Nursing students' willingness to respond in disasters: a cross sectional study of facilitators and barriers.

INTRODUCTION: The preparedness of the healthcare system to address emergency situations is contingent on the inclination of healthcare personnel. Nursing students can serve as valuable resources to supplement the workforce during major incidents and disasters. This study investigated the facilitators and barriers of nursing students' willingness to respond to disasters at the Alborz University of Medical Sciences in 2022. METHODS: In this cross-sectional descriptive study, 234 nursing students were recruited using convenience sampling. A deductive-inductive questionnaire was developed and distributed through an online self-administered survey comprising demographic information and questions on barriers, facilitators, various disaster scenarios, preferred activities, and reasons for pursuing a nursing career. RESULTS: The mean willingness scores of nursing students in response to various disasters were as follows: 3.15 for natural disasters, 2.60 for man-made disasters, 2.94 for pandemics, and 3.32 overall. Among the disaster scenarios, the earthquake response obtained the highest willingness score, while infectious disease epidemics received the lowest score. The most and least willingness to perform activities during disaster response were related to bedside care and participation in patients' personal hygiene, respectively. Key determinants of participation included the possibility of immunization and concerns for family safety. CONCLUSION: The findings indicated that nursing students are generally willing to assist as members of the healthcare team during disasters. However, the willingness to respond to infectious disease epidemics and man-made disasters was below the norm. Concerns about family health and the risk of disease transmission were identified as primary barriers. Addressing these concerns is crucial to enhance nursing students' participation in disaster response.

Evolutionary history of an Irano-Turanian cushion-forming legume (Onobrychis cornuta).

The Irano-Turanian region is one of the largest floristic regions in the world and harbors a high percentage of endemics, including cushion-like and dwarf-shrubby taxa. Onobrychis cornuta is an important cushion-forming element of the subalpine/alpine flora of the Irano-Turanian floristic region. To specify the genetic diversity among the populations of this species (including individuals of O. elymaitica), we employed nrDNA ITS and two noncoding regions of plastid DNA (rpl32-trnL(UAG) and trnT(UGU)-trnL(UAA)). The most striking feature of O. cornuta assemblages was the unexpectedly high nucleotide diversity in both the nDNA and cpDNA dataset. In the analyses of nuclear and plastid regions, 25 ribotypes and 42 haplotypes were found among 77 and 59 accessions, respectively, from Iran, Turkey, and Afghanistan. Network analysis of the datasets demonstrated geographic differentiation within the species. Phylogenetic analyses of all dataset retrieved O. cornuta as a non-monophyletic species due to the inclusion of O. elymaitica, comprising four distinct lineages. In addition, our analyses showed cytonuclear discordance between both nuclear and plastid topologies regarding the position of some O. cornuta individuals. The underlying causes of this inconsistency remain unclear. However, we speculate that chloroplast capture, incomplete lineage sorting, and introgression were the main reasons for this event. Furthermore, molecular dating analysis indicated that O. cornuta originated in the early Pliocene (around 4.8 Mya) and started to diversify throughout the Pliocene and in particular the Pleistocene. Moreover, O. elymaitica was reduced to a subspecific rank within the species.

PseAAC2Vec protein encoding for TCR protein sequence classification.

The classification and prediction of T-cell receptors (TCRs) protein sequences are of significant interest in understanding the immune system and developing personalized immunotherapies. In this study, we propose a novel approach using Pseudo Amino Acid Composition (PseAAC) protein encoding for accurate TCR protein sequence classification. The PseAAC2Vec encoding method captures the physicochemical properties of amino acids and their local sequence information, enabling the representation of protein sequences as fixed-length feature vectors. By incorporating physicochemical properties such as hydrophobicity, polarity, charge, molecular weight, and solvent accessibility, PseAAC2Vec provides a comprehensive and informative characterization of TCR protein sequences. To evaluate the effectiveness of the proposed PseAAC2Vec encoding approach, we assembled a large dataset of TCR protein sequences with annotated classes. We applied the PseAAC2Vec encoding scheme to each sequence and generated feature vectors based on a specified window size. Subsequently, we employed state-of-the-art machine learning algorithms, such as support vector machines (SVM) and random forests (RF), to classify the TCR protein sequences. Experimental results on the benchmark dataset demonstrated the superior performance of the PseAAC2Vec-based approach compared to existing methods. The PseAAC2Vec encoding effectively captures the discriminative patterns in TCR protein sequences, leading to improved classification accuracy and robustness. Furthermore, the encoding scheme showed promising results across different window sizes, indicating its adaptability to varying sequence contexts.

The effect of micro-learning on trauma care knowledge and learning satisfaction in nursing students.

BACKGROUND: Despite the fact that there are few formal trauma training courses for nurses, they play an important role in the care of trauma patients. This study aims to investigate the effect of micro-learning on the knowledge of managing trauma patients and learning satisfaction in nursing students. METHODS: The convenience sampling method was used to enroll 30 final-year nursing students from Alborz University of Medical Sciences in this quasi experimental One-group pretest -posttest design. The educational content was created and repeated 4 times over the course of 36 days using a micro-learning approach through whiteboard animations, video casts, and live videos. MCQ scenario-based exam was used to assess participants' knowledge of trauma in three phases: pretest, immediately following the intervention, and one month after the end of the educational program. An e-learning satisfaction psychometric questionnaire was used to measure satisfaction. RESULTS: The mean knowledge score 1 month after the intervention did not differ significantly from the score immediately after the intervention (p = 1), but there was a significant relationship between the mean knowledge score immediately after the intervention and before that (p = 0.047). Demographic variables and knowledge of trauma management did not differ statistically significant. The majority of students were pleased with how the course was implemented (5.64). CONCLUSION: The use of micro-learning has a positive effect on the promotion and retention of knowledge of trauma care, as well as increasing nursing students' satisfaction. Micro-learning is proposed as a new educational approach that can be used as a complementary or as a stand-alone method to convey important educational concepts and increase learner satisfaction.

ViralVectors: compact and scalable alignment-free virome feature generation.

The amount of sequencing data for SARS-CoV-2 is several orders of magnitude larger than any virus. This will continue to grow geometrically for SARS-CoV-2, and other viruses, as many countries heavily finance genomic surveillance efforts. Hence, we need methods for processing large amounts of sequence data to allow for effective yet timely decision-making. Such data will come from heterogeneous sources: aligned, unaligned, or even unassembled raw nucleotide or amino acid sequencing reads pertaining to the whole genome or regions (e.g., spike) of interest. In this work, we propose ViralVectors, a compact feature vector generation from virome sequencing data that allows effective downstream analysis. Such generation is based on minimizers, a type of lightweight "signature" of a sequence, used traditionally in assembly and read mapping - to our knowledge, the first use minimizers in this way. We validate our approach on different types of sequencing data: (a) 2.5M SARS-CoV-2 spike sequences (to show scalability); (b) 3K Coronaviridae spike sequences (to show robustness to more genomic variability); and (c) 4K raw WGS reads sets taken from nasal-swab PCR tests (to show the ability to process unassembled reads). Our results show that ViralVectors outperforms current benchmarks in most classification and clustering tasks. Graphical Abstract showing the all steps of proposed approach. We start by collecting the sequence-based data. Then Data cleaning and preprocessing is applied. After that, we generate the feature embeddings using minimizer based approach. Then Classification and clustering algorithms are applied on the resultant data and predictions are made on the test set.

The diagnostic utility of creatine kinase-MB versus total creatine phosphokinase ratio in patients with non-ST elevation myocardial infarction from unstable angina.

Objective: The present study seeks to find a way to quickly and correctly differentiate myocardial infarction from unstable angina by measuring the creatine kinase-MB/creatine phosphokinase ratio and comparing in non-ST elevation myocardial infarction patients with unstable angina at different time intervals, to improve the health quality of patients with coronary artery disease. Methods: The present study is a retrospective epidemiological analysis of 260 patients with non-ST elevation myocardial infarction and 260 patients with unstable angina, including age, sex, creatine kinase-MB, and creatine phosphokinase biomarkers at two-time intervals, including referral (4-8 h from the onset of pain) as the first interval, and 8 h after the first sampling was extracted as the second interval. Moreover, the delta of the creatine kinase-MB/creatine phosphokinase ratio during two interval times was measured. Results: In non-ST elevation myocardial infarction patients in the first and second intervals, creatine kinase-MB/creatine phosphokinase ratio was 32.7 and 33.8% higher than the normal laboratory cutoff (positive), respectively, and in the group of unstable angina patients, this index was positive in 31.9 and 30.4% of patients, respectively. There was no significant difference between the mean creatine kinase-MB to creatine phosphokinase index between the patients with non-ST elevation myocardial infarction and unstable angina (p = 0.507). In the first interval, the sensitivity and specificity of this index in differentiating non-ST elevation myocardial infarction from unstable angina were 51.5 and 57.3% (area under the curve = 0.518), respectively. While in the second interval, the sensitivity and specificity of this index were 17.7 and 87.8% (area under the curve = 0.519), respectively. The creatine kinase-MB/creatine phosphokinase delta in the non-ST elevation myocardial infarction group was significantly higher than in patients with unstable angina during different time intervals (p = 0.01). Conclusion: According to our results, creatine kinase-MB/creatine phosphokinase index cannot help differentiate the two groups of non-ST elevation myocardial infarction and unstable angina. However, the findings show that higher levels of creatine kinase-MB enzyme and creatine kinase-MB/creatine phosphokinase delta in the early hours, 4-16 h after the onset of pain in non-ST elevation myocardial infarction patients, can be used to differentiate between non-ST elevation myocardial infarction and unstable angina.

Characterizing SARS-CoV-2 Spike Sequences Based on Geographical Location.

With the rapid spread of COVID-19 worldwide, viral genomic data are available in the order of millions of sequences on public databases such as GISAID. This Big Data creates a unique opportunity for analysis toward the research of effective vaccine development for current pandemics, and avoiding or mitigating future pandemics. One piece of information that comes with every such viral sequence is the geographical location where it was collected-the patterns found between viral variants and geographical location surely being an important part of this analysis. One major challenge that researchers face is processing such huge, highly dimensional data to obtain useful insights as quickly as possible. Most of the existing methods face scalability issues when dealing with the magnitude of such data. In this article, we propose an approach that first computes a numerical representation of the spike protein sequence of SARS-CoV-2 using k-mers (substrings) and then uses several machine learning models to classify the sequences based on geographical location. We show that our proposed model significantly outperforms the baselines. We also show the importance of different amino acids in the spike sequences by computing the information gain corresponding to the true class labels.

Clinical outcomes of off-pump coronary artery bypass graft in patients with diabetes and non-diabetics: A systematic review and meta-analysis.

BACKGROUND AND AIM: Diabetes mellitus is a prevalent risk factor for developing coronary artery disease which worsens the clinical outcomes of patients undergoing coronary artery bypass grafting (CABG). This study aimed to determine the clinical outcomes of patients with diabetes and non-diabetic patients who underwent off-pump CABG surgery. METHOD: Medline, Scopus, Proquest, Embase, Web of Science, and Google scholar were searched until September 10, 2021. The effect sizes including unstandardized mean difference and odds ratio with 95% confidence interval were calculated using "Metan" package. The Cochran's Q-test and I2 statistic were used to assess heterogeneity, a random-effects model was applied to estimate the pooled effect sizes, and meta-regression was used to investigate the factors affecting heterogeneity between studies. RESULTS: 10 studies with 6200 sample sizes were included in the study. In groups with diabetes, Summary odds ratio (SOR) and 95% confidence interval of infection was 2.18 more than non-diabetic groups. Also, odds renal complication was 1.74 more than non-diabetic groups, and the odds cardiovascular complication in groups with diabetes was 1.30 more than non-diabetics. There were no differences in mortality, neurologic, respiratory and surgical complications between groups with diabetes and non-diabetics. Based on meta-regression results, age (Coefficient: 0.942; p = 0.009) had a significant direct relationship and sample size (Coefficient: 0.001; p = 0.009) had an indirect significant relationship with heterogeneity of neurologic outcomes. There was no significant publication bias in our results. CONCLUSION: Our study revealed that off-pump CABG led to some significant outcomes in patients with diabetes compared to non-diabetics. Renal and infection complications were higher in patients with diabetes but no significant differences were seen in most of other postoperative outcomes between the two groups.

Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study.

This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.

Molecular characterization of invasive Staphylococcus aureus strains isolated from patients with diabetes in Iran: USA300 emerges as the major type.

There have been few studies focused on the molecular characterization of invasive Staphylococcus aureus strains in patients with diabetes in Iran. In the present study, 20 invasive S. aureus strains recovered from the patients with diabetes characterized by the virulence and resistance analysis, biofilm formation, staphylocoagulase (SC) typing, S. aureus protein A locus (spa) typing staphylococcal cassette chromosome mec (SCCmec) typing, and multilocus sequence typing (MLST). Virulence gene detection indicated a high prevalence of strains encoding the pvl genes (50%), a low prevalence of the tst and seg gene (each of them was 5%) and a markedly high prevalence of fnbB (95%), fnbA (85%), icaD (75%), icaA (65%). A total of 3 coagulase types (III, 85%; II, 10%; V, 5%), 2 agr types (I, 90%; II 10%) and 2 SCCmec types (IV, 65%; III, 35%) and four different clones namely ST8-MRSA-IV/t008 (50%) (USA300), ST239-MRSA-III/t030 (35%), ST5-MRSA-IV/t002 (10%), and ST45-MRSA-IV/t038 (5%) were detected in this study. Eighty-five percent of the isolates were biofilm producers. All the 4 high-level mupirocin resistance (HLMUPR) strains belonged to CC/ST8-MRSA-IV/t008 clone and carried mupA gene. Fusidic acid-resistant isolate belonged to ST239-SCCmec III/t030 clone. One vancomycin-intermediate resistance isolates was detected in our study, which belonged to ST5-MRSA-IVt002. Circulating clone in MRSA strains (USA300) isolated from the patients with diabetes highlighting the possibility of transmission of these microorganisms' clones between hospital, community, and environments. However, further studies require providing critical insights into the importance of continued controlling and treatment of S. aureus infections in patients with diabetes.

Genotype distribution of methicillin-susceptible Staphylococcus aureus clinical isolates in Iran: high multiresistant clonal complex 8.

OBJECTIVE: Compared to methicillin-resistant Staphylococcus aureus (MRSA), there have been few studies focused on the molecular characterization of methicillin-susceptible Staphylococcus aureus (MSSA). In this cross-sectional study, 85 MSSA isolates were characterized by antimicrobial susceptibility testing, virulence genes analysis, accessory gene regulator (agr) typing, and S. aureus protein A locus (spa) typing. RESULTS: In present study, 9 different clonal complexes namely CC8-MSSA-t037 (22.4%), CC8-MSSA-t008 (11.8%), CC7-MSSA-t091 and CC30-MSSA-t021 (each 9.4%), CC8-MSSA-t037 (8.3%), CC398-MSSA-t034 (7.1%), CC22-MSSA-t005 (5.9%), CC5-MSSA-t002 and CC15-MSSA-t084 (each 4.7%), CC22-MSSA-t790 and CC59-MSSA-t437 (each 3.5%), CC22-MSSA-t1869, CC5-MSSA-t045, and CC45-MSSA-t015 (each 2.3%), CC30-MSSA-t318 and CC15-MSSA-t491 (each 1.2%) were found. agr types detected in tested strains were mainly type I (76.5%), II (12.9%), and III (10.6%). Of 85 MSSA examined isolates, 48 (56.5%) isolates were toxinogenic with 27 producing pvl (31.8%) and 21 tst (24.7%). The findings of the study show a high genetic diversity in MSSA strains warranting continued surveillance to provide critical insights into control and treatment of MSSA infections.

Molecular Characterization, Drug Resistance and Virulence Analysis of Constitutive and Inducible Clindamycin Resistance Staphylococcus aureus Strains Recovered from Clinical Samples, Tehran - Iran.

BACKGROUND: Macrolide-lincosamide streptogramin B family is one of the important alternative antibiotics for treating staphylococcal infections. The aim of this study was to determine the characteristics and prevalence of antibiotic resistance genes in different coagulase types of clinical Staphylococcus aureus strains. METHODS: In the present study, 86 isolates with different phenotypes of MLSB resistance were investigated. In vitro susceptibility was assessed by the disk diffusion and broth microdilution methods. PCR assays were used to detect resistance-related genes. Coagulase and SCCmec types were identified by multiplex PCR assay. RESULTS: The prevalences of constitutive MLSB, inducible MLSB, and MS phenotypes were found to be 23%, 14.2%, and 4.9%, respectively. The rates of resistance to mupirocin, fusidic acid, and tigecycline were found to be 9.3%, 4.6%, and 2.3%, respectively. The top three predominant resistance genes were mecA, tet(M), erm(C) representing 75.6, 50, and 40.7% of isolates. mupA (7%), fusB (3.5%), and fusC (1.2%) genes were also detected among tested isolates. Coagulase types were mainly type II (34.9%), followed by III (32.6%), V (20.9%), and I (11.6%). CONCLUSION: These findings indicated high resistance rate and low genetic variability with the prominence of coa type II, highlighting the particular importance of diagnosis of these strains to avoid treatment failure.

Challenges of postgraduate critical care nursing program in Iran.

Background: The main philosophy of postgraduate preparation for working in critical care units is to ensure the safety and quality of patients' care. Increasing the complexity of technology, decision-making challenges and the high demand for advanced communication skills necessitate the need to educate learners. Within this aim, a master's degree in critical care nursing has been established in Iran. Current study was designed to collect critical care nursing students' experiences as well as their feedback to the field critical care nursing. Methods: This study used qualitative content analysis through in-depth semi-structured interviews. Graneheim and Lundman method was used for data analysis. Results: The results of the total 15 interviews were classified in the following domains: The vision of hope and illusion; shades of grey attitude; inefficient program and planning; inadequacy to run the program; and multiple outcomes: Far from the effectiveness. Overall findings indicated the necessity to review the curriculum and the way the program is implemented. Conclusion: The findings of this study provided valuable information to improve the critical care-nursing program. It also facilitated the next review of the program by the authorities.

Linezolid activity against clinical Gram-positive cocci with advanced antimicrobial drug resistance in Iran.

OBJECTIVES: The aim of the study was to investigate the linezolid activity against clinical Gram-positive cocci with advanced antimicrobial drug resistance. METHODS: A collection of methicillin resistant Staphylococcus aureus (MRSA), vancomycin resistant enterococci (VRE), penicillin non-susceptible Streptococcus pneumoniae (PNSP), and group B streptococci (GBS) were isolated from various clinical samples. Antimicrobial susceptibility tests were done using standard methods Subsequently, we investigated linezolid antibacterial activities, the first approved oxazolidinone against isolates by the standard broth microdilution method. RESULTS: According to our results, MRSA and PNSP isolates were multidrug resistant, and almost half of the VRE isolates were high level gentamicin resistant (HLGR). Furthermore, resistance to linezolid was not seen among the isolates. The MIC90 values for MRSA, VRE, PNSP and GBS isolates were 4µg/ml, 2µg/ml, 1µg/ml, and 0.5µg/ml, respectively. Only 6.25% of vancomycin resistant enterococci showed intermediate susceptibility to this antibiotic. CONCLUSIONS: These findings indicate that linezolid has an excellent activity against clinical drug resistant Gram-positive isolates in Iran. Constant monitoring and surveillance of linezolid MIC distribution allows the researchers to assess and detect gradual upward MIC drifts.

Pathology of apprenticeships for masters of nursing critical care.

INTRODUCTION: The increasing complexity of patient care conditions in intensive care units, along with the development of these units, has increased the need for qualified nurses and health professionals. Therefore, due to recent changes and in response to the shortage of capable nurses, a master's major in intensive care nursing has been created. One of the main challenges of this curriculum is to ensure that graduates have the required competencies. The current study aimed to explain the pathology of apprenticeships for a masters in nursing critical care. METHODS: This qualitative study was conducted for masters in nursing critical care students of Tehran University of Medical Sciences in 2014-2015. The sampling was purposeful. Data were collected through face-to-face interviews with 15 students. Conventional content analysis was used to analyze the data. RESULTS: Three categories "ineffective management, unfavorable context for achieving skills, and lack of clinical instructors and sufficient competence" were extracted. CONCLUSION: Preparing settings for entering students such as having an adequate training field and expert educators, providing conditions for orientation of educators and participation in the related workshops, and recruitment of experienced instructors in the apprenticeships field can increase the quality of MS levels.

Fabrication of an electrochemical sensor for determination of doxorubicin in human plasma and its interaction with DNA.

In this work, an electrochemical sensor was fabricated for determination of an anthracycline, doxorubicin (DOX) as a chemotherapy drug in plasma based on multi-walled carbon nanotubes modified platinum electrode (Pt/MWCNTs). DOX was effectively accumulated on the surface of modified electrode and generated a pair of redox peaks at around 0.522 and 0.647 V (vs. Ag/AgCl) in Britton Robinson (B-R) buffer (pH 4.0, 0.1 M). The electrochemical parameters including pH, type of buffer, accumulation time, amount of modifier and scan rate were optimized. Under the optimized conditions, there was a linear correlation between cathodic peak current and concentration of DOX in the range of 0.05-4.0 µg/mL with the detection limit of 0.002 µg/mL. The number of electron transfers (n) and electron transfer-coefficient (α) were estimated as 2.0 and 0.25, respectively. The constructed sensor displayed excellent precision, sensitivity, repeatability and selectivity in the determination of doxorubicin in plasma. Moreover, cyclic voltammetry studies of DOX in the presence of DNA showed an intercalation mechanism with binding constant (Kb) of 1.12×105 L/mol.

Fabrication of an electrochemical sensor for determination of doxorubicin in human plasma and its interaction with DNA / 药物分析学报

In this work, an electrochemical sensor was fabricated for determination of an anthracycline, doxorubicin (DOX) as a chemotherapy drug in plasma based on multi-walled carbon nanotubes modified platinum electrode (Pt/MWCNTs). DOX was effectively accumulated on the surface of modified electrode and generated a pair of redox peaks at around 0.522 and 0.647 V (vs. Ag/AgCl) in Britton Robinson (B-R) buffer (pH 4.0, 0.1 M). The electrochemical parameters including pH, type of buffer, accumulation time, amount of modifier and scan rate were optimized. Under the optimized conditions, there was a linear correlation between cathodic peak current and concentration of DOX in the range of 0.05–4.0 μg/mL with the detection limit of 0.002 μg/mL. The number of electron transfers (n) and electron transfer-coe?cient (α) were estimated as 2.0 and 0.25, respectively. The constructed sensor displayed excellent precision, sensitivity, repeatability and selectivity in the determination of DOX in plasma. Moreover, cyclic voltammetry studies of DOX in the presence of DNA showed an intercalation mechanism with binding constant (Kb) of 1.12×105 L/mol.

Comparison of quinolone and beta-lactam resistance among Escherichia coli strains isolated from urinary tract infections.

The growing frequency of antibiotic resistances is now a universal problem. Increasing resistance to new generations of ß-lactam and quinolone antibiotics in multidrug-resistant Enterobacteriaceae isolates is considered an emergency health issue worldwide. The aim of this study was to evaluate plasmid-mediated quinolone resistance genes in ESBL-producing Escherichia coli isolated from urinary tract infections (UTIs). In our study ESBL-producing isolates were assessed by screening methods. After determination of antimicrobial susceptibility testing, detection of ESBLs and quinolone resistance genes was performed. A total of 97 ESBL-producing E. coli were determined. The bla-TEM, bla-SHV and bla-CTX-M genes were detected in 90 isolates. The bla-TEM was the most frequently detected gene (46.4%), followed by bla-SHV (31.9%) and bla-CTX-M (14.4%). The most prevalent quinolone resistance gene among ESBL-producing isolates was oqxAB which was found in 67 isolates (69.1%). The frequencies of the aac(6')-Ib-cr, qnr and qepA were 65 (67%), 8 (8.2%) and 6 (6.2%), respectively. Our data indicate that the prevalence of plasmid-mediated quinolone resistance genes in ESBL-positive isolates is increasing. The co-dissemination of PMQR and ESBL genes among E. coli isolates can be considered a threat to public health. Therefore, prescription of antibiotics against infectious disease should be managed carefully.

Rationales of restricted visiting hour in Iranian intensive care units: a qualitative study.

BACKGROUND: Today, critical care visitation is considered an important aspect of patient-centred care and its positive effects on patients and their relatives have been demonstrated. However, restricted visiting hours in the intensive care units (ICUs) is often an adopted norm. The reasons for such restricted policies in Iran still remain unknown. OBJECTIVES: The purpose of this study was to identify the rationales for restricted visiting hours in adult ICUs in Iran. METHODS: A qualitative design using a thematic analysis approach was used for data gathering and analysis. Participants in this study were six nurses, three head nurses, two patients and four visitors. They were chosen through purposive sampling method. Data were gathered through semi-structured individual interviews. FINDINGS: The data analysis resulted in three themes: 'health protection', 'safety promotion' and 'privacy preservation'. CONCLUSION: The result showed that through restricted visiting hours, nurses try to protect vulnerable ICU patients from physical, psychological and legal risk. Although the ICU nurses' concerns seem reasonable in some cases, a review of visiting policies in order to meet the needs of patients and their families is essential. RELEVANCE TO CLINICAL PRACTICE: Effective supervision by charge nurses and regulation of environmental activities with visiting hours can resolve many concerns. Health care professionals, especially nurses, are required to create the conditions in which patients' family members are informed about the patients' health status and patients can be visited in suitable ward conditions.

Liver transplant recipients quality of life instrument: development and psychometric testing.

BACKGROUND: Liver transplantation is a life-saving intervention for many patients with end-stage liver disease. In the past, evaluation of successful liver transplantation was based on patients' survival rate. However, in recent years this evaluation has been based on patients' quality of life. Various instruments have been developed to evaluate patients' quality of life. Nonetheless, scholars still believe that it is crucial to develop a standardized and disease specific instrument for evaluating the quality of life in liver transplant recipients. OBJECTIVES: The aim of this paper was to describe the development and psychometric testing process of a quality of life instrument specific to liver transplant recipients. MATERIALS AND METHODS: Initial items of this instrument were extracted from a conventional content analysis study, and then were completed with findings of related international literature. The face validity was assessed by interviewing with four liver transplant recipients, and the content validity was evaluated by eleven experts in the field of transplantation. The construct validity was achieved by involving 250 liver transplant recipients through exploratory factor analysis method, and reliability was calculated by Cronbach's alpha. RESULTS: Three main factors with 40 items were extracted from the exploratory factor analysis: Health Satisfaction, Concerns, and Complications. Reliability of the instrument was confirmed (alpha = 0.922). CONCLUSIONS: Given the special considerations regarding liver transplant recipients, this questionnaire is more accurate in evaluating the success of liver transplantation.