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Background & Objective: Research utilization is a new phenomenon in Iran and the Iranian nurses tend to practice based on evidences. The objective of this research is to investigate nurses' attitude toward research utilization.Methods & Materials: This research is an analytical-descriptive study. The sample included 410 clinical nurses and instructors who were selected through multistage stratified sampling method. Data were gathered using a two-section questionnaire and analyzed using statistical package for social sciences (SPSS).Results: 91.2% of respondents believed in using research findings in practice. 77.6% of nurses agreed with the following statement: "Research is not applicable in practice". Furthermore 88.3% agreed that" Research helps to build a scientific base for nursing". The majority of respondents had positive attitude toward research utilization. There was a significant difference between attitude and kind of professional activity, setting and research activity. Conclusion: It seems having positive attitude toward research utilization is not sufficient for applying research results in practice. In order to utilize the research findings, more relevant research in this field of nursing is required.

ackground & Aim: Performance appraisal is one of the most important duties for nursing managers. This will improve the quality of nursing care, and it needs suitable approaches and effective strategies in nursing services. The aim of this study is to determine the impact of performance appraisal using management by objective approach on nursing care quality. Methods & Materials: This was a quasi-experimental and single-blind study that was carried out in two surgical units of an affiliated hospital of Tehran University of Medical Sciences. 80 patients were selected using a randomized sampling. The quality of nursing care were controlled in both experiment and control units before and after the performance appraisal procedure. The procedure was programmed on the basis of management by objective approach for six months in the experiment unit. In the intervention unit, nursing performance appraisal was done three times and in every time head nurse and supervisors participated in giving feedbacks and recommendations for the nurses. At the end of the intervention, quality of nursing care was assessed in both groups blindly. The results were compared and statistically analyzed. Results: Significant difference was found between quality of nursing care in the experiment and control units (P

Introduction and objectives: Despite the advances in the control of food-borne diseases, still one of the dilemmas in the health of most societies and a matter of concern for health authorities is food poi­soning and food-borne diseases by unsafe foods.Materials and methods: In total 390 samples, including 195 samples of raw kebabs and hamburgers and 195 samples of the cooked ones were gathered from shops, sampling raw and cooked meat at the same time, and they were sent to the laboratory for testing, over a period of one year. The methods used for the tests were based on the Iranian National Standard procedures, numbers 356 and 2394.Results: All the cooked specimens had bacterial contamination in acceptable standard levels and there­fore were considered consumable. From the 165 raw kebab samples, 90 samples (54.5%) were con­sumable but 75 samples (45.5%) were not fit for consumption, where from 30 raw hamburger samples, 22 samples (73.3%) were consumable and 8 (26.7%) were inconsumable. In serological evaluations, Thompson serotype had the highest prevalence in kebab and hamburger samples.Conclusion: The results of present study show that there is no reason for concern in consuming cooked kebabs.

Background&Objective: Research utilization provides quality and cost- effective care, optimizing patient outcomes and enhancing the credibility of nursing. Despite of increase in the amount and quality of nursing research, the conduct of research and use of its results remains poor. In Iran one of the most important barriers of research is related to research utilization. The aim of this study is to identify the barriers and facilitators of research utilization in nursing practice. Materials&Methods: The study used a descriptive- analytic design. The questionnaire was divided into two sections: The former asked for information on the academic and professional profiles of respondents, the latter was based on the BARRIERS Scale. In addition there was one open –ended question to measure the facilitators of research utilization. Content and face validity was further enhanced by submitting it to nursing researchers. Results: In factor analysis procedure four factors were extracted. The factors were labeled as: organization barriers and limitations, Quality of research, Nurses' values, awareness and skills, Communication of research. Factor loading for barrier item ''the nurse is unaware of the research'' was not included under factor headings. The top three barriers were The nurses do not have time to read research, the facilities are inadequate for implementation and the nurses do not feel they have enough authority to change patient care procedures. All the participants suggested facilitators to increase research use The most frequently mentioned facilitators were related to human resources, individual and organizational factors. Conclusion: The most dominant findings were related to organizational support. The top three barriers mentioned by the participants reflect a traditional organizational culture which hinders professional autonomy. Organizations need to ensure that facilities are provided and give the authority to the nurses to change the practice based on research.

Background&Objective: Foodstuffs additives are a general term for materials that are added to the foodstuffs in order to increase durability and to improve the appearance, composition, taste and food nutritional value. Colors are classified in this group and are added to foodstuffs in order to increase their attraction. Colors may cause illness such as allergy, rash and hyper activation in children and also they may debilitate the Immune system, Anaphylaxis reactions may also occur and they may have cancerous effect. The aim of this survey was to analyze status of added colors to the dried sweets which are produced in south of Tehran city. Materials & Methods: 191 samples of dried sweets were randomly collected and analyzed from south of Tehran areas. First, the samples were de-colored by Clorhidric Acid, and then were analyzed after refining by Thin Layer Chromatography (T.L.C) method. Samples were identified by taking Retention Factor (RF values) into consideration. Results: 93.2 percent from the total samples contained colors. Among chromatic samples, 42 samples (22%) out the total samples, contained artificial, non-edible colors and 96 samples (50.3%) from the total samples contained artificial and edible colors (for Industrial Producers) and 40 samples (21%), contained natural colors. Sunset yellow color was detected more than other added colors in sweets. Conclusion: Low costs, stability, PH, purity, and environmental conditions, motivate the producers for high utilization of edible colors without considering their possible hazards and/or their edible quality aspects. It is suggested that, based on the findings of this study and high consumption of colors.

Background & Aim: Nurses have the major role at care continuity and health promotion. They frequently affect total productivity in a organization. However, the nurses believe that due to several barriers they have not desire productivity, therefore the health care have been left at level of quality. The aim of this research are assessing nurses' view about productivity and role of human resource on it. Methods & Materials: This study has been done based on grounded theory method. Open interviews has been used for gathering of data. Sampling was purposive in beginning study but so that study was proceeding and categories were completed, it changes to theoretic sampling. Constant comparative analysis was method of data analyses. Results: Essential themes emerged from the data in human resource category. These are: systemic calculating number of staff, accurate staff select and use criteria for them, provide adequate staff from various categories in total year's day, accept patient when as coordinate to in charge nurse and well communication. These make necessary groundwork for productivity. Then accidents that emerged from inappropriate quantity and quality of human resource will be decreased. These enhance nursing productivity the biggest group of health care services. Model of Productivity and human resource effects on it’s, from nurses' view, has concluded of this research. Conclusion: In nurses' view that participates in this research, human resource can affect on productivity process and improve it, then it lead to develop quality care- health care vision and goal.

Introduction: Bed sore is an important complication of operation. Long immobility, hypotension and hypothermia in perioperative period predispose patients to bed sore. The prevention of bed sore is a priority in caring for immobilized patients and different methods have been used for this purpose. Hydrocolloid dressing is one of these methods. Materials and Methods: This study is a quasi-experimental research. Subjects consisted of 60 patients aged 40-70 years who had eligibility criteria for this study. Subjects were selected with convenience sampling and randomly allocated to two 30-patient groups (experimental and control). In experimental group, hydrocolloid dressing was used before surgery. No procedure was performed for control group. After surgery sacral area was examined on three occasions to detect bed sore: immediately, 24 and 48 hours after surgery. The data were collected by demographic questionnaire and staging bed sore checklist and analyzed by SPSS statistic program and use of descriptive methods such as Chi square, Fisher exact test, t test, ANOVA and least significant difference (LSD). Results: Incidence of bed sore was 13.3% in experimental group and %36.7 in control group. Chi square test showed significant difference between incidence of bed sore in two groups (p=0.03). Incidence of bed sore in two groups had no relationship with respect to gender and number of grafts. There was a significant relationship between bed sore and age, body mass index and duration of hypothermia, immobility and cardiopulmonary bypass (p

Background & Aims : The nursing profession is beyond the knowledge or set of skills and techniques to perform. To achieve holistic care, nurses must be educated the ethical knowledge. Nurses in their daily clinical practice are faced with numerous ethical issues and they are expected to have an active role to solution the ethical challenges. Exploration of effective Factors on active participation of clinical nurses to solution of ethical challenges can provide holistic care of the patients in three dimensions; technical, professional and ethical care. The purpose of this study was to explore the perspectives of master nursing students regarding these effective factors. Materials & Methods : A qualitative study, using the content analysis approach, was conducted. The questionnaire with demographic and openended question were held with 46 master students who were studying nursing in tarbiat modaress, shahid beheshti and Guilan University of Medical sciences in 1390-91. Result : During the data analysis, three main themes emerged: "Inherent and personal characteristics of nurses", "management and training roles of hospital as employer", and " professional performance of nurses". Conclusion: Healthcare team members and administrators should support nurses to solution of ethical challenges if they are improving the ethical nursing care and active participation that are expected. [ABSTRACT FROM AUTHOR]

In the many definitions that are accompanied with nursing, in addition to the scientific aspect, art has always been mentioned. Since Florence Nightingale introduced nursing as an art, several theorists have emphasized the aesthetic aspect of nursing in their literature. However, many experts believe that the word "art" has been accepted in nursing without deep thought and criticism. To judge the statement: "Nursing is an art", it seems that it is necessary to review the similarities and differences of "art" concept in nursing and other fields literature. Art has a complex and multidimensional meaning that is the backbone of many theories presented; however, they each have their own strengths and weaknesses. Nursing has artistic properties; but this characteristic is referred to as folk art and not to specific features of art. In comparing these theories with the concept of art used in nursing, it is essential to note that art in nursing refers to skills of nursing. In other words, nursing is not a kind of fine art. From the aesthetic perspective, nursing can be easily defined as a form of art; however, we must put great importance in the inseparable words of "aesthetic" and "art of nursing". With such a connection, we are able to introduce and capture the true spirit of both art and nursing. In this article, we have reviewed the most important definitions and theories of art as a "specific term", and as "skill", where they have linked nursing to art. Moreover, we have discussed their similarities and differences. [ABSTRACT FROM AUTHOR]

Divergence in Iranian nursing organization including academic and clinical settings adversely affects knowledge transfer. Centralized and medical focused nursing with a lack of effective representation at senior or national level was inferred as the main causal conditions. Using grounded theory methodology, in-depth individual interviews were conducted with 17 participants to better understand their perceptions of the organizational factors influencing knowledge transfer. Organizational factors affecting knowledge transfer can be grouped into two main categories or themes: (i) the dimensions of incompetent organizational content (such as work culture); and (ii) incompetent organizational structure (such as the hierarchy of authority, the expertise and the standardization). The findings showed that there was a range of competing subcultures between management and nursing. The most important basic social problem was inferred as divergence in nursing organization across academic and clinical settings. [ABSTRACT FROM AUTHOR]

Background & Objective: Research utilization is an important way to extent the knowledge in nursing practice. It empowers the nursing profession. Research utilization is a new paradigm in Iran's nursing care. This study aimed to assess the extent of research utilization in nursing clinical practice in Tehran, Iran. Methods & Materials: This is a cross-sectional study. The clinical nurses with at least one year of work experience were selected through a multistage stratified sampling method. They completed a five-sectioned self-report questionnaire. The scores were categorized into high, intermediate, and low. Data were analyzed using descriptive statistics and Chi-Square test in SPSS. Results: Findings revealed that the research utilization in 66.9% of the nurses was low. There was significant relationships between the extent of research utilization and the level of education, professional condition, clinical setting, research activities, work shift, job satisfaction, and English language skills. Conclusion: The majority of nurses' practice is not according to the research findings. We need to find appropriate strategies to enable us to utilize the research findings. [ABSTRACT FROM AUTHOR]

AIM: The focus of the study is the identification of barriers to and facilitators of research utilization in nursing practice from the perspective of Iranian nurses. BACKGROUND: In Iran, research utilization is a new phenomenon thus our knowledge with regard to those factors that promote or discourage research use is limited. No overall picture of the state of research utilization in Iran therefore exists. METHOD: A descriptive design is used. The questionnaire was distributed to 410 nurses from educational hospitals and nursing schools affiliated with Tehran Medical Sciences University in Iran. RESULTS: The major barriers to research utilization were that the nurses do not have time to read research; facilities are inadequate for implementation; and nurses do not feel they have enough authority to change patient care procedures. Findings revealed a number of facilitators which were categorised into two main groups of human resources and individual/organisational factors. CONCLUSION: The healthcare system in Iran does not provide the incentive for nurses to engage in research or to avail themselves of research findings. Also, time is the major issue owing to a nursing shortage. If research utilization is to increase in Iran, therefore, the most important organisational change that needs to occur is the provision of available facilities for nurses to use research evidence. RELEVANCE TO CLINICAL PRACTICE: Key factors that need attention in implementing research results into practice are suggested. Clearly, identification of barriers and facilitators is useful potentially to overcome barriers and enforce facilitators and this could ultimately improve nursing practice. [ABSTRACT FROM AUTHOR]

Research utilisation poses significant challenges for the nursing profession in Iran. Nurses' attitudes toward research and their motivation to engage in research utilisation have repeatedly been identified as potential barriers. Yet little is known about the attitudes of Iranian nurses' regarding research. Therefore, there is a need for a study that focuses particularly on Iranian nurses' attitudes toward research utilisation. The objective was to assess the attitude of Iranian clinical nurses and nurse educators towards nursing research. A self-administered questionnaire based on a cross-sectional survey conducted on 410 respondents from 15 educational hospitals and nursing schools affiliated to Tehran Medical Sciences University, Iran. According to the self-report, nurses generally held positive attitudes toward research. Education, professional role and research activities had a statistically significant relationship with their research attitudes. Although the attitudes towards research were positive, they do not perceive that research is relevant to the day-to-day work of nursing and research is not applicable to nursing as well. The majority of nurses are still not convinced of the importance of research to nursing practice and to the nursing profession. This, in turn, means that nurses do not implement research findings in clinical practice. There is an immediate need to improve research training in our teaching hospital to facilitate the development of the local literature both in terms of research utilisation and production. [ABSTRACT FROM AUTHOR]

As the biggest proportion of hospital personnel, Iranian nurses have a major role in providing quality care to patients. Nursing managers and nurses no longer feel that nurses' work is valued and they are concerned about their productivity. Nurses' views about productivity and management factors affecting it have been identified as the most important aspects affecting productivity. Thus, this study assesses productivity from the nurse's view. A grounded theory approach was used for this research. Purposive sampling and semistructured interviews were used. The data were analyzed using constant comparative analysis. Most participants felt that the qualitative nature (effectiveness) of productivity is very important. Also, participants indicated that management is the most important factor that can promote or impede their productivity. They suggested that managers' performance and their skill level are the factors influencing productivity. Effective management can improve nurses' productivity and the quality of care that nurses provide. [ABSTRACT FROM AUTHOR]

Abstract Background This paper identifies the views of Iranian clinical nurses regarding the utilization of nursing research in practice. There is a need to understand what restricts Iranian clinical nurses to use research findings. The aim of this study was to identify practicing nurses' view of aspects which they perceived constrain them from research utilization that summarizes and uses research findings to address a nursing practice problem. Methods Data were collected during 6 months by means of face-to face interviews follow by one focus group. Analysis was undertaken using a qualitative content analysis. Results Findings disclosed some key themes perceived by nurses to restrict them to use research findings: level of support require to be research active, to be research minded, the extent of nurses knowledge and skills about research and research utilization, level of educational preparation relating to using research, administration and executive challenges in clinical setting, and theory-practice gap. Conclusion This study identifies constraints that require to be overcome for clinical nurses to actively get involved in research utilization. In this study nurses were generally interested to use research findings. However they felt restricted because of lack of time, lack of peer and manager support and limited knowledge and skills of the research process. This study also confirms that research utilization and the change to research nursing practice are complex issues which require both organizational and educational efforts.

Abstract Background Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients. Productivity is a significant indicator of professional development within any professional group, including nurses. The human resource element has been identified as the most important factor affecting productivity. This research aimed to explore nurses' perceptions and experiences of productivity and human resource factors improving or impeding it. Method A qualitative approach was used to obtain rich data; open, semi-structured interviews were also conducted. The sampling was based on the maximum variant approach; data analysis was carried out by content analysis, with the constant comparative method. Results Participants indicated that human resources issues are the most important factor in promoting or impeding their productivity. They suggested that the factors influencing effectiveness of human resource elements include: systematic evaluation of staff numbers; a sound selection process based on verifiable criteria; provision of an adequate staffing level throughout the year; full involvement of the ward sister in the process of admitting patients; and sound communication within the care team. Paying attention to these factors creates a suitable background for improved productivity and decreases negative impacts of human resource shortages, whereas ignoring or interfering with them would result in lowering of nurses' productivity. Conclusion Participants maintained that satisfactory human resources can improve nurses' productivity and the quality of care they provide; thereby fulfilling the core objective of the health care system.

Abstract Background The main objective of this study was to determine the perceptions of Iranian nurse educators and students regarding the evaluation of teaching effectiveness in university-based programs. Methods An exploratory descriptive design was employed. 143 nurse educators in nursing faculties from the three universities in Tehran, 40 undergraduate, and 30 graduate students from Tehran University composed the study sample. In addition, deans from the three nursing faculties were interviewed. A researcher-developed questionnaire was used to determine the perceptions of both faculty and students about evaluating the teaching effectiveness of nurse educators, and an interview guide was employed to elicit the views of deans of faculties of nursing regarding evaluation policies and procedures. Data were analyzed using parametric and nonparametric statistics to identify similarities and differences in perceptions within the Iranian nurse educator group and the student group, and between these two groups of respondents. Results While faculty evaluation has always been a major part of university based nursing programs, faculty evaluation must be approached more analytically, objectively, and comprehensively to ensure that all nursing educators receive the fairest treatment possible and that the teaching-learning process is enhanced. Conclusion Educators and students stressed that systematic and continuous evaluation as well as staff development should be the primary goals for the faculty evaluation process. The ultimate goals is the improvement of teaching by nurse educators.

Abstract Background While the Iranian nursing profession tries to reach to its full capacity for participating in the maintenance of public health, its desire to develop is strongly influenced by cultural, economic, and religious factors. The concept of empowerment is frequently used in nursing and the health services, particularly in relation to the quality of care, since the mission of nursing is to provide safe and quality nursing care thereby enabling patients to achieve their maximum level of wellness. When considering the importance of nursing services in any health system, the 54th World Health Assembly recommended that programs be designed to strengthen and promote the nursing profession. Since empowerment is crucial to the role of nurses, a qualitative study was conducted and aimed at designing a model for empowering nurses in Iran. Methods A grounded theory approach was used for analyzing the participants' experiences, their perceptions and the strategies affecting empowerment. Data collection was done through Semi-structured interviews and participant observation. Forty-four participants were interviewed and 12 sessions of observation were carried out. Results Three main categories emerged from the data collected; these are "personal empowerment", "collective empowerment", and "the culture and structure of the organization." From the participants' perspective, empowerment is a dynamic process that results from mutual interaction between personal and collective traits of nurses as well as the culture and the structure of the organization. Impediments, such as power dynamics within the health care system hinder nurses from demonstrating that they possess the essential ingredients of empowerment. Conclusion A model was designed for empowering the nursing profession in Iran. Implementing this model will not only define nursing roles, identify territories in the national healthcare system, but it will restructure nursing systems, sub-systems, and services. Currently no such model exists; therefore, restructuring of the nursing system, including its services, education and research subsystems is recommended.

Abstract Background Nurses are expected to empower their clients, but they cannot do so if they themselves feel powerless. They must become empowered before they can empower others. Some researchers have emphasized that understanding the concept of power is an important prerequisite of any empowerment program. While many authors have tried to define the concept of power, there is no comprehensive definition. This paper is an attempt to clarify the concept of power in nursing. It also would present a model describing the factors affecting nurse empowerment. Methods We chose the grounded-theory approach for analysis of the participants' experiences and their viewpoints regarding the concept of professional power in nursing. Semi-structured interviews and participant observation methods were used to gather the data. Forty-four participants were interviewed and 12 sessions of observation were carried out. The constant comparative analysis method was used. Results Six main themes emerged from the data: "Application of knowledge and skills", "Having authority", "Being self-confident", "Unification and solidarity", "Being supported" and "Organizational culture and structure". According to the participants, nurses' power is influenced by these six variables. A theoretical model was designed to represent the interrelationships between these six variables. Conclusions Nurses' power depends on gaining and applying professional knowledge and skills. Delegating authority and enhancing self-confidence of the nurses also help them to apply their knowledge in practice. Unification of the nurses and their mutual support play the key roles in development of their collective power and provide a base for better working conditions, professional independence and self-regulation.

Abstract Background Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied. Methods Grounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data. Results Five main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making. Conclusion As participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making.

INTRODUCTION: Painful medical procedures are the major sources of distress among children; and for those with chronic diseases, the procedure-related pain can be worse than that of the illness itself. OBJECTIVE: The purpose of the study was to determine the effect of local refrigeration prior to venipuncture on pain-related responses in school-age children. DESIGN: Quasi-experimental study. SETTING: This study was undertaken in a paediatric emergency ward of a paediatric centre. SUBJECTS: The subjects were 80 children 6 to 12 years of age selected by purposive sampling after being referred to the paediatric emergency ward. INTERVENTIONS: Two groups were chosen for the study: the test and control groups, in order to test the effect of local coldness in reducing the pain of venipuncture. In the test group, the injection site was refrigerated for three minutes using an ice bag. In the control group, the procedure was performed according to usual routine. Physiological responses (ie. blood pressure, pulse, and respiration), behavioural responses (using the Children's Hospital of Eastern Ontario Pain Scale: CHEOPS), and subjective responses (or intensity of pain using the Oucher scale) were measured in the two groups. A non-invasive (electronic) sphygmomanometer was used before and 5 minutes after the procedure to measure the physiological responses. The measurement of behavioral responses by CHEOPS was done at two time points (during the procedure and 5 minutes after the procedure), measuring six areas of behavior: cry, facial expressions, child verbal, torso, touch and leg movement in reaction to painful stimulation. Finally, the subjective responses were measured at 5 minutes after the procedure. MAIN OUTCOME MEASURES: In this study the main outcome measures were: range of physiologic responses, and scores of behavioral and subjective responses. The study hypothesised there would be a lower score in the test group than the control group in behavioural and subjective responses and a lower range in physiologic responses. RESULTS: Results showed no significant difference between the two groups for physiological responses (before and after procedure). However behavioural responses during and after the procedure (p = 0.0011), and subjective responses after the procedure (p = 0.0097) were significantly lower (ie. the test group had lower scores in behavioural and subjective responses compared to the control group. CONCLUSION: The results of this study suggest that the use of local refrigeration prior to venipuncture can be considered an easy and effective intervention of reducing venipuncture-related pain. [ABSTRACT FROM AUTHOR]

Most sports and leisure activities involve repetitive movements in the upper limb, which are typically linked to pain and discomfort in the neck and shoulder area. Movement variability is generally expressed by changes in movement parameters from one movement to another and is a time-dependent feature of repetitive activities. The purpose of this study was to examine the effect of repeated movement-induced fatigue on biomechanical coordination and variability in athletes with and without chronic shoulder pain (CSP). In this controlled laboratory study, 24 overhead athletes in two groups of athletes with (N = 12) and without (N = 12) CSP were recruited. Biomechanical and Electromyographical data were recorded while the athletes were asked to perform repeating reaching tasks (RRT). Kinematic data was recorded every 30 s of the minutes of the repetitive pointing task (RPT). The kinematic and electromyography data were recorded at the first 30 s of "Fatigue-Terminal" (FT) and the last 30 s of "No-Fatigue" (NF) in the repetitive pointing task (RPT). Raw data was analyzed by using MATLAB code to extract the relevant coordination and movement variability data. Different fatigue conditions led to significant kinematic changes during the repetitive pointing task. In the CSP group, trunk lateral flexion decreased after fatigue, while it increased in the CON group (p < 0.013). Trunk rotation and shoulder elevation angles were smaller before fatigue than after in both groups (p < 0.001). Variability in joint angles, including trunk lateral flexion and elbow flexion, increased after fatigue, indicating less stability in movement patterns (p < 0.001). The coordination between trunk movement and shoulder elevation was altered post-fatigue, with significant changes in EMG variability for muscles like the Lower Trapezius and Long Head of the Biceps (p < 0.001). Results of our study indicate that both groups were able to accomplish fatigue, but they employed different movement strategies. The CSP group primarily focused on controlling the shoulder joint, while the CON group utilized both the shoulder and elbow joints in their strategy. This difference suggests that individuals in the CSP group who experienced chronic pain may have developed a strategy to minimize pain and fatigue during the task. Specifically, the CSP group's approach appeared to involve adjustments in movement patterns to manage the task despite fatigue. This adaptation contrasts with the CON group's more complex movement strategy, which involved greater variability and adjustments in both the shoulder and elbow joints., Competing Interests: Declarations. Ethics approval and consent to participate: Prior to starting the investigation, study approval was obtained from the Biomedical Research Ethics Committee of Allameh Tabatab’i University (Ethics code: IR.ATU.REC.1401.084), and all participants gave written informed consent. The authors confirm that all methods were performed in accordance with the relevant guidelines and regulations. Moreover, informed consent has been obtained to publish the images in an online open-access publication. Consent for publication: Written consent for publication has been obtained from the patient, as shown in Fig. 2. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: To estimate the possible associations between posture and physical activity (PA)., Design: A systematic review and meta-analysis., Data Sources: The search was conducted in seven databases (PubMed, Web of Science, SportDiscus, EMBASE, Scopus, Cochrane Library, and CINAHL) for studies published from inception to January 2023., Eligibility Criteria for Selecting Studies: Studies were required to meet following criteria: (1) study design: cross-sectional, case control and cohort studies. (2) Participants: people of all ages without any diagnosed diseases. (3) Exposure and outcome: studies that examined the possible effect or correlations between PA, physical inactivity, physical exertion and human body posture., Results: Sixteen cross-sectional studies, two cohort studies and one case control study involving a total of 16772 participants aged from 6 to 79 years were included. Correlational studies showed that there was a significant relationship between PA and posture (C = 0.100, CI 95% = 0.012-0.186). However, regression studies demonstrated that there was not a significant association between PA and posture (C = 1.00, CI 95% = 0.998-1.002). Three studies investigated the association between PA and the lumbar lordosis and showed that there was not a significant association between the lordosis and PA (CI 95%: -0.253-0.048, P = 0.180). In addition, four studies showed that there were not any associations between scoliosis and PA (CI 95%: 0.819, 1.123, P = 0.607). The evidence of heterogeneity and publication bias was found among all analyzed data (P < 0.05). Also, meta regression was used for age and BMI and the results were not significant., Conclusion: Although a weak correlation was shown to exist between PA and human posture, the odds ratio indicated that there was not a significant association between PA and human posture. The lack of a significant relationship may indicate that multiple biopsychosocial factors may be involved in human posture. In summary, our study highlights the need for caution when interpreting the results of meta-analyses, particularly when there is significant heterogeneity and publication bias in the included studies., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: Osteoarthritis (OA) of the knee is one of the most common global joint disorders, especially in aging population, and is among leading health-related concerns of societies. Therefore, this systematic review and meta-analysis was done to investigate the results related to the effects of exercise interventions on knee repositioning sense in patients with knee OA., Methods: An extensive search was independently performed in electronic databases including PubMed, MEDLINE, Web of Science, SCOPUS, and Google Scholar, to identify randomized clinical trials (RCTs) conducted on knee OA and to evaluate knee repositioning sense before and after different exercise interventions. After extracting relevant data from eligible studies, results of the studies were pooled using a random-effects model of meta-analysis. The Physiotherapy Evidence Database (PEDro) of clinical trials was used for quality assessment of eligible studies., Results: Among 2702 studies identified in the initial search, 17 studies were eligible for final systematic review and meta-analysis. The results showed that the patients who participated in different exercise interventions had significantly less knee repositioning error (mean differences: -1.141 degrees (95%CI: -1.510, -0.772, P < .001) compared to those who did not undergo exercise interventions. The eligible studies exhibited publication bias (Intercept: -6.69, P = .002), and the data showed significant heterogeneity (I2 = 85.633%, Q = 153.125, P < .001). Moreover, meta regression showed more prolonged exercise duration might have more effects on knee repositioning error (Coefficient=-0.860, 95% CI=-1.705, -0.016, Z=-2.00, P = .045)., Conclusion: There is strong evidence that exercise interventions may effectively reduce knee repositioning error. Moreover, it seems that more prolonged exercise duration may be associated with the greater effect size., (© 2023. The Author(s).)

Managing violent behavior is a particularly challenging aspect of hospital psychiatric care. Available pharmacological interventions are often unsatisfactory. Aim: To assess the effectiveness and safety of daytime zopiclone add-on administration in violent and difficult-to-treat psychiatric inpatients. Methods: Chart review of inpatients treated with daytime zopiclone, between 2014 and 2018, with up to 12 weeks follow-up. Effectiveness was retrospectively assessed with the Clinical Global Impression rating scale (CGI) and the frequency and severity of aggressive incidents recorded with the Staff Observation Aggression Scale-Revised (SOAS-R). Results: Forty-five (30 male, 15 female) cases, 18-69 years age range, average (SD) baseline CGI-S score of 5.4 (1.0), and a variety of diagnoses. Sixty-nine percent showed CGI-S improvement of any degree. For patients with at least one aggressive incident within 7 days prior to initiation of zopiclone ( N = 22), average (SD) SOAS-R-Severity LOCF to baseline change was -3.5 (2.7) P < 0.0001. Most patients reported no side effects; 24% reported one or more side effects, and 11% discontinued zopiclone due to sedation (4), insomnia (1) or slurred speech (1). No SAEs were recorded. Zopiclone maximum daily dose correlated with CGI-S baseline-to-LOCF change (rho = -0.5, P = 0.0003). The ROC AUC of zopiclone maximum daily dose and improvement on CGI-S was 0.84 (95% CI 0.70-0.93, P < 0.0001). The ROC AUC of zopiclone maximum daily dose and SOAS-R-N improvement was 0.80 (95% CI 0.58-0.92; P = 0.0008) and maximum Youden's index value was achieved at a dose of >30 mg. Conclusions: Zopiclone doses >30 mg daily achieved the best anti-aggressive effect., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Ceccherini-Nelli, Bucuci, Burback, Li, Alikouzehgaran, Latif, Morin, Ganapathy, Salsali, Abdullah, Westwood, Orris and White.)

The current study aimed to investigate the effects of a Namaste care program on the quality of life of 25 women with late-stage Alzheimer's disease. The program was implemented two hours daily and four days per week for six months in a nursing facility, Tehran, Iran. Women's quality of life was measured using the Persian version of the Quality of Life in Late-Stage Dementia scale before and after the program implementation. After a six-month intervention with the Namaste care program, the total score of quality of life significantly decreased (17.79 ± 1.10 at the end of trial compared with 24.67 ± 1.62 at baseline, P = 0.01), indicating improved quality of life. This effect was obtained after controlling for demographic variables and comorbidities. Hence, it seems that the Namaste care program might be an effective supportive method to improve the quality of life of women with late-stage Alzheimer's disease in Iranian culture. However, further large-sample studies are needed to investigate the generalizability of the findings., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Aim: This study aimed to determine comprehensive and applicable indicators for assessing the quality of nursing clinical services., Design: Methodological research., Methods: The checklist was designed in three phases (conceptualization, item generation and item reduction). In the first phase, a qualitative study using conventional content analysis was performed to clarify the concept of accreditation of clinical nursing services. In the second phase, using the views of experts was obtained in phase 1 and then by a review of the literature, related items were extracted, and item pool was formed. In the last phase, validity and reliability of the checklist were examined., Result: Based on three phases (Conceptualization, Item Generation and Item Reduction), the accreditation indicators of clinical nursing services were extracted in three dimensions including structure, process and outcome at two levels of organizational (including structural and outcome indicators) and individual performance appraisal (process indicators) in 19 main categories., Competing Interests: The authors declare no conflicts of interest., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: Clinical services evaluation with specific indicators are very helpful to identify improvable points. This study was conducted to analyze the factors affecting the quality of clinical nursing services and offer practical solutions for accreditation of clinical nursing services., Methods: The present study was conducted using Delphi method with two rounds. At the beginning of the study a questionnaire was prepared using results of another project (clinical nursing services audit). This questionnaire was sent to 47 nursing and accreditation professionals. After the first round, causes and solutions were categorized. Then participants were asked to comment on the significance of each strategy on the prepared questionnaire., Results: In the first round of Delphi in response to the question about the main causes and solutions of low quality of nursing clinical services, 394 causes and 212 solutions were mentioned by the participants. In the second round, considering moralists and specialization in the selection of nursing managers, staffing according to workload and attendance in comprehensive exam after graduation and before entering clinical fields attained the most importance., Conclusion: Mismatch of human resources with workload and lack of clarity with regard to duties have maximum correlation with poor quality of care. Organizational structure and communication program categories gained the highest and lowest importance respectively. This information could be used by nursing managers and policy makers to plan programs in order to improve the quality of clinical nursing services.