Association between type 2 diabetes and different types of dietary fats: A case-control study.

BACKGROUND: The effect of dietary fats on type 2 diabetes (T2D) is not clear. This study aimed to determine the association between T2D and dietary fatty acids among Iranian adults. METHODS: This case-control study was performed on 4241 participants aged 35-70, including 1804 people with T2D and pre-diabetes as the case group and 2437 people without diabetes as the control group. Dietary intake was assessed using a food frequency questionnaire (FFQ). RESULTS: The cases had higher age (48.36 ± 8.62 vs. 54.53 ± 7.75 y, P < 0.001), weight (73.7713.41 vs. 76.18 ± 13.49 kg, P = 0.001), body mass index (BMI) (28.02 ± 4.70 vs. 24 ± 4.74 kg/m2, P = 0.001), right systolic blood pressure (RSBP) (113.33 ± 16.7 vs. 121.61 ± 17.24 mmHg, P = 0.001), right diastolic blood pressure (RDBP) (71.41 ± 10.53 vs. 75.33 ± 9.92 mmHg, P = 0.001), fasting blood sugar (FBS) (96.87 ± 19.39 vs. 169.95 ± 69.28 mg/dl, P = 0.001), blood urine nitrogen (BUN) (13.65 ± 3.74 vs. 14.26 ± 4.03 mg/dl, P = 0.001), triglyceride (TG) (141.61 ± 99.37 vs. 175.96 ± 114.74 mg/dl, P = 0.001), alkaline phosphatase (ALP) (218.24 ± 66.35 vs. 246.97 ± 72.65 IU/L, P = 0.001), low-density lipoprotein cholesterol (LDL) (111.68 ± 33.02 vs. 101.97 ± 36.54 mg/dl, P = 0.001), serum glutamic-pyruvic transaminase (SGPT) (21.88 ± 15.15 vs. 23.55 ± 15.96 IU/L, P = 0.001), gamma-glutamyl transferase (GGT) (24.66 ± 20.42 vs. 30.72 ± 30.43 IU/L P = 0.001), and cholesterol (192.45 ± 39.1190 vs. 187.12 ± 46.19 mg/dl P = 0.001) compared to the control group. T2D was negatively associated with dietary intake of PUFAs (OR = 0.93, CI95%:0.84-1.03, P = 0.01) and positively associated with dietary cholesterol (OR: 1.01, CI95%:1.001-1.01, P = 0.02). CONCLUSION: In summary, cholesterol was positively and PUFAs were negatively associated with diabetes. If the results of the present study on the effect of fat intake on diabetes are proven, future dietary recommendations for people at risk of diabetes may be corrected by providing diets rich in polyunsaturated fatty acids and low in cholesterol.

Fear of the unknown, anxiety, and social isolation in Iranian patients with Covid-19, the grounded theory.

BACKGROUND: Coronavirus 2019 (COVID-19) pandemic has incurred a health challenge. Patients suffer from many physical and mental disorders. To accurately identify the experience of patients with Covid-19 in the Iranian society. MATERIALS AND METHODS: This qualitative research was conducted using the grounded theory. The data of this grounded theory study were collected using 32 semi-structured interviews with participants and field notes including the patients with Covid-19, nurses, physicians, and the patients' families. Data analysis was performed using Corbin and Strauss (2008) approach for concepts, context, process, and categories' integration. RESULTS: Qualitative analysis of data led to the extraction of 54 sub-categories and 7 final categories. "Isolation, fear of death, and fear of infection of relatives and family members" were identified as the main issue. The context to this concern was the "unfamiliarity with the virus due to its ambiguous nature that was obtained with a wide range of symptoms." Facing this issue, the patients used the strategy of "adherence to health protocol in the coronavirus infection process" that was recognized as the central variable. CONCLUSION: The ambiguous and complex nature of the emerging virus, the appearance of different symptoms in different people, and the fear of infecting others, death and anxiety due to unknown complications of the disease make patients go through the most difficult experience of their lives. That requires ongoing training on up-to-date prevention and treatment protocols, along with the emergence of mutated viruses and new symptoms.

The obstetric and gynecological service providers' and recipients' perception and experience of the quality of obstetric triage services during the COVID-19 pandemic in Iran.

BACKGROUND: Enhancing the quality of obstetric triage services requires a clear perception of the current situations and problems, this issue gained more importance during the COVID-19 pandemic. The purpose of this study was to explore the obstetric and gynecological service providers' and recipients' perception and experience of the quality of obstetric triage services during the COVID-19 pandemic. METHODS: This research was a qualitative study carried out using conventional content analysis. Participants were selected through purposive sampling, and data collection was conducted using in-depth semi-structured interviews. Data were analyzed using MAXQDA software and conventional content analysis. Validity of the data was approved based on four criteria: credibility, dependability, conformability and transferability. RESULTS: Five themes emerged through analysis: "unpreparedness to deal with the COVID-19 resulting in disorganized triage", "threat to the physical and mental health of personnel during the COVID-19 pandemic", "degradation of the quality of services due to improper triage structure during the COVID-19 pandemic", "communicating with patients which is neglected during the COVID-19 pandemic" and finally "accountability required to improve the provision of services during the COVID-19 pandemic. CONCLUSION: Obstetrics and gynecology service providers and recipients faced formidable challenges in the triage department during this pandemic caused by the complex and ambiguous nature of the Coronavirus. Identifying the problems, barriers and challenges in providing services to patients in this situation especially in triage, can lead to an improvement in the outcome of services.

Nurses' Experience of Occupational Alienation in the Clinical Setting: A Content Analysis.

Background: Job alienation of nurses leads to adverse consequences such as occupational dysfunction and low quality of health-care services provided by these individuals to patients. This study aimed to explain nurses' experience of occupational alienation in the clinical setting. Materials and Methods: This qualitative study was conducted using the content analysis method. Data were collected via 18 in-depth and semistructured interviews from nurses working in the hospitals in Sabzevar, Iran. The participants were selected via purposive sampling and continued till data saturation. The obtained data were simultaneously analyzed using conventional qualitative content analysis. Results: The qualitative analysis of data content led to the extraction of the themes that reflected the nurses' experience of occupational alienation in the clinical environment. After the transcription of each interview, the obtained data were broken down into codes in the form of sentences and paragraphs related to the main concept. The codes were reviewed several times and the relevant semantic unit codes were written down and classified based on conceptual and semantic similarity. Qualitative data analysis led to the emergence of 260 initial codes, 120 subcategories, 30 main categories, and 6 themes. Finally, the main theme of the "nursing gradual separation from caring and clinical aspect" was extracted. Conclusions: According to the results, occupational alienation reduces the quality of patient care, weakens nurses, and reduces the continuity of their effective and active presence in the provision of care services and clinical decision-making. Therefore, managerial and organizational interventions are required to address this issue.

The ethical obligation to provide care to patients diagnosed with brain death until the end stages based on grounded theory.

Nurses are faced with tremendous pressure when providing brain-dead patients with care. There is limited guidance for nurses on the care of these patients. The present study aimed to report the experiences of nurses regarding the care of patients diagnosed with brain death. Semi-structured interviews were conducted with 31 nurses and other stakeholders, and the observations and field notes were analyzed using continuous and comparative analysis based on grounded theory. The qualitative analysis of the data resulted in extraction of six final categories, including 'facing increased tensions and conflicts', 'organ donation: a distinct care element', 'inconsistency of care management', 'effective care requirements', 'challenges, rights and duty requirements', and 'moral obligation to provide holistic care until the last minute'. Data analysis identified 'Challenges, rights and duty requirements' as the main issue and showed that the nurses managed this issue using the strategy of 'moral obligation to provide holistic care until the last minute' as the core variable. According to the results, it is recommended that the healthcare system (especially hospital management) take supportive action for nurses in various fields of care of brain-dead patients to resolve educational, moral and legal challenges.

The Impact of Incentive Spirometry on Shoulder Tip Pain in Laparoscopic Cholecystectomy: A Randomized Clinical Trial.

BACKGROUND: Shoulder pain is among the early postlaparoscopic symptoms related to carbon dioxide used for pneumoperitoneum, which remains in the abdominal cavity. Therefore, incentive spirometry (IS) is a novel technique to alleviate this pain following laparoscopic cholecystectomy (LC). The present study was designed to investigate if the use of IS after LC would relieve shoulder tip pain, and determine the amount of postoperative opioid analgesics utilized. MATERIALS AND METHODS: This randomized clinical trial was conducted on patients who were clinically diagnosed with cholecystitis, and underwent LC. Accordingly, group I patients (n=42) received IS (including 10 deep breaths with a spirometer in sitting or semisitting positions) in full consciousness every 2 hours starting at 2 hours after surgery, but group II patients (n=42) did not have respiratory physiotherapy. The postoperative shoulder pain after the surgery was further evaluated by a numerical rating scale (NRS). RESULTS: At 4, 8, 12, 24, and 48 hours following LC, the NRS pain scores significantly reduced in group I compared with group II. In addition, the results of the repeated measures analysis of variance indicated significantly lower NRS pain scores within the first 48 hours after LC in group I compared with group II. Consequently, the study findings showed a significantly higher percentage of cases in group II, requiring postoperative analgesics, in comparison with group I. CONCLUSIONS: IS decreased the severity of shoulder tip pain after LC with no complications. Thus, IS may be considered as a viable alternative to other laparoscopic interventions. However, still further studies are necessary to evaluate its efficacy compared with other techniques.

Designing a comprehensive clinical competency test for operating room technology student: Using Delphi technique and CIPP model evaluation.

BACKGROUND: The ultimate goal in educating medical students is to train skilled workforce who by obtaining the required knowledge of the discipline, personal and professional skills, and attitudes to enter the national health-care system. This study was conducted with the goal of designing a comprehensive clinical competency test of operating room technology student using the Delphi technique, and then, the clinical skills of the operating room technology students of the paramedical school were assessed using the CIPP evaluation model. MATERIALS AND METHODS: The present study was conducted in the University of Medical Sciences to evaluate clinical skills with Delphi technique and CIPP evaluation model. This was a mixed methods study. Purposive sampling method was employed in the qualitative stage, and a census was conducted in the quantitative part. A comprehensive clinical competency test was designed in this research using the Delphi technique and was conducted with 18 students. Then, clinical skills evaluation was performed by descriptive-analytical statistical tests and evaluator's observation using the CIPP model. RESULTS: The comprehensive clinical competencies test of the surgical technology students was designed in four sections: content, evaluation method, test conditions, and the criteria for passing the comprehensive test. The results in the implementation stage showed that the operating room technology students had a range of excellent to weak performances in exhibiting basic skills at different levels. CONCLUSIONS: The results of the present study showed that the comprehensive test, designed based on the Delphi technique of experts, and using the CIPP model can be a good criterion for the evaluation of the operating room technology students before entering the clerkship.

Improving psychological security and empowerment: New model for nurses toward the care of potential organ donors.

BACKGROUND: Caring for brain dead patients is the heaviest of duties for nurses, and despite tremendous stress, there are no theories/models to support nurses in this situation. This study designed a supportive model for nurses to provide care for potential organ donors. MATERIALS AND METHODS: This qualitative study was conducted in two stages. In the first stage, semi-structured interviews with 31 nurses and other stakeholders, observation and field notes continued until data saturation, (on 2018), were analyzed using continuous and comparative analysis through Corbin-Strauss method. In the second stage, theory synthesis of Walker and Avant's strategies for theory construction (2011) was used to design a supportive model/theory. The theory synthesis includes three stages: (i) selection of focal concept (the concept of "moral obligation to provide holistic care until the last minute" was selected); (ii) review of studies to identify the factors related to focal concept relevant studies (42 articles were reviewed, statements and concepts related to focal concept were then extracted and classified, and their relations were specified); and (iii) organization of concepts and statements within a relevant general and effective manifestation of the phenomenon under study which led to developing of a model. RESULTS: In this supportive model/theory, "improving psychological security and empowerment" was conceptualized within the conceptual framework. This supportive model entails three main components, including (i) informational and educational support, (ii) systematically support, and (iii) management support. CONCLUSIONS: According to the results, nurses with moral obligation to provide holistic care were faced with several challenges. Therefore, it is recommended that the healthcare system take supportive proceedings for nurses in various fields of the care for brain dead patients to resolve educational, moral, and legal challenges. This supportive model is essential for maintaining the nurses' health, increasing the quality of nursing care and the health of potential transplant organs.

Nurses' Challenges in Caring for an Organ Donor Brain Dead Patient and their solution strategies: A Systematic Review.

BACKGROUND: Caring for brain dead patient is one of the most troublous duties of an Intensive Care Unit (ICU) nurse. This study aimed to determine nursing challenges based on recent literature and identify the strategies to overcome these challenges. MATERIALS AND METHODS: In this systematic review, the standard systematic review guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used with articles published in PubMed, Science Direct, Scientific Information Database (SID), and Google Scholar databases during 2000-2018 on the keywords "brain dead OR brain death" and "nurses OR nursing." After the primary search, 212 articles were found. Eventually, 21 articles were selected for the final evaluation. RESULTS: According to the results, the challenges included the concept and diagnosis of brain death, religious, and cultural beliefs opposing organ donation, lack of knowledge about the care process, interactions with the families. The proposed strategies were providing medical and nursing interventions to maintain a brain dead patient for organ donation, providing working conditions that maintain nurses' health, and increase the quality of care. CONCLUSIONS: Nurses play an important role in the care process of brain dead patients; therefore, recognizing their challenges can be thefirst step in increasing holistic care and maintaining organ vitality for transplantation. It is suggested that nursing authorities commence special educational programs with the aim to increase the knowledge of nurses about the care process of brain dead patients.