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Background: Uncertainty is a common challenge for nurses in clinical decision-making, which can compromise patient care quality and safety. To address this issue, it is essential to understand how nurses perceive and cope with uncertainty in their practice. Aim: This study aimed to explore nurses’ perceptions of uncertainty in clinical decision-making using a qualitative approach. Methods: This study was conducted with a qualitative approach and conventional content analysis in 2020. Participants consisted of 17 nurses from different wards of teaching hospitals in Northwestern Iran, recruited using the purposive sampling method. Data were collected through semi-structured interviews and analyzed simultaneously with data collection (June to December 2020). The data were analyzed using the content analysis approach suggested by Wildemuth. Data were managed with MAXQDA10 software. The analysis revealed four main themes and ten subthemes that described the nurses' experiences of uncertainty in clinical decision-making. Results: The main themes were: difficult choice, difficult situation, insufficient judgment, and emotional burden. Conclusions: The study participants defined uncertainty in clinical decision-making as a difficult choice that occurs in difficult situations, which influenced their clinical judgment and emotional well-being. These findings provide valuable insights for developing interventions to help nurses manage uncertainty and improve their decision-making skills and safety.

Background: The COVID-19 pandemic has had a profound impact globally, presenting significant social and economic challenges. This study aims to explore the factors affecting mortality among hospitalized COVID-19 patients and construct a machine learning-based model to predict the risk of mortality. Methods: The study examined COVID-19 patients admitted to Imam Reza Hospital in Tabriz, Iran, between March 2020 and November 2021. The Elastic Net method was employed to identify and rank features associated with mortality risk. Subsequently, an artificial neural network (ANN) model was developed based on these features to predict mortality risk. The performance of the model was evaluated by receiver operating characteristic (ROC) curve analysis. Results: The study included 706 patients with 96 features, out of them 26 features were identified as crucial predictors of mortality. The ANN model, utilizing 20 of these features, achieved an area under the ROC curve (AUC) of 98.8 %, effectively stratifying patients by mortality risk. Conclusion: The developed model offers accurate and precipitous mortality risk predictions for COVID-19 patients, enhancing the responsiveness of healthcare systems to high-risk individuals.

Aim: Traffic accidents are caused by several interacting risk factors. This study aimed to investigate the interactions among risk factors associated with death at the accident scene (DATAS) as an indicator of the crash severity, for pedestrians, passengers, and drivers by adopting “Logic Regression” as a novel approach in the traffic field. Method: A case-control study was designed based on the police data from the Road Traffic Injury Registry in northwest of Iran during 2014–2016. For each of the pedestrians, passengers, and drivers’ datasets, logic regression with “logit” link function was fitted and interactions were identified using Annealing algorithm. Model selection was performed using the cross-validation and the null model randomization procedure. Results: regarding pedestrians, “The occurrence of the accident outside a city in a situation where there was insufficient light” (OR = 6.87, P-value

Background: The topical application of boron has been significantly associated with intensifying wound healing. Using 3% boric acid in deep wounds significantly contributes to wound healing and reduces the duration of hospitalization in the intensive care. The objective of this study was to assess the therapeutic impact of a topical gel containing sodium pentaborate pentahydrate on the management of wounds resulting from grade 1 to 3 hemorrhoids. Methods: In this randomized double-blind placebo-controlled trial, we applied a topical gel consisting of sodium pentaborate pentahydrate 3% on 206 eligible patients with the diagnosis of grade 1, 2, and 3 hemorrhoid diseases. Then patients were randomly allocated to two groups of sodium pentaborate pentahydrate or placebo gel with a ratio of 1:1 and received the allocated gel for four weeks. Patient hemorrhoid symptoms severity, hemorrhoid degree, and anoscopy findings were compared before and after the trial. Results: Before the intervention, symptom severity (p > 0.05) and anoscopy findings (p = 0.815) were similar between the two groups. Subsequent to the intervention, a majority of patients in the intervention group experienced a reduction in anal itching compared to the placebo group [adjusted mean difference (aMD) 95% CI: -1.98 (−2.2 to −1.8), p = 0.007]. Moreover, resting pain [aMD (95% CI): -1.37 (−1.6 to −1.1), p = 0.015], pain during defecation [aMD (95% CI): -2.19 (−2.4 to −2.0), p = 0.005], feeling a lump in the anus (aMD (95% CI): -0.71 (−1.2 to −0.2), p = 0.011), bleeding during defecation (41.7% vs. 66.9%, p = 0.027), and hemorrhoid degree (p

Offshore operations are generally challenging and hazardous, and the workers are exposed to conditions that may lead to fatigue. A cross-sectional study evaluated physical and psychological job demands and their associations with fatigue among offshore workers. The offshore workers (n = 251) completed a questionnaire including demographic/job details, Multidimensional Fatigue Inventory (MFI‒20), and Job Content Questionnaire (JCQ). Data were analysed using linear regression modelling. Results indicated that the physical (particularly performing repetitive motions and applying pressure with hands and wrists) and psychological (e.g., intense task concentration and fast working) job demands were relatively high. The total mean (SD) fatigue score (MFI‒20) was 56.3 (13.9). Individual factors (Body Mass Index ‒ BMI), physical job demands (awkward working postures, frequent moving/lifting heavy objects and doing lots of physical efforts) and psychological job demands (task interruptions by other people and doing an excessive amount of work) were the main variables associated with different dimensions of fatigue in the multivariate models. While physical fatigue was only associated with the physical job demands, both physical and psychological job demands were significantly associated with mental fatigue in the multivariate context. The findings have possible implications for job design and implementation of intervention programmes to promote health and performance of the employees.

Background: Vitamin D status seems to have an association with cardiometabolic risk factors and its deficiency may negatively affect the cardiovascular outcomes. The aim of this study was to determine the possible association between vitamin D status and cardiovascular outcomes., Method: We performed a nested case control study within the Tehran Lipid and Glucose Study (TLGS), which followed a representative sample of Tehranian adults. A total of 251 matched pairs, aged>30 years, were selected. Cases were TLGS individuals that were free of cardiovascular disease (CVD) at the beginning of study and developed CVD during assessments of 5.7 year follow up. Each case was matched by age, sex and the month of entry to study with a randomly selected control (risk-set sampling). Prespecified cut points were used to characterize varying degrees of 25-OH D deficiency (<10, between 10 and 14.9, and ≥ 15 ng/ml). Conditional logistic regression was used to investigate the association between 25-OH-D concentration and the incident cardiovascular outcomes., Results: The mean age of participants was 56.84 ± 11.17 years and 244 (48.6%) were women. The median (IQ: 25-75) of serum 25-OH-D was 14.1 ng/ml (9.6-29 ng/ml) and 306 (61%) of participants had serum 25-OH-D<15 g/ml. Median serum 25-OH-D was lower in cases (12.5 vs. 18.1, P<0.001). After adjustment for potential confounders, the odds ratio of serum 25-OH-D<10 ng/ml for having CVD outcomes was 2.90 compared with 25-OH-D ≥ 15 (95% confidence interval (CI): 1.67-5.12, P<0.001)., Conclusion: Our results indicate that serum 25-OH-D concentration has an independent association with cardiovascular outcomes in adult Tehranians., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)