ملیحه کدیور

Social skills refer to socially acceptable behaviors that enable a person to interact effectively with others, and avoid socially unacceptable reactions. Social skills developed in childhood often form the basis of success in later stages of life. The purpose of this study is to review studies which have assessed social skills and empowerment developed in childhood and further influence the future life stages.

This narrative review was conducted using the keywords such as; social skills, social empowerment and child education. We searched English and Farsi scientific databases. Out of 512 articles, 86 were extracted.

The importance of social skills and empowerment during childhood were categorized in eight dimensions: definitions, various components of social skills, necessity of acquiring these skills, different methods of education, factors influencing child empowerment, role of games in social skills education and methods of evaluating social skills in children. Any deficiency in these skills may lead to many undesirable consequences such as behavioral disorders, poor academic performance, isolation and psychological disorders in adolescence. Various factors are influential in acquiring social skills, the most important of which are the role of age and gender, parents and teachers, and the cultural level of the family.

Education, especially in the preschool period, plays a significant role in empowering children with social skills. One of the best training programs in this domain is cognitive behavioral training (CB Training) program.

The pediatric palliative care (PPC) includes active care of the child's body, soul, and mind, as well as family support. The purpose of this study was to develop a model for providing pediatric palliative care based on the point of views of the Irania nurses and the physicians in Iran. The objective of this descriptive analytic study was to develop a model for PPC and to confirm each of the factors presented in the model. Factor analysis was performed using Keizer-Meier (KMO) and Bartlett (BT) tests. A researcher-made questionnaire was used to measure the necessity of providing PPC services. This questionnaire contained 28 questions in three areas or factors (9 items about the children, 12 items related to the family issues, and 7 items related to national health), and the statistical analysis was done by using SPSS 21. The item "Attention to moral concepts in dealing with the family at the family level" had the highest mean score (4.4±0.28). The items "Trying to have a peaceful death in the end stages of life in the child's area" and "Benefiting from equal palliative services at the national level", respectively with average scores of 4.2±0.52 and 4.1±0.4 in the ranks, at the second and third of this necessity. The PPC model was developed based on the results of this questionnaire. According to the result of the questionnaire items used in this study, the palliative care necessity model was developed. It is also concluded that providing PPC in Iran is necessary.

Optimal collaboration between members of the patient management team; especially physicians and nurses; can effectively prevent stress by creating an appropriate moral atmosphere that leads to the improvement of the quality of care.This study aimed to determine the attitude of nurses and physicians toward physician-nurse collaboration working in the neonatal intensive care units of the teaching hospitals in Tehran, the capital of Iran.

In this descriptive and analytical study, carried out in the neonatal intensive care units of the teaching hospitals in Tehran in 2018-2019, 234 physicians and nurses, selected by the available sampling method, participated in the study. Data were analyzed by SPSS V21 software with T-test, Pearson, and Anova.

The mean attitude score of nurses was 24.15 with a frequency percentage (40.25%) compared to physicians' 25.70 with a frequency percentage (42.80%) (P<0.05). The highest average score in the questionnaire was related to teamwork and information sharing among physicians and nurses, 6.75 and 8.73 respectively. A significant relationship was found between nurses' attitudes toward work experience, working hours, and liability insurance (P<0.05).

The attitude of the nurses and physicians about physician-nurse collaboration in this study was revealed to be unsatisfactory. One of the important reasons for the negative score of the attitude of nurses and physicians towards collaboration may be the point that sufficient importance is not given to the role of nurses in patient management. It is therefore recommended to identify factors affecting the improvement of collaboration, as well as maintaining enough weight to the role of nurses in patient management by further studies.

Futile medical care is referred to any medical intervention or activity that bring no benefit to patients. The aim of this study was to evaluate the frequency of futile treatment and its cost in neonates with a probable diagnosis of inherited metabolic disorder.

In this cross-sectional study, hospitalization records of all admitted neonates in Children's Medical Center, Tehran were evaluated between 2013 and 2016. Demographic characteristics of the patients, duration of hospitalization, diagnostic and therapeutic management, and costs were investigated.

In the period studied, 1668 neonates were hospitalized of whom 20 (1.2%) died in neonatal intensive care unite with a probable diagnosis of inherited metabolic disorder. Six (30%) cases had deceased siblings. The total duration of hospitalization was 290 day-patient ranging from 20 hours to 37 days. The costs of hospitalization and medical treatments were calculated. Despite disagreement of eight (40%) parents with any futile treatments, the medical team discontinued the futile care in only one case who received palliative care. In other patients futile treatment continued before death.

Futile medical treatments in neonates with inherited metabolic disorders are not uncommon. Lack of a comprehensive guideline about this issue leads to continuation of futile medical care.

Pediatric palliative care defined as any intervention that focuses on relieving suffering, slowing the progression of disease, and improving quality of life at any stage of disease is rather a new concept in Iran's health care system. This study aims at needs assessment of delivering pediatric palliative care from the viewpoint of pediatric nurses and physicians. 

211 pediatricians and pediatric nurses participated in this descriptive study. A self-administered pre-tested standardized questionnaire was used as the study material. Needs assessment of delivering pediatric palliative care was investigated through 28 Likert questions mainly on three domains including National, Family and Child (scores ranging from 28 to 140). To confirm the items on the questionnaire, confirmatory factor analysis was used. Mean scores of each domain was compared using Mann-Whitney test and Kruskal-Wallis. Correlations were studied through Pearson Correlation Test. Data was analyzed by SPSS version 21.

Overall score of necessity for delivering pediatric palliative care was 130.43. The item "Considering ethical issues while contacting the family" had the highest score (4.4±0.28) in the Family domain." In two other domains, National and Child, the items " Trying to have a peaceful death in the late stages of life " and " To benefit equally from palliative care" had the highest scores respectively (4.2±0.52 and 4.1±0.4).

The results of this study revealed the necessity of delivering pediatric palliative care in Iran. Additionally, considering ethical issues in palliative medicine and providing justice-oriented care were indicated as important subjects in this area. In the end, a pediatric palliative care model was designed based on the total score and the items of the questionnaire.

Infants born with congenital heart disease (CHD) typically present different clinical manifestations which make this condition hard to diagnose. Considering serious complications arising from misdiagnosis, inventing new methods and/or improving traditional diagnostic approaches has always been a research objective.

In this cross-sectional analysis, which took place in Children's Medical Center in Tehran, 150 infants admitted to an intensive care unit were evaluated based on echocardiographic findings from 2015 to 2017. Echocardiography was done due to abnormalities in physical examination and/or oxygen saturation level.

The sensitivity of clinical study value was 82% and the negative predictive value was 20%. The sensitivity of arterial oxygen saturation immediately after admission to the neonatal intensive care was 92%, the specificity was 34%, positive predictive value was 56% and negative predictive value was 25%.

In terms of high sensitivity, clinical symptom including tachypnea, cyanosis, arrhythmias, respiratory distress, cardiac murmur, or arterial oxygen saturation level in newborns may be useful for screening CHD. Among the clinical manifestations, cyanosis and respiratory distress are more valuable.

The effects of magnesium physiology are contradictory to the neurotoxic effect of bilirubin, but the relationship between magnesium level and hyperbilirubinemia in neonates has not been well studied. In this study, we investigated the relationship between serum magnesium level and hyperbilirubinemia and hyperbilirubinemia complications at the Children’s Medical Center.

In this cross-sectional and prospective study, 100 neonates who were admitted to the Childrenchr('39')s Medical Center from October 2018 to 2019 due to neonatal jaundice were enrolled. Neonates were divided into two groups: serum bilirubin levels 16-20 mg/dl were included in the moderate hyperbilirubinemia group and bilirubin >20 mg/dl into severe hyperbilirubinemia group. Serum magnesium levels and clinical complications of hyperbilirubinemia including fever, seizure, apnea, bradycardia, and abnormal neurological examinations were recorded in these infants.

In this study, 100 neonates were evaluated. The mean serum magnesium level in these patients was 2.32 mg/dl. This rate was significantly higher in neonates with seizure (P=0.038), hyperbilirubinemia fever (P=0.048), and neonates with chronic encephalopathy (P=0.003). The mean serum magnesium level was significantly higher in severe hyperbilirubinemia (P<0.001). Serum Magnesium in complications of chronic encephalopathy (P=0.007), Fisting (P=0.001), retrocoli (P=0.001), hypertonia (P=0.004), hypotonia (P=0.001) and seizures (P=0.030) were significantly different. The serum magnesium levels were positively correlated with total bilirubin (r=0.443, P<0.001). The magnesium levels correlated with the chronic encephalopathy (OR: 4.15, P=0.040) and it was observed that magnesium levels above 2.15 could predict chronic encephalopathy with a sensitivity of 100%, the specificity of 47.82%, a negative predictive value of 100% and a positive predictive value of 14.28%.

The results of this study showed that serum magnesium levels significantly correlated with serum total bilirubin and magnesium cutting points above 2.15 mg/dl in patients with jaundice could predict chronic encephalopathy.

Neonatal jaundice is a matter that is very important for clinicians all over the world because this disease is one of the most common cases that requires clinical care. The aim of this study is to use data classification algorithms to predict the type of jaundice in neonates, and therefore, to prevent irreparable damages in future.
This is a descriptive study and is done with the use of neonatal jaundice dataset that has been collected in Cairo, Egypt. In this study, after preprocessing the data, classification algorithms such as decision tree, Naïve Bayes, and kNN (k-Nearest Neighbors) were used, compared and analyzed in Orange application.
Based on the findings, decision tree with precision of 94%, Naïve Bayes with precision of 91%, and kNN with precision of 89% can classify the types of neonatal jaundice. So, among these types, the most precise classification algorithm is decision tree.
Classification algorithms can be used in clinical decision support systems to help physicians make decisions about the types of special diseases; therefore, physicians can look after patients appropriately. So the probable risks for patients can be decreased.

Neonatal care unit nurses should acquire and maintain the necessary specialized knowledge for providing skillful and high quality care during their professional career. This study aimed to examine the impact of virtual-based education on nurses’ psychological empowerment in the level II neonatal care unit.
This quasi- experimental study was carried out in 2015 on 80 nurses working in level II neonatal care units of hospitals affiliated to Tehran University of Medical Sciences; subjects were randomly assigned to two groups of intervention and control groups. The level of nurses’ psychological empowerment was measured using Spreitzer’s psychological empowerment questionnaire on the first day of study and after the course. For the intervention group, the educational content of level II neonatal cares was developed and presented on Namad System of the virtual faculty of Tehran University of Medical Sciences (TUMS) for two months. Data were analyzed using paired t-test, Fisher’s exact test, chi-square and independent t-test.
The research units were homogeneous in all demographic variables except work experience in the neonatal unit. The respective mean scores and standard deviations of empowerment in the intervention and control groups were 61.57±7.8 and 56.74±6.386 (out of 84) before the intervention and 60.71±7.595 and 63.60±5.6 after the intervention. The results of the independent t-test and paired t-test showed that there was a statistically significant difference in the mean scores of psychological empowerment of the two groups before the intervention (p=0.006), of the control group before and after the intervention (p≤0.001), and of the intervention group before and after the intervention (p≤0.001).
The results indicated the effectiveness of virtual-based education on nurses’ psychological empowerment in level II neonatal care units. With regard to the benefits of virtual-based education, its application is recommended in continuing education programs for nurses.

Human rights issues are based on human dignity. In this regard, Rights of the Child are considered by most of world's organizations and the scientific communities. Different types of child punishment are prohibited according to international conventions as well as national legislation. Historically, the first legal action to protect the rights of children was taken in 1924. Then rights of the child were briefly referred to in the Universal Declaration of Human Rights approved in 1948. Afterwards, United Nations General Assembly adopted, in a resolution, the draft prepared by the Human Rights Commission under the Declaration of the Rights of the Child in 1959. Iran is also among the states that signed and approved this declaration in 1993. However, child abuse has become a global problem and violence against children is one of the major challenges for health care providers that has endangered their physical and mental health and creates serious problems for them in the future. According to Islamic-Iranian culture, children counts as trust and the family is responsible to take care of them and strive for their excellence. This study aimed to analyze a case of child abuse in 2016 with an ethical approach.
In this case study, a real case was referred to Tehran Children Medical Center in a monthly session of medical ethics, and the ethical analysis was later carried out based on ethical considerations raised by the medical staff and specialists in various fields. The case is a 5-year-old boy who was physically abused and was brought to the emergency department at Children's Medical Center in the morning due to the multiple fractures in different parts of the hands as well as cigarette burn caused by his parents in his hands and feet. According to his mother, she first noticed the swelling of the child's hands and referred to the physician. After exact examination and radiography of the child's body, physicians noticed old and new fractures in the arm, the elbow and wrist. The mother claimed that the child's fractures were caused by falling off the swings and slides. The physicians also saw scars of old wounds on the child's head, as the mother claimed, they were caused as a result of fractures associated with falls. The child's physical examination showed that part of the back and posterior side of the thigh of one of his legs was burned and traces of cigarette burns were seen on one of the child’s hands. Thus, physicians requested help from forensic experts. After examining the child's condition and examining him thoroughly, they, while acknowledging the child physical abuse, found that the victim underwent sexual harassment by some of the family boys.
Ethical considerations: While observing honesty in the case report, attempts were made to respect the confidentiality of personal information of the case and his family.
Findings: The mother has rejected the occurrence of physical child abuse in the form of for multiple fractures in areas of the hands and feet as well as multiple burn cases on the child's body and tried to mislead the medical staff. Investigations suggest that the child's father was responsible for the physical abuse, but the mother denied it. On the other hand, the mother tried to hide the child molestation by male relatives, and following this sexual abuse, the father also resorted to unethical manner and has punished the child rather than appeasing and supporting the child as well as denouncing the actions of those who commit this immoral act. Employees participating in the study, said that it is essential to examine all surfaces of the child's body in cases of child abuse. It is essential to monitor vital signs of the abused child, particularly his temperature because high temperature could be the reason for this accident and the fact that child abuse is committed through exposing him to high temperature. Physical examination must also include any examination of external genitalia and anal area. Considering that the sexual abuse is a hidden conduct, if there is suspicion of rape, the assessment is necessary. The child's privacy must be respected during a physical examination, and explanations should be provided regarding measures that are going to be taken. Considering the foregoing, obtaining thorough medical and social history, thorough examination of the naked body, lack of secrecy about sexual assault on children, respect for human dignity, honesty, privacy, confidentiality and privacy of information, respectful conduct, respect for the child's independence, neutrality and social protection are considered as the most important ethical considerations referred to in this analysis . Also, helping families adapt in order to prevent further incidents of child abuse is another finding of the present analysis.
In this study, it was found that the families of abused children deny and distort the facts about the children instead of supporting them for some reasons. However, medical staffs are usually the first individuals who are informed about the child abuse, so it is logical to consider their views in order to find appropriate solutions to help these children. In this case, one can provide better education and adequate facilities to properly deal with this vulnerable group. The relevant authorities are also recommended to design a written programs based on the ethical considerations raised and submitted it to the medical centers of the country. Also, a group consisted of pediatrics and medical ethics, social workers, psychiatric nurse and psychiatrist should assess needs of abused children and their families and plan to solve their problems. The importance of this lies in the right to social protection and care of abused children and their families to improve their quality of life. Effective measures can be taken in this regard through awareness raising at different levels of society, training for child rearing free from any violence, amending the Child Protection Act, identifying vulnerable families and providing rehabilitation services for victims of child abuse and finally take steps to prevent this phenomenon.

Peripherally inserted central catheters (PICC) are utilized in neonatal intensive care units (NICUs) as an instrument to vascular access. The PICCs significantly reduce side effects compared to central and peripheral venous catheters and can be the cause of catheter-related bloodstream infections (CRBSIs). The purpose of this study was to create a fuzzy expert system for the early diagnosis of PICC-related infections in newborns.
This descriptive-applied study was conducted in 2016. The statistical population of this research consisted of the medical files of newborns in Children's Medical Center in Tehran, Iran, and sampling was carried out using convenient sampling method. The research tools were a checklist and questionnaires. Factors affecting infection diagnosis were determined based on pediatric specialists’ comments. The system was designed bilingually (Persian and English) using C# software and SQL Server database. The output of the system is the percentage of infection risk. The system evaluations were carried out using data from the medical files of newborns in a hospital in Tehran, Iran. Data was analyzed using Excel software.
Based on system assessment and comparison of the system output with the diagnosis of the specialists, the sensitivity, specificity, and accuracy of the system were 95%, 88%, and 91%, respectively.
The non-specificity of clinical signs and laboratory findings of blood infection in newborns have made its diagnosis difficult and uncertain. Using a designed expert system can be effective in the diagnosis of CRBSIs.

Education is an important issue in improvement knowledge of health care professionals. The Web-based education could be considered because of the flexibility of the education system, a good opportunity to extend, and deepen learning of scientific content providers. This study aimed to assess the impact of virtual learning in increasing knowledge and its effectiveness inNICU.
In this quasi- experimental study,80 nurses working in the neonatal intensive care in third unite of chosen hospital of Tehran University of Medical Sciences using random samples method (lottery)were divided into two experimental and control groups. And then use virtual symbol system [ through learning management system(LMS)] of the virtual school of Tehran University of Medical Sciences, the experimental group received two months of training through an asynchronous on–line learning method using the educational content in the form of visual (multimedia files), audio (podcasting) and text files (PDF) were. The study was conducted during 2 months in 2015-2016. Data collected by demographic questionnaire and caring ability scales CAI on the first day and two months after intervention for pre-test and post-test were collected.
Subjects in the intervention and control groups in terms of demographic variables were matched. The results of the independent and paired samples T test showed, between the unmeant score of caring ability in two groups before the intervention(p=0.001) And between the mean caring ability before and after the study (p =0.071), there was no statistically significant difference. But between the mean caring ability intervention group before and after the intervention (P E-learning can be used as a flexible manner, which allows access to multimedia and interactive educational content at any time and place to provide for nurses, and using to train for newborn' nursing and other sectors.

The Neonatal period is a highly vulnerable time. Provision, maintenance and improvement of neonatal welfare level in health care are the most indicators of health and development. The purpose of this study was investigating the Iranian physicians’ attitudes toward factors in neonatal mortality in order to access minimum data set in neonatal death.
This study was a cross-sectional performed using convenience sampling and a researcher made questionnaire in order to access minimum data set in neonatal death. Questionnaires were completed by neonatologists working in Tehran teaching hospitals by 71% contribution rate. In order to compare the results of the questionnaire and real data from neonatal records, t-test, Mann-Whitney and K-square tests were used.
The results of the comparison between questionnaire and neonatal records on four variables that had the highest mean showed that there were relationships between birth weight, gestational age, Apgar scores and mortality, but there was not a significant relationship between neonatal status at birth and mortality rate.
According to local condition and access level to quality care, important parameters in neonatal death were different and it is necessity to have comprehensive analysis in order to reduce neonatal mortality rate. Use of obtained parameters can be helpful in creating clinical decision support system for predicting the neonatal death, but comprehensive studies are needed for further evaluation.

Birth of a premature infant can create emotional crisis for the mothers and encounter them with a variety of problems. The purpose of this study was to identify the perception of mothers with premature infants hospitalized in the neonatal intensive care units (NICU).
This was a qualitative study. In all 25 mothers were selected through purposive sampling, and a face-to-face semi structured interview was conducted with each participant. For the analysis of the data, the content analysis was applied containing verbatim transcription, reading interviews several times to obtain a sense of the whole, division of the text into meaning units and coding them, categorization of the codes into sub- categories and categories, and finally formulation of the latent content into categories.
In general, 2 categories and 5 sub-categories were identified. Categories encompass the followings: ‘living with tension, and ‘empowerment’. Living with tension has 2 sub-categories consisting of ‘fear of future’ and ‘damage to family’. Empowerment has 3 sub-categories consisting of ‘seeking for learning of unknowns’, ‘participation in treatment’ and ‘preparation for discharge’.
Understanding of mothers’ premature infant’s perceptions can help health care team to provide better services.

Chronic renal failure in infants is a life-threatening condition that can also severely affect their families. Patients and their families are under great physical, mental and social pressure, and therefore require medical, palliative and supportive care. Moreover, ethics has an important role in care for these infants and their families. The purpose of this study was to identify an ethical approach to providing medical, supportive and palliative services for infants with chronic renal failure and their families. The study was based on a case report in the Medical Ethics Grand Rounds of the Children's Medical Center in Tehran, Iran. The case pertained to a male newborn infant with diagnosis of renal failure. Assessments indicated severe bilateral hydronephrosis and multicystic dysplastic kidneys accompanied by high creatinine levels. The patient underwent surgery but further evaluations revealed a low glomerular filtration rate accompanied by elevated blood pressure. The physicians suggested insertion of a catheter for CAPD (continuous ambulatory peritoneal dialysis) after the initial peritoneal dialysis until a kidney transplant was performed. The proposal, however, was rejected by the parents and the patient was discharged by their consent. A few weeks later, the infant expired at home. It seems that health professionals need effective ethical strategies to offer medical, supportive and palliative services for infants with chronic renal failure and their families

Over the last two decades invasive candidiasis has become an increasing problem in neonatal intensive care units (NICUs). Colonization of skin and mucous membranes with Candida spp. is important factor in the pathogenesis of neonatal infection and several colonized sites are major risk factors evoking higher frequencies of progression to invasive candidiasis. The aim of this study was to detect Candida colonization in NICU patients.
This cross-sectional study was conducted on 93 neonates in NICUs at Imam Khomeini and Children Medical Center Hospitals in Tehran. Cutaneous and mucous membrane samples obtained at first, third, and seventh days of patients’ stay in NICUs during nine months from August 2013 to May 2014. The samples were primarily cultured on CHROMagar Candida medium. The cultured media were incubated at 35°C for 48h and evaluated based on colony color produced on CHROMagar Candida. In addition, isolated colonies were cultured on Corn Meal Agar medium supplemented with tween 80 for identification of Candida spp. based on their morphology. Finally, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was performed for definite identification of isolated species.
Colonization by Candida spp. was occurred in 20.43% of neonates. Fifteen and four patients colonized with one and two different Candida spp., respectively. Isolated Candida spp. identified as; C. parapsilosis (n: 10), C. albicans (n: 7), C. tropicalis (n: 3), C. guilliermondii (n: 2), and C. krusei (n: 1). In present study non-albicans Candia species were dominant (69.56%) and C. parapsilosis was the most frequent isolate (43.47%). Using Fisher's exact test, the correlation between fungal colonization with low birth weight, low gestational age, and duration of hospital stay was found to be statistically significant (P=0.003).
The results of this study imply to the candida species colonization of neonates. Neonates in NICU are at the highest risk for severe infection with Candida parapsilosis. Therefore, isolation of C. parapsilosis as the most common species (43.47%) in present study was noteworthy.

Staff of different wards face diverse ethical issues. Also cultural, social and economic factors affect these issues. A team of experts in the fields of neonatal care and medical ethics tried to explore ethical issues in intensive care units in Iran.
Methods and Materials: this was a Methodological Research that was done in two steps. In the first step ethical issues in clinical settings explored. The instrument was designed between Aprils to October 2013. The content validity method was used for validity of the instrument. To calculate the reliability, internal consistency was used. The data was analyzed by SPSS 16 and AMOS 16.
Findings: The result of the first run was a 26 item questionnaire with four domains including commitment, patient rights, and inappropriate interaction with parents and end of life care. Internal consistency for the whole instrument was α= 0.89. The result model has suitable fitness.
The results of our study showed the ethical issues of neonatal care with main domains of it. There is an interesting field for research in future.