Hospitals are often the front line in dealing with incidents. With the technological trends and threats of Chemical, biological, nuclear, and radiation (CBRN) incidents, considering future wars and the risk of community epidemics and complex threats in the field of CBRN, the importance of the issue has doubled. The most rational way to manage a potential danger is having sufficient preparation in the face of critical situations, this, however, requires scientific models. Therefore, the aim of this study was to, first, look at the level of preparedness of emergency rooms to respond to CBRN incidents and, second, to construct a multi-purpose model of hospitals’ general emergency in CBRN conditions.

This study was a narrative review. The statistical population included available documents and articles about CBRN emergencies between January 2000 and April 2022. Document review tools were used to aggregate documents related to general emergency, trauma, chemical, biological, nuclear, and radiation. Validation was done by searching reliable Persian and English scientific databases such as PubMed, Scopus, Magiran, IranMedex and Google Scholar. Also, for reliability testing, a comparative study of documents was performed. The keywords "General Emergency", "Trauma Emergency", "Chemical Emergency", "Biological Emergency", "Nuclear Emergency", and "Radiation Emergency" and their Persian equivalents were utilized. Then it was analyzed using the Prisma checklist.

Considering the entry and exit criteria, a total of 22 articles from 7 countries; Iran (10), America (5), Canada (3), Great Britain (1), Belgium (1), Australia (1), and Hong Kong (1) were evaluated. The results of the research indicated that the most important success factor against CBRN incidents in the emergency department is the anticipation and preparation of necessary measures. The findings of the present study according to the documents, articles, and the subsequent comparison of their common factors and also using the indicators of international organizations in the field of crisis management indicated that there are 6 axes in the field of CBRN emergency. The axes are namely; 1. Design of the emergency department, 2. Medicines and required equipment, 3. Required staff, 4. Education and training of staff, 5. Structure and organization, 6. Processes and instructions.

Studies have been conducted and the analyzes performed based on the axes showed that many organizations and countries do not use a specific model to deal with CBRN incidents. It can be said that most hospitals, except for the hospitals that have a dedicated emergency room for one of the CBRN agents, are not prepared to manage such incidents. In this regard, developing a comprehensive CBRN crisis management model including the dimensions of human resources, structure and organization, physical space, instructions and processes, and equipment is of particular importance.

Artificial intelligence is a set of different technologies that, by working together, enable machines to make decisions like humans and behave in terms of functionality similar to human intelligence. The increasing development of the use of artificial intelligence in various branches of medical sciences, pharmacy, genetics, etc. has led to the improvement of effectiveness and reduction of human errors in the diagnosis and treatment of various diseases and the provision of new methods in order to expand the boundaries of medical knowledge. In the field of trauma, which has always been considered a very important cause of death and disability in most countries of the world, the need to investigate and study the capacities and expand the use of artificial intelligence in the management of trauma victims seems essential. In this article, by briefly introducing the basics of artificial intelligence and its capabilities, the capacities of this field in the management of trauma victims have been examined, and finally, the optimal features for the design and application of systems based on artificial intelligence have been presented.

Patellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder with a high prevalence among military personnel. Changing the movement pattern and applying loads can lead to an increase in postural sway and contribute to the development of patellofemoral pain syndrome in military personnel. Therefore, the aim of the present study is to comparison of knee valgus angle and the effect of carrying a military backpack on postural sway in the military with and without patellofemoral pain syndrome.

In this case-control study, 21 military personnel with patellofemoral pain syndrome participated voluntarily with Convenience Judgmental Sampling method and 21 healthy military personnel with the case group matching method. The indices of postural sway, including the path length, the standard deviation of medial-lateral sway (M-L), and the standard deviation of anterior-posterior sway (A-P) were measured using the Zebris pressure distribution device in two situations with and without carrying a military backpack. Also, the knee valgus angle was assessed during the single-leg squat test. To analyze the data, an independent t-test and paired sample t-test with a significance level of 0.05 were used in SPSS software version 23.

The results of the independent t-test showed that knee valgus angle, path length, SD(M-L), SD (A-P), in both positions with and without carrying a military backpack showed a significant increase in patellofemoral pain syndrome group in comparison with the healthy military (P<0.05). Comparing the changes in the center of pressure variables during the static balance test, and static balance with carrying a military backpack, there were also significant changes between the two positions (P<0.05).

According to the results, military with patellofemoral pain syndrome who had an increase in knee valgus angle had more postural sway and changes in postural sway indices compared to the healthy military, which could be caused by changing posture control strategies and changing the movement pattern of the military with patellofemoral pain syndrome. It is necessary to pay attention to these changes in providing an appropriate treatment plan for preventing re-injury and secondary changes in military suffering from patellofemoral pain syndrome.

 The high transparency and validity of the Medical Exemption Regulations can improve the unity of the procedure. The aim of this study was to determine the validity and revision of the neurological and mental illnesses part of the medical exemption regulation for 2021.

 A qualitative study with the classical Delphi technique approach was performed in three rounds. The first round consisted of interviews and focus group discussions to extract the flaws and ambiguities of the existing regulation. In the second round, the face and content validity of the amended regulations were assessed based on the opinions of experts, and in the third round, the opinions of experts were assessed to investigate the agreement on the final regulations. The study population consisted of psychiatrists, conscientious objectors, and medical doctors with experience in attending medical commissions.

 Thirty-two specialists participated in at least one round of the study. The mean age and experience of their presence in medical commissions were 47.9 ± 5.8 and 10.7 ± 5.5 years, respectively. In the first round, a total of 62 initial codes were extracted. The regulation document, including 15 clauses and 27 sub-categories, was provided to the participants to assess the content validity (second round) and the content validity index (CVI), and the content validity ratio (CVR) for the neurological and mental illnesses part of the medical exemption regulation were 84.87 and 61.1, respectively. The final version of regulations with 14 clauses and 25 sub-categories was provided to the experts to assess the agreement, and the mean agreement for the neurological and mental illnesses part of the medical exemption regulation was 84.8.

 The revised regulation can be used as an alternative to the existing regulation. Utilizing the opinions of a large number of experts during different rounds and using different approaches has increased the validity of the findings and provided reliable results.

Spiritual fitness in combat requires spiritual intelligence to give meaning to life and change the attitude towards crises as a spiritual experience. The purpose of the study was to investigate the effect of the spiritual counseling of the Sound Heart Model on the spiritual intelligence and spiritual experience of military commanders.

The research method was a clinical trial type. The research population consisted of 98 military commanders of the army, who were selected according to the inclusion criteria through available sampling. They were divided into two groups by random group allocation. The intervention for the experimental group was implemented for 51 weeks with model-based multimedia training with the aim of gaining trust, increasing knowledge, developing communication, and motivation, by means of educational software and follow-up in the virtual network. Before and after the intervention, daily spiritual experiences and spiritual intelligence questionnaires were completed by both groups.

The spiritual intelligence of the commanders of the two groups before the intervention had no significant difference (P = 0.80) (intervention 65.39 ± 4.33 - control 65.15 ± 5.38). But after the intervention, a significant difference was created (P<0.001) (intervention 84.16 ± 2.97 - control 65.41 ± 5.82). There was no significant difference in the spiritual experience of the commanders of the two groups before the intervention (P = 0.92) (intervention 48.08 ± 2.13 - control 48.12 ± 2.36). But after the intervention, the difference was significant (P<0.001) (intervention 67.96 ± 4.18 - control 48.37 ± 2.20).

Considering the effect of spiritual counseling on improving the spiritual intelligence and spiritual experience of military commanders, it is recommended to use the "Sound Heart Model" for the spiritual fitness of military personnel.

Patients with end-stage renal disease (ESRD) are at risk for fractures and bone disorders approximately 17 times more than the general population. Evaluating fracture risk in patients with ESRD in the dialysis department of the hospital, can provide useful information to the treatment for staff and researchers. The Fracture Risk Assessment Tool (FRAX®) algorithm is used along with dual-energy x-ray absorptiometry (DXA) or bone densitometry and is capable in predicting the rate of 10-year probability of hip and major osteoporotic fracture (MOF) in a certain group of patients.

This cross-sectional study was conducted to evaluate the fracture risk in 107 hemodialysis patients, who underwent hemodialysis three times a week for 4 hours in 2018 in Baqiyatullah Hospital. Patients who have done bone densitometry and for whom the standardized FRAX questionnaire of the World Health Organization was filled were included in the study.

The mean age of the participants was 59.95 ± 14.18 years and 58.2% of them were male. The average levels of calcium, phosphorus, parathyroid hormone, albumin, and vitamin D were determined to be 8.40 ± 1.14 mg/dL, 4.97 ± 1.41 mg/dL, 269.40 ± 297.66 ng/ml, 3.86 ± 0.49 g/dL, 22.15 ± 13.93 nmol/L and -2.08 ± 1, respectively. The minimum, mean and maximum values of BMD were found to be -5.30, -2.09, and -2.20, respectively. The FRAX scores of hip fracture and MOFs with BMD were 5.01 and 8.81, respectively, while the corresponding values for FRAX scores of hip fracture and MOFs without BMD were determined 2.23 and 5.82, respectively. A significant difference was observed between FRAX scores with and without BMD. Furthermore, a statistically significant difference was found between MOFs and hip fracture risk values ​​calculated with and without BMD. In our study, the patient's previous fracture history predicts a higher hip FRAX score in the future, but the parents' hip fracture history had no effect on the hip FRAX score. We also found that the increase in PTH level had an increasing effect on the FRAX score of the hip joint. The results demonstrated that increasing the height and BMD of patients can significantly reduce the FRAX score related to MOFs and tight, while this index increases with increasing age of patients and PTH. In our study, thin and short patients are prone to more fractures in the hip joint.

Our finding suggests that FRAXB with MD may be a valuable tool for clinicians in this center to accurately assess fracture risk in ESRD patients and ultimately reduce treatment costs. We encourage nephrologists to pay close attention to this algorithm information.

Oxygen therapy is one of the important topics of supportive treatment in COVID-19 patients. The present study aims of determining the effect of targeted oxygen therapy on the recovery outcomes of patients with COVID-19 in a selected military hospital in Tehran in 1400.

A single-blind clinical trial with a control and intervention group was performed on COVID-19 patients admitted to Baqiyatallah Al-Azam Hospital from October 26 to November 20, 2021. The sampling method was simply random and the sample size of 40 people in both groups was calculated. Data collection (improvement outcomes) using demographic information registration form and checklist of clinical findings (shortness of breath, respiratory retention test, six-minute walk test, laboratory tests (Troponin, CDK, LDH), chest pain, in The period at arrival was 24 hours after admission and discharge time. Data using SPSS software version 25, descriptive statistics (mean, standard deviation, and frequency), and inferential statistics (Chi-square test, paired t-test, Friedman) in 95% confidence level were analyzed.

The results of the present study showed a significant difference between the consequences of shortness of breath, systolic blood pressure, chest pain, and a six-minute walk test (P<0.05). Also, there was no significant difference in serum LDH and CPK levels between the intervention and control groups at the time of admission. But there was a significant difference in serum Tropinin level (P<0.05).

Targeted oxygen therapy has been effective as a supportive strategy to improve oxygen delivery in COVID-19 patients and reduce the consequences of this disease. Given the current need for additional supportive therapy to improve oxygen delivery, targeted oxygen therapy is recommended as a new medical supportive treatment in COVID-19 patients.

Educating nurses about spiritual principles and values helps to have a deeper understanding of problems and increases the quality-of-care delivery. However, the issue of spirituality is not included in the educational content. The purpose of this study was to the effect of spiritual care training on the empathy and professional commitment of nurses at Bam University of Medical Sciences.

This was a quasi-experimental study with a two-group pretest-posttest design. The research sample consisted of 80 nurses from different wards of Pasteur Hospital affiliated to Bam University of Medical Sciences were divided into two groups of intervention and control using a simple random sampling. Spiritual care training program in the intervention group was held as a 2-session webinar. The questionnaire used included the Jefferson Standard Empathy Questionnaire, the Kleikman and Henning Professional Commitment Questionnaire, and the Demographic Information Form.

The results showed a significant difference between the mean scores of professional commitments before (33.11 ± 0.32) and after (65.43 ± 0.28) the intervention and also the empathy variable before (53.41 ± 0.21) and after (78.83 ± 0.25) of the intervention in the experimental group (P<0.05). This difference was not observed in the scores before and after the intervention in the control group. Also, there was no significant difference between the mean scores of professional commitment and empathy of the subjects before the intervention (P>0.05) while there was a significant difference between the mean scores of professional commitment and empathy of the two groups after the intervention (P<0.05), which indicated that these scores improved due to the intervention.

According to the results of this study, it is suggested that the spiritual care training program should be inserted in-service training programs or nurses' curriculum content to promote nursing professional commitment and empathy.