The relationship between nurses' moral competency and missed nursing care: a descriptive-correlational study.

BACKGROUND: When any aspect of patient care is overlooked or delayed, it is known as Missed Nursing Care (MNC), leading to adverse events such as medication errors, infections, increased mortality rates, and poor prognosis. Moral competence is crucial for clinical nurses as it guarantees high-quality patient care in nursing practice. Thus, this study aimed to investigate the correlation between moral competencies and MNC among nurses. METHODS: This study was conducted with a descriptive-correlational design. The participants in the study were nurses who were currently enrolled at Shahid Beheshti University of Medical Sciences. In order to recruit nurses for the study, a convenience sampling method was implemented. The study tools were completed by a total of two hundred nurses. Research tools included a demographic questionnaire, the Moral Competence of Clinical Nurses Questionnaire, and the Kalisch and Williams Missed Nursing Care (MISSCARE) survey. ETHICAL CONSIDERATION: This study was approved by the Medical Ethics and Law Research Center of Shahid Beheshti University of Medical Sciences. RESULTS: The mean scores of moral competencies and MNC were 151.83 ± 12.60 and 42.71 ± 9.38, respectively. In other words, descriptive statistics showed that the moral competence score was more than 75%, and the MNC score was less than 50%. Also, there was a significant negative correlation between the total scores of moral competencies and MNC (r = -0.38, p < 0.001), indicating that more moral competence was correlated with lower levels of MNC. CONCLUSION: The study revealed a negative correlation between nurses' moral competence and MNC, suggesting that enhancing moral competence could reduce MNC. To reduce MNC occurrences, hospitals, and organizations should prioritize moral competency, according to our research.

Mask-related pressure injury prevention associated with non-invasive ventilation: A systematic review.

Noninvasive ventilation interfaces are one of the main factors contributing to pressure injuries caused by medical devices. Prevention is still the best course of action when discussing noninvasive ventilation-induced pressure injuries. A systematic review was designed to summarize and analyse all published literature on strategies to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The protocol of the systematic review followed the PRISMA guideline. An extensive search from the beginning to May 16, 2023, using current articles in databases such as Web of Science (WOS), Scopus, PubMed, and Cochrane Library was conducted. Medical Subject Headings (MESH) were used as follows: "Pressure Injury," "Noninvasive Ventilation," "Prevention," and "Pressure Sore." Any language-published studies that met the inclusion criteria were included in this review. A risk of bias assessment was conducted using the Joanna Briggs Institute tool, including evaluation methodologies for all studies. Database searches yielded 2546 articles, which were reduced to 23 that met our criteria after reviewing full texts. A narrative synthesis was conducted. As a result, type of interface (14 studies), dressings (4 studies), adjustment of mask leakage (1 study), humidity (1 study), positioning (1 study), and design of personalized masks (2 studies) seem to be a practical approach to prevent pressure injuries caused by masks in patients undergoing noninvasive ventilation. The results of our study show the effectiveness of preventive methods in reducing the incidence of pressure injuries caused by masks. Given the significant occurrence of pressure injury related to noninvasive ventilation and the crucial role of prevention and treatment, it is imperative to conduct more rigorous studies to ascertain the efficacy of each strategy.

Solving the Combined Heat and Power Economic Dispatch Problem in Different Scale Systems Using the Imperialist Competitive Harris Hawks Optimization Algorithm.

The aim of electrical load dispatch (ELD) is to achieve the optimal planning of different power plants to supply the required power at the minimum operation cost. Using the combined heat and power (CHP) units in modern power systems, increases energy efficiency and, produce less environmental pollution than conventional units, by producing electricity and heat, simultaneously. Consequently, the ELD problem in the presence of CHP units becomes a very non-linear and non-convex complex problem called the combined heat and power economic dispatch (CHPED), which supplies both electric and thermal loads at the minimum operational cost. In this work, at first, a brief review of optimization algorithms, in different categories of classical, or conventional, stochastic search-based, and hybrid optimization techniques for solving the CHPED problem is presented. Then the CHPED problem in large-scale power systems is investigated by applying the imperialist competitive Harris hawks optimization (ICHHO), as the combination of imperialist competitive algorithm (ICA), and Harris hawks optimizer (HHO), for the first time, to overcome the shortcomings of using the ICA and HHO in the exploitation, and exploration phases, respectively, to solve this complex optimization problem. The effectiveness of the combined algorithm on four standard case studies, including 24 units as a medium-scale, 48, 84, units as the large-scale, and 96-unit as a very large-scale heat and power system, is detailed. The obtained results are compared to those of different algorithms to demonstrate the performance of the ICHHO algorithm in terms of better solution quality and lower fuel cost. The simulation studies verify that the proposed algorithm decreases the minimum operation costs by at least 0.1870%, 0.342%, 0.05224%, and 0.07875% compared to the best results in the literature.

The effect of Benson relaxation technique on cancer patients: a systematic review.

PURPOSE: Although many studies have investigated the effect of this method on cancer patients, no review of the available literature has been done. So, a literature review is conducted to evaluate all published literature on the Benson relaxation technique in cancer patients. METHODS: A systematic literature search was conducted. A systematic search of online electronic databases including PubMed/MEDLINE, Scopus Web of Science, PsycINFO, and EMBASE was performed using keywords extracted from Medical Subject Headings such as "Benson Relaxation Technique," "Cancer Patients," "Malignancy," and "Neoplasia" from the beginning to April 27, 2023. A total of 810 publications were assessed for relevance by title and abstract. The remaining 31 articles were examined using inclusion criteria for all Persian and English-language publications that evaluate the effectiveness of the Benson relaxation technique on cancer patients. We did not have gray literature in our review. The methodological quality of the included studies was appraised using specific checklists. RESULTS: Finally, nine studies were included in this systematic review. Studies on breast cancer patients showed improvement in fatigue, nausea, vomiting, pain, shortness of breath, insomnia, anorexia, constipation, diarrhea, treatment side effects, breast symptoms, arm symptoms, worry about hair loss, and scores of hope. Two studies were conducted among cervical cancer patients that showed a decrease in anxiety scores and an improvement in the quality of sleep. Another study on gastric cancer patients showed decreased Chemotherapy-Induced Nausea, Vomiting, and Retching scores. CONCLUSION: Overall, this systematic review showed that the Benson relaxation method could improve sleep quality, appetite, anxiety, and quality of life. Therefore, using the Benson relaxation technique is suggested to improve health-related outcomes in cancer patients.

Age and aging effects on blood pressure: 15 years follow-up of Tehran lipid and glucose study.

Age is a known predictor of blood pressure (BP); however, the literature mostly includes cross-sectional investigations. This prospective cohort study aimed to decompose the cross-sectional and longitudinal age effects on BP. The secondary data were obtained from the Tehran lipid and glucose study, which comprised six repeated measurements of participants, with median follow-up of 15.8 (interquartile range of 14.2-16.9) years. The sample is representative of the metropolitan area of Tehran, Iran, containing 7,460 participants aged 20-70. The cross-sectional and longitudinal effects of age (age at baseline and aging, respectively) were fitted in the mixed effects models, taking systolic, diastolic, and pulse BPs as response, adjusting for adiposity, smoking, diabetes, and antihypertensive medication, and stratifying for sex and 10-year age-groups. The mean age at baseline was 41.3 (SD = 12.9) years, and 41.7% of the participants were male. Age at baseline and aging were directly associated with BP, aging owned the weaker effect, and the largest distinction were for systolic blood pressure of men aged 40-49 years (0.75 vs 0.10, p-value < .001). Moreover, the aging effects on systolic and diastolic BPs were higher in men than women, in the age groups 40-49 and 30-39 years (0.35 vs 0.10 and 0.30 vs 0.07, p-values < .001), respectively. Adjusting for adiposity remarkably declined the impact of aging on BP, among the < 50 years old.

Preferences of Patients With HR+ and HER2- Breast Cancer Regarding Hormonal and Targeted Therapies in the First Line of Their Metastatic Stage: A Discrete Choice Experiment.

OBJECTIVE: Some hormonal and targeted treatment options are available in the first line of metastatic HR+ & HER2- breast cancer. This study aimed to quantify the preferences of Iranian breast cancer patients regarding the levels of attributes of hypothetical treatment options. METHODS: The discrete choice experiment included 16 orthogonally designed scenarios. A novel method (named "the World Cup") was used to offer the scenarios to the respondents. Each choice task had 2 hypothetical treatments. A conditional logit regression model was used to obtain preference estimates, based on an expected utility model without interactions between attributes. RESULTS: A total of 78 patients with breast cancer participated in the survey. The effectiveness was the main concern of the patient, which was followed by monthly cost. Participant patients significantly preferred to avoid adverse events; preference dummy-coded estimates were reported. CONCLUSION: Followed by the effectiveness and cost, the risk of neutropenia, stomatitis, and arthralgia was least prioritized by the respondents. The estimation for the levels of the attribute "administration mode" is not significant (P = .690). Patients with breast cancer were willing to pay significant amounts to gain the benefit of the treatments and showed a significant willingness to accept to avoid the adverse events of the treatments.

Mechanical response of dental cements as determined by nanoindentation and scanning electron microscopy.

This study evaluated the effects of nanoindentation on the surface of white mineral trioxide aggregate (WMTA), Bioaggregate and Nano WMTA cements. Cements were mixed according to the manufacturer directions, condensed inside glass tubes, and randomly divided into three groups (n = 8). Specimens were soaked in synthetic tissue fluid (pH = 7.4) and incubated for 3 days. Cement pellets were subjected to nanoindentation tests and observed by scanning electron microscopy. Then, the images were processed and the number of cracks and total surface area of defects on the surface were calculated and analyzed using ImageJ. Data were submitted to one-way analysis of variance and a post hoc Tukey's test. The lowest number of cracks and total surface of defects were detected in Nano WMTA samples; however, it was not significantly different from WMTA samples (p = 0.588), while the highest values were noticed in Bioaggregate specimens that were significantly different from Nano WMTA and WMTA (p = 0.0001). The surface of WMTA and Nano WMTA showed more resistance after exposure to nano-compressive forces which indicated a better surface tolerance against these forces and crack formation. This suggests these substances are more tolerant cement materials which can predictably withstand loaded situations in a clinical scenario.

Nondestructive assessment of current one-step self-etch dental adhesives using optical coherence tomography.

ABSTRACT. This study aimed to nondestructively evaluate sealing performance of eight one-step self-etch adhesives (1-SEAs) using optical coherence tomography (OCT). The two-step self-etch adhesive (2-SEA) served as the control. Round tapered class-I cavities (D=4 mm, H=2 mm) were prepared in bovine incisors, treated with each adhesive (n=5), and restored with a flowable resin composite. Cross-sections were obtained from each restoration using swept-source OCT with 1310-nm laser. The average percentage of the sealed interface (SI%) for each adhesive was calculated using image analysis software, considering increased signal intensity at the interface as gap. Samples were then sectioned and observed under confocal laser scanning microscope (CLSM). Significantly different SI% values were found among different adhesives (analysis of variance, Bonferroni, p<0.05). There was also a significant correlation in SI% between OCT and CLSM (p<0.0001, r=0.96). Additionally, microscopic analysis revealed that the gaps in 1-SEAs occurred not only at dentine-adhesive interfaces but also frequently at adhesive-composite interfaces. Some recent 1-SEAs could achieve reliable short-term sealing comparable to 2-SEA. OCT is a unique tool to nondestructively evaluate the sealing performance of the restoratives through the cavity, provided that cavity walls have a certain minimum inclination with respect to the beam.

3D assessment of void and gap formation in flowable resin composites using optical coherence tomography.

PURPOSE: To investigate the effect of composite type and cavity size on gap and void formation using optical coherence tomography (OCT). MATERIALS AND METHODS: Class I cavities of two depths (2 mm or 4 mm; 4 mm diameter) were prepared, treated with Tri-S Bond (Kuraray Medical), and bulk filled with either Surefil SDR Flow (SF; Dentsply) or Clearfil Majesty LV (MJ; Kuraray Medical) to form four groups. After 24 h, the specimens were 3D scanned using swept-source OCT (Santec) with 1310 nm laser at a 20 kHz sweep rate. In OCT tomograms, the bonding interface and the bulk of the restorations were evaluated. The percentage values of sealed interfaces (SP) and void volume (VP) for all groups were calculated and statistically analyzed using two- and one-way ANOVA and Tukey's post-hoc test. Selected specimens were cross sectioned and observed using a scanning electron microscope (SEM) and a confocal laser scanning microscope to confirm OCT findings. RESULTS: The following values were obtained for SP and VP, respectively: SF-2mm: 92% and 0.08%; SF-4mm: 66% and 0.13%; MJ-2mm: 86% and 1.79%; MJ-4mm: 33% and 1.96%. Both composites showed a significant increase in gap formation at 4-mm cavity depth (p < 0.001). While SF showed a rather homogeneous bulk compared to MJ, cavity depth did not significantly affect the void volume fraction (p = 0.08). CONCLUSION: The flowable composite with SDR (stress-decreasing resin) technology performed better than the conventional composite; however, bulk filling a 4-mm-deep cavity will compromise the sealing of the bonding interface regardless of the type of composite. OCT is a unique method of characterizing materials and their behaviors nondestructively and precisely.

Effect of hydration on assessment of early enamel lesion using swept-source optical coherence tomography.

Establishing reproducible methodologies for assessment of early enamel lesions using optical coherence tomography (OCT) appears to be challenging. This in vitro study longitudinally evaluated the subsurface enamel lesion progression after 3, 9 and 15 days by cross-sectional scanning using 1310 nm centered swept-source OCT (SS-OCT) under hydrated and dry conditions. The positive difference between the depth-integrated OCT signals at dry and hydrated conditions were calculated and adopted as dehydration parameter (DH). A linear regression was found between DH and the square root of demineralization time (R(2) = 0.99). Significant differences were found in DH between sound and demineralized enamel, and between different periods of demineralization (p < 0.001). Hydration state affects the reflectivity of demineralized porous enamel, and the effect can be potentially used for assessment of early enamel lesion using OCT.

Non-destructive characterization of voids in six flowable composites using swept-source optical coherence tomography.

OBJECTIVE: The aim of this study was to evaluate the void frequency (V(F)) and void volume (V(V)) in different flowable composites using swept-source optical coherence tomography (SS-OCT). METHODS: Standard class I cavities were prepared and filled with six different flowable composites: Clearfil Majesty LV (MJ; Kuraray), MI Flow (MW; GC), MI Fil (ML; GC), Beautifil flow plus (BF; Shofu), Palfique Estelite low flow (EL; Tokuyama) and Surefil SDR flow (SF; Dentsply). The restorations were scanned under OCT. The OCT tomograms were analyzed and average V(F) and V(V) per restoration for each composite were calculated. Scanning electron microscope (SEM) was used to observe the structure of each composite. In addition, the flowability of the materials was evaluated measuring the displacement of each material placed up-right on a glass slide. V(F) and V(V) obtained by OCT were also compared to those calculated using micro-computed tomography (micro-CT). RESULTS: Kruskal-Wallis ANOVA and Mann-Whitney U tests revealed significantly different V(F) and V(V) values (p<0.05) among the composites. Voids ranging from 35 to 785 µm in diameter were detected in OCT tomograms. MJ showed highest V(F) and V(V) values followed by MW, but ML, BF, EL and SF showed no significant difference. Filler volume in composites showed a positive correlation with void formation, but flowability did not show a specific trend. Micro-CT evaluation validated the V(F) and V(V) calculation by OCT, with a significant correlation in void size (p<0.001, r=0.94). CONCLUSION: The results of this study indicate the reliability of SS-OCT for real-time void characterization of composite materials and restorations. Void formation in flowable composites is material dependent.

3D evaluation of composite resin restoration at practical training using swept-source optical coherence tomography (SS-OCT).

Internal adaptation of restorations to the cavity wall is one of the important topics in clinical dentistry. The purpose of this study was to investigate the possibility to utilize the non-invasive tomographic imaging system for teaching the importance of cavity adaptation at dental school pre-clinical training. Swept-source optical coherence tomography (SS-OCT) was used for detection of marginal and internal defects in the composite resin restorations as an educational device. Class 1 and Class 2 composite restorations to melamine resin molar tooth were assigned to the students and prepared during the skill test, and SS-OCT imaging was performed to evaluate students' works. SS-OCT could detect the internal gaps and voids within the restorations in tomography images synthesized based on the backscatter signal from within the restoration. It is suggested that the SS-OCT is promising diagnostic modality, as well as educational imaging device for the detection of internal gaps in adhesive restorations.

Pre-etching vs. grinding in promotion of adhesion to intact enamel using self-etch adhesives.

This study was aimed to determine the effectiveness of grinding and pre-etching in promotion of adhesion to human intact enamel using the self-etch adhesive (SEA) Adper Easy Bond (3M ESPE). Etch-and-rinse adhesive Adper Single Bond (3M ESPE) served as control. Composite cylinders (AP-X Kuraray) were built and after 24 h micro-shear bond strengths (MSBS) were measured. Bonding interfaces were evaluated under scanning electron microscope (SEM). For evaluation of average roughness (Ra) and morphological analysis, treated enamel surfaces were observed under SEM and confocal laser scanning microscope (CLSM) with 3D surface profiling. Highest bond strengths were obtained by pre-etching and grinding showed a less significant role. Phosphoric acid (PA) etching compare to grinding created significantly rougher surface (Ra: 0.72 and 0.43 µm respectively). Therefore, this study recommends pre-etching the intact enamel prior to application of the adhesive instead of grinding.

Effect of storage temperature on sealing ability and solubility of white mineral trioxide aggregate.

OBJECTIVE: Knowledge about the effect of storage conditions on the clinical performance of Mineral Trioxide Aggregate (MTA) is of great importance for clinicians. The aim of this study was to evaluate the effect of storage temperature on sealing ability and solubility of white MTA. MATERIALS AND METHODS: This study was divided into two parts: sealing ability and solubility tests. Forty single-rooted human pre-molars were divided into three experimental (n = 10) and two control groups (n = 5). The root canals were instrumented and root apices were resected. Root-end cavities were prepared and filled with white MTA stored at 4°C, 25°C or 40°C. Microleakage was evaluated using a protein leakage test with bovine serum albumin at 24-h intervals for 120 days. The solubility test was also performed based on ISO specifications (ISO 2001-6876). Data were analyzed by one-way analysis of variance and post-hoc Tukey test, with a significance level set at p = 0.05. RESULTS: The highest bovine serum albumin microleakage and the highest solubility rates were observed in 4°C followed by 25°C and 40°C groups. At higher temperatures, leakage needed significantly longer times to occur (p < 0.05). CONCLUSIONS: Based on these findings, storage temperature appears to play an important role in the properties and hence clinical outcomes of MTA.