Effect of Dill (Anethum graveolens) Oil on Pruritus and Quality of Life of Hemodialysis Patients: A Randomized Double-Blind Three-Arm Controlled Trial.

Introduction: Anethum graveolens (AG), commonly known as dill, is a plant from the Apiaceae family that has been traditionally used as a skin softener and purifying agent in Persian medicine. In a previous study conducted on male rats, dill was found to have anti-inflammatory effects. The current study aimed to examine the efficacy of topical application of Anethum graveolens oil on pruritus severity, skin dryness, sleep quality, and quality of life in patients undergoing hemodialysis. Methods: In the current clinical trial, the participants were randomly assigned to one of these groups: topical AG preparation, sesame oil, or a control group receiving no treatment. The study was double-blind and placebo-controlled. The topical treatment was applied twice a day for one month to areas of the skin affected by pruritus. The outcome measures included the severity of skin dryness, the Pittsburgh Sleep Quality Index, Duo's Uremic Pruritus Severity Scale, and the Itchy QoL questionnaire. Results: This study involved 106 hemodialysis patients, and after intervention for one month, the medication group had a significantly lower mean score of sleep quality (3.24 ± 2.41) than the placebo (4.54 ± 3.11) and control (5.05 ± 3.21) groups (P=0.032). The mean change in pruritus severity was significantly greater in the medication group (-17.28 ± 8.938) than the placebo (-5.91 ± 5.398) and control (-3.43 ± 3.228) groups (P < 0.001). Moreover, a significant difference was observed in the mean changes in quality of life between the medication, placebo, and control groups, with values of -14.88 ± 7.89, -5.34 ± 4.50, and -1.92 ± 2.86, respectively (P < 0.001). Furthermore, both the medication and placebo groups showed improvement in skin dryness compared to the control group having the values of -1.65 ± 0.91, -1.11 ± 0.79, and -0.38 ± 0.54, respectively (P < 0.001). Conclusion: Topical Anethum graveolens preparation significantly improved the sleep quality and quality of life and reduced skin pruritus and dryness in hemodialysis patients. It could be considered as a simple therapeutic modality to control pruritus in hemodialysis patients. This trial is registered with IRCT2017022032671N1.

Heterogeneous Sono-Fenton like catalytic degradation of metronidazole by Fe3O4@HZSM-5 magnetite nanocomposite.

In this research, Fe3O4@HZSM-5 magnetic nanocomposite was synthesized via a coprecipitation method for metronidazole (MNZ) degradation from aqueous solutions under ultrasonic irradiation which showed superb sonocatalytic activity. The synthesized magnetite nanocomposite was characterized by using field-emission scanning electron microscope-energy dispersive X-ray Spectroscopy, (FESEM-EDS), Line Scan, Dot Mapping, X-ray diffraction (XRD), vibrating sample magnetometer (VSM), and Brunauer-Emmett-Teller (BET). To investigate the sonocatalytic activity of the Fe3O4@HZSM-5 magnetite nanocomposite, the sonocatalytic removal conditions were optimized by evaluating the influences of operating parameters like the dosage of catalyst, reaction time, pH, the concentration of H2O2, MNZ concentration, and pH on the MNZ removal. The MNZ maximum removal efficiency and TOC at reaction time 40 min, catalyst dose 0.4 g/L, H2O2 concentration 1 mM, MNZ initial concentration 25 mg/L, and pH 7 were achieved at 98% and 81%, respectively. Additionally, the MNZ removal efficiency in the real wastewater sample under optimal conditions was obtained at 83%. The achieved results showed that using Langmuir-Hinshelwood kinetic model KL-H = 0.40 L mg-1, KC = 1.38 mg/L min) can describe the kinetic removal of the process. The radical scavenger tests indicated that the major reactive oxygen species were formed by hydroxyl radicals in the Sono-Fenton-like process. Evaluation of the nanocomposite reusability showed an 85% reduction in the MNZ removal efficiency after seven cycles. Based on the results, it can be concluded that Fe3O4@HZSM-5 were synthesized as magnetic heterogeneous nano-catalysts to effectively degrade MNZ, and the observed stability and recyclability demonstrated that Fe3O4@HZSM-5 was promising for the treatment of wastewater contaminated with antibiotics.

The Effect of Training the Nonverbal Pain Scale (NVPS) on the Ability of Nurses to Monitor the Pain of Patients in the Intensive Care Unit.

Introduction: Pain in the intensive care unit is a silent fact. Considering the positive features of the nonverbal pain scale (NVPS) in assessing the pain of non-verbal patients, this study investigates the effect of training the NVPS on the ability of nurses to monitor the pain of patients in the intensive care unit. Materials and methods: In this semi-experimental study, the effect of the NVPS training on the ability of 50 intensive care unit (ICU) nurses of Imam Khomeini Hospital affiliated to Ahvaz University of Medical Sciences was investigated. At first, the ability to diagnose the presence and intensity of pain was checked by a checklist. Then the nurses were taught how to use the scale correctly. After 2 weeks of training completion, the ability to correctly use the scale was measured again. Data analysis was performed using descriptive statistics (mean and standard deviation) and inferential statistics (McNemar, Chi-squared, paired t-test, and Fisher's exact test) in SPSS software version 16. Results: After the training on the non-verbal pain scale, there was a significant difference between the intervention and control groups in diagnosing the presence of pain related to changing the patient's position (p = 0.023). Also, nurses ability to diagnose pain intensity during airway suction increased fourfold and for physiotherapy procedures twice as much as before training. Conclusion: Nonverbal pain scale training improves ICU nurses ability in diagnosing the presence and severity of pain in nonverbal patients. How to cite this article: Ghayem H, Heidari MR, Aghaei B, Norouzadeh R. The Effect of Training the Nonverbal Pain Scale (NVPS) on the Ability of Nurses to Monitor the Pain of Patients in the Intensive Care Unit. Indian J Crit Care Med 2023;27(3):195-200.

Psychometric Properties of the Intensive Care Unit Nurses' Perceptions Questionnaire of Self-Performance With Families of Critically Ill Patients (Persian Version).

BACKGROUND AND PURPOSE: Nurses' self-perception of their performance toward family members of patients is one of the most important issues in predicting family adaptive behaviors. This study analyzed the psychometric properties of the Persian version of intensive care unit (ICU) nurses' perceptions questionnaire of self-performance with families of critically ill patients. METHODS: Among 135 intensive care nurses, to determine face validity, 10 nurses were asked to comment on, comprehensibility, grammar, and writing of items. Exploratory factor analysis was used to assess construct validity. RESULTS: The intra-cluster correlation coefficient (ICC) was 0.82 and Cronbach's alpha was 0.74. Exploratory factor analysis showed the first nine related factors have 65.22% variance. CONCLUSION: Persian version of ICU nurses' perceptions of self-performance with families of critically ill patients had good reliability and validity.

Experimental data on the removal of phenol by electro-H2O2 in presence of UV with response surface methodology.

Phenol is classified as priority pollutant. Phenol and its derivatives are stable in water, environmental contamination, and health concerns that are used as raw material in many chemical industries. This study investigated the removal of phenol by electro-H2O2/UV system. The response surface methodology (RSM) using central composite design (CCD) was used to modeling and optimization of experimental parameters such as pH, contact time, initial concentration of phenol, concentration of hydrogen peroxide, and current density. The obtained results demonstrated that the efficiency of the electro-H2O2/UV system was maximum (>99%) under the optimal conditions for the phenol removal from aqueous solutions, 2 mM of hydrogen peroxide concentration, 50 mg/L of initial phenol concentration, pH of 5, 10 mA/cm2 of current density, reaction time of 25 min and 2.1 kW h/m3 of energy consumption. Therefore, the electro-H2O2/UV system is an efficient method for the removal of organic compounds from industrial wastewater.

Citrus aurantium Aroma for Anxiety in Patients with Acute Coronary Syndrome: A Double-Blind Placebo-Controlled Trial.

Objective: This study evaluated the antianxiety effect of Citrus aurantium aroma (neroli oil) inhalation on patients with acute coronary syndrome (ACS). Design: A double-blind, placebo-controlled randomized trial. Setting/Location: This study was conducted in the Coronary Care Unit of Torfeh Hospital in Tehran, Iran, from September 2017 to February 2018. Subjects: A total of 140 hospitalized ACS patients (mean age = 56.72 ± 11.38 years) Interventions: Eligible patients were randomly assigned to citrus aroma and placebo groups to receive inhalation aromatherapy 2 days after hospitalization. Citrus aroma was 30% essential oil of Citrus aurantium L. flowers in paraffin, which was administrated three times a day. The placebo group received paraffin similarly. Outcome measures: The rate of anxiety was measured at baseline and after intervention using the State-Trait Anxiety Inventory. Results: At baseline, citrus aroma and placebo groups were similar in demographic characteristics as well as anxiety scores. After intervention, mean anxiety scores in the two groups become significantly different; the scores were 34.66 ± 9.6 and 42.36 ± 6.4 for citrus aroma and placebo groups, respectively (p < 0.0001). No side effect was observed. Conclusions: According to the current findings, aromatherapy with Citrus aurantium L. aroma (neroli oil) may be a safe and efficient intervention and can be considered an easy and applicable method to reduce anxiety in patients with ACS.

A Second-Order Confirmatory Factor Analysis of the Moral Distress Scale-Revised for Nurses.

BACKGROUND: Moral distress is a growing problem for healthcare professionals that may lead to dissatisfaction, resignation, or occupational burnout if left unattended, and nurses experience different levels of this phenomenon. OBJECTIVES: This study aims to investigate the factor structure of the Persian version of the Moral Distress Scale-Revised in intensive care and general nurses. RESEARCH DESIGN: This methodological research was conducted with 771 nurses from eight hospitals in the Mazandaran Province of Iran in 2017. Participants completed the Moral Distress Scale-Revised, data collected, and factor structure assessed using the construct, convergent, and divergent validity methods. The reliability of the scale was assessed using internal consistency (Cronbach's alpha, Theta, and McDonald's omega coefficients) and construct reliability. ETHICAL CONSIDERATIONS: This study was approved by the Ethics Committee of Mazandaran University of Medical Sciences. FINDINGS: The exploratory factor analysis (N = 380) showed that the Moral Distress Scale-Revised has five factors: lack of professional competence at work, ignoring ethical issues and patient conditions, futile care, carrying out the physician's orders without question and unsafe care, and providing care under personal and organizational pressures, which explained 56.62% of the overall variance. The confirmatory factor analysis (N = 391) supported the five-factor solution and the second-order latent factor model. The first-order model did not show a favorable convergent and divergent validity. Ultimately, the Moral Distress Scale-Revised was found to have a favorable internal consistency and construct reliability. DISCUSSION AND CONCLUSION: The Moral Distress Scale-Revised was found to be a multidimensional construct. The data obtained confirmed the hypothesis of the factor structure model with a latent second-order variable. Since the convergent and divergent validity of the scale were not confirmed in this study, further assessment is necessary in future studies.

Removal of phenol from steel wastewater by combined electrocoagulation with photo-Fenton.

Phenol and its derivatives are available in various industries such as refineries, coking plants, steel mills, drugs, pesticides, paints, plastics, explosives and herbicides industries. This substance is carcinogenic and highly toxic to humans. The purpose of the study was to investigate the removal of phenol from wastewater of the steel industry using the electrocoagulation-photo-Fenton (EC-PF) process. Phenol and chemical oxygen demand (COD) removal efficiency were investigated using the parameters pH, Fe2+/H2O2, reaction time and current density. The highest removal efficiency rates of phenol and COD were 100 and 98%, respectively, for real wastewater under optimal conditions of pH = 4, current density = 1.5 mA/cm2, Fe2+/H2O2 = 1.5 and reaction time of 25 min. Combination of the two effective methods for the removal of phenol and COD, photocatalytic electrocoagulation photo-Fenton process is a suitable alternative for the removal of organic pollutants in industry wastewater because of the low consumption of chemicals, absence of sludge and other side products, and its high efficiency.

Psychometric Evaluation of the Sex After Myocardial Infarction Knowledge Test in Iranian Context.

PURPOSE: To translate, adapt, and assess the psychometric properties of the Sex After MI Knowledge Test in Iranian context (where MI is myocardial infarction). DESIGN AND METHODS: A cross-sectional descriptive survey was performed. The sample comprised 250 patients with MI. Confirmatory factor analysis was applied to extract three indicators. FINDINGS: The Sex After MI Knowledge Test indicated good reproducibility (Cronbach's α = .76, Intraclass correlation (ICC) = 0.729, CI = 0.7280-0.781, p < .001 ICC: Intraclass correlation). Nonnormed and normed fit indices (FI) were 0.89, and incremental and comparative FIs were 0.90. Goodness-of-fit index (GFI) and adjusted GFI were below the criteria. After a varimax rotation, the first six items of the instrument explained 58.71% of total variance. PRACTICE IMPLICATIONS: The instrument showed acceptable psychometric properties in terms of construct validity and internal consistency. The instrument might be used to stimulate conversations patients with MI regarding sexual knowledge and concerns.

The Effect of Testicular Self-Examination Education on Knowledge, Performance, and Health Beliefs of Turkish Men.

Testicular cancer is the most common cancer among young adult men and easily detected at an early stage by periodic testicular self-examination (TSE); however, health care providers seldom teach TSE, thus opportunities for early detection are missed. We aimed to evaluate the efficacy of TSE education on the knowledge, performance, and health beliefs of Turkish young men. This quasi-experimental follow-up research was conducted on 174 male Health Science university students in Turkey. The data was collected by a modified socio-demographic form and questionnaire, and the Turkish version of Champion Health Belief Model Scale which was performed at two stages: before and 3 months after education. Before education, 66.2% of the students did not know anything about TSE, and the main reason for not to perform TSE was the lack of knowledge prior to education. The results showed a significant increase in the perceived benefits in terms of TSE after education (p < 0.05). Furthermore, a positive improvement in the behavior of the students toward TSE was observed after education. These results indicate that TSE training is effective in young men, but TSE training should be repeated periodically for better efficacy. These results support that health professionals should have a more active role in the training of adult young men in colleges in terms of TSE.

Gender differences in symptom predictors associated with acute coronary syndrome: A prospective observational study.

Signs and symptoms (typical and atypical symptoms) of acute coronary syndromes (ACS) differ between men and women. Identification of gender differences has implications for both health care providers and the general public. The aim of this study was to determine the symptom predictors of the acute coronary syndromes in men and women. In this prospective study, nurse data collectors directly observed 256 men and 182 women (N = 438) with symptoms suggestive of ACS in the Emergency Departments of eight hospitals in Tehran. ACS was eventually diagnosed in 183 (57.2%) men and 137 (42.8%) women on the basis of standard electrocardiogram and cardiac enzyme (CPK-MB) level. In men, chest symptoms (OR = 3.22, CI = 0.137-0.756, P = 0.009), dyspnea (OR = 2.65, CI = 1.78-4.123 P = 0.001) and diaphoresis (OR = 2.175, CI = 1.020-4.639, P = 0.044) were significantly associated with the diagnosis of ACS 3.78, 2.72 and 1.87 times more than in women having these symptoms, respectively. These results indicated that chest symptoms, diaphoresis and dyspnea were the more pronounced typical symptoms of ACS in men compared to women. Additionally, the numbers of typical symptoms can be considered as more predictive of ACS in men (OR = 1.673, CI = 1.211-2.224, P < 0.001) than women (OR = 1.271, CI = 1.157-2.331, P = 0.212). Therefore, clinicians need to take men showing typical symptoms into consideration carefully.

Nursing students' perspectives on clinical education.

INTRODUCTION: The importance of optimal clinical nursing education in professional skills development is undeniable. In clinical education, nursing students are often faced with problems. Recognizing nursing students' perception on clinical education is the first step to remove the barriers of this challenge. Methods This descriptive cross-sectional study was conducted to determine the nursing students' perspectives on clinical education. 150 nursing students were selected randomly from nursing and midwifery schools (Tehran). Data collection instrument was a researcher made questionnaire consisting of five domains: objective and curricula, instructor, feedback to student in clinical field, clinical environment, supervision and evaluation. Mean and standard deviation were calculated for each item, using SPSS, ver.14. Chi- square test was used to compare the nursing students' perspectives on clinical education based on age, sex and the work experience. The significance level was considered 0.05. RESULTS: Mean age of the students was 21.58±26.97 students (66%) were male. 44 students (30.1%) had work experience (3.58±6.48 month). Male and female students had different perceptions in domains of clinical education (p<0.05). Nursing student had different perceptions as to objectives and curricula (p=0.039), how to deal with students in the clinical environment (p=0.032), supervision, and evaluation (p<0.001) with respect to their work experience duration. The most positive responses were in clinical instructor (81.5%) and the most negative ones were the clinical environment (33.66%), respectively. CONCLUSION: Providing an optimal clinical environment and improving the supervision and evaluation of student practice should prioritized in schools of nursing and midwifery.

Supporting families of dying patients in the intensive care units.

Family support in the intensive care units is a challenge for nurses who take care of dying patients. This article aimed to determine the Iranian nurses' experience of supporting families in end-of-life care. Using grounded theory methodology, 23 critical care nurses were interviewed. The theme of family support was extracted and divided into 5 categories: death with dignity; facilitate visitation; value orientation; preparing; and distress. With implementation of family support approaches, family-centered care plans will be realized in the standard framework.