.18; P = 0.002), serum ferritin level (r = +0.21; P < 0.001), total iron-binding capacity (r = -0.19; P < 0.001), body mass index (r = -0.15; P = 0.008), vintage (r = +0.14; P = 0.01), low-density lipoprotein cholesterol level (r = +0.13; P = 0.03), and body fat (r = -0.11; P = 0.06). During the 33-month follow-up, 71 (23%) patients died. Multivariable Cox proportional analysis adjusted for case-mix and other nutritional and inflammatory confounders, including serum tumor necrosis factor alpha, C-reactive protein, and interleukin 6 levels, showed that compared with the lowest sCD14 tertile, sCD14 levels in the third tertile (>7.8 microg/mL) were associated with greater death risk (hazard ratio, 1.94; 95% confidence interval, 1.01 to 3.75; P = 0.04).Limitations: Survivor bias in combined incident/prevalent studies.Conclusions: Increased sCD14 level is related positively to markers of inflammation and negatively to nutritional status and is an independent predictor of mortality in long-term HD patients. Additional studies are needed to examine the usefulness of sCD14 level in risk stratification and the clinical decision-making process in HD patients. [ABSTRACT FROM AUTHOR]

Background: The Malnutrition-Inflammation Score (MIS), an inexpensive and easy-to-assess score of 0 to 30 to examine protein-energy wasting (PEW) and inflammation, includes 7 components of the Subjective Global Assessment, body mass index, and serum albumin and transferrin concentrations. We hypothesized that MIS risk stratification of hemodialysis (HD) patients in predicting outcomes is better than its components or laboratory markers of inflammation.Study Design: 5-Year cohort study.Setting& Participants: We examined 809 stable HD outpatients and followed them for up to 5 years (October 2001 to December 2006).Predictors: MIS and other nutritional and inflammatory markers.Outcomes& Measurements: Prospective all-cause mortality, health-related quality of life using the 36-Item Short Form Health Survey (SF-36), and tests of body composition.Results: The MIS correlated with logarithm of serum interleukin 6 level (r = +0.26; P < 0.001), logarithm of C-reactive protein level (r = +0.16; P < 0.001), and several measures of nutritional status. Patients with a higher MIS had lower SF-36 scores. After multivariate adjustment for case-mix and other measures of PEW, HD patients in the second (3 to 4), third (5 to 7), and fourth (>or=8) quartiles of MIS had worse survival rates than those in the first (0 to 2) quartile (P < 0.001). Each 2-unit increase in MIS was associated with a 2-fold greater death risk, ie, adjusted death hazard ratio of 2.03 (95% confidence interval, 1.76 to 2.33; P < 0.001). Cubic spline survival models confirmed linear trends. Adding MIS to the constellation of age, sex, race/ethnicity, and vintage significantly improved the area under the receiver operating characteristic curve developed for predicting mortality (0.71 versus 0.67; P < 0.001).Limitations: Selection bias and unknown confounders.Conclusions: In HD patients, the MIS is associated with inflammation, nutritional status, quality of life, and 5-year prospective mortality. The mortality predictability of the MIS appears equal to serum interleukin 6 and somewhat greater than C-reactive protein levels. Controlled trials are warranted to examine whether interventions to improve the MIS can also improve clinical outcomes in HD patients. [ABSTRACT FROM AUTHOR]

Objective: Injury is a major neglected health problem in developing countries. The first step in dealing with injury problem is to identify the injury patterns and characteristics. Therefore, we aimed to demonstrate the current status of trauma admissions to hospitals in Shiraz, as a major city of Iran.Methods: A hospital-based study was conducted in 2002. All injured patients admitted during 6 months in emergency departments of two general hospitals of Shiraz, Nemazi and Chamran were included.Results: A total of 1,765 injured patients were registered during the study period, with mean age of 33 years. Manual workers were the most vulnerable group among occupational categories. Inner-city roads were the most common place of injury and traffic accident was the major cause of injury. Overally, falling injury was the second common cause of injury in males and the first cause in females (especially at the age of over 60).Conclusion: As other studies conducted in our society, traffic accidents are the major cause of morbidity and mortality and this can emphasize on the obligation to take legislative action in the field of driving and road safety, directing resources and educating the public and raising the awareness of the community in prevention of this iceberg-like problem. [ABSTRACT FROM AUTHOR]

Without treatment, acute myeloid leukemia (AML) is almost always fatal. Spontaneous remission of AML is a rare phenomenon and usually with a short duration. The exact mechanisms are unknown. However, its association with infection and blood transfusions has been described. We report a 53-year-old male who presented with severe sepsis and who was diagnosed with AML (M4). He has experienced complete spontaneous remission with relatively long duration. To the best of our knowledge, it is the first case of spontaneous remission described in Iran.

Objective. To determine the incidence rate of infection after a clean-contaminated surgery and its relationship with some risk factors. Methodology. Cross sectional study, in a convenience sample of 300 patients who underwent surgery classified as clean-contaminated in a hospital of Yasuj, Iran. Samples were taken directly from the wound at the first dressing change to all the patients. They were studied to determine bacteria growth. Results. The rate of infection after a clean-contaminated surgery was 53%. The most common gram positive microorganism was Staphylococcus aureus (22%), and among gram negative: Escherichia coli (26%), Klebsiella sp (26%) and Pseudomonas sp (25%). Significant correlation between the type of surgery and surgical site infection was found, it was not seen with the variables sex and surgical procedure. Conclusion. This study shows important problems regarding patient’s safety. Protocols should be reviewed to control infections.Objetivo. Determinar la tasa de incidencia por infección de herida por cirugía limpia-contaminada y su relación con algunos factores de riesgo. Metodología. Estudio de corte transversal en una muestra por conveniencia de 300 pacientes sometidos a cirugía clasificada como limpia-contaminada. A todos los pacientes les tomaron una muestra para cultivo directamente de la herida en el primer cambio del apósito, la cual se estudió para determinar el crecimiento de bacterias. Resultados. La tasa de infección en heridas quirúrgicas limpias-contaminadas fue del 53%. El microorganismo gram positivo más frecuente fue Staphylococcus aureus (22%), y dentro de los gram negatives fueron: Escherichia coli (26%), Klebsiella sp (26%) y Pseudomonas sp (25%). Se encontró asociación significativa entre el tipo de cirugía y la infección de la herida quirúrgica, lo que no se observó con las variables sexo y el procedimiento quirúrgico. Conclusión. Este estudio muestra problemas importantes en el aseguramiento del paciente. Por consiguiente, es preciso revisar los protocolos para el control de las infecciones.Objetivo. Determinar a taxa de incidência por infecção de ferida depois de cirurgia limpa-contaminada e sua relação com alguns fatores de risco. Metodologia. Estudo de corte transversal numa mostra por conveniência de 300 pacientes submetidos a cirurgia classificada como limpa-contaminada num hospital de Yasuj, Irã. A todos os pacientes lhes foi tomada uma mostra para cultivo diretamente da ferida na primeira mudança do apósito, a qual foi estudada para determinar o crescimento de bactérias. Resultados. A taxa de infecção em feridas depois de cirurgia limpa-contaminada foi de 53%. O microorganismo gram positivo mais frequente foi Staphylococcus aureus (22%), e dentro dos gram negativos: Escherichia coli (26%), Klebsiella sp (26%) e Pseudomonas sp (25%). Encontrou-se associação significativa entre o tipo de cirurgia e a infecção da ferida cirúrgica, o que não se observou com as variáveis sexo e o procedimento cirúrgico. Conclusão. Este estudo mostra problemas importantes na garantia do paciente. Devem revisar-se os protocolos para o controle das infecções.

Abstract Background In the diagnostic reasoning process medical students and novice physicians need to be made aware of the diagnostic values of the clinical findings (including history, signs, and symptoms) to make an appropriate diagnostic decision. Diagnostic reasoning has been understood in light of two paradigms on clinical reasoning: problem solving and decision making. They advocate the reasoning strategies used by expert physicians and the statistical models of reasoning, respectively. Evidence-based medicine (EBM) applies decision theory to the clinical diagnosis, which can be a challenging topic in medical education. This theoretical article tries to compare evidence-based diagnosis with expert-based strategies in clinical diagnosis and also defines a novel concept of category-oriented likelihood ratio (LR) to propose a new model combining both aforementioned methods. Discussion Evidence-based medicine advocates the use of quantitative evidence to estimate the probability of diseases more accurately and objectively; however, the published evidence for a given diagnosis cannot practically be utilized in primary care, especially if the patient is complaining of a nonspecific problem such as abdominal pain that could have a long list of differential diagnoses. In this case, expert physicians examine the key clinical findings that could differentiate between broader categories of diseases such as organic and non-organic disease categories to shorten the list of differential diagnoses. To approach nonspecific problems, not only do the experts revise the probability estimate of specific diseases, but also they revise the probability estimate of the categories of diseases by using the available clinical findings. Summary To make this approach analytical and objective, we need to know how much more likely it is for a key clinical finding to be present in patients with one of the diseases of a specific category versus those with a disease not included in that category. In this paper, we call this value category-oriented LR.

Abstract Background Mustard gas, a known chemical weapon, was used during the Iran-Iraq war of 1980-1988. We aimed to determine if exposure to mustard gas among men was significantly associated with abnormalities and disorders among progenies. Methods Using a case-control design, we identified all progenies of Sardasht men (exposed group, n = 498), who were born at least nine months after the exposure, compared to age-matched controls in Rabat, a nearby city (non-exposed group, n = 689). We conducted a thorough medical history, physical examination, and appropriate paraclinical studies to detect any physical abnormality and/or disorder. Given the presence of correlated data, we applied Generalized Estimating Equation (GEE) multivariable models to determine associations. Results The overall frequency of detected physical abnormalities and disorders was significantly higher in the exposed group (19% vs. 11%, Odds Ratio [OR] 1.93, 95% Confidence Interval [CI], 1.37-2.72, P = 0.0002). This was consistent across sexes. Congenital anomalies (OR 3.54, 95% CI, 1.58-7.93, P = 0.002) and asthma (OR, 3.12, 95% CI, 1.43-6.80, P = 0.004) were most commonly associated with exposure. No single abnormality was associated with paternal exposure to mustard gas. Conclusion Our study demonstrates a generational effect of exposure to mustard gas. The lasting effects of mustard gas exposure in parents effects fertility and may impact child health and development in the long-term.

Abstract Background Little evidence exists regarding the magnitude of contribution of excess weight to diabetes in the Middle East countries. This study aimed at quantification of the impact of overweight and obesity on the incidence of type 2 diabetes mellitus (T2DM) at a population level in Tehran, Iran. Methods Using data of a population-based short-term cohort study in Iran, which began in 1997 with 3.6-year follow-up, we calculated the adjusted odds ratios (OR) and population attributable risks (PAR) of developing T2DM, i.e. the proportion of diabetes that could have been avoided had overweight and/or obesity not been present in the population. Results Of the 4728 subjects studied, aged ≥ 20 years, during the 3.6-year follow-up period, 3.8% (n = 182) developed T2DM. This proportion was 1.4%, 3.6%, and 7.8% for the normal, overweight, and obese subjects, respectively. When compared to normal BMI, the adjusted ORs for incident diabetes were 1.76 [95% confidence interval (CI) 1.07 to 2.89] for overweight and 3.54 (95% CI 2.16 to 5.79) for obesity. The PARs adjusted for family history of diabetes, age, triglycerides, systolic blood pressure was 23.3% for overweight and 37.1% for obesity. These figures were 7.8% and 26.6% for men and 35.3% and 48.3% for women, respectively. Conclusion Incident T2DM is mainly attributable to excess weight, significantly more so in Tehranian women than men. Nonetheless, the contribution of excess weight in developing T2DM was lower in our short-term study than that reported in long-term periods. This probably reflects the significant role of other risk factors of T2DM in a short-term follow-up. Hence, prevention of excess weight probably should be considered as a major strategy for reducing incidence of T2DM; the contribution of other risk factors in developing T2DM in short-term period deserve to be studied and be taken into account.

Background & Aim: Physical and psychosocial problems along with the changes in life style, put hemodialysis patients under pressure. It seems that social support decreases psychological stresses and improves quality of life. This study aimed to describe hemodialysis patients' perceptions on their social supports and related factors. Methods & Materials: This descriptive-correlational study is a part of a larger study. All patients (n=202) referred to the hemodialysis units of Iran University of Medical Sciences were recruited to the study during a fourmonths period. Data were collected using "Personal Resources Questionnaire" (PRQ 85-PART 2) and analyzed using SPSS v.14. Results: Findings revealed that the most patients (64.9%) had perceived social support at high levels. There were significant relationships between social support with economic status, gender and marital status (P<0.05). Findings also indicated that the statements of "I enjoy doing little extra things that make another person's life more pleasant" and, "I belong to a group in which I feel important" had the highest and lowest scores respectively. Conclusion: Regarding the variety of perceptions in hemodialysis patients on social support and its related factors, nurses can prevent social isolation of these patients through identification of high risk groups and can also reduce their stresses and help them to improve their quality of life by providing adequate supportive interventions. [ABSTRACT FROM AUTHOR]

Background: Improving the professional competency of nursing students during the internship is critical. This study aimed to compare the professional competency and anxiety of nursing students trained based on two internship models., Methods: This is a two-group posttest-only quasi-experimental design study. One hundred nursing students who passed internship models A (a previous internship model) and B (an intervention with more educator support and a more planned and programmed process) were randomly enrolled in this study. Internship model groups A and B were conducted for the students in semesters 7 and 8. The outcomes assessed in both groups were "The Competency Inventory for Registered Nurses" and Spielberger "State-Trait Anxiety Inventory". T-test and MANOVA were used to analyze the data., Results: The mean scores of competency were 134.56 (SD = 43.23) and 160.19 (SD = 35.81) for the nursing students in the internship model groups A and B, respectively. The mean scores of nursing students' anxiety were 92.14 (SD = 15.36) and 80.44 (SD = 18.16) in the internship model groups A and B, respectively. MANOVA test showed a significant difference between the groups regarding professional competency (F = 10.34, p = 0.002) and anxiety (F = 11.31, p = 0.001)., Conclusions: The internship model group B could improve the professional competency of nursing students to a great extent and they experienced mild anxiety; it is suggested that this intervention should be done for nursing students. Conducting more studies to evaluate the effect of this model on the nursing students' competency and anxiety after graduation and as a novice nurse is suggested., (© 2024. The Author(s).)

Background: Scleroderma is a complex multisystem disorder that could have effects on the quality of patients' lives. This study was conducted by determining the psychometric properties of the Persian version of the systemic sclerosis questionnaire (SySQ) that specifically assesses indications and functional limitations of scleroderma patients., Materials and Methods: In the present cross-sectional study, the method included: translation and back translation. Psychometric properties of the questionnaire including its content and face validity were assessed. Internal consistency with the SySQ (Cronbach's alpha) and reproducibility was by test-retest method. The factor structure of the questionnaire was evaluated using exploratory factor analysis. The convergent validity of the SySQ was assessed using the General Health Assessment Scale (HAQ)., Results: Altogether 32 SySQ items, the internal consistency coefficient (Cronbach's alpha) of the whole tool was 0.906. The content validity index was 0.98 and the content validity ratio was 0.796, there was a significant relationship between the questions and the relevant factors in the factor analysis. The correlation coefficient = 0.953 for the instrument. The correlation of SySQ dimensions with HAQ questionnaire dimensions in convergent validity showed that musculoskeletal dimensions, general condition, and cardiorespiratory of the questionnaire are correlated with all dimensions of the HAQ questionnaire., Conclusion: The Persian version of the questionnaire SySQ with competency is valid and reliable and is suitable for measuring specific changes in Persian systemic sclerosis patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

This study aimed to determine the mediation role of hope in the relationship of resilience with depression, anxiety, and stress in caregivers of children and adolescents with cancer. This cross-sectional study was conducted on 200 caregivers of children and adolescents with cancer. Adult Hope Scale, Connor-Davidson Resilience Scale, and Depression, Anxiety and Stress (DAS) scales were used for data collection. The mediator and moderator model was tested using the SPSS macro PROCESS (Model 4, and 5). The mediator model (model 4) indicated that DAS significantly correlated with resilience (β = - 0.54, t-value = - 5.01, p < 0.001), and hope (β = - 0.84, t-value = - 3.45, p = 0.0007). Hope mediated the relationship between resilience and DAS among caregivers of children and adolescents with cancer (Effect = - 0.18, SE = 0.06, 95% CI - 0.33 to - 0.06). The mediator and moderator model (model 5) showed that female caregivers had a stronger correlation between resilience and DAS when compared to their male counterparts (β = - 0.56, t-value = - 3.90, p-value = 0.0001); also, hope mediated the relationship between resilience and DAS among caregivers of children and adolescents with cancer (Effect = - 0.20, SE = 0.08, 95% CI - 0.37 to - 0.04). In conclusion, hope was a mediator, and female caregivers were a moderator in the relationship of resilience with depression, anxiety, and stress, and its promotion might be effective among caregivers of children and adolescents with cancer. It seems that resilience, female caregivers, and hope may provide good protection against depression, anxiety, and stress in caregivers of cancer patients., (© 2024. The Author(s).)

Background: Fatigue in surgical technologists is of paramount importance and is known as a priority because it can be regarded as a threat to the nurse's health and patient's safety. The fatigue level of healthcare workers can be affected by some factors, while the role of part of these factors is less known. This study aimed to determine the predictive role of resilience and the hospital ethical climate in the fatigue of surgical technologists working in operating rooms (ORs)., Methods: This is a cross-sectional study conducted on 217 surgical technologists working in ORs of hospitals affiliated with Shiraz University of Medical Sciences. Data were collected using Connor-Davidson's Resilience scale, Olson's Hospital Ethical Climate Survey, and the Multidimensional Fatigue Inventory, and then analyzed using Pearson's correlation coefficient and multiple regression analysis., Results: 87.1% and 12.9% of surgical technologists reported low and high fatigue, respectively. All fatigue subscales had significant and negative relationships with resilience (p < 0.05). Moreover, the relationship between fatigue and ethical climate was significant (p = 0.02). The multiple linear regression model showed the predictive role of resilience in fatigue (β=-0.29, P < 0.001). According to the model, 10% of the change of fatigue was related to resilience and ethical climate., Conclusion: The present study demonstrated the relationship between resilience and ethical climate with fatigue. Moreover, resilience was a predictor of the surgical technologists' fatigue, so that their fatigue decreased with increasing resilience. However, future studies are recommended to determine other factors influencing fatigue in surgical technologists., (© 2024. The Author(s).)

Background: Resilience is a psychological trait and a protective factor that plays a vital role in coping with Chronic Pain (CP). Despite its importance, research has yet to fully clarify the concept and components of resilience in patients with CP. Accordingly, the present study aims to explain the components of resilience in patients with CP., Materials and Methods: The current qualitative study used a conventional content analysis methodology. The research population included all patients with CP who were referred to clinics affiliated with Shiraz University of Medical Sciences (south of Iran) from August 2021 to August 2022. Participants were selected using the purposive sampling method. In-depth semi-structured interviews were conducted with 20 participants to collect information. Data analysis was conducted using MAXQDA 2020 software in conjunction with data collection efforts., Results: Generally, in the current study, 30 sub-sub-categories, 11 sub-categories, and five main categories were extracted as components of resilience in patients with CP. The main categories of resilience against CP included the following: 1. emotional self-regulation, 2. psychological flexibility, 3. self-care, 4. appeal to religion-spirituality, and 5. internal resources and individual competencies., Conclusions: The present study highlights the different physical, mental, and religious-spiritual strategies that may contribute to resilience against pain. The resilience components identified in this study provide a foundation for healthcare professionals, particularly nurses, to design and implement diverse pain management strategies that enhance adjustment to CP conditions., Competing Interests: Nothing to declare., (Copyright: © 2024 Iranian Journal of Nursing and Midwifery Research.)

Background: Scleroderma is a rare disease with complex disorders. It affects the quality of life with severe impacts on the skin and extensive complications in the internal organs, and does not have a definitive treatment. This study aimed to investigate the effect of a self-management program on the quality of life of patients with scleroderma., Materials and Methods: This was a clinical trial in which 54 patients with scleroderma were randomly divided into two groups of 27 each (experimental and control groups). The data were collected using the Systemic Sclerosis Questionnaire. A self-management program was sent to the experimental group via a mobile phone application (WhatsApp) every day for three months. Statistical analysis was performed in Statistical Package for the Social Sciences V21., Results: The Wilcoxon signed-rank test showed that the average overall quality of life score of the experimental group showed a significant increase after the implementation of the program ( P value: 0.00). The average overall quality of life score of the control group also significantly declined after the intervention ( P value: 0.00). The Mann-Whitney U test revealed that there was no significant difference in the overall quality of life score of the two groups before the intervention ( P value: 0.31); however, after the implementation of the self-management program, a significant difference was observed between the two groups ( P value: 0.00)., Conclusion: According to the results, the self-management program can help improve the quality of life of patients with scleroderma., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Background: Implantable cardioverter defibrillators (ICD), as a gold and standard treatment for fatal cardiac arrhythmia, may lead to some physical and psychological problems for the patients. Therefore, performing some interventions to reduce or eliminate these issues is crucial. This study aimed to determine the effect of virtual interactive nurse-led support group intervention on fatigue, shock anxiety, and acceptance of ICD patients., Methods: This is a clinical trial study on 72 patients with ICD. They were randomly allocated to the intervention (n = 36) and control (n = 36) groups. A virtual interactive nurse-led support group intervention through WhasApp was performed for one month. Multidimensional fatigue inventory, Florida Shock Anxiety Scale, and Florida Patient Acceptance Scale were used. Data were analyzed to perform the analysis of data through SPSS, using independent and paired-t test, Mann-Whitney U test, Wilcoxon test, and ANCOVA., Results: Before the intervention, no significant difference was observed between the two groups with regard to fatigue, shock anxiety, and ICD acceptance. However, after the intervention, a significant difference was found between the two groups with regard to fatigue, shock anxiety, and ICD acceptance (P < 0.05)., Conclusion: This study showed that virtual interactive nurse-led support group intervention reduced fatigue and shock anxiety and improved the ICD acceptance., Practice Implications: This flexible, accessible, and interactive nurse-led support group intervention is suggested to be used for ICD patients., Trial Registration: This trial was registered and approved by Iranian Registry of Clinical Trials (Trial Id: 60,738, date: (24/02/2022). ( https://www.irct.ir/trial/60738 )., (© 2024. The Author(s).)

Background: Hospitalization of newborns in neonatal intensive care units (NICU) exposes parents to considerable stress. This study aimed to determine the predictive role of parental stress and intolerance of uncertainty on the psychological well-being of parents with a newborn in NICU using hierarchical linear regression analysis., Methods: This cross-sectional study included 130 parents of newborns hospitalized in the NICU. Data were collected using Parental Stress Scale, Intolerance of Uncertainty Scale, and Psychological Wellbeing Scale. The data were analyzed in SPSS v.26 using hierarchical linear regression analysis., Results: The mean scores of the parents' psychological well-being, parental stress, and intolerance of uncertainty were 79.08 (SD = 11.70), 63.06 (SD = 26.71), and 75.38 (SD = 19.40), respectively. The result of the hierarchical linear regression analysis revealed that, in step 1, academic education had a significant proportion of the variance of parents' psychological well-being (β = 0.26, P = 0.005). In step 2, it was shown that academic education (β=-0.25, P = 0.006) and parental stress (β=-0.25, P = 0.006) had a significant proportion of the variance of parents' psychological well-being. According to step 2, education levels, parental stress, and intolerance of uncertainty explained 22% of the changes in parents' psychological well-being., Conclusion: There was a significant association between the parents' psychological well-being and education levels, intolerance of uncertainty, and parental stress. Academic education and parental stress were the predictors of parents' psychological well-being. Based on these findings, early detection of parents' education and stress are important for their psychological well-being., (© 2023. The Author(s).)

Background: This study aimed to determine the effect of telephone counseling based on Orem's Self-Care Model on adherence to treatment and resilience of patients with coronary angioplasty., Methods: This randomized clinical trial was performed on 80 patients in the Cardiac Intensive Care Unit of Shiraz University of Medical Sciences. Patients were randomly divided into two groups of 40 (intervention and control). Questionnaires on adherence to treatment of chronic patients and resilience for patients with cardiovascular and respiratory diseases were filled out before and 8 weeks after the intervention. In the intervention group, the telephone call schedule consisted of three calls per week for 8 weeks., Results: Before the intervention, no significant difference was found between the groups about adherence to treatment and resilience. However, after the intervention, a significant difference was found between the groups as to adherence to treatment and resilience (P < 0.001)., Conclusion: Nursing consultation using telephone calls based on Orem's model increases the adherence to treatment and resilience of patients undergoing coronary angioplasty. Telephone counseling can help the patients adhere to their treatment plans and develop resilience skills., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: End Stage Renal Disease (ESRD) patients undergoing hemodialysis are faced with serious problems in their lives. Hope, as a multifaceted factor, plays a critical role in these patients' lives. Given the multifaceted process of hope, this study aimed to describe hope and identify the challenges, strategies, and outcomes of hope in Iranian ESRD patients undergoing hemodialysis., Methods: This is a qualitative study using content analysis. The participants were selected using purposive sampling. The data were collected using deep, semi-structured interviews with 14 participants; it continued until reaching data saturation. Graneheim and Lundman content analysis approach was used to analyze the data., Results: Five main categories and twenty-two subcategories emerged; the categories consisted of (1) Hope described as a particular event to happen, (2) Opportunities and threats to achieve hope, (3) Negative emotions as barriers to achieve hope, (4) Positive coping strategies to achieve hope, and (5) Growth and excellence as the outcomes of hope., Conclusions: Based on the findings, ESRD patients undergoing hemodialysis described hope as a positive feeling of expectation and desire for a special thing to happen. They faced threats and opportunities to achieve hope, which exposed them to negative emotions as barriers of hope. Thus, they make use of positive coping strategies to achieve hope. Moreover, hope led to growth and excellence. Through awareness of hope, definition and strategies to achieve it, and teaching them, physicians and nurses working in hemodialysis wards can enhance hope in patients., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Resilience is the ability to overcome adversity in response to a potentially traumatic event. It can relieve people's discomfort and build personal capacity when facing a stressful situation such as beta thalassemia major. Resilience is a complex and multidimensional concept and is influenced by protective and risk factors. Therefore, the aims of the present study were to (1) investigate the relationship between protective (social support and hope) and risk (uncertainty and defensive coping) factors with resilience and (2) examine the mediating role of courageous coping between these protective and risk factors in resilience., Methods: This descriptive-analytical study was performed on 312 adolescents and young adults with beta-thalassemia major aged 12-24 years; they were selected using purposeful sampling from two different outpatient thalassemia clinics in the south of Iran. Data were collected in a face-to-face survey using Zimmet Multidimensional Scale of Perceived Social Support, Herth Hope, Stewart Uncertainty in Illness scale, Jalowiec Coping, and Connor-Davidson resilience Scale from April 2022 to November 2022. The collected data were analyzed using descriptive tests, Pearson correlation, and a structural equation model., Results: According to the main findings of mediation analysis, courageous coping partially mediated the relationship between social support and resilience [(β = 0.042; 95% BC CI (0.003, 0.131)] and fully mediated the relationship between hope and resilience [(β = 0.166; 95% BC CI (0.031, 0.348)]. In other cases, uncertainty and defensive coping had a direct and indirect effect on resilience, respectively., Conclusion: Based on these results, health professionals and healthcare policymakers should consider this mediator in developing programs to improve resilience. Also, the use of courageous coping could modulate the effect of defensive coping on resilience. Therefore, teaching the use of courageous coping can play an important role in improving resilience., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Complementary and integrative medicine may be effective for postoperative outcomes. This study aimed to determine the effect of lemon inhalation aromatherapy on pain, nausea, and vomiting and neurovascular assessment in patients for lower extremity fracture surgery., Methods: This is a randomized clinical trial study. Ninety patients who had undergone lower extremity fracture surgery were randomly assigned to the intervention (lemon aromatherapy) and control groups. Lemon aromatherapy was started in the morning of the surgery and extended at two-hour intervals until the end of the surgery, in the recovery room, and 16 h after surgery. Numerical pain and nausea and vomiting scales, the Rhodes Index of Nausea, Vomiting, and Retching, and the WACHS Neurovascular Observation Chart were used to assess the outcomes before and after the intervention (in the recovery room and 4, 8, 12, and 16 h post-surgery). The data were analyzed using the Wilcoxon test, ANCOVA, and Repeated Measure ANCOVA., Results: A significant difference was observed between the groups in terms of the intensity of pain (P < 0.001) and nausea and vomiting (P = 0.001) during the study period. Moreover, a significant difference was found between groups as to the frequency and severity of nausea, vomiting, and retching. The amount and duration of postoperative vomiting and nausea were significantly lower in the intervention group compared to the control group. In addition, lemon inhalation aromatherapy decreased the frequency of anti-emetic drug administration in the recovery room (P = 0.04) and 16 h post-surgery (P = 0.03)., Conclusions: This study indicated that aromatherapy reduced pain intensity, postoperative nausea, vomiting, and retching, as well as the incidence of anti-emetic drug administration. Therefore, using lemon inhalation aromatherapy to relieve pain and reduce nausea and vomiting is suggested for lower extremity fracture patients who have undergone surgery., Trial Registration: This study was registered in the Iranian Registry of Clinical Trail (Number = 57,331, IRCT20130616013690N10, approved 24/07/2021) ( https://www.irct.ir/trial/57331 )., (© 2023. The Author(s).)