Payavard Salamat

Explaining the Experiences of Hospital Emergency Clinical Staff Regarding Preparedness for CBRN Incidents

Seyed Amir Hosein Pishgooie

Background and Aim: CBRN incidents Chemical, Biological, Radioactive and Nuclear are often unpredictable and invisible, leading to fear, anxiety, and disruptions in the provision of healthcare services in the community. The potential consequences and costs of unpreparedness for CBRN incidents can be significant. Rapid and appropriate responses to CBRN incidents play a crucial role in mitigating adverse physical health effects and reducing mortality rates. These factors heavily depend on the preparedness of hospital emergency staff. This study aimed to explore the experiences of hospital emergency clinical staff regarding their preparedness for responding to CBRN incidents in 2024 in Tehran.
Materials and Methods: The present study was a qualitative research employing a conventional content analysis approach. The study population consisted of clinical emergency staff from four hospitals, including one educational-specialized hospital, two public-general hospitals, and one private-general hospital. Participants were selected purposively and through snowball sampling, ensuring maximum variation among clinical emergency staff of hospitals in Tehran Province. Data were collected via in-depth, semi-structured interviews with 13 participants, and sampling continued until data saturation was achieved. For data analysis, the qualitative approach proposed by Graneheim and Lundman was employed, and MAXQDA software version 2022 was used for qualitative data management.
Results: In this study, 13 hospital emergency clinical staff members, including nurses, nursing managers, physicians, and laboratory science experts (8 males and 5 females), with an average work experience of 13 years and 11 months, were interviewed. Findings were extracted in the form of 7 main categories (resources, training and practice, contamination control, coordination, planning and instructions, management and treatment of casualties, structure), 13 subcategories, and 35 semantic codes. The results showed that the lack of specialized training, the absence of appropriate infrastructure for decontamination, and weak intra- and extra-departmental coordination are among the most important challenges to the preparedness of emergency staff in dealing with CBRN incidents. Participants also emphasized the need to provide personal protective equipment, develop specific instructions, and hold periodic drills.
Conclusion: Currently, the level of preparedness of hospital emergency clinical staff in responding to CBRN incidents is limited. Emergency staff play a vital role in responding to CBRN incidents. To ensure their preparedness and response efforts are fully effective, and considering the rising global threats of CBRN incidents, it is recommended to adopt strategies, policies, programs, coordination efforts, funding, and other necessary measures to enhance the preparedness of emergency staff for CBRN incidents.

Applications and Role of Artificial Intelligence in the Management of Cardiac Diseases: A Systematic Review of Persian Research Studies

Soheila Saeedi

Background and Aim: Cardiovascular diseases have a very high prevalence globally and are recognized as one of the main causes of mortality worldwide. Artificial intelligence, as a novel technology, has garnered attention in recent years in Iran and other parts of the world for the management of a wide variety of diseases. The present study aimed to systematically review research studies conducted in the field of applying artificial intelligence in cardiovascular diseases.
Materials and Methods: To investigate research studies conducted in the field of cardiovascular diseases utilizing artificial intelligence, the Persian language databases SID, Google Scholar, and Magiran were searched. This search was conducted without time limitations on April 3, 2024 and included all research studies that, up to this date, had used various artificial intelligence methods in the field of cardiovascular diseases in the present systematic review.
Results: The results of the search in the aforementioned three databases led to the retrieval of 17,819 research studies, of which 46 research studies met the inclusion and exclusion criteria of the study. These research studies had used artificial intelligence in three areas: prediction, treatment, and diagnosis. Neural networks (n=22), support vector machines (n=20), and decision trees (n=16) were the algorithms that were used more than other techniques. The data sources of the included research studies were mainly patient medical records and the UCI database. Additionally, MATLAB software was used more than other software. The most frequently mentioned limitations in the research studies included not considering all factors, limited access to data, insufficient data, the presence of noise in signals or images, and the presence of outliers, missing values, and non-normality of data.
Conclusion: The systematic review of research studies conducted in the field of cardiovascular diseases utilizing artificial intelligence showed that this technology has been used in a wide range of cardiovascular diseases, and most of the conducted research studies confirmed its effectiveness and successful performance.

Analysis of the Status of Research Outputs in the Field of Knowledge Management in the Health and Healthcare Field

Ali Mansouri

Background and Aim: The expansion of information technology has led to the production of increasing knowledge, which may be a part of this knowledge that is hidden, so the role of knowledge management is very important to reveal knowledge. On the other hand, in health research, which is basically based on the needs of patients, their caregivers, and specialists, knowledge management is of great importance for the quality of their services. The aim of the current research is to analyze the status of research outputs in the field of knowledge management in the health sector.
Materials and Methods: Based on its nature, the present study is descriptive, quantitative, and applied, and was conducted using a lexical co-occurrence scientometric technique. The research community includes 2487 sources, which are the results of all research outputs in the field of knowledge management in the health sector, which are indexed in the Web of Science database. The analysis of the research questions was done through Excel, BibExcel, and VOSviewer software.
Results: According to research findings, the continents of Europe, Asia, and North America, respectively, have had the highest contributions to research output in the field of knowledge management in the health and healthcare sector. Among individual countries, the United States, the United Kingdom, and Canada demonstrated the most significant activity in this area, while Iran ranked 17th. Among the United Nations Sustainable Development Goals (SDGs), the goals of Good Health and Well-being, Industry, Innovation and Infrastructure, and Quality Education have received the most attention in knowledge management research related to health and healthcare. The keyword co-occurrence map highlights the prominence of terms such as “knowledge management,” “healthcare,” and “electronic health records.” The identified thematic clusters also underscore the significance of three key domains: organizational performance, information management, and health information systems.
Conclusion: In developed countries and the first level of the world, attention to knowledge management in the field of health and health is more prominent. Also, in order to achieve a high level in the field of health and health as an important and effective criterion in most development sectors, it is necessary to address other sustainable development goals, especially by establishing systems Knowledge management in the field of health helped to achieve important goals such as eradicating poverty and hunger and reducing inequalities.

Comparison of the Effects of Dexmedetomidine and Fentanyl with Midazolam and Sufentanil for Anesthesia after Phacoemolsification: A Double-Blind Clinical Trial

Behzad Imani

Background and Aim: Cataract surgery is one of the most common eye surgeries worldwide. Most individuals undergoing this surgery are elderly patients, and the use of general anesthesia and additional medications can lead to complications during and after the surgery, as well as increased costs for patients. Therefore, the present study aimed to investigate the effects of intravenous Dexmedetomidine and Fentanyl, as well as Midazolam and intravenous Sufentanil, on pain intensity, hemodynamic status, surgeon satisfaction, and the level of sedation in patients undergoing cataract surgery.
Materials and Methods: This double-blind clinical trial was conducted on 80 patients who were candidates for cataract surgery at Farshchian Sina Hospital in Hamadan. Sampling was carried out from March 10, 2023 to August 21, 2024. The intervention group received Dexmedetomidine and intravenous fentanyl, while the control group received midazolam and Sufentanil. Blood pressure, heart rate, and oxygen saturation level, were measured. Pain intensity, surgeon satisfaction, and the level of sedation in patients were measured and recorded. The results of the research utilized qualitative and quantitative variables based on the study groups, using counts (percentages) and means (standard deviations). For the statistical analysis of these variables at baseline, chi-square tests and independent t-tests were employed. To assess the impact of treatment groups on pain throughout the study, repeated measures ANOVA was used, and the interaction between time and group was evaluated. In cases where the outcome variable under study was not normally distributed, non-parametric equivalents such as the Mann-Whitney test were applied. A significance level of P-Value<0.05 was considered. All statistical tests were conducted using Stata software.
Results: In the intervention group, heart rate and blood pressure decreased over time. Changes in heart rate and blood pressure had no effect on the patients’ recovery process. Oxygen saturation level in the intervention group did not change compared to the control group over time. The medication used in the intervention group did not cause shortness of breath or a decrease in oxygen saturation levels. Additionally, there was no significant difference in pain levels between the two groups. The level of sedation in patients and surgeon satisfaction in the intervention group was higher than the control group.
Conclusion: Based on the results of the research, it is recommended to use Dexmedetomidine in cataract surgery and other surgeries that require sedation.

The Relationship between Demographic Characteristics and Nurses’ Intention to Adopt Telenursing in Bushehr Province, Iran

Mohammadreza Yazdankhahfard

Background and Aim: With the advancement of information and communication technology, telehealth has rapidly emerged as a new approach to delivering health-related care. Telenursing, a subset of telehealth, allows nurses to coordinate and manage care using communication technologies. Despite its significant potential, the adoption of telenursing in Iran has been limited, necessitating an examination of the factors that influence its implementation. The aim of this study is to examine the relationship between demographic characteristics, including age, gender, marital status, education level, employment history, position, hospital of service, experience with telephone interviews, experience in responding to telephone consultation requests, and knowledge and experience in using telenursing systems, with nurses’ behavioral intention to accept and use this technology.
Materials and Methods: This descriptive-analytical study was conducted in 2023 with 281 nurses from two educational hospitals affiliated with Bushehr University of Medical Sciences, utilizing a complete enumeration method. Data collection tools included a demographic information questionnaire and the Chang et al. questionnaire focusing on the behavioral intention domain. The reliability of the behavioral intention domain of the questionnaire was assessed using Cronbach’s alpha coefficient, which was found to be 0.73. Data analysis was conducted using descriptive statistics, such as the mean and standard deviation, as well as inferential tests, including the Mann-Whitney U test, the Kruskal-Wallis test, and the Spearman correlation coefficient. This analysis was performed with SPSS software. A significance level of less than 0.05 was used for all tests.
Results: The mean age of the participants was 33.30±7.46 years, and most of them were female and married. A significant relationship was observed between several demographic characteristics of the nurses and their behavioral intention to adopt telenursing. marital status (r=0.13, P=0.036), experience of conducting phone interviews with patients (r=0.20, P=0.001), experience of responding to phone consultation requests from patients or families (r=0.13, P=0.028), possession of knowledge and information about telenursing (r=0.26, P<0.001), and experience using the telenursing system (r=0.3, P<0.001), were all significantly associated with behavioral intention.
Conclusion: Telenursing, as one of the modern technologies of the present century, can be an effective solution to address the challenges of the healthcare system. The results of the study showed that some individual characteristics are related to the nurses’ behavioral intention to use this technology. To promote this technology, targeted training programs and supportive policies that address these factors are necessary.

Comparing the Effectiveness of Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Therapy (CBT) on the Mental Health of Patients with a History of Myocardial Infarction

Mehrdad Azarbarzin

Background and Aim: Cognitive-behavioral therapy is one of the effective types of psychotherapy in the treatment of psychiatric disorders such as anxiety disorders, depression and improving mental health. This study was conducted with the aim of comparing the effectiveness of acceptance and commitment therapy and cognitive-behavioral therapy on the mental health of patients with a history of myocardial infarction hospitalized in hospitals in Kermanshah province in 2024.
Materials and Methods: The present study is applied in terms of purpose and in terms of implementation method, it is a quasi-experimental study with a pretest-posttest design and a control group. The statistical population of this study included all patients hospitalized with myocardial infarction in hospitals in Kermanshah province, from whom 45 people were selected conveniently and based on the inclusion and exclusion criteria and were randomly assigned to two experimental groups and one control group (three groups of 15 people). To collect the information required for the study, the Goldberg (2003) Demographic and Mental Health Questionnaire was used. SPSS statistical software and t-test and ANOVA statistical tests were used to analyze the research data.
Results: Out of a total of 45 participants, 29 were male (65.4%) and 16 were female (34.6%). The comparison of their mean mental health scores before the intervention in the pre-test and post-test was (64.8±11.18, 63.33±11.34), (62.6±12.22, 58.07±12.94) and (64.87±10.56, 61.87±10.59), respectively. Also, the results of the analysis of covariance test for comparing mental health in the acceptance and commitment therapy and cognitive therapy groups showed that the F value obtained was 7.111 and its significance level was also smaller than 0.05 and was significant (P<0.05). As a result, both text-based acceptance and commitment therapy and cognitive behavioral therapy had a positive effect on the mental health of patients with a history of heart attack, and among them, the effectiveness of acceptance and commitment therapy was higher.
Conclusion: Considering the lower mean scores of the ACT-based therapy group in the post-test, it can be concluded that it was more effective than cognitive behavioral therapy in increasing mental health.

Investigating the Association between Resilience and Demographic Information in Nurses Working in COVID-19 Special Wards

Afzal Shamsi

Background and Aim: One of the risks of the nursing profession is psychosocial risks that affect their adaptation and, consequently, their resilience. This risk can have a deeper impact in certain situations such as the COVID-19 pandemic; Accordingly, the present study was conducted with the aim of “determining the relationship between resilience and demographic information in nurses working in COVID-19 special wards”.
Materials and Methods: The present study was a cross-sectional descriptive-analytical study and was conducted among 128 nurses working in the COVID-19 special wards of Ziaian Hospital in 2021. Participants were selected using convenience sampling based on inclusion criteria. Data were collected using demographic questionnaires and the Connor-Davidson Resilience Scale (CD-RISC). The scale’s score ranges from 0 to 100 (cutoff point 50), with scores above 50 indicating resilience. This questionnaire has been translated and validated by Iranian researchers. Its content validity was 0.82, and its reliability, based on Cronbach’s alpha, ranged from 0.74 to 0.9 for all subscales. The data were then analyzed using SPSS software with descriptive and inferential statistical tests. A P-value of less than 0.05 was considered statistically significant.
Results: The mean age of the participants was 35.59±7.22 years. The majority of nurses were male (61.7%) and married (89.8%). The mean resilience score among nurses was 37.25±5.68, which is considered very low given the cutoff point of 50. Results from linear regression showed that work experience (β=0.485, P=0.000), shift work (β=0.233, P=0.084), and employment type (β=0.189, P=0.021) had significant predictive power for overall resilience. This indicates that nurses with fixed shifts, more work experience, and permanent or contractual employment tend to have greater resilience. This analysis revealed that these variables, in total, predict 26% of the variance in the overall resilience variable.
Conclusion: Finally, the results of this study showed that the resilience of nurses working in COVID-19 special wards was low. Factors such as service history, work shift, and employment status were effective on their resilience. Accordingly, planning to improve the level of nurses’ resilience is necessary, especially in critical situations.

Psychometric Properties and Validation of the Iranian Version of the Missed Nursing Care Tool

Zahra Zare

Background and Aim: Ensuring the quality of care and maintaining patient safety are fundamental challenges within the nursing profession. Having a culturally relevant and valid tool to assess the phenomenon of “missed nursing care” can significantly assist in identifying actions and conditions that result in negative patient outcomes or situations where care is inadequately provided. Therefore, the aim of the present study was to culturally adapt and validate the Iranian version of the Missed Care Survey tool.

Materials and Methods: The translation and psychometric testing were carried out in six stages: 1) translation from the original language to the target language, 2) comparison of the two translated versions, 3) back-translation, 4) comparison of the back-translated versions with the original, 5) pilot testing of the pre-final version with a monolingual sample, and 6) full psychometric validation of the pre-final version. These stages were conducted with a sample of 330 nursing staff from hospitals affiliated with Tehran University of Medical Sciences.
Results: A total of 330 participants were included in the present study, the majority of whom were female and worked rotating shifts. Approximately half of the participants were aged between 25 and 34 years, and the longest duration of employment in the nursing profession was more than ten years (100 participants, 30.3%). In addition, more than half of the participants held a bachelor’s degree in nursing, and the majority worked more than 30 hours per week (316 participants, 95.8%).The Cronbach’s alpha for the entire instrument was 0.89, and for the subscales of Part B it ranged from 0.79 to 0.93. Moreover, the test–retest correlation coefficients for Part A (missed nursing care, including a list of nursing activities) and Part B (reasons for missed nursing care) were 0.83 and 0.80, respectively. The results of confirmatory factor analysis indicated an acceptable and satisfactory model fit for the three-factor structure of Part B based on overall goodness-of-fit indices. Collectively, these findings provide evidence for the instrument’s robust construct validity and reliability, supporting its suitability for assessing missed nursing care in clinical settings.

Conclusion: Given the critical role of nurses in the healthcare system, providing high-quality and safe nursing care becomes increasingly important. The growing diversity of populations worldwide highlights the pressing need for researchers and healthcare providers to access valid tools across different cultural groups and languages. The Iranian version of the “Missed Nursing Care Survey” is a reliable tool with acceptable internal consistency, good test-retest reliability, and sufficient validity due to its correlation with the original version. Therefore, this tool can be utilized in studies aimed at generating deeper insights into the factors influencing or moderating this complex phenomenon.