Hospital Practices and Research

Abstract Background: Investigating the frequency pattern and types of skin diseases is considered to be extremely important in order to improve the diagnosis process and patients' conditions.
Objectives: The aim of this study was to investigate the epidemiological pattern of skin diseases in patients referred to the skin clinic of Baqiyatallah Hospital.
Methods: This cross-sectional study was conducted on 400 patients who had referred to the skin clinic of Baqiyatallah Hospital during 2016 and 2017. These participants were selected using a convinced sampling model. The type of skin diseases were determined in patients and then collected data were analyzed using the SPSS(V-22) software.
Results: Out of the 400 patients who had referred to the abovementioned clinic, 281 (70.3%) were women and 119 (29.7%) were men. The most common reasons for visiting the skin clinic were acne, warts, wrinkles and acute eczema, respectively. The most affected area was the face. The skin disease diagnosed in patients had a significant relationship with patients' age (P = 0.001), gender (P = 0.001), and education (P = 0.011).
Conclusion: According to the findings of the present study, acne, warts, and wrinkles are the most common skin problems in patients who had referred to the skin clinic of Baqiyatallah Hospital, respectively. Demographic and background factors have a significant effect on the type of skin disease.

Abstract Background: Hospital nurses are more exposed to health anxiety due to close contact with patients.
Objectives: This study aimed to determine the mediating role of mental toughness in the relationship between meta-emotion and co-rumination with nurses' health anxiety.
Methods: The research method was structural equations type correlation. The statistical sample of the research included 250 nurses from hospitals in West Azarbaijan province in 2022, who were selected by simple random sampling. Salkovskis and Warwick's (2002) health anxiety scale, Mitmansgruber et al.'s meta-emotion questionnaire (2009), Clough et al.'s (2002) mental toughness scale, and Davidson's co-rumination questionnaire (2014) were used to measure the variables. The data were analyzed using Pearson's correlation coefficient, Sobel test and bootstrap.
Results: Findings indicated that the meta-emotion and co-rumination variable interact with the mediating role of mental toughness which has a role in explaining the nurses’ model of health anxiety. In total, 38% of the variance of health anxiety was explained through the variables of negative and positive meta-emotion, co-rumination and psychological stability. The direct effect of positive meta-emotion (-0.327), negative meta-emotion (0.318), mental toughness (-0.452), and co-rumination (0.367) are significant in explaining the health anxiety model. Furthermore, the indirect effect of negative meta-emotion (0.158), positive meta-emotion (-0.161), and co-rumination (0.155) with the mediation of the role of mental toughness is significant.
Conclusion: Considering the direct and indirect effects of meta-emotion, mental toughness and co-rumination variables on the level of health anxiety variable, it seems that by strengthening positive meta-emotion and mental toughness, and improving co-rumination and negative meta-emotion, the health anxiety in nurses can be reduced.

Abstract Background: The Internet of Things (IoT) for patient care at home, which means that instead of going to the hospital and spending a lot of time and money, patients' clinical data can be viewed remotely and the data can be processed and then sent to the doctor.
Objectives: The use of any new technology by the society faces challenges. For this particular reason, before the introduction of any technology, the effective factors in its use must be investigated. In this research, the acceptance rate of the IoT for patient care at home is investigated.
Methods: This research was conducted using the grounded theory method with a case study of veterans who need home care. In order to collect information, 15 veterans and their nurses were interviewed in the statistical community of Zahedan.
Results: The findings of the present research revealed that the impact of IOT on the improvement of health services can be understood, and positive advertising about the performance of the IoT has a significant effect on its use and confidence. However, due to the unknown nature of the IoT and the security issue of users' information, there are doubts about its use.
Conclusion: In order to increase the use of IoT in order to take care of patients at home, the influencing factors of the IoT should be taken into account in order to create trust in IoT.

Abstract Background: In recent decades, some countries have experienced imbalanced and rapid development of physical spaces, leading to negative social, economic, and physical consequences. The trend towards urbanization, combined with recent disease outbreaks, has put a strain on healthcare services in large cities.
Objectives: To reduce vulnerability to natural disasters and improve adaptive capacity, it's important to evaluate, monitor, and plan for healthcare resilience. A comprehensive model for measuring hospital resilience to accidents and disasters, including the COVID-19 pandemic, is essential.
Methods: This research identifies, collects, and classifies factors that affect user resilience and spatial definition of healthcare services usage against COVID-19. To better quantify the results, the research combines the conceptual framework of the DPSIR model with the structural equation model (SEM-PLS).
Results: According to the fuzzy cognitive map, the index of economic factors with weights of 62%, 62%, and 5% respectively has a two-way and positive relationship with environmental and natural factors. This factor with a weight of 65% has a two-way and negative relationship with the index of social factors. In addition, the index of economic factors with a weight of 69% has a one-way and negative relationship with the index of physical factors.
Conclusion: The results also show that the economic factors in the model of redefining the spatial pattern of therapeutic uses of big cities at the time of the emergence of a pandemic disease with a resilience approach have more centrality than other factors.

Abstract Background: A comprehensive overview of ESKAPE pathogens, highlighting their antibiotic resistance mechanisms and the urgent need to address the clinical impact of these pathogens in bloodstream infections.
Objectives: The aim of the present study was to observe the prevalence and trends of antibiotic susceptibility profiles of ESKAPE blood pathogens in Intensive Care Units (ICUs), providing valuable insights for improving patient care and infection control.
Methods: A detailed description of our descriptive cross-sectional study conducted in various ICUs, including blood sample collection, antibiotic susceptibility testing, and data management and statistical analysis.
Results: The findings of the present study reveal insight into the distribution of ESKAPE pathogens in different ICUs, with a focus on prevalence, age-specific variations, and antibiotic resistance patterns.
Conclusion: A thorough discussion on the clinical implications of our results, emphasizing the high prevalence of Acinetobacter baumannii, Staphylococcus aureus, and Klebsiella pneumoniae, and the concerning levels of antibiotic resistance observed.

Abstract Background: In recent years in Iran, several studies have examined the effectiveness of therapeutic interventions based on the second and third psychological waves on academic burnout.
Objectives: The aim of this study was to integrate the results of these studies and compare the impact of these interventions on academic burnout.
Methods: The research method is meta-analysis. The study population includes all scientific research articles published in Iran that have been performed in the field of effectiveness of second and third wave psychological interventions for academic burnout. The sample size includes scientific research articles that have been published between 2016 and 2021 and have the necessary conditions in terms of methodology. The research tool is a content analysis checklist by examining the magnitude of the effect of each of the second and third wave psychotherapies. The effect size scale was the mean difference and the statistical analysis was performed with Comprehensive Meta-Analysis software (CMA-2).
Results: The results showed that the average size of Cohen's effect in the second wave studies was d= 2.460 and in the third wave studies was d = 2.080 (p <0.01). According to Cohen's interpretation table means the size of the effect is large or high. Also, the results did not show a significant difference between the effect size of second wave studies and third wave studies (p >0.05).
Conclusion: Therefore, it can be stated that based on the results of this meta-analysis, therapeutic interventions based on the second and third psychological waves is effective in improving the learners' academic burnout.

Abstract Background: Craniosynostosis, is defined as the premature fusion of the cranial sutures, which can cause impair brain development and cognitive problems.
Objectives: The purpose of this study was to assess the epidemiological features of children with craniosynostosis. This assessment includes the characteristics of the patients, their parents as well as their socioeconomic status.
Methods: This cross-sectional study was performed from 2015 to 2020 in Imam Hossein Children's Hospital, Isfahan, Iran. For this purpose, 220 patients under craniosynostosis treatment were included. Accordingly, multidisciplinary team examined the participants. Furthermore, a CT-scan was performed on all patients. Participants underwent surgical intervention. The recorded information was classified into four sections: 1. characteristic data of children with craniosynostosis 2. Family history and parental information, including underlying diseases and drug history 3. Socioeconomic status 4. Treatment and surgery.
Results: According to findings, 151 (68.7 %) of participants were male and 171 (77.9%) had term delivery.  The average birth weight was 2.92 kg and head circumference were 34.4 cm. The mean age of children at the time of surgery was 7.74 months and the mortality rate was 3 (1.4%). Moreover, 90% were operated once and 10% were operated two or three times. The most common type of craniosynostosis was Metopic 59 (59.4%). In relation to parenteral data, 96 (43.6%) of parents had consanguineous marriage and 6.4% had 1st and 2nd degree family with craniosynostosis.
Conclusion: To coclude, attention must be directed towards the potential risk of craniosynostosis in offspring born to consanguineous couples. Moreover, parents must receive guidelines for managing children affected by craniosynostosis.

Abstract Background: Resilience refers to human ability for adapting to disasters, traumas, pain, and suffering from important troubles and stressors in life.
Objectives: Regarding the fact that people are continuously exposed to various physical and mental health traumatic stimuli, this study aimed to investigate the resilience correlations in Emergency Medical Services (EMS) workers.
Methods: The study was descriptive-correlation which examined 15 individuals for each scale and subscale. Therefore, 150 EMS workers were selected for this study.
Results: All four variables, including resilience, self-control, problem-solving style, and self-compassion, were above average. Resilience had a positive and significant correlation with self-control, problem-solving, creativity, confidence in problem-solving, and tendency (a subscale of problem-solving). Self-control had a positive and significant correlation with self-compassion. The final model was as resilience = 0.454 + 41.317 [15.941+ 0.622 (self-compassion)] + 3.453 (tendency) + 3.255 (creativity).
Conclusion: According to the findings of the present study, it is suggested to strengthen four variables of resilience, self-compassion, self-control, and problem-solving styles in the EMS personnel.

Abstract Background: Traumatic Brain Injury (TBI) is considered as a risk factor for several neurological diseases, including Alzheimer's disease, amyotrophic lateral sclerosis, and Parkinson's disease.
Objectives: The aim of the present study was to evaluate the occurrence of post-TBI PD.
Methods: This descriptive cross-sectional study was performed on two groups of patients referred to Al-Zahra Hospital in Isfahan in 2023. The first group consisted of patients who had suffered TBI 10 years ago. The second group included Parkinson's Disease (PD) patients. Census sampling was performed in both groups based on the number of patients referred to the selected center. The collected data were analyzed using SPSS ver.22 and p<0.05 was considered as the significance level.
Results: Out of 1260 PD patients, 25 (1.98%) had TBI and out of 200 TBI patients, 2 (1%) had PD. There was a significant relationship between the severity of moderate TBI and the PD incidence in patients in both groups (first group p = 0.0001 and second group p = 0.002) (p <0.05). There was no significant relationship between the frequency of TBI and its mechanism with the PD incidence in both groups (p >0.05). The odd ratio of developing PD with a mean of 7 years after TBI diagnosis was 0.36, which increased to 1.42 with increasing the TBI duration to the mean age of 30 years.
Conclusion: The findings of the present study confirmed the need for information on the treatment and prevention of post-TBI PD. It should be noted that other underlying factors such as aging, genetics, etc. can also be effective in the development of PD.

Abstract Background: Sodium disorders are one of the most important electrolyte disorders among brain trauma patients.
Objectives: The purpose of this study was to determine the frequency of hyponatremia in patients with moderate and severe brain trauma and its relationship with disease prognosis.
Methods: This descriptive-cross-sectional and prospective study was conducted on brain trauma patients visiting Kashani Hospital in Isfahan city in 2023. The obtained data was analyzed by SPSS 24.
Results: Out of the 54 examined (23 severe TBI and 31 moderate TBI) patients, hypernatremia was observed in seven cases (13%), and hyponatremia was observed in 23 cases (42.7%). Hyponatremia on the first day had a significant relationship with the bad prognosis of the disease. In addition, a significant relationship was observed between the type of imaging findings and GOS, so that people who had ICH imaging findings were associated with a poorer prognosis p <0.05.
Conclusion: On the first day, hyponatremia had a significant prevalence in moderate and severe brain trauma patients, which was associated with a bad prognosis of the disease, and this relationship is not dependent on factors such as age, gender, and cause of trauma.

Abstract Background: During disasters, hospitals play a key role in providing quality and appropriate medical services to increase resilience.
Objectives: This study was carried out with the aim of determining the response rate of the emergency department of Shiraz University of Medical Sciences hospitals to the Corona pandemic in 2021.
Methods: This cross-sectional descriptive research was conducted in educational-therapeutic hospitals of Shiraz University of Medical Sciences. For this purpose, 230 senior and middle managers, emergency department nurses and emergency medicine specialists participated in this study. Hospitals were placed in two categories: special centers for COVID-19 (3 hospitals) and other educational and medical centers (general and specialized centers) (8 hospitals). The information was collected by the hospital readiness assessment checklist (2020) for the management of infectious disease epidemic crisis based on the guidelines of the World Health Organization for the response of hospitals to the COVID-19. After collecting the data, it was entered into SPSS 22 and analyzed.
Results: Findings of this study showed that the readiness of hospitals is at a good level (87%). The studied hospitals performed very well in items of support and management of financial resources, communication management, human resources management, diagnosis and management of patients, but in item of rapid identification and control and prevention of infection, they performed very poorly. The centers of COVID-19 scored higher than other educational-treatment centers, continuation of services and increased capacity, rapid identification, diagnosis, prevention and control of infection, which was statistically significant (p <0.05).
Conclusion: Rapid identification of patients seems to be an important challenge in Shiraz University of Medical Sciences. The allocation of special hospitals for the care of COVID-19 patients is also effective in preparing them for the pandemic.

Abstract Background: Nurses play a vital role in healthcare, and their well-being directly impacts the quality of patient care they provide. However, the demanding nature of nursing work, characterized by long hours, shift work, and emotional strain, can affect their personal lives, including marital quality.
Objectives: This study aimed to investigate the relationship between emotional empathy, alexithymia, and marital quality in nursing students in Ahvaz City and to predict marital quality based on emotional empathy and alexithymia.
Methods: This study employed a cross-sectional, descriptive-correlational design. The statistical population included all married nursing students at Ahvaz University of Medical Sciences in 2023. A sample of 204 married students was selected using the convenience sampling method. Data were collected using the Revised Dyadic Adjustment Scale (RDAS), Interpersonal Reactivity Index (IRI), and Toronto Alexithymia Scale (TAS). Data were analyzed using the Pearson correlation coefficient and simultaneous regression analysis. SPSS software v27 was used for data analysis.
Results: The results showed that emotional empathy had a positive and significant correlation with marital quality (p <0.001), and alexithymia had a negative and significant correlation with marital quality (p <0.001) in nursing students. The results of the simultaneous regression analysis showed that emotional empathy and alexithymia predicted 49% of the variance in marital quality.
Conclusion: This study identifies emotional empathy and alexithymia as important factors in marital quality for nursing students. However, recognizing the complexity of marital satisfaction, the authors advocate for interventions that address these factors alongside other relevant contributors.

Abstract Background: Low back pain is an important health problem and is one of the main symptoms in lumbar disc pathology. It is not known whether paraspinal muscular weakness is a cause or a result of low back pain.
Objectives: The current study was performed in order to investigate paraspinal muscles Cross-Section Area (CSA) and Fat Infiltration (FI) in chronic versus acute Low Back Pain (LBP) patients and their association with disc herniation.
Methods: 76 acute and 76 chronic LBP adult subjects who were candidates for magnetic resonance imaging in a referral hospital in Isfahan, Iran, were evaluated in terms of demographics, their pain and disability severity, FI (signal intensity index) of paraspinal muscles in five lumbar levels, CSA of paraspinal muscles in five lumbar levels and disk herniation degree in five lumbar levels.
Results: Overweight patients: 34 (45.9 %); obese: 12 (16.2 %); ODI score: 25.2 (6.7) and mean VAS score was: 6.44 (1.2). The longer the pain persisted, the higher its severity was felt. Similar numbers were found for females. Females had higher pain scores and higher FI in paraspinal muscles. Accordingly, FI was higher, and CSA was lower in chronic LBP than acute LBP (P<0.05). Women had smaller, and fattier paraspinal muscles (P<0.05).
Conclusion: Chronic LBP is associated with a decreased muscle volume in paraspinal muscles. Regular physical activity routines, weight loss meal plans, physiotherapy and corrective training programs might prevent chronicity of LBP, increase paraspinal CSA, decrease paraspinal FI, attenuate back pain severity and hence improve patients’ quality of life.

Abstract Background: Parasitic infections are most prevalent in developing nations and among individuals with weakened immune systems or immunocompromised.
Objectives: Due to the lack of epidemiologic information on such infections, the prevalence of enteric, respiratory, and urogenital parasites was investigated among patients in teaching hospitals in Alborz province, Iran.
Methods: In this cross-sectional study, 1248 samples were collected from January to July 2023. Microscopic examination was performed using direct wet mount, formalin-ether concentration techniques, and trichrome staining. To detect Enterobius vermicularis parasite, we have used the Scotch test method.
Results: The prevalence of parasitic infections was 7.1%. The most commonly identified parasitic infections in the study were Entamoeba histolytica/dispar (29 cases, 2.3%), and Blastocystis sp. (26 cases, 2.1%). 40.2% of our studied cases showed gastrointestinal symptoms and the majority of symptoms were relating to anorexia and abdominal pain.
Conclusion: Given the significant global prevalence of parasitic infections, it is crucial to identify and treat infected individuals, implement urban water improvement programs, avoid the use of human feces as fertilizer in agriculture, and maintain public, and personal hygiene.

Abstract Background: The outbreak of COVID-19 has put more pressure on the medical staff.
Objectives: The current study was performed to determine the role of emotional exhaustion on self-compassion in nurses via the mediation of empathy during the outbreak of COVID-19.
Methods: The present study was a descriptive and analytical study conducted on 150 nurses working in Al-Zahra and Kashani hospitals in Isfahan, Iran in 2021. The data were collected by three standard questionnaires of Emotional exhaustion (Chen), Self-compassion (Neff), and Empathy (Davis) and were analyzed in SPSS version 24 and LISREL8 software.
Results: The results of the study revealed that the three variables of self-compassion, empathy and emotional exhaustion are not significantly different according to the demographic characteristics of nurses (P>0.05). There was a direct and significant relationship between empathy and emotional exhaustion (P<0.05). Ultimately, the proposed model has a good fit and in the direct and indirect relationships of the model, the role of empathy as a mediator between emotional exhaustion and self-compassion is confirmed.
Conclusion: In line with the obtained results, it is suggested that considering the spread of a deadly infectious disease, appropriate educational measures and strategies should be implemented to promote or boost the spirit of empathy among health sector employees, especially nurses.

Abstract Background: Hospitals in the national capital were staring at the rising cases of pink eye, more than 100 of which had been daily hitting the outpatient departments of major hospitals in Delhi during the month of July 2023. Outbreaks of Conjunctivitis are common globally, with people across all age and socio-economic status getting affected.
Objectives: The aim of the study was to do a molecular analysis on the etiology in cases of epidemic keratoconjunctivitis.
Methods: A multicentric prospective observational study was carried out during the outbreak of conjunctivitis in Delhi. The clinical samples were processed by polymerase chain reaction for common etiology of acute keratoconjunctivitis.
Results: Adenoviral etiology was witnessed in 8.3% of cases, while no other bacterial or viral etiology could be documented.
Conclusion: Studying the etiological pattern of any outbreak of infections can provide insights into the prevalent transmissible pathogens and help in future preparedness.

Abstract Background: Platelets/Lymphocyte Ratio (PLR) has been investigated not only in hematological diseases but also in clinical conditions involving almost all organs and systems including inflammatory, neoplastic, and cardiovascular diseases.
Objectives: This study was planned to perform an analysis of the studies on PLR through the PubMed database, to measure the impact of the relevant studies on the diagnosis of diseases.
Methods: This analysis was performed on 16.01.2021 by searching with the word group "platelet lymphocyte ratio", "platelet lymphocyte ratio" in the PubMed database.
Results: The study included 723 articles, of which 580 (80.2%) were retrospective. It was determined that 420 (58.1%) of the studies were conducted by a single clinical department, 55.6% (n=402) were indexed in SCI/SCI-E index, 56.7% (n=410) were Open Access, and 58.8% (n=425) had significant results related to the clinical condition studied. Most publications were from Turkey (n=239, 33.1%), China (n=211, 29.2%), and Japan (n=55, 7.6%).
Conclusion: The majority of the analyzed studies were retrospective, and were SCI/SCI-E indexed. Their role in malignancy diagnoses was evaluated the most. A total of 59 different clinical conditions were evaluated and "platelet lymphocyte ratio" was found useful in the diagnosis of relevant clinical conditions in 58.8% of the studies. PLR is a value that is significantly associated with the diagnosis and prognosis of many diseases and can be obtained by a simple calculation from a complete blood count.

Abstract Background: Health literacy involves the ability to obtain, comprehend, and use essential information and services to make informed decisions in various life contexts. Spiritual health literacy, specifically, relates to applying principles that foster a balanced and harmonious relationship with oneself and others.
Objectives: This study aims to explore the outcomes of spiritual health literacy among students.
Methods: The present study is a qualitative research of thematic analysis type. The data collection tool was a semi-structured interview conducted with 13 experts selected through purposive sampling. Thematic analysis involving descriptive coding, interpretive coding, and integration through overarching themes was used to analyze the interviews.
Results: Based on the interviews conducted with experts and the subsequent coding, eight main themes and 28 sub-themes were identified under the consequences of spiritual health literacy among university students in Gonabad city in Iran. These themes include self-management skills, self-awareness, self-control, problem-solving, personal development, social development, and cultural development.
Conclusion: The results of this study reveal the significant outcomes of spiritual health literacy among students, showing that it has a multifaceted impact on their personal and social development. Accordingly, incorporating various aspects of spiritual health literacy into educational policy is of particular importance.

Abstract Background: The coronavirus Disease 2019 (COVID-19) pandemic emerged in December 2019, resulting in a high number of deaths worldwide. There is a need to investigate how this condition affected people with different diseases, particularly atopy.
Objectives: This study aimed to compare clinical symptoms, laboratory test results, radiological manifestations, and clinical outcomes between hospitalized COVID-19 patients with and without atopy.
Methods: This single-center cross-sectional study with matched controls was conducted on 106 (out of 334) COVID-19 patients hospitalized in Baqiyatallah Hospital, Tehran, Iran, from March 24 to April 24, 2020. Among them, there were 40 and 66 cases with and without atopy, respectively. The non-atopic patients were also matched with the atopic patients in terms of age, gender, Body Mass Index (BMI), and the prevalence of comorbidities, particularly hypertension and diabetes. Patients' clinical characteristics, laboratory findings, and radiological features, recorded upon their admission, and the outcomes were then compared between both study groups.
Results: Compared with the non-atopic group, weakness, myalgia, and chills were more frequent in the patients affected with atopy (P <0.05), and neutrophil count, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), bilateral lung involvement, bilateral pneumonia, and Ground-Glass Opacity (GGO) were among the laboratory test results and radiological manifestations that were observed significantly less in atopic patients (P <0.05). No significant difference was further detected regarding the COVID-19 outcomes in both study groups (P >0.05).
Conclusion: This study showed that atopic conditions were capable of increasing the frequency of some COVID-19 clinical symptoms and reducing the severity of COVID-19 with regard to laboratory findings and radiological features on admission. In addition, atopy was not correlated with COVID-19 outcomes in atopic patients.

Abstract Background: Different studies have shown that despite the expanding number of antifungal drugs, the death rate caused by Candida species has increased during the recent decades due to drug resistance occurrence.
Objectives: The present study aims to identify molecular structure and evaluate drug susceptibility in Candida species isolated from bronchoalveolar lavage fluid in patients diagnosed with hematological malignancies.
Methods: In this cross-sectional study, 54 clinical specimens were taken from the bronchoalveolar lavage of patients. The suspected colonies were investigated by microscopic examination and subsequent passages were evaluated according to standard operating procedures and specification of the type of colony color prescribed by CHROMagar to isolate the yeast. The sequencing method (ITS1, ITS4) was used to approve Candida species. Finally, susceptibility test was carried out according to M27S-3 and M38-A2 micro-dilution methods.
Results: Among 54 samples investigated with culture and PCR methods, 33 Candida species were identified in patients with hematological malignancies. Candida albicans (75.7%) was the most common fungal isolate. Results of drug susceptibility tests showed that the isolated C. albicans (n = 2), C. glabrata (n = 1), and C. tropicalis (n = 1) from patients with hematological malignancies were resistant to fluconazole. The present study showed that the prevalence of C. albicans was higher than other fungal species among patients with hematological malignancies.
Conclusion: Candida species are more susceptible to voriconazole, amphotericin B and Caspofungin. Therefore, identification of candida species along with their antifungal susceptibility pattern can help clinicians to better treat patients.

Abstract Background: Device-Associated Infections (DAIs) pose significant challenges in healthcare settings, leading to increased morbidity, mortality, and healthcare costs. Understanding the impact of the COVID-19 pandemic on DAIs and device utilization rates is crucial for optimizing infection control practices and enhancing patient safety.
Objectives: This study aims to elucidate the shifts in infection rates, specifically CAUTI, VAP, and CLABSI in a tertiary care centre before and after the onset of the global pandemic.
Methods: In this retrospective study, we analysed trends in DAIs and device utilization rates before (October 2019 - March 2020) and after (August 2021 - January 2022) the COVID-19 pandemic. Data on urinary catheter days, central line days, ventilator days, and rates of Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infection (CLABSI), and Ventilator-Associated Pneumonia (VAP) were collected from medical records.
Results: According to the findings of the present study, fluctuations in CAUTI, CLABSI, and VAP rates pre- and post-pandemic, with no significant difference in infection rates between the two periods (P >0.05) were observed. There was a notable increase in urinary catheter days post-pandemic, accompanied by reductions in ventilator days and central line days. The urinary catheter utilization ratio substantially increased post-pandemic, while ventilator and central line utilization ratios showed slight declines.
Conclusion: This study highlights the dynamic nature of DAIs and device utilization rates in the wake of the COVID-19 pandemic. Implementing evidence-based protocols and continuing research in infection control practices are essential for optimizing healthcare delivery and enhancing patient safety in the post-pandemic era.

Abstract Background: Nursing is stressful, especially for female nurses, due to workload and emotional labor. These stressors can contribute to negative emotional states, including meta-worry, irritable mood, and difficulties processing emotions effectively.
Objectives: The purpose of the present study was to investigate the effectiveness of Acceptance and Commitment Therapy (ACT) in reducing meta-worry, irritability, and improving emotional processing in anxious female nurses.
Methods: A quasi-experimental pre-test, post-test control group design was employed.  The target population comprised all female nurses at Imam Khomeini Hospital, Ahvaz, Iran, experiencing anxiety in 2023. A convenience sample of 30 nurses was randomly assigned to either the ACT intervention group (n = 15) or the control group (n = 15). The intervention group received an eight-week ACT program each lasting for 90 minutes. Anxiety-related outcomes were assessed using the Meta-worry Questionnaire, The Irritability Questionnaire, and The Emotional Processing Scale. Data were analyzed using ANCOVA with SPSS-25 software.
Results: Prior to the intervention, no statistically significant differences were identified between the control and experimental groups on measures of meta-worry, irritable mood, and emotional experience processing. Following the ACT intervention, the experimental group demonstrated significant improvements (P <0.001) compared to the control group. Specifically, ACT led to a decrease in meta-worry scores and positive changes in both irritable mood and emotional experience processing among anxious female nurses.
Conclusion: The findings demonstrated that ACT positively improved meta-worry, irritable mood, and emotional experience processing among the participants. These results suggest that ACT may be a valuable intervention for reducing anxiety-related symptoms and improving emotional well-being in female nurses experiencing anxiety.

Abstract Background: Acute kidney injury appears to be both the cause and the result of developing chronic kidney disease. "Acute on chronic kidney disease" refers to acute kidney injury that develops in the presence of pre-existing chronic kidney disease.
Objectives: This study aimed to gain a better understanding of the disease's incidence and outcomes in a rural area.
Methods: A retrospective analysis was conducted to identify individuals with acute or chronic kidney disease who had acute dialysis at Sakon Nakhon Hospital in Thailand between January 2021 and December 2022. The patient's demographics, clinical symptoms, laboratory values, and outcomes were documented.
Results: There were 82 patients with acute kidney injury requiring dialysis, of which 35 (42.7%) had acute on chronic kidney disease. The mean age was 61.6 ± 13.46 years, with 48.6% being male. Diabetes was the most frequent primary cause and comorbid condition (60%). The majority of indication for acute dialysis (57.1%) was volume overload. Sepsis (37.1%), and urinary tract obstruction (25.7%) were the leading causes of acute renal function decline. There was a significant difference in risk variables between non-survivors and survivors, including shock (P <0.00001), mechanical ventilation use (P = 0.0017), and Intensive Care Unit (ICU) admission (P = 0.0005). Significant mortality-related risk factors identified by logistic regression analysis were shock [OR 159.00, 95%CI 6.86-3683.71; P = 0.002], mechanical ventilation usage [OR 30.79, 95%CI 1.59-597.71; P = 0.024], and ICU admission [OR 43.00, 95%CI 2.18-847.42; P = 0.013].
Conclusion: Acute on chronic kidney disease increased not just in-hospital mortality and morbidity, but also the risk of chronic kidney disease onset and progression.

Abstract Background: Numerous factors involve in the incidence of addiction including social, economic and psychological stress.
Objectives: The present study aimed at studying the effectiveness of cognitive-behavioral stress management on irrational beliefs and resilience of drug addicts.
Methods: In an experimental study, 20 addicts who were in the camp were randomly assigned into two groups of experimental (10 individuals) and control (10 individuals). The experimental group were being treated with cognitive-behavioral stress management for ten 90-minute sessions, and the control group did not receive any treatment. All participants in the study, at the beginning and the end of the treatment and two months after treatment filled out the irrational beliefs and resiliency questionnaire. Analysis of covariance and multivariate analysis of covariance (MANCOVA) was used to analyze the collected data.
Results: The findings of analysis of covariance between two groups in the post-test was significant in ten aspects of irrational beliefs including the need to recognize and protect others (F = 4.09), high expectations of themselves (F = 16.84), tend to blame (F = 17.03), reaction to frustration (F = 11.88), emotional irresponsibility (F = 10.97), excessive preoccupation (F = 10.97), avoiding the issues (F = 8.48), dependency (F = 12.45), despair to change (F = 8.94), and perfectionism (F = 15.56) in the one present level. In addition, the results of analysis of covariance of second hypothesis showed that resilience (F = 22.61) in the experimental group had a significant difference with the control group. Also, the obtained results were significant at the 0.01 level. Therefore, according to the above-mentioned finding, cognitive-behavioral stress management training is effective in reducing irrational beliefs and increasing the resilience of addicts.
Conclusion: According to the lower average scores of the experimental group in the post-test stage in the dimensions of irrational beliefs, it can be concluded that stress management training in a cognitive-behavioral way reduces the irrational beliefs of addicts. Also, according to the higher average scores of the experimental group in the post-test stage in resilience, it can be concluded that cognitive-behavioral stress management training is effective in increasing the resilience of addicts.

Abstract Background: Infertility is a significant psychosocial stressor associated with adverse mental health outcomes. Given the intricate link between mental health and self-concept, enhancing self-concept may be crucial for improving overall well-being among infertile women.
Objectives: The present study aimed to enhance self-concept in infertile women through Mindfulness-Based Cognitive Therapy (MBCT).
Methods: This study employed a quasi-experimental design with a three-wave (pre-test, post-test, 45-day follow-up) assessment and two groups: experimental and control. To conduct the research, 40 infertile women referring to the Isfahan Infertility and Infertility Center in 2023 were selected conveniently based on inclusion and exclusion criteria and were randomly assigned to the experimental (n = 20) and control (n = 20) groups. The participants completed the Beck Self-Concept Test in three stages of pre-test, post-test, and follow-up. The experimental group participated in an eight-week MBCT intervention, consisting of one 90-minute session per week. The control group received no intervention during this period. Data were subjected to repeated-measures analysis of variance (ANOVA) using SPSS-24.
Results: The findings indicated that MBCT significantly improved self-concept in infertile women in the social skills dimension (P <0.01). The significant improvement in self-concept, particularly in the social skills dimension, suggests that MBCT can be a helpful intervention for this population.
Conclusion: Infertility-related social isolation and diminished self-concept may be ameliorated through MBCT. This study demonstrates that MBCT can enhance social interaction skills in infertile women, thereby positively influencing their overall self-concept. These results support MBCT as a beneficial approach for enhancing the mental health of women facing infertility.