abbasali ebrahimian

Abstract Using an effective method to enhance nurses’ knowledge of ECG interpretation is one of the most essential requirements for nursing managers. Self-directed learning approaches can help to introduce lifelong learning in learners, especially in clinical settings. This study purposed to detect the effect of the implementation of the clinical teammate nurse program on the critical care nurses’ knowledge of ECG interpretation on cardiac arrhythmia.  A pilot study was performed by a quasi-experimental design with a nonequivalent control group. The participants were 32 critical care nurses divided into two groups: the clinical teammate nurse program and control groups. The data were collected by a knowledge assessment questionnaire that measured nurses’ knowledge of ECG interpretation of cardiac arrhythmia. The nurses’ knowledge was measured three times: initial study, one month, and six months later. The mean and standard deviation of age of participants was 32.38±7.03 years. There was a significant difference between three scores of repeated measurement of nurses’ knowledge (p<0.001), as the nurses’ knowledge one month after the study was significantly higher than in the initial test six months later. Also, pairwise comparisons showed that nurses in the clinical teammate program had higher knowledge scores than the control group (p<0.001).  The clinical teammate nurse program can be used as an easy and economical way to improve nurses’ knowledge in interpreting ECG. This method can also be an excellent alternative to formal and traditional methods such as lecturing programs in continuing education programs.

Intuition plays an essential role in caring for children with high-risk diseases and making appropriate decisions in critical situations. Understanding the context of intuition will lead to a more appropriate use of intuition. This study was proposed to explore pediatric nurses’ experiences of contextual factors influencing intuition formation in pediatric nursing. This qualitative content analysis was conducted on 16 nurses and 2 pediatricians in pediatric settings of Bandar Abbas hospitals, Iran, in 2020. Participants were purposefully selected with maximum variation in job position, age, and work experience. Data were collected through semi-structured interviews that focused on the occurrence of their intuition experiences and influencing factors. The interviews were transcribed and analyzed using the Graneheim and Lundman method of content analysis. To increase the trustworthiness of the data, the codes extracted were peer-checked, member-checked, and external-checked. The theme of "competence in the shadow of limitation and uncertainty" represented the context in which intuition occurred and was used in pediatric nursing. This theme was derived from the two categories “the limited scope and inexplicability of intuitive actions” and “rational mastery.” Despite the belief in the role of knowledge and experience in forming intuition, pediatric nurses were mostly reluctant to intervene based on their intuition. Organizational issues such as the limited and ambiguous nature of Iranian nurses' independent practice and the inexplicable nature of intuitive actions have limited pediatric nurses' use of intuition. Hospital leadership should moderate barriers to using intuition by changing mindsets, culture, and legislation.

 Nurses' job stress can affect their physical and mental health. If sexual health is endangered, the sexual health of the sexual partner might be in trouble.

 This study aimed to investigate sexual dysfunction and related factors in hospital emergency male nurses and its relationship with their spouses' sexual function.

 This study was a descriptive-analytic cross-sectional study. Data collection tools were the International Men's Erectile Performance Questionnaire and Women's Sexual Performance Index Questionnaire. Male nurses and their spouses completed the questionnaires separately and mailed them.

 One hundred and ten people participated in this study. The prevalence of sexual dysfunction in emergency male nurses and their spouses was 40% and 92.7%, respectively. There was no significant relationship between the sexual dysfunction of male nurses and the sexual dysfunction of their spouses (P = 0.324). There was a statistically significant relationship between the mean score of male nurses' sexual dysfunction and the number of children (P = 0.002) and between the spouses of emergency male nurses' mean scores of sexual dysfunction and their employment (P = 0.032).

 Being a male emergency nurse could not play a role in developing sexual dysfunction in their spouses. The prevalence of sexual dysfunction in male nurses is almost equivalent in other men and their spouses higher than in other women in the community. While sexual dysfunction in the male emergency nurses was related to the number of children, their spouses' sexual dysfunction was related to their jobs.

Mint and chamomile can effectively reduce the gastric residual volume (GRV). This study aimed to determine the effect of mint extract and chamomile drops on the GRV of trauma patients under mechanical ventilation and nasogastric tube feeding in the intensive care unit. This study was a triple-blinded randomized clinical trial with a 2×2 crossover design. Eighty patients were randomly divided to receive mint extract and chamomile drops. Five drops of mint extract and 11 drops of chamomile were gavaged every 6 hr. GRV was measured using a syringe-aspiration method before and 3 hr after each intervention. After a 24-hour washout period, the two groups changed places. In the first phase of the study, before the interventions, the GRV in the mint and chamomile groups was 14.60±7.89 and 13.79±7.12 ml, and after the interventions were 8.13±6.31 and 6.61±4.68 ml, respectively. In the study's second phase, before the interventions, the GRV in the mint and chamomile groups was 10.03±4.93 and 11.46±7.17 ml and after the interventions, GRV was 4.97±4.05 and 6.98±4.60 ml, respectively. The difference in the GRV before and after the intervention was not significantly different between the two groups. Both herbal drugs effectively reduced the GRV (p=0.382). Mint extract and chamomile drops are similarly effective in reducing the GRV in trauma patients under mechanical ventilation and nasogastric tube (NGT) feeding in the intensive care unit.

Intuition is one of the key factors in decision-making leading to timely recognition of problems and quality care.

The purpose of this study was to determine the extent of intuition and the factors influencing it in pediatric nurses.

A cross-sectional study was conducted in 2020 with 100 pediatric nurses working in hospitals of Bandar Abbas, Iran. Smith Intuition Instrument was used to collect data. Descriptive statistical methods, t-test, and analysis of variance were used for data analysis.

Most nurses (59%) demonstrated moderate use of intuition whereas the others (41%) showed high use of intuition. Nurses with less than 10 years of work experience and those working in pediatric intensive units scored significantly higher on the reassuring feelings subscale (P<0.001).

The pediatric nurses’ intuition was appropriate. Nurses are encouraged to confidently use their intuition without fear of blame in the difficult and sensitive situations of pediatric care.

 Cost management of inpatient records can directly and indirectly affect the management and control of hospital costs. Therefore, the present study was conducted with the aim of designing and validating the cost management model of inpatient records in the global system.

 The present mixed method study was conducted in 2021. Senior and middle managers composed the statistical population in the qualitative section and the senior, middle managers and staff of Niknafas Hospital in Rafsanjan were the quantitative section statistical population. In the qualitative section, in-depth interviews were conducted with 33 experts using the purposive sampling accompanied with snowball method. A researcher-made questionnaire with a random sampling method was used to assess the model among 210 people in the quantitative section. Qualitative data were analyzed by Atlas.ti software and quantitative data were analyzed by exploratory and confirmatory factor analysis using SPSS and SmartPLS version 3 software.

 The results of the qualitative section indicated that the cost management model includes 15 sub-categories and 6 main categories. "Information and awareness", "sensitivity", "risk-taking and motivation", "control and supervision", "experience and skill", and "factors beyond the hospital's control" were the main categories. The SRMR fit indices (0.069), R2 (>0.67), GOF (>0.36) showed that the fit of the measurement, structural and general models were appropriate and approved.

 The present study showed that the designed model of cost management of inpatient records in the global system has a good fit and can be used in medical centers.

In a pre-hospital emergency, identifying high-risk medical patients and appropriate decision making is very important. The classifying of life-threatening risks in pre-hospital settings can improve the decision-making process. This study was purposed to classify the risk level of death in patients in pre-hospital emergency settings.

This study was a descriptive longitudinal study design that performed on the patients requesting the pre-hospital emergency services. This study was a descriptive longitudinal descriptive study that lasted from May 1 to the end of August 2017. 675 patients participated in this study. A demographic questionnaire and pre-hospital internal emergency alert scale were used for data collection. Then the patients' condition was followed up until discharge from the emergency department.

The mean score of the Pre-Hospital Internal Emergency Warning Scale was 11.95 ± 6.21. The odds ratio for each Prehospital Medical Early Warning Scale (Pre-MEWS) score was 1.193, which indicated for each unit increase in Pre-MEWS scores, the risk of death of patients increased by 19.3%. Then, the patients classified into three levels of green, yellow, and red based on Pre-MEWS scores. The Area Under the Rock curve for Pre-MEWS scores to identify death and the need for hospitalization in intensive care units was equal to 0.847 (CI=0.793-0.901), and0.755 (CI= 0.711-0.799) respectively).

The Pre-MEWS scale can use for classifying and triage of patients in pre-hospital emergencies, especially in times of disaster. According to the Pre-MEWS scale, patients who are in the third level or green color can transfer to the hospital with more delay, and this can improve the quality of pre-hospital emergency services in times of disaster.

Uremic pruritus is one of the important problems in patients undergoing hemodialysis. Causing the mechanism of uremic pruritus in hemodialysis patients is complex and multifactorial. Almost 60 percent of hemodialysis patients suffer from uremic pruritus. Oral hydroxyzine is a common treatment for uremic pruritus of this patients. This study aimed to survey effect of hydroxyzine on uremic pruritus of hemodialysis patients.

This quasi-experimental study (pre and post design) performed on 40 patients with eligible criteria. All of the hemodialysis patients who suffer from pruritus received a tablet of hydroxyzine 25 mg daily for 6 weeks. In this time, drugs and the plan of hemodialysis were constant. Pruritus score of patients, evaluated with 5-D pruritus scale that had 8 items with 5-score Likert scale and evaluate duration, direction, disability, and distribution of pruritus. Severity scores of pruritus before and after treatment with tablet of hydroxyzine were compared. This study was conducted on hemodialysis patients in the Soodeh Center of Hemodialysis in the south of Tehran, Iran, from September 2016 to February 2017.

The findings of this study showed that most of the patients in this study were male (55%) with mean age of 55.97±11.59 years. The most cause of chronic renal failure in these patients was diabetes (37.5%). This study showed that 32.5% of the hemodialysis patients had moderate to severe uremic pruritus. The mean score of pruritus before the treatment with hydroxyzine was 16.73±3.4 and the most effect of this drug was in the social activity item (2.47±0.6). After treatment with hydroxyzine, the mean score of pruritus in the patients was 9.65±2.15 that was decreased significantly (P<0.001). The findings showed that there was no significant relationship between decrease of pruritus and characteristics of patients.    

This study showed that uremic pruritus is still a challenge in hemodialysis patients. According to this study use of hydroxyzine, regardless of uremic pruritus mechanism, could be decreased uremic pruritus of hemodialysis patients.

Simulation is one of the strategies which are suggested and used to reduce stress and anxiety in clinical student education. This study aimed to determine the effect of simulation‑based training method on psychological health promotion in operating room students in their educational internships.

This study was a clinical trial. Research population was operating room students at Semnan University of Medical Sciences. A demographic questionnaire and the Spielberger’s Situational Anxiety Inventory were used as data collection tools. Students were divided into two intervention and control groups randomly. Situational anxiety was measured before the intervention and on the 1st and the last days of the internship. The data from the two groups were compared by using the Mann–Whitney and Friedman statistics at the significant level of 0.05.

There was a significant difference between students’ situational anxiety scores in the experimental and control groups on the 1st day of internship after education by simulation (P = 0.481). There was a significant difference between the students’ anxiety scores in the two groups on the last day of the internship (P = 0.008).

Simulation of the operating room environment before the internship cannot reduce the operating room students’ situational anxiety on the 1st day of internship, but it can reduce their situational anxiety during the internship and significantly reduce it at the end of internship compared to those who are not in the simulated environment.

Nowadays, medical tourism as a branch of tourism, with its key role in improving the economies of countries, has attracted the attention of researchers. This article aims to investigate the role of the nurse as a key member of the treatment team in this industry.

In this review article, first 200 English and Persian articles using searches in valid databases, PubMed Scientific Information Database (SID) and Scopus, Web of Science and Keywords (Nursing and Nursing, Medical Tourism, Nursing Role), Were identified between 2004 and 2018 with no study-type restrictions. By reviewing the articles and reviewing them further, 41 articles appropriate to the subject and purpose of the study were used to evaluate and compare the purpose of the study.

Nurses' attitudes, nurse coordination with the treatment team, nursing care in a timely manner, explanation of procedures, respect for patient privacy and the ability to perform specialized tasks are listed as significant and influential factors in the growth of medical tourism industry.

The results indicate that despite the importance of the role of the nurse in the treatment team, this issue has not been investigated. Managers and researchers' attention to the nurse's position in the tourism industry will improve the health, treatment and thus economic growth.

Aromatic herbs and spices contain essential oils and are recognized by their considerable antimicrobial activity. One of the natural mouthwashes in traditional Iranian medicine is Zufa. It is not clear, however, that the extract of Zufa can affect oral health as much as Chlorhexidine gluconate, which is a potent antimicrobial mouthwash. This study aimed to compare the effect of Zufa and Chlorhexidine gluconate mouthwashes on oral flora of patients under mechanical ventilation in ICUs. This double-blind, randomized clinical trial was conducted on the ninety-ICU-patients receiving mechanical ventilation in a university-affiliated hospital in Sari, Iran, from June 2017 to March 2018. The patients were randomly divided into three groups (n = 30) using block randomization method; the Zufa, Chlorhexidine gluconate, and normal saline groups; the patients’ mouth were washed with 15 mL of the Zufa 0.02%, Chlorhexidine gluconate 2%, or normal saline 0.09%, 30 seconds, twice a day (eight am and four pm), for 3 days, respectively. Oral hygiene status was evaluated before the intervention, and then up to three days after that by the Beck oral assessment scales (BOAS). The data of BOAS showed no significant difference between the Zufa, Chlorhexidine gluconate, and normal saline groups before the intervention phase (P > 0.05), and in this phase BOAS means in the Zufa, Chlorhexidine gluconate, and normal saline were 6.0 ± 40.56, 6.0 ± 43.72, and 6.47 ± 0.62, respectively. A significant association was found between the BOAS score after mouthwashes and the oral health of the patients in the three groups (P > 0.05). Based on the results of our study, mouthwashes of Zufa and normal saline showed the same effectiveness as Chlorhexidine gluconate on the oral health of intubated patients hospitalized in the ICU.

Today, improving patients’ quality of life (QOL) is the criterion for the treatment of coronary artery disease. The aim of this study was to evaluate the effect of spiritual care based on GHALBE SALIM model on QOL of acute myocardial infarction (AMI) patients. This single-blind clinical trial was conducted on 92 patients with AMI hospitalized in CCU of Chamran Hospital of Isfahan, Iran in 2016. In this account, after random allocation of the subjects to the intervention and control groups, the spiritual intervention based on GHALBE SALIM model was regularly performed on the subjects of the intervention group at 17-20 hours for three days. In addition, the QOL of patients was assessed before and one month after the intervention by using the World Health Organization questionnaire. 50% of the participants were female. Mean ± SD of the patient’s age was 61.3 ±8.9 and 62.7 ±6.9 in the intervention and control groups, respectively. On average, the spiritual care program increased the scores of physical, mental, and social health, QOL and general health to 19.8, 17.5, 11.6, and 27.2, respectively. Furthermore, a significant difference was observed between the study groups in terms of the quality of life score (P<0.05). The study results confirmed the effect of spiritual care based on GHALBE SALIM model on the QOL of patients with AMI admitted to the CCU. Therefore, as a comprehensive care approach its application is recommended to improve the symptoms and dimensions of QOL in patients with IHD, especially MI.

Hospital bed capacity is one of problems in intensive care unit during at the time of crisis, emergencies and disasters. At this regard, it seems reverse triage can resolve this issue by using predictive score systems. This study was purposed to develop a reverse triage system in intensive care unit using APACHE II scoring system for crisis, emergencies and disasters situations.

This study was performed by a prospective longitudinal design that lasted from March 2016 to February 2017. Research population were 420 internal patients that were admitted in intensive care units of Imam Reza Hospital in Mashhad, Iran. Data were collected and documented for each patient by demographic questionnaire and APACHE II scoring system daily until discharging time from intensive care units. The patient’s status after discharge from the intensive care unit was used as a criterion for statistical tests.

APACHE II mean score in first day of admission was 18.9±16.20. Risk ratio of patients’ discharging from intensive care unit was 1.034. The patients were placed in four levels of inverse triage according to mortality rate and risk ratio. The scores of four levels were including: 0-10 (first level and green color), 11-16 (second level and yellow color), 27-71 (third level and black color) and 17-26 (fourth level and red color).

The Apache II system can be used as a tool for reverse triage in intensive care units during at the time of crisis, emergencies and disasters. When using this system for reverse triage, patients at the first to third levels can be discharged from intensive care unit. However, patients on the fourth level should not be discharged from intensive care units under any circumstances

In most of studies, Modified Sequential Organ Failure Assessment (MSOFA) was used in admission time of patients in intensive care units, while its changes in the value of the scores have been underestimated during the patients’ hospitalization. So, this study was purposed to detect the trend of mean changes and the ability of MSOFA to predict the sequel of patients in internal critical care units.

In a prospective analytical descriptive study, 346 medical patients of intensive care units of Imam Reza hospital in Mashhad city (Iran) were monitored. Data collection tool was MSOFA check list. Information of each patient was collected and recorded for 12 days.

During 12 days of study, the progression of the mean scores of MSOFA was indicated an increasing and decreasing trend for patients who died and discharged respectively. Conspicoiusly, the trend of changes in area under the ROC curve also showed that modified SOFA had more ability in recognition of ill patients and detection of sequel of them in the days after the admission of patients in the intensive care units.

Ability of MSOFA in detection of sequel of medical patients in intensive care units was increased with duration of hospitalization of them. Thus, it was suggested that the daily MSOFA scores were calculated and recorded in addition to other care and treatment measurements. Also, trend of MSOFA scores during hospitalization, especially scores of last days, can use as decision making index about deterioration of patients in intensive care units

Nine equivalents of nursing manpower use score (NEMS) is one of the scoring systems used in some studies to determine the severity of the status of patients in the ICU. The present study was conducted to investigate the application of NEMS to identify patients at the end stages of life.

This study was a prospective design where 420 patients were selected from the intensive care unit (ICU) of a referral hospital. Data collection tools were demographic, disease-related, and NEMS questionnaires. The last calculated NEMS score for patients was used to detect their need for end-of-life care. After completing the sampling, the data were analyzed by descriptive statistics and Cox regression at 95% confidence interval.

The relative risk of death in the ICU was 1.027 (95% CI = 1.015 - 1.042). All patients with NEMS ≥ 38 died, however, all patients who had a NEMS score ≤ 15 were discharged from the ICU with a satisfactory general health. The death rate was 22.1% in the 15 ≤ NEMS ≥ 34 scores. Finally, the patients admitted to the ICU were divided into three groups. The first group was the patients with a mortality risk < 41%, the second group had a mortality risk between 41% and 99%, and the third group were the patients with the mortality risk of 100%.

The present study presented a numerical criterion (NEMS > 34) for identifying the patients in need of end-of-life care instead of life-saving measures. However, further studies should be carried out in this area to argue the exact NEMS score requiring life-saving measures in ICU patients.

The operating room internship is associated with stress and anxiety and using simulations may reduce this anxiety. The aim of this study was to determine the effect of operating room simulation on students’ hidden anxiety during operating room internship.

This study was a quasi-experimental research. All students of a class (n=17) were simple randomly assigned to a simulation and a control group. The students in the simulation group were trained by simulation method prior to the internship program. The control group received routine and traditional training. The students’ anxiety level was measured before the intervention, the first and the last day of the internship using Spielberger's hidden anxiety questionnaire. Data were analyzed by Mann-Whitney U and Friedman tests at a significance level of 0.05.

Mean anxiety scores (total=80) before the intervention, the first and the last day of internship were 43.7±75.64, 41.5±00.12, and 37.62±2.32 in the simulation group and 42.11±6.23, 40.88±6.8 and 42.55±5.07 in the control group, respectively. There was no significant difference between the two groups (P=0.321) in the anxiety scores before the intervention and the first day of internship, while a significant difference was found between the two groups in the anxiety scores on the last day of the internship program (P=0.021, t=-2/078).

Exposing the operating room students to a simulated environment before the internship cannot reduce their anxiety on the first day of internship, but it can lower their anxiety during the internship period and significantly reduce anxiety at the end of this period.

Emergency medical services (EMS) staff’s attention level may be affected by various work conditions. This study aims to compare the beginning- and end-of-shift attention levels of Tehran’s pre-hospital emergency staff with those of Semnan Province.
This is a descriptive and cross-sectional research study conducted in 2013. In this study, 192 emergency medical technicians (EMT) of Tehran and Semnan Province participated. The research instrument was Bonnardel Attention Level Test. The participants’ attention level was assessed at 10 am and 5 am. The data were analyzed by chi-square test and independent samples t-test.
At 10 am (arrival attention), the average rate of attention level of Tehran’s pre-hospital emergency staff was 0.49±0.25 and that of Semnan Province staff was 0.51±0.23. There was not a significant difference (p=0.58) at that time between the average rate of attention in these two groups. At 5 am (exit attention), however, the average attention level of Tehran’s pre-hospital emergency staff was 0.45±0.25, and of Semnan Province staff was 0.55±0.20. At this time, there was a statistically significant difference (P= 0.044) between the average rate of attention in these two groups.
The means of arrival and exit attention levels in pre-hospital emergency staffs were moderate. Besides, there was no significant difference between the arrival attention levels of the two groups. Therefore, in order to increase the attention level in both groups, it is suggested that the workload and the length of shifts should be reduced for pre-hospital emergency staffs, specially in Tehran.

Sexual dysfunction, which may occur after lower extremity trauma, is a main physical problem with negative mental health impacts.
This study aimed at comparing male sexual dysfunction before and after lower extremity trauma.
In this cross sectional study, all patients with lower extremity trauma who were admitted to Kowsar hospital in Semnan, Iran, were recruited and assessed. Two main questionnaires were administered: a questionnaire including demographic and incident variables and the international index of erectile dysfunction (IIEF). Sampling was done from June 2014 to August 2015. Statistical analyses were performed using Friedman and Wilcoxon's test in SPSS Version 19.
Overall, 153 male patients participated in the study. The changes of sexual dysfunctions were significantly different before and after the incident in 1 and 3 months after the incident in all the IIEF subscales (P = 0

Scoring systems are considered as a guideline for caring personnel in intensive care units (ICU) to evaluate patients’ status or estimate recovery chance. Nine Equivalents of Nursing Manpower Use Score (NEMS) is one of these systems. Considerably, the credits of obtained scores of NEMS in different days after patients’ admission or deciding about current status of patients according to previous scores of NEMS are not clear properly. So, this study was performed to evaluate the mean alteration trends and credit of Nine Equivalents of NEMS in internal patients’ admission in intensive care units.
In a descriptive-prospective study, the information of 156 patients that admitted in critical care units of Edalatian hospital of Mashhad city, were calculated and recorded until 7 days according to demographic questionnaire and NEMS. A purposeful sampling method was adopted and all eligible patients were included. Then using the ROC curve, the validity of daily NEMS scores of patients were demonstrated.
The curve of mean alteration trends of NEMS of expired patients was increased and for discharged patients was decreased during seven days of admission in ICU. Also, the ROC curve showed that with increasing duration of hospital stay, NEMS ability to diagnosis of critically ill patients was improved.
The credit of NEMS increases with duration of hospital staying. So, it is suggested when using the NEMS, the scores of final days of hospitalization in ICU be considered more seriously.

Nursing students become responsible for many elements of nursing care. Their efforts of care generate caregiving burden. This study was conducted to determine caregiver burden and related factors in nursing students.
This cross-sectional study performed by using a convenience sampling method in 2015. One hundred and thirty-three nursing student from Semnan University of Medical Sciences participated in this study. The Caregiver Burden Inventory (CBI), Demographic and Educational Status Questionnaire (DEQ) were used to assess the caregiver burden and related factors in nursing students. The range of tools to measure caregiver burden scores from 0 to 100. Spearman correlation and Chi-Square tests were used to analyze the relationship between demographic and educational factors with caregiver burden.
The mean scores of total caregiver burden in nursing students were 39.47±11.52. Subscale analysis on the CBI revealed that the mean scores of time dependence, developmental, physical, social and emotional burdens were respectively 8.77±3.05, 10.04±2.88, 8.37±3.86, 6.02±3.37, and 6.27±3.44. The Spearman correlation test demonstrated that having a history of patient care was significantly associated with total CBI (p=0. 049). Also, there was no significant difference between other nursing student's demographic and educational status characteristics with total CBI (P> 0.05).
Caregiver burden is one of the educational problems in nursing students. Therefore, recommended that during clinical training, nursing students more supported by teachers and nursing staffs

The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of modified sequential organ failure assessment (MSOFA) scale to predict mortality and length of stay in intensive care unit patients respectively.
This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit. All patients’ records who admitted to the intensive care unit of Kowsar Hospital, Semnan city (the capital of the province), Iran, in 2015 considered as the sample. Collecting data were done during 4 weeks in April and May 2016. The data collection tool was a demographic questionnaire and modified sequential organ failure assessment scale. Exclusion criteria included discharge in the first 24 hours after admission, the patient died a few hours after admission and incomplete information to complete the modified sequential organ failure assessment form.
The study of 105 patient's records of the intensive care unit showed that 45.7% of patients were died, 15.2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and receiver operating characteristic (ROC) curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0.635, CI= 0.527-0.743) and each unit increase in modified sequential organ failure assessment score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P= 0.001(. Also each unit increase in modified sequential organ failure assessment (MSOFA) score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P= 0.015(.
The results of this study showed that the modified sequential organ failure assessment scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.

Activity restrictions can have potential impacts on the prevalence of mental disorders. However, in patients with lower limb traumas the problems and the physical disabilities are usually taken more into consideration than mental status, while they refer for further examinations. Therefore, this study is aimed to investigate the changes in the process of depression, anxiety and stress in men with lower limb traumas.
In a prospective study the patients with lower limb traumas, who have been hospitalized in Amir Al-Mo’menin and Kowsar hospitals in Semnan since June 2012 to August 2015, were selected randomly and studied. The data was collected by demographic and incident questionnaire and depression, anxiety and stress questionnaire. At first the patients were asked to complete the questionnaires based on their psychological experience of one month prior to the trauma. Then same questionnaires were completed by the patients one and three months after the trauma. The data was analyzed using Friedman and Wilcoxon tests.
The data of 157 patients was analyzed. The results showed that there was a significant difference in the severity of depression disorders, anxiety and stress in three stages of the study (P0.05).
The prevalence of depression, anxiety and stress is increased in people with lower limb traumas. Therefore it is recommended that the patients with lower limb traumas to be supported mentally, socially and economically.

Coronary artery disease is considered as main factor for patients’ hospitalization. Chest pain is the most common symptoms of patients and its assessment is an important factor in coronary artery disease. So, this study aimed to determine the relationship between the severity of chest pain with physiological indexes in patients with coronary artery disease.
This study was a descriptive-analytical design that performed on 80 patients with that were hospitalized in coronary care unit of Shahid Mofatteh Hospital in Varamin city, Iran, from March to September, 2014. In this study, the relationship between the chest pain severity and blood pressure, pulse rate, respiratory rate, O2 saturation and ST segment alterations were assessed. Finally, the gathered data were analyzed by descriptive and inferential statistics.
The mean of chest pain severity was 6.51±2.14 in patients. Patients’ age was between 26 to 85 years old and the mean of age was 60.79±13.79 and there was no significant correlation between age and chest pain severity (P=0.985). Also male and female patients were equal. There was no significant difference between chest pain severity of men and women (P=0.471). The findings of study showed no correlation between chest pain severity and heart rate (r=-0.174 and P=0.122), respiratory rate (r=-0.013 and P=0.909), O2 saturation (r=0.051 and P=0.651), ST segment alterations (r=0.07 and P=0.539). Also, there was no significant difference between chest pain severity and systolic pressure (P=0.353), diastolic blood pressure (P=0.312) and body mass index (P=0.256) among patients.
In this study, there were not enough evidences for relation between chest pain and physiological indexes in patients with coronary artery disease. So performing more studies in another settings and conditions recommended.

More than four years has been passed from the execution of efficiency improvement law in Iran. But still it is not clear how far the law had been successful in meeting nurse's job expectation. So, this study was purposed to determine nurses’ job expectation in regard of efficiency improvement law.
This was a descriptive analytical study that was performed by participation of 155 employed nurses in the case of running efficacy law hospitals in Semnan city. Nurses were selected by quota sampling method. The data was collected by a questionnaire that measured the nurses’ opinions to efficacy law. Finally, the data were analyzed by descriptive and inferential statistics.
The efficacy law could answer to half of nurses’ expectations in the area of their wages, while in the field of carrier development did not have that much success. More than 63% of nurses believed that efficacy law enhanced their communications in working environment. Also, there was no significant difference between nurses’ demographic characteristics and dimensions of job expectations (P> 0.05).
The nurse's efficiency improvement law was successful in occupational communication domain of job expectations. But in other dimensions of job expectations did not have significant success. Therefore, it is suggested that the strengths and weaknesses of this law to be re-examined and nurse's job expectation to be more attended in that area.

Driving in flood is the first major cause of flood-related death. This study was aimed to determine risk factors associated with dangerous behavior of driving in flood and related behavioral modeling. This study was descriptive-analytical. Target population was 150 residents over 18 years old of Quchan city. Data was gathered by a questionnaire. chi-square test and logistic regression analysis were used to data analysis and estimating model. Chi-square test results showed that the three variables: level of education, reaction to flood warnings and knowledge about the main causes of deaths in floods had significant relationship with variable of behavior of driving in floods. in the estimated logistic regression model, two variables, level of education and reaction to flood warnings, had predicting value for behavior of driving in floods. Results show the likelihood of incidence of risky driving behavior among those without college education when exposure to flooding is more than 2.6 times of those with college education. In addition, people who donot take flood warnings seriously 2.5 times more likely than others to express the risky driving behavior. By identifying high risk groups in flood-porn areas, some interventions and training programs can be set to reduce dangerous behavior of driving in floods.