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Background: Depression is one of the most common mental disorders that leads to anxiety, sleep disturbances, and suicidal thoughts. Due to the high cost of treatment and the reluctance of many patients to seek medical help, major depressive disorder (MDD) is becoming more prevalent. Therefore, alternative methods like smartphone applications can help prevent and improve depression symptoms. The present study aimed to determine the effect of the newly developed Yara smartphone application on anxiety, sleep quality, and suicidal thoughts in patients with MDD. Methods: This randomized controlled trial with a pretest-posttest design was conducted on Iranian patients with MDD in 2022. Sixty-four patients were recruited using convenience sampling and randomly assigned to two control and intervention groups. The intervention was conducted using the Yara smartphone application for three months. Data were collected using the Spielberger State-Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI), and Beck Scale for Suicidal Ideation (BSSI). Data were first entered into IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA) and then analyzed using descriptive and analytical statistics. Results: There was no statistically significant difference in the mean score of anxiety and sleep quality between the intervention and control groups before the intervention (p ≥.05). However, this difference in the mean score of anxiety and sleep quality was statistically significant in the two groups after the intervention (p <.05). The results showed no statistically significant difference in the mean score of suicidal thoughts between the two groups before and after the intervention (p ≥.05). The use of the Yara smartphone application had a significant positive effect on anxiety and sleep quality in depressed patients (p <.001). At the same time, it had no significant effect on suicidal thoughts (p ≥.05). Conclusion: Considering the positive effect of using the Yara smartphone application on reducing anxiety and improving sleep quality in depressed patients, this application can help alleviate the problems of depressed patients alongside existing treatment methods. Thus, this application is recommended for this group of patients in psychiatric clinics and departments. The Yara application's effectiveness was not approved on suicidal thoughts in this study so that further investigation would be necessary. Trial Registration: Iranian Registry of Clinical Trial approval code (IRCT# IRCT20131112015390N7). [ABSTRACT FROM AUTHOR]

Background: Estrogen is involved in the pathogenesis of breast and gynecological cancers. Regular use of aspirin reduces estrogen levels. The present study aimed to evaluate the effect of aspirin on estrogen levels in postmenopausal women. Methods: This double-blind, placebo-controlled parallel-group trial was conducted on postmenopausal women referred to an outpatient clinic at a women's hospital in Tehran. Volunteers were randomly assigned to receive aspirin 100 mg/day or placebo for 6 weeks. Estradiol, sex hormone-binding globulin (SHBG), and testosterone levels at baseline and at the end of the intervention were measured by ELISA. Data were analyzed using SPSS 20, Kolmogorov–Smirnov test, independent samples t-test, and Mann–Whitney U test. Results: Twenty-seven and 28 participants were finally analyzed in the aspirin and placebo groups, respectively. There was no significant difference between the two groups in body mass index (BMI), age, or menopausal years. There was a statistically significant difference (p = 0.002) in the amount of change in estradiol levels of the intervention group (median=− 3.5 pg/ml) compared to the control group (median=1.5 pg/ml). In contrast, there were no significant differences between the two groups regarding testosterone and SHBG levels (p = 0.58, p = 0.32). Conclusions: Since low doses of aspirin may decrease estradiol levels, it could be considered a promising adjunctive therapeutic candidate in postmenopausal women to decrease BC incidence. However, further studies with larger sample sizes, measurements of estrogen levels and its related compounds in different time points accompanied by long-term follow-ups are needed to better elucidate the potential mechanisms by which nonsteroidal anti-inflammatory drugs (NSAIDs) negatively affect breast cancer. Trial registration: IRCT201012195397N1. Date of first registration: 03/01/2011. [ABSTRACT FROM AUTHOR]

OBJECTIVE Although technique improvements have drastically reduced radiotherapy (RT) related toxicity, most patients still experience burdensome RT side effects. Studies have shown an increase in distress, anxiety, fatigue, and depression in patients undergoing radiation. Radiation-induced side effects adversely affect quality of life for cancer survivors. This study aimed to determine the mood status in patients with gastrointestinal tract cancer undergoing RT. METHODS This randomized cross-sectional study conducted on 126 patients with gastrointestinal tract cancer undergoing RT. We used a demographic form, and the Persian Version of Profile of Mood States 2nd edition questionnaire for data collection. RESULTS The mean of total mood disturbance was 77.39±15.03. The results demonstrated there is a relationship between tension-anxiety with; depression-dejection (DD), anger-hostility (AH), fatigue-inertia (FI); and confusion-bewilderment (CB) (p<0.001). In addition, there was a significant relationship between DD with AH, FI, and CB (p<0.001). There was also a significant relationship between AH with FI and CB (p<0.001). In addition, there was a statistically significant relationship between FI with CB (p<0.001). CONCLUSION Our results suggested that there is a high prevalence of mood disturbance in patients with gastrointestinal tract cancer undergoing RT. Therefore, applying strategies for improving mood are important among these patients, because it can lead to better therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Background: Hospitalization could be an unpleasant experience for patients with cardiovascular disease leading to some negative emotional reactions. These emotions can be managed by nursing empathy. There are different methods for improving empathy, but some evidence indicates a dramatic drop in nurses' empathy. In this study, we aim to provide a protocol for investigating the effect of knowledge brokering on nurses' empathy with patients receiving cardiac care.Methods: This study protocol is developed based on SPIRIT checklist with an experimental design. The study population are nurses working in cardiac wards of three educational hospitals in western Iran, Khorramabad. The quota sampling method is used. The sample size is 100 individuals. The samples will be assigned to two intervention and comparison groups using stratified random allocation method. Permuted block randomization is used in each stratum. To prevent contamination between participants; firstly, the measurements of the comparison group is done. Knowledge brokering intervention is performed in 7 stages based on Dobbins' knowledge translation framework 2009. Monica's Empathy Construct Self-Rating Scale is used for measuring empathy. Statistical analyses are performed using SPSS (SPPS Inc. Chicago, Il, version 21). P value below 0.05 is considered as statistically significant.Discussion: To our knowledge, there is no similar study using an experimental design to examine the efficacy of a knowledge brokering method to improve humanistic knowledge. It helps nurses to improve their empathy in caring relationships. [ABSTRACT FROM AUTHOR]

Background: Professional quality of life (ProQOL) comprises two aspects: compassion satisfaction and compassion fatigue. Although intensive care unit (ICU) nurses obtain professional satisfaction from their work, their repeated exposure to the aftermath of critical illness puts them at high risk for compassion fatigue. Aim: This study aimed to investigate the impact of chromotherapy-based interventions on the ProQOL in ICU nurses. Methods: In this randomized controlled trial, 80 ICU nurses were assigned into 2 groups (experiment and control). A demographic form and ProQOL questionnaire were used for data collection. The interventions included three parts; (A) changing color of decoration in experimental ICU, such as the installation of color panels in ICU ward, (B) providing a mobile cover and a pencil case in yellow, orange, and green colors based on the principles of chromotherapy, for each of experimental group nurses, and (C) in addition, three educational sessions on chromotherapy were held and then participants received individualized consulting sessions weekly on chromotherapy applying in their personal life for 3 months. Results: Applying chromotherapy increased ProQOL score in all of its dimensions (satisfaction of compassion, fatigue due to compassion, and secondary post-traumatic stress) in the experimental group (p <.05). Conclusion: Chromotherapy may enhance ProQOL in ICU nurses. Interventions such as chromotherapy can be implemented easily to combat compassion fatigue and secondary post-traumatic stress in ICU nurses. Trial registration: Iranian Registry of Clinical Trials identifier: IRCT2017101431588N3. [ABSTRACT FROM AUTHOR]

Background: Many patients on maintenance hemodialysis experience sleep disorders. This problem is related to depression, anxiety, hospitalizations, chronic medical conditions, decreased quality of life, and increasing mortality rate in patients on maintenance hemodialysis. The objective of this research is to determine the impact of massage therapy by hot stone on quality of sleep in patients on maintenance hemodialysis. Materials and Methods: This was a randomized controlled trial conducted on 60 patients on maintenance hemodialysis. They were assigned via random allocation process into two groups of study: intervention group (n = 30), or control group (n = 30). Patients in the experimental group received massage therapy by hot basalt stone for 12 séances. During the massage therapy, each of five basalt stones were placed at the sites of the fifth, fourth, third, second, and first chakra. Control group received their treatment as usual without any massage therapy. Using Pittsburgh Sleep Quality Index (PSQI), the global score and its components were computed in both groups of study, two times (before the intervention and 1 month after the intervention). Results: Although there were not any baseline differences between the two groups of study for the mean of global PSQI score (P = 0.92) before the study, the mean of global PSQI score in the intervention group, after the intervention decreased to 5.7 ± 3.06, but in the control group sleep quality increased to 10.7 ± 3.6. The difference between the mean of global score of PSQI among two groups of study after the massage therapy was statistically significant (P < 0.001). Conclusion: Applying massage therapy by hot stone in hemodialysis patients may contribute in enhancing their quality of sleep. [ABSTRACT FROM AUTHOR]

Objective: Although, the lapse and relapse are synonymous with the return to substance use disorder but they have different meanings. Lapse is suddenly return to substance use but relapse is reuse of substance after substance use quitting. Lapse does not have to lead to relapse. Lapse is one of the major challenges in methadone maintenance treatment (MMT). Lapse is the stage that occurs before relapse. Craving is the most important factor for lapse after the treatment periods, too. The aim of this study was to determine the effectiveness of applying continuous care model on lapse and craving prevention in patients on MMT. Methods: This parallel randomized controlled trial was conducted on 95 patients who were selected through the convenience sampling and randomly assigned to intervention (n=48) and control (n=47) groups. Continuous care model which consisted of four stages (orientation, sensitization, control and evaluation) was conducted on intervention group over a period of 3 months. At the end, two groups were compared. Craving Questionnaire and Lapse-and-Absence Check List were used to collect data. Results: At the end of third month, the mean of the lapse in the experimental group decreased to 1.57±1.1 times (from 2.07±0.89 times) and the mean of craving score decreased to 50.47±15.1 (from 53.73±13.58) that showed a significant difference comparing to the control group. Discussion: Continuous care model is effective to reduce lapse and craving in male patients on MMT. Therefore, it is suggested that this model should be implemented along with a medical treatment to prevent lapse and craving in male substance abuse disorder. [ABSTRACT FROM AUTHOR]

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Purpose: Evaluation of the effect of supportive expressive discussion groups on loneliness, hope and quality of life in breast cancer survivors.Methods: A randomized control trial including breast cancer patients who had completed chemotherapy and randomly allocated into two groups: intervention (n = 41) and control (n = 40). The intervention consisted of twelve weekly 90-min sessions for groups of six to eight breast cancer survivors. Data were obtained pre-to -post the intervention and at 8-week follow-up. The data were analyzed using a repeated-measures analysis of variance (ANOVA).Results: The findings revealed a significant reduction in loneliness scores (F = 69.85, p < 0.001), promotion in total hope (F = 20.8, p < 0.05) and enhancement in quality of life from pre- to post-intervention, and then over the 8-week follow-up period in the intervention group, while scores of control participants did not show this pattern during the study. The strongest effects were found for global quality of life (effect size) = 0.59), for future perspectives (effect size = 0.51), emotional functioning (effect size = 0.35) and social functioning (effect size = 0.31).Conclusion: The intervention was effective on loneliness, hope and quality of life in the intervention group. The intervention needs further evaluation in a larger study and with other cancer types. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background & Aims: Pain is one of the common and detrimental clinical feature of multiple sclerosis (MS). Hypnotherapy is one of the effective psychological approaches. Hypnosis is a safe, effective and non-invasive method that can alleviate both emotional and affective aspects of pain. It seems necessary to conduct the present study with the aim of effect of self-hypnosis on degree of pain in patients with MS, in terms of severity and quality. Materials & Methods: This clinical trial was carried out on 60 patients with MS in Urmia University of Medical Sciences. The tools were general health questionnaire-28 (GHQ-28), Stanford Hypnotic Susceptibility Scale (SHSS), numerical rating scale (severity of pain), McGill pain questionnaire (quality of pain), and record of pain pills. After initial assessments, patients were randomly assigned into two groups of intervention and control. Education of Self-Hypnosis for the intervention group was performed within 6 half-hour sessions, with no intervention for controls. Then change of pain severity and quality and amount of pain pills were evaluated after one month. Data were analyzed by SPSS using of independent t and Chi-square tests. Results: Self-hypnosis was significantly effective in terms of severity and quality of pain in patients with MS (p<0.05) as mean score of pain severity decreased from 5.63±1.01 to 2.70±1.07 and, score of pain quality decreased from 1.50±0.47 to 0.93±0.29 in the intervention group. This effect was maintained four weeks post-intervention (p<0.05). Amount of pain pills had a decreasing trend. Changes were not significant in controls (p>0.05). Conclusions: Results of this study showed that self-hypnosis is effective in decreasing pain severity and alleviating its quality in female patients with MS. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE To compare the effectiveness and safety of two glycemic control regimens in stable critical care patients receiving parenteral nutrition (PN). DESIGN Prospective, randomized open-label clinical trial. METHODS Eligible postoperative critical care patients in the ICU began PN on the first to the seventh day of ICU admission. The PN admixture included regular insulin, in doses sufficient to maintain 3 or more goal blood glucose (BG) levels between 110 and 180 mg/dl. After 3 to 5 days of PN containing regular insulin, patients were randomized to 3 more days of regular insulin at the same dose or 80% of their total daily regular insulin dose provided in PN solution as glargine insulin. Capillary BG monitoring was performed every 6 hours. RESULTS Twenty one patients were randomized to each treatment group. Median APACHE II scores were not significantly different between the two groups within the first 24-hour of ICU admission. There were no significant differences between the two groups at day 3 for mean daily dextrose (306.9 ± 46.2 vs. 305.2 ± 52.2 g; p=0.913) or insulin (18.3 ± 8.8 vs. 19.5 ± 10.0 units; p=0.696) doses. The percentage of BG values in the goal (110-180 mg/dl), hyperglycemic (> 180 mg/dl), and hypoglycemic (< 70 mg/ dl) BG levels were similar between the two groups (69.0% vs. 66.7%, p=0.567; 11.9% vs. 11.1%, p=0.780; 0% vs. 1.6%, p=0.124, respectively). Mean daily BG levels were not significantly different between the two groups on each of the 3 study days (day 1: 140 ± 20 vs. 131 ± 25 mg/dl, p=0.194; day 2: 136 ± 20 vs. 140 ± 18 mg/dl, p=0.498; day 3: 142 ± 15 vs. 140 ± 19 mg/dl; p=0.741). CONCLUSION These data suggest that, compared with regular insulin added to PN, glargine insulin results in similar glycemic control and rates of hyperglycemia and hypoglycemia in stable critical care patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate meperidine-sparing effect of intravenous (IV) paracetamol in patients undergoing percutaneous nephrolithotomy (PCNL). Patients and Methods: One hundred patients who underwent PCNL were randomized to paracetamol ( n=50) and placebo ( n=50) groups. Patients received 100 mL of physiologic saline with or without 1 g IV paracetamol every 8 hours after PCNL up to 24 hours in the paracetamol and placebo groups, respectively. Patients in both groups received intramuscular meperidine in case of unrelieved pain. The visual analog scale (VAS) was used to evaluate pain intensity scores in the postoperative period. Total meperidine consumption, mean VAS score in the first 6 and 24 hours, demographic variables, operative variables, and side effects were recorded. Results: The mean VAS pain intensity scores at 6 and 24 hours were 50.22 and 41.32 mm in the paracetamol and 75.29 or 65.5 mm in the placebo group ( P<0.001). The mean consumed meperidine dose was 54.40 mg and 77.60 mg in the paracetamol and placebo groups, respectively ( P<0.001). Conclusion: In this study, IV paracetamol significantly reduced total meperidine consumption and pain intensity scores compared with placebo. IV paracetamol can be an effective and safe part of multimodal analgesia regimes for postoperative pain management after PCNL. [ABSTRACT FROM AUTHOR]

Background and the purpose of the study: The febrile reaction is a complex response involving immunologic and other physiologic systems. Antipyretics are commonly used in critically ill patients with fever. We investigated the inflammatory responses following application of antipyretic therapy in febrile critically ill patients with Systemic Inflammatory Response Syndrome (SIRS). Patients and methods: In a prospective, randomized controlled study, critically ill patients with fever (T ≥ 38.3°C), SIRS diagnosed within 24 hours of Intensive Care Unit (ICU) admission and Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥10 were randomized into two groups. Upon appearance of fever, one group received intravenous paracetamol 650 mg every 6 hours for 10 days and other group received no treatment unless temperature reached 40°C. Body temperature, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sepsis-related Organ Failure Assessment (SOFA) scores, length of ICU stay, ICU mortality and infectious complications were recorded. Levels of Interleukin-1 alpha (IL-1α), IL-6, IL-10, Tumour Necrosis Factor alpha (TNFα) and High-Sensitive C-Reactive Protein (HS-CRP) were assessed at baseline and 2, 6 and 24 hours after intervention. Results and discussion: During a period of 15-month screening, 20 patients met the criteria and randomized to the control or paracetamol group. Body temperature decreased significantly in the paracetamol group (p = 0.004) and control group (p = 0.001) after 24 hours, but there was no significant difference between two groups at this time point (p = 0.649). Levels of IL-6 and IL-10 decreased significantly (p = 0.025 and p = 0.047, respectively) in the paracetamol group at 24 hours but this was not of statistical significance in control group. No patterns over time in each group or differences across two groups were found for HS-CRP, TNFα, and IL-1α (p > 0.05). There were no differences regarding ICU length of stay, mortality and infectious complications between both groups. Conclusion: These results suggest that antipyretic therapy may not be indicated in all ICU patients. Allowing fever to take its natural course does not appear to have detrimental effects on critically ill patients with SIRS and may avoid unnecessary expenses. [ABSTRACT FROM AUTHOR]

Purpose: To compare the outcome of percutaneous nephrolithotomy (PCNL) using split or intact Amplatz sheath. Materials and Methods: Seventy two patients who underwent PCNL were randomly divided into two groups; PCNL using intact (group 1) and split (group 2) Amplatz sheath. Preoperative data, operative time, largest extracted stone size, fluoroscopy and lithotripsy time, and serum biochemistry tests before and after PCNL were evaluated. Results: Preoperative features and stone size were not significantly different between the groups. There were no significant differences in complications and postoperative changes in hemoglobin and serum electrolytes. Stone free rate in group 2 (88.1%) was insignificantly higher than group 1 (83.3%) (p = .05), but in staghorn stones and stones larger than 1000 mm2, stone free rate in group 2 was significantly higher than group 1 (82% vs. 72%). The mean extracted stone size in group 2 (150 ± 49mm2) was significantly larger than group 1 (40 ± 16 mm2) (p < .005). The mean operative, lithotripsy and fluoroscopy times were significantly longer in group 1. Conclusion: Using split Amplatz sheath in PCNL facilitates extraction of larger stone fragments which could contribute to shorter fluoroscopy, lithotripsy and operative times. [ABSTRACT FROM AUTHOR]