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Considering the improvment of technology and development in medical and basic medical science. Continuation of learning in community are necessary. The method is to create a cooperative learning environment for students. Students support in exprience, past information about subject reaction and holistic theory and practice helping notice, problem based learning bridge between theory and practice step intervention strategies P.B.L. which include eight steps: helping problem definition, Data collection, problem formulation, intervention, Assessment of learning needs, independent study, Reporting back review of in dependent study, in this paper, this method was investigated with some examples . Using this method in education of science , particularly medical science will improve the translation of science in education and producing science in research.

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Today besides the different avilable data there is no unique successfultreatment to cure psoriasis and to prevent its complications and recurrances.This study has been done on 50 psoriatic patients in oder to find out if self -care education can reduce the complications and the severity of the disease(Itching, fissuring, scaling) .Data shows that self - care educations can successfully reduce the fissuringfrom 100% in sever cases to 96% (p< 0/001) , and Itching that is seen in 100%of cases subside to 50% (p< 0/001) . skin scaling that is seen in 100% casesdisapper and the skin become normal in all of them (p<0/001) .In general the 88% of the patients has sever pseriasis and after the education itreduces to 50% in mild form.

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This is a double - blind clinical trial to evaluate the safety and efficacy of topical nitroglycerin ointment on venous catheterization in patients referred to emergency ward of Baghiyatollah hospital in 1997.The units under investigation consisting of 70 patients, 40 women and 30 men ranging in age from 20 to 69.The samples were randomly assigned into two equal groups, 35 patients in case group and 35 patients in experimental group. The experimental group received 2% nitroglycerin ointment and the case group received the placebo ointment that was applied prior to venus catheterization on the skin of the dorsum of the hand, wrist or front part of forearm.To collect data, an observational checklist was used in which demographic characteristics, and efficacy and immunity of the ointment were recorded.The findings revealed that the vein diameter in case group was not increased after applying the ointment, while it was considerably increased in experimental group from 4 mm to 6.6 mm. Although the method of catheterization in two groups was the same, catheterization in case group was more difficult than experimental group. Using T.test, the findings revealed that there was statistically significant relationship between vein diameter before and after applying the ointment in experimental group and after applying it in case and experimental groups (PO.001). Moreover, tachycardia and hypotension was not observed in both groups during 15, 30, 45 minutes and one and two hours immediately after applying the ointment, however in both groups, a sort of mild headache was observed. The findings also showed that there was significant relationship in observing the vein after catheterization in two groups (P<0.2). However, before applying the ointment, there was significant relationship in observing the vein in the experimental group. Furthermore, after applying the ointment, arhythmia appeared, but it was not significant.The results showed that applying nitroglycerin ointment was a useful method in expanding the peripheral veins, therefore, it resulted in easy venous catheterization.

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Background & Aim: One of the cause of anxiety for most patients is hospitalization. Once the patients are hospitalized for cardiac catheterization, the anxiety would be augmented. The anxiety raises body physiological and psychological activities such as: heart rate and respiratory rate. This research, as clinical trial study, has the objective to determine the influence of applying two methods of relaxation and premeditation on respiratory rate and pulse rate in hospitalized patients, experiencing coronary angiography, in heart and postangio wards of Shahid Beheshti Hospital in Zanjan, at 2003.

Methods & Materials: 40 patients who were candidates for CA, has been studied, in regard to existing conditions and methods of sampling and random allocation to two groups of relaxation, and premedication. Data collection tool included demographic and disease related information sheet, as well as record sheets for respiratory rate and pulse rate at intervals of 8-12 and ½ hrs before, during and after the angiography. For relaxation group, the researcher would speak individually about the influence of relaxation, the day before angiography then with the aid of client himself/herself, performed relaxation instances in a single bout, and eventually asked client to perform relaxation technique 2-3 times before going for angiography. In premedication group, patients received regular preangiographic medications including diazepam, chlorpheniramine, metoclopramid, and hydrocortisone. Respiratory rate and pulse rate were measured in both groups 8-12 and ½ hrs, before during and after CA. Afterward, resulted data were analyzed statistically by (SPSS) software for windows.

Results: Pulse rate at 8-12 hours before, during and after the angiography showed no significant difference between two groups (p>0.05). Thus our research hypothesis that “alterations of respiratory rate and pulse rate in patients under coronary angiography, who get relaxation, are identical to those in premedicaton group”, would be confirmed

Conclusion: These results show that the premeditation method can be substituted by relaxation before practicing invasive procedures.

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Background & Aim: Peripherally intravenous catheters (PIVs) are an important part of therapy for hospitalized children. Although such catheters provide necessary vascular access, their use puts patients at risk for local and systemic infectious complications with serious morbidity. Migration of skin organisms at the insertion site into the coetaneous catheter tract with colonization of the catheter tip is the most common rout of infection for peripherally inserted catheters in adults but in children this is controversial. The objective of this study is to find any relationship between colonization and catheter-related consequences.

Methods & Materials: In a descriptive cross-sectional study, 108 catheters of children and neonates hospitalized in NICU and infectious ward of Markaz Tebby Kodakan were cultured at a 2-month period. For all cases, a questionnaire of demographic characteristics and information about catheterization including location, dwell time, drugs and total parental nutrition was filled. The condition of catheterization for all cases was the same. Presence of only one colony was considered as positive colonization. Finally the data were analyzed by SPSS software.

Results: Excluding one case because of positive blood culture, from 107 catheters, 36 were colonized (33.6% of cases). Coagulate negative staphylococcus was the most common pathogen seen in 50% of total positive cases. Although there was a clinically significance between the dwell time of catheter and colonization but there was not any statistical significant association between colonization and any other variables including sex, age, hospitalization time, ward, location of catheter, dwell time, infusion of parental nutrition, and the administered drug.

Conclusion: This study is consistent with guidelines of CDC about avoiding unnecessarily routine replacement of catheters in neonates and children. As the risk of infection did not increase in association with dwell time of peripheral venous catheters, it seems it is better to leave catheters in place until there is a sign of local infection or infiltration.

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Background & Aim: Pulse Oximeter monitoring technology has become so common in intensive health care settings over the last decade that blood oxygen level is now considered as the fifth vital sign. However, it seems that medical and nursing staffs are not specially educated to operate with the devices. The aim of the study was to investigate the knowledge of medical assistants (residents), nurses and anesthesia technicians of pediatric intensive care units regarding Pulse Oximetery.

Methods & Materials: This is a cross-sectional study. The study population consisted of all nurses, first year to third year medical assistants, and anesthesia technicians who working in intensive care units in Pediatric Center. A questionnaire was used for data gathering that had three sections: the first section as demographic data (occupational condition, record of service in pediatric unit, having the experience of using Pulse Oximetery, having enough knowledge about Pulse Oximetery, and its educational program type) the second section (eighteen short answer questions) in order to determine the participants knowledge about Pulse Oximetery and the third section (four imaginary clinical scenarios) evaluating the participants interpretation on Pulse Oximetery reports and its changes in patients. The collected data were analyzed through descriptive and inferential statistics (Fisher exact test) by SPSS v.15 and EPI6 computer softwares.

Results: The analyses showed that 77.4% of the participants did not pass any educational course regarding Pulse Oximetery, also 67.9% of them correctly identified what Pulse Oximeter measures, and 47.2% of the subjects correctly identified how a Pulse Oximeter works, and 13.2% identified its normal range, but only 26.4% had a correct understanding of the Oxhemoglobin dissociation curve and explained it completely true. It was found that the majority of the participants were wrong in their answers about Pulse Oximeter monitoring. They made mistakes in interpretation of the imaginary clinical scenarios.

Conclusion: The results of the study showed that the majority of pediatric intensive care unit staffs have little knowledge regarding Pulse Oximeter monitoring, then with attention to the vast usage of the technology the necessity of formal educational programs in colleges and retraining courses during employment about the device for health care providers is apparent.

 

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Background & Aim: Healthy behaviors of teenagers are effective on the community development. This study was carried out in order to compare healthy behaviors of female teenagers living with their families and in orphanage centers in Tehran.

Methods & Materials: This was a cross-sectional study. The subjects were consisted of 110 female teenagers that 55 of them dwelled in the orphanage centers and the remaining lived with their families. Both groups were studying at the same schools. Samples were selected using stratified random sampling method. Questionnaire was used to gather data. The data were analyzed by descriptive and analytical statistical methods in SPSS software.

Results: There were statistically significant differences between two groups in nutrition (P<0.0003), sleep & rest (P<0.001), physical exercise (P<0.0013), and individual health (P<0.001). Total score of health behaviors were 112.3, and 87.8 in family group and orphanage group respectively (P<0.001).

Conclusion: The average score of health behaviors in girls that reside in orphanage centers was lower than the score of them who lived with their families. This shows the necessity of planning educational and managerial tools to improve their healthy behaviors.

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Background & Objective: Assessment of mental health is one of the most important aspects of assessing health status. Entering to the university is a challenging life event for young adults because students encounter with changes in social communication, expectations and roles. As a result, they are susceptible for experiencing stress and anxiety that could affect their functions. The aim of this study was to determine the mental health status and related stressors among Hamadan Medical Sciences University Students.

Methods & Materials: In this cross-sectional study, 180 medical sciences&apos students were selected using stratified sampling method. Data were collected using the Stressor questionnaire and the SCL90. Data were analyzed by SPSS.

Results: The study showed that 57.1 percent of the students were female. The ages ranged 18-22. Most of the students (94.8 percent) were single. Most of the students had no mental disorders (66.1%). Mild and moderate mental disorders were 29.4& and 4.4%, respectively. Mean of mental health score was 72.99 (±46.02). Mental health status was correlated with marital status, concerns about family, changes in religious activities, concerns about the future, working in the hospitals, problems with friends, sexual problems, and the number of experienced stressors (P<0.05).

Conclusion: Experiencing stressors threatens students&apos mental health status and provide a potential cause for mental disorders.

 

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Background & Aim: Communication is one of the basic concepts which nursing students must learn. Nurse instructors&apos behaviors have key role on effective clinical education. The aim of this study was to assess the effect of situational leadership model on nursing students&apos communication competency.

Methods & Materials: In this before-after trial, we recruited the students who had medical & surgical practicum in the second semester and summer of 1385-86 in public hospitals in Arak. They were selected randomly and then allocated to case (n=40) and control (n=35) groups. In the first week of practicum (before), we measured the students&apos communication competency using a self-structured questionnaire. For intervention, we defined behavioral objectives and designed a diagnosis form for identifying level of maturity and a feedback form for the students. After orientation of the students with behavioral objectives, we accompanied with main instructors based on their maturity levels in caring and applied effective leadership style. Along with the practicum period, we supervised the students&apos level of maturity in different nursing care skills. In the end (after), we measured the students&apos competency. We analyzed the data in SPSS, version 13.

Results: The results showed that there was significant difference before and after the intervention (P<0.001). Also, there was significant difference between two groups (P<0.001). Self-evaluation showed no significant differences between students&apos competency in two groups (P=0.335).

Conclusion: The situational leadership model would promote nursing students&apos communication competency.

 

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Background & Objective: The mortality rate of pneumonia caused by mechanical ventilation is about %25-30. Pneumonia prolongs length of stay in hospital to more than 13 days. There are various approaches to decrease rate of pneumonia in medical wards. The aim of this study was to assess the effect of planned passive respiratory exercise on prevention of pneumonia in coma patients undergo ventilation.

Methods & Materials: In this quasi-experimental study, 76 patients were assigned into two experimental and control groups. The control group (n=38) received usual care in the ICU. The experiment group (n=38) received planned respiratory care within six days. The procedure was done in five minutes/six hours for a three day period and then in 10 minutes/six hours for the next three days. Laboratory tests were done before the intervention and in the third and sixth days of the intervention. The respiratory care planning included respiratory passive exercises along with the common respiratory care.

Results: The results indicated that there were significant differences in the results of lab tests between two groups after the intervention (P<0.0001).

Conclusion: The results of this study showed that planned respiratory care had positive effect on prevention of respiratory infection in coma patients.

 

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Background & Aim: Diet rich in fruits and vegetables is shown to be an important factor in prevention of chronic diseases. Adolescence is a critical period in adopting eating behaviors. Schools are important social environments in adolescents' lives and are important settings for interventions that aim to improve eating behaviors, including fruit and vegetable intake. This study aimed to assess effectiveness of a school-based intervention based on social cognitive theory on fruit and vegetable (F&V) intake of female adolescents in Tehran.

Methods & Materials: This experimental school based field trial was conducted on 296 female students aged 10-13 years old (157 in the intervention and 139 in the control groups). The intervention included classroom nutrition education on F&V and increasing availability of F&V through school buffet. Psychosocial characteristics of the students were assessed using a questionnaire and F&V intake were measured using 24-hr recall method, at baseline and after three months intervention. Descriptive and inferential statistics were used for data analysis.

Results: After the intervention, vegetable and fruit intake were 0.6 and 0.63 servings higher in the intervention group compared to the controls. Knowledge and self-efficacy scores were significantly higher in the intervention group compared to the control group. Home availability and observational learning scores were significantly decreased in the intervention group.

Conclusion: Through the intervention process, many valuable experiences were gained to be used in future interventions.

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Background & Aim: Nursing prescription is an expanding category with many supporters and critics. The present research attempts to answer three questions: What are the fields of activity of nurse prescribers? What are the challenges of nursing prescription? and what are the positive outcomes of nursing prescription?
Methods & Materials: In the present systematic review, all relevant papers published until March 2017, were examined. Search was done in databases: SID, Iran Medex, Iran Doc, Magiran, Science Direct, Medline/PubMed, Web of Science, Scopus, ProQuest, Google Scholar, Cochrane Library and with keywords: nursing prescription, nurse prescribing, nurse prescriber, independent prescribing, supplementary prescribing and their equivalent terms in persian. Inclusion criteria were articles in English or persian, quasi experimental, questionnaire based study, qualitative study and relevant to the objectives of the study. Exclusion criteria were review articles, posters, presentation, and letter to the editor.
Results: A total of 72 articles that were included in the systematic review, showed extensive nurse prescribing activity in the fields of diabetes, mental health, rheumatology, dermatology, primary care, elderly care, epilepsy, pain, asthma, hypertension, constipation, emergency, hemodialysis, glaucoma and elderly. Challenges included: the critical look of the care team and lack of support, lack of attention to professional competence assessment, legal constraints, and lack of community awareness of the role of nurse purscribers. The positive outcomes of nursing prescription were classified in three areas related to the patient, the nurse and the organization.
Conclusion: Nurse prescribing activity is changing, and identifying its challenges and outcomes will help it progress.
 

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Background & Aim: Fear of childbirth is one of the reasons for choosing cesarean section. Given the consequences of repeated cesarean section, interventions that control the fear of childbirth are important in mother's decision for the mode of birth. The aim of the study is to assess the effect of individual counseling based on the Fogg model on the motivation and the fear of natural childbirth in women with previous cesarean section.
Methods & Materials: In this clinical trial, 62 pregnant women with a previous cesarean section, referred to Mashhad Comprehensive Health Centers in 2020, were randomly assigned into intervention or control groups. In the intervention group, individual counseling based on the Fogg model was provided in two face-to-face 45-60 minute sessions biweekly and one non-face-to-face session on the Telegram channel at 28-30 weeks of pregnancy. Data was collected by a demographic form, the motivation questionnaire, and the Wijma expectation/ experience questionnaire at the beginning and two weeks after the intervention. Data analysis was performed using statistical tests by the SPSS software version 25 at a significance level of 0.05.
Results: The mean difference of the fear of childbirth score before and after the intervention was 15.84±20.07 for the intervention group and 6.06±23.28 for the control group. Counseling with the fog approach has significantly changed the fear of childbirth score in the intervention group compared to the control group (P<0.001), but the changes in motivation were not statistically significant.
Conclusion: Counseling with the Fogg approach reduced the fear of childbirth score. It is recommended to use this counseling method to reduce the fear of childbirth, and to use strategies to increase the motivation for natural childbirth after cesarean section.
Clinical trial registry: IRCT20200105046014N1