Journal of Clinical Care and Skills

Aims: Impulsivity and dysregulated neural circuits characterize substance use disorders, necessitating interventions like Narcotics Anonymous (NA) to enhance self-regulation and recovery outcomes. This study aimed to evaluate the impact of engagement in NA group therapy on the reduction of impulsivity and the modulation of the brain-behavioral systems among individuals diagnosed with substance use disorders (SUDs).
Materials & Methods: This study utilized a quasi-experimental pre-test-post-test control group design to assess the effectiveness of the intervention. The study population comprised individuals with SUDs who sought support from the Shahrekord Narcotics Anonymous Association in 2023. A sample of 40 participants was randomly allocated to either the experimental group, which received NA group therapy, or the control group, with 20 participants in each. The experimental group engaged in the NA Twelve Step Education Package, consisting of 12 weekly 90-minute sessions, whereas the control group received standard methadone maintenance treatment. Data on impulsivity and brain/behavioral systems were collected using validated questionnaires administered at both pre- and post-intervention time points. Analysis of covariance (ANCOVA) was employed using SPSS version 23 to analyze the data.
Findings: Engagement in NA group therapy resulted in a statistically significant reduction in impulsivity and a significant improvement in the functioning of the brain-behavioral systems within the experimental group when compared to the control group (P<0.01).
Conclusions: NA group therapy significantly reduces impulsivity and improves brain behavioral system functioning, enhancing self-regulation in individuals with SUDs, highlighting its efficacy as a community-based intervention for neurobehavioral outcomes and long-term recovery.
 

Abstract
Aims: Coronary artery bypass grafting (CABG) is a recommended and effective treatment for some heart patients. Among its psychological complications, death anxiety is one of the most common. Various factors can influence the development and severity of this anxiety. This study aimed to investigate death anxiety and its related factors in patients scheduled for CABG.
Methods: This descriptive-correlational study was conducted in 2024 at Shariati Hospital in Isfahan. A total of 100 CABG candidates admitted to the cardiac intensive care unit were selected via convenience sampling. After obtaining informed consent, participants were instructed on completing a questionnaire, which consisted of three parts: demographic data and Templer's Death Anxiety Scale. Data were analyzed using SPSS version 20 through descriptive statistics and Pearson correlation.
Findings: The overall level of death anxiety in patients was moderate. There was a significant relationship between death anxiety and variables such as age, sex, marital status, employment, and the presence of underlying disease (P≤0.05). However, no significant relationship was found with place of residence (urban/rural), education level, or duration of illness (P>0.05).
Conclusion: Death anxiety is prevalent among heart patients awaiting CABG. It is essential for healthcare providers, especially nurses in cardiac units, to recognize and address this concern. Understanding contributing factors can guide supportive interventions. Therefore, it is recommended to incorporate the topic of death anxiety into the training programs for caregivers of cardiac patients.
If you'd like a version under 200 or 150 words, I can adjust it further.

Aims: Cancer disrupts the quality of life of patients, as well as increases the care burden of the patients' families. The current study aimed to determine the effect of Glenn Abdellah's nursing theory on quality of life of patients with cancer.
Materials & Methods: In this randomized control trial, 60 patients with cancer were selected by purposive sampling method in Shahid Modarres Hospital, Saveh city in 2020.
Then the samples were divided into intervention and control groups using random allocation. Then the samples were divided into intervention (n=30) and control (n=30) groups using random allocation. The intervention related to ten steps in Faye Glenn Abdellah’s Nursing Theory was implemented for intervention group, but there was no intervention in the control group. Information was collected before, after the intervention, and one month after the intervention through World Health Organization Quality-of-Life Scale (WHOQOL-BREF). Data were analyzed by SPSS 22 software, using descriptive statistics methods and inferential analysis tests.
Findings: In the intervention group, the mean score of patients' quality of life increased significantly after intervention and one month after intervention (p<0.001). After intervention and the follow-up period, the quality of life in the intervention group was better than that of the control group (p<0.001).
Conclusion: The use of nursing care theories, such as Faye Glenn Abdellah's nursing theory, can improve the quality of life in cancer patients.

 

Aim: Asthma is one of the common, chronic respiratory diseases which psychological factors play an important role in it and comorbidities of several psychological disorders such as anxiety, depression, and panic attacks are common in asthmatic patients. The aim of this study was to determine the effect of hypnosis on pulmonary function and severity of the disease in asthmatic patients.
Materials and Methods: This randomized clinical trial study, was carried out on 64 asthmatic patients, who referred to the clinic of Shahid Mofattah in Yasuj, Iran in 2010. The subjects were selected by purposeful sampling method, and randomly assigned into the tow group of the intervention (subjects were treated by solo hypnosis in a 90-minute session and conventional treatments) and control group (subjects were treated by conventional treatments, in addition, providing an explanation about requirement care point for improvement of asthma in 15 minutes) by use of balanced block randomization. In addition to completing demographic information at the beginning of the study, determination of pulmonary function and asthma severity were conducted respectively through measurement of FEV1 and NAEPP classification (EPR-3) at the starting point of the study and one month after the completion of the research intervention. Data were analyzed using SPSS 21 software, through independent sample t-test, paired sample t-test, Chi-square test, and marginal homogeneity test.
Findings: one month after completing the research intervention, the FEV1 in the intervention group increased than the control group and the severity of asthma in the intervention group decreased than the control group.
Conclusion: Hypnosis as an adjuvant treatment is effective in the improvement of pulmonary function and reducing the disease severity in asthmatic patients.

Aims: Hospital indicators are one of the most important criteria of hospital efficiency. The aim of this study was to determine the performance indicators of affiliated hospitals of Yasuj University of Medical Sciences in 2011-2018.
Instruments & Methods: This cross-sectional descriptive study was conducted on 5 hospitals, including Shahid Beheshti, Shahid Rajaei, and Emam-Sajjad Yasuj hospitals, and Shahid Rajaei Hospital in Gachsaran and Emam-Khomeini Hospital in Dehdasht affiliated to Yasuj University of Medical Sciences in 2011-2018. Bed Occupancy Rate (BOR), Bed Turnover (BTR) and Average Length of Stay (ALS) were collected through hospital information system and analyzed according to Pabon Lasso model and compared with the standard levels.
Findings: The mean BTR (98.76 times per year), ALS (2.12 days) and BOR (70.9%) in hospitals in 2011-2018 were favorable. ALS was 15.24 days in Shahid Rajaei hospital in Yasuj. Shahid Beheshti hospital was in zone 3 in all years. Emam-Sajjad hospital was in zone 3 in all years except 2014. Shahid Rajaei hospital of Yasuj was in zone 4 in 2011-2018. Emam-Khomeini hospital was in zone 1 in 2015-2016, zone 3 in 2011-2012, 2014, 2017-2018, and zone 4 in 2013. Shahid Rajaei hospital of Gachsaran was in zone 3 only in 2012, zone 1 in 2016-2019 and zone 2 in 2011 and 2013-2015.
Conclusion: The performance indicators of affiliated hospitals of Yasuj University of Medical Sciences are at the favorable and moderate level, and in total, in 2011-2018, most of the hospitals have been in zone 3, which indicates good performance.
 

Aims: Coughing is one of the most common clinical complaints in pediatric medicine. Since caffeine, as a central nervous system stimulant from methylxanthine, inhibits tumor necrosis factor-alpha (TNFα) and leukotriene synthesis and reduces inflammation and initiates the immune process, the aim of this study was to determine the effect of caffeine on coughing in children aged 3-36 months.
Materials and Methods: In this randomized clinical trial study in 2015, among children referred to the Shahid Mofateh Pediatric Clinic of Yasuj, 120 children aged 3-36 months with coughing due to bronchiolitis, lower respiratory viral disease, increased airway sensitivity, or moderate persistent asthma were selected by convenience sampling method. They were assigned in intervention (reciving salbutamol and caffeine) and control (reciving salbutamol alone) groups by quadratic block randomization. In addition to completing demographic information at the beginning of the study, data on daily and nocturnal cough at the beginning of the study, 48 hours, 1 week, and 2 weeks after starting the drug were recorded. The data were analyzed by SPSS 21 software, using Mann-Whitney test, Chi-square or Fisher's exact test, generalized estimating equation, Friedman, and Wilcoxon statistical tests.
Findings: Daily cough and nocturnal cough significantly decreased in the intervention group at 48 hours, 1 and 2 weeks after beginning the treatment (p<0.05).
Conclusion: Prescription of caffeine with salbutamol is effective in accelerating improvement of cough in children.
 

Aim(s): Obesity in pregnant women is a serious health problem that has many complications such as pre-eclampsia and fetal growth restriction (FGR). The aim of the present study was to evaluate the effect of aspirin on prevalence of pre-eclampsia and FGR in obese pregnant women.
Materials & Methods: This randomized controlled clinical trial was conducted on 187 pregnant women referring to birth center of Mofatteh Clinic, Yasuj University of Medical Sciences, Yasuj, Iran in 2017-2018.
The subjects were selected using purposive sampling method and randomly divided into two groups; intervention group (n=89) and control group (n=98). The intervention group received 80mg/day aspirin and the control group received placebo at 13-20 weeks of gestation until 34 weeks of pregnancy. Data were analyzed by SPSS 21 software using Chi square test.
Findings: The prevalence of pre-eclampsia (1.1 vs. 11.2) and FGR (3.4 vs. 21.4) were significantly lower in the intervention group compared to the control group (p<0.05).
Conclusion: Administration of 80mg/daily of aspirin from 13-20 weeks of gestation in obese pregnant women reduces the incidence of pre-eclampsia and FGR, which could support the positive role of aspirin in preventing pre-eclampsia and FGR.

Aims: Patients with thalassemia major suffer from iron overload due to excessive cell lysis. Iron-chelating agents are used to preventing the effects of iron overload on the body. Deferoxamine, deferiprone, and deferasirox are the most common iron-chelating agents. The aim of this study was to compare deferoxamine, deferiprone, and deferasirox iron-chelating agents in reducing serum ferritin levels in patients with thalassemia major.
Instrument & Methods: This descriptive cross-sectional study was performed on 114 thalassemia major patients in the Cooley's ward of Shahid Beheshti Hospital, Yasuj, Iran, in 2018 who had been taking iron supplements for the past year. Census sampling was done. After recording patients’ information, such as age, sex, and type of iron used, the blood sample was taken from the patients to measure serum ferritin and the results were analyzed using SPSS 22 software and multivariate analysis of variance.
Findings: The mean serum ferritin level was 3438.70±2872.88 ng/ml. 14 patients were taking deferoxamine, 62 patients were using deferiprone, and 38 patients were consuming deferasirox. There was no significant difference between iron-chelating agents in reducing ferritin levels (p>0.05). Also, there was no significant difference between males and females in terms of decreased ferritin levels (p>0.05).
Conclusion: There is no difference between deferoxamine, deferiprone and deferasirox iron-chelating agents in reducing the ferritin levels of patients with thalassemia and all can be administrated considering the cost, availability, condition, and patient's desire.

Aims: Interleukin-10 is an important immunoregulatory cytokine that has an inhibitory effect on the initiation and progression of inflammatory responses in different situations such as autoimmune diseases including rheumatoid arthritis. Polymorphism in IL-10 promoter region affects the expression of this gene. It therefore seems reasonable that these polymorphisms may contribute to rheumatoid arthritis susceptibility in special populations. the aim of this study was to investigate the association between IL-10 rs1800872 polymorphism in the promoter region of human IL-10 gene and susceptibility to rheumatoid arthritis in the patients in southwest of Iran.
Materials & Methods: The present study is a case-control study conducted among patients with and without rheumatoid arthritis referred to the Mofateh clinic in Yasuj, Iran. Both case (n=64) and control (n=65) groups were selected using purposive sampling and were matched in terms of age, gender and ethnicity. Peripheral blood samples were collected from subjects and rs1800872 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism method. SPSS 26.0 software was used for statistical analysis of data
Findings: The association between the frequency of TT genotypes and the incidence of rheumatoid arthritis was significant (OR=6.45; 95% CI= 1.30-32.00; p=0.023). On the other hand, the distribution of the T allele showed a significant relationship with rheumatoid arthritis (OR= 2.23; 95% CI= 1.26–3.97; p=0.006).
Conclusion: TT genotype of rs1800872 polymorphism is associated with rheumatoid arthritis susceptibility in southwestern Iranian population and can be considered as a risk factor for rheumatism.
 

Aims: Psoriasis is a common immune-related skin disorder that affects 2-3% of worldwide people. This study aimed to determine the disease characteristics of psoriasis patients.
Materials & Methods: In this descriptive cross-sectional study, using the convenience sampling method, 164 psoriatic patients who were referred to a dermatology clinic in Yasuj from 2013 to 2014 participated. Demographic information and medical parameters were collected by a dermatologist through observation and using a researcher-made checklist. SPSS software version 19 was used for the statistical analysis of data.
Findings: Participants were consisting of 106 males and 58 females. The mean age of females was 28.72±15.89, and for males was 29.83±23.19. Most of them had the mild disease (48.3%), and common plaque-type psoriasis (87.7%). Sites of skin involvement were 80.4% on extremities. Nail involvement was 31.7% and arthritis was detected in 3% of cases. There was a history of pruritus or burning sensation in 41.5% of cases. There was only a 17.1% positive family history.
Conclusion: According to the results of this study, the ratio of men with psoriasis to women was higher. Most of the skin lesions caused by this disease were observed in the extremities, head, face and trunk, respectively, and in this respect both gender were similar and few participants reported a positive family history in this regard.

Aims: Chronic non-specific low back pain is the most common chronic lower back pain, and developing a therapeutic and rehabilitative plan to more rapidly mend patients with lower back pain has always been discussed. The present study aimed to determine the effect of prayer-based movements on pain and endurance of flexor muscles in patients with non-specific chronic low back pain.
Materials & Methods: This quasi-experimental study was conducted on all the patients with a chronic non-specific LBP referring to Shahid Mofatteh Clinic No. 1 in Yasuj, 2020. According to block random assignment, Sixty-six patients were divided into two groups of the intervention and control. In the intervention group, prayer-based exercises were performed three sessions a week for eight weeks. The control group was not instructed. The demographic questionnaire and Quebec back pain disability scale were used to measure pain, and the maintain the 60° angle test was used to collect data before intervention; the visual pain measurement scale was used immediately after the intervention, and the endurance test of spine flexor muscles performed at the angle of 60° was used a week after the intervention. The collected data were analyzed by SPSS 21 using descriptive statistics and statistical tests of Paired T, Mann-Whitney, Independent T, Wilcoxon, Chi-square, and Shapiro-Wilk.
Findings: There was no significant difference between the two groups in terms of pain severity and endurance of the flexor muscles at the starting point (p>0.05). The comparisons of the mean immediately and a week after the intervention were significant (p<0.05).
Conclusion: Prayer-based exercises effectively affect pain severity and endurance of flexor muscles in patients with non-chronic lower back pain.

Aims: Pregabalin is one of the anti-seizure and analgesic drugs, which is widely used in the treatment of neuropathic pain and chronic radiculopathy in the form of monotherapy. The aim of this study was to evaluate the effectiveness of pregabalin drug therapy with common treatment (an NSAID) on reducing pain in patients with lumbosacral radiculopathy.
Materials & Methods: In this clinical trial, 90 patients with lumbosacral radiculopathy referring to the clinic of Shahid Mofatteh, Yasuj, Iran in 2018, were selected using purposeful convenience sampling and divided into intervention (N=45) and control (N=45) groups. The pain severity was assessed by a standard visual analog scale (VAS). In the intervention group, 100 mg celecoxib every 12 hours, plus 75 mg per day pregabalin, and in the control group, 100 mg celecoxib every 12 hours, plus 75 mg per day pregabalin placebo were prescribed. After 8 weeks, the severity of the pain was again assessed and compared.
Findings: At the beginning of the study, the mean pain severity in the intervention and control group did not differ significantly (p>0.05). After the intervention, the mean pain severity between the two groups did not show a significant difference (p>0.05). The severity of the pain did not differ significantly between the two groups of intervention and control according to age, disease history, location of pain, and body weight (p>0.05).
Conclusion: The efficacy of pregabalin and NSAID in comparison with NSAID use in patients with lumbosacral radiculopathy is not different in reducing pain severity.Aims: Pregabalin is one of the anti-seizure and analgesic drugs, which is widely used in the treatment of neuropathic pain and chronic radiculopathy in the form of monotherapy. The aim of this study was to evaluate the effectiveness of pregabalin drug therapy with common treatment (an NSAID) on reducing pain in patients with lumbosacral radiculopathy.
 

Aims: Acute appendicitis is the most common emergency surgery; thus, its diagnosis requires high accuracy. This study aimed to determine the agreement between clinical and paraclinical diagnoses in patients with acute appendicitis.
Instrument & Methods: This descriptive study was performed on patients referred to Shahid Beheshti Hospital in Yasouj with suspicion of acute appendicitis in 2018. After considering the inclusion criteria, the files of 200 patients were included in the study by purposive sampling. Age, sex, main problem, symptoms, clinical signs, white blood cell count, and ultrasonography and pathology report were extracted from the patients' files, and the Modified Alvarado Score was calculated based on their information.
Findings: The mean age of the patients was 24.3±13.2 years, and the most common symptoms were anorexia and abdominal tenderness. The Modified Alvarado Score was  4-6 in 126 (63%) and 7 or higher (37%) in 74 patients. In addition, 182 patients (91%) had a positive pathology for appendicitis. There was a statistically significant relationship (p=0.03) between Modified Alvarado Score and pathology; however, there was no statistically significant relationship (p=0.43) between Modified Alvarado Score and ultrasonography. There was a significant relationship (p=0.0001) between pathology and ultrasonography. The ultrasonography sensitivity was 37.1%, specificity was 87.2%, positive predictive value was 96.8%, and negative predictive value was 11.7%.
Conclusion: There is an agreement between the Modified Alvarado Score and ultrasonography in diagnosing acute appendicitis with the pathology as the gold standard in the diagnosis of appendicitis; however, there is no agreement between the Modified Alvarado Score and ultrasonography.
 

Aims: Mothers whose children suffer from chronic diseases experience high levels of stress. Promoting the sense of coherence can be a way to reduce the stress. The aim of this study was to compare the effect of teach-back method and video clip teaching on the sense of coherence of mothers with children suffering from asthma.
Materials & Methods: In this randomized controlled trial, 75 eligible mothers with children suffering from asthma in Yasuj in 2020 were selected by convenience sampling method and randomly assigned into three groups: video clip group, teach-back method group and control group. In video clip group, training was performed through a 15-minute clip in two sessions. In teach-back method group 8 training sessions were held. Data were collected using the Antonovsky's Sense of Coherence scale-13 at baseline and one month after the intervention. Data were analyzed using SPSS 21 by descriptive and inferential statistics.
Findings: Before the intervention, there was no significant difference in the mean score of sense of coherence and its subscale in the three groups (p>0.05). One month after the intervention, there was a significant difference in the mean score of sense of coherence and its subscales between the two intervention groups with the control group (p=0.001). Also, a significant difference was observed between the two intervention groups in the mean scores of the sense of coherence and comprehensibility (p<0.05).
Conclusion: Both video clip and teach-back methods improves mothers' sense of coherence, but teach-back method is more effective than video clip teaching.

 

Introduction: Fibroepithelial stromal polyp (FESP) of the female lower genital tract is a rare benign lesion characterized by polypoid proliferation of stroma, covered by a benign squamous epithelium in the vulvovaginal region. These hormone-sensitive lesions usually occur in young to middle-aged women. The lesions are typically no larger than 5 cm in diameter and are found randomly during routine gynecologic examinations.
Patient Information: The case of this study was an 88-year-old man with a solitary polypoid lesion measuring 3×2×2 in the low back area showing the histological appearances of those described in the vulvovaginal region.
It was a well-circumscribed gray-brown lesion covered by wrinkled skin. Histopathological examination revealed edematous hypocellular lesion at low magnification with hyperplastic squamous epithelium coating with reactive epithelial change. At high magnification, the lesion consisted of bland-appearing spindle and stellate-shaped cells in an edematous and fibrous stroma with a large number of variably-sized blood vessels. Immunohistochemistry showed the lesional cells to be focally immunoreactive for EMA and negative for CD34, SMA in stromal cells.
Conclusion: FESPs is an uncommon benign lesion that can occur in men and areas other than the genitals with independence from female sex hormones. Although this is a benign finding, reporting it will increase the knowledge about this rare tumor.

 

Aims: Anxiety caused by repeated venipuncture is common in patients with thalassemia in the thalassemia ward. Acupressure is one of the methods used to reduce patients' anxiety. This study aimed to determine the effect of the P6 point acupressure on anxiety caused by venipuncture in thalassemia patients.
Materials & Methods: This randomized controlled clinical trial was conducted on 80 patients with thalassemia at Shahid Beheshti Hospital in Yasuj city in 2019, who were divided into two intervention and control groups by blocked random allocation. Acupressure intervention was performed at P6 point on the inner side of the arm and in the cavity between the bones of the forearm, above the crease of the wrist. The Spielberger State-Trait Anxiety Inventory was used to collect information. Data were analyzed using descriptive and inferential statistics (independent t-test, paired t-test, and chi-square test) through SPSS 21 software.
Findings: There was no significant difference in the state and trait anxiety between the intervention and control groups at the beginning of the study (p>0.05). However, a significant difference was observed in the state anxiety between the intervention and control groups after the intervention (p<0.05), but there was no significant difference in the trait anxiety score between the two groups (p>0.05).
Conclusion: Acupressure reduces trait anxiety caused by venipuncture in thalassemia patients hospitalized to the thalassemia ward, while it does not affect their trait anxiety.
 

Aims: Sleep is one of the basic physiological needs of human beings, and sleep quality is an effective criterion on the quality of life of hemodialysis patients. Therefore, paying attention to sleep and its improvement should be a priority in nursing care. This study aimed to determine the effect of increasing the pumped blood volume delivered to dialyzer on sleep quality in hemodialysis patients.
Materials & Methods: This semi-experimental study is a clinical trial carried out on 50 hemodialysis patients referred to the hospitals affiliated with Tehran University of Medical Sciences in 2011. Convenience sampling selected samples and randomly divided them into control and intervention groups through permuted block randomization. Data were collected by Pittsburgh Sleep Quality Index in the three stages before intervention and 2 and 4 weeks after intervention. The blood volume delivered to the dialyzer increased by 25ml in the first two weeks and 50ml in the second two weeks compared to before the intervention. Data were analyzed by SPSS 21 software using repeated measures ANOVA and Kruskal-Wallis test. 
Findings: The mean score of sleep quality in the intervention group before the intervention and two and four weeks after the intervention were 10.2±2.6, 8.8±3.4 and 6.9±2.9, respectively and in the control group were 11.4±2.8, 12.5±3.3, and 12.6±3.4, respectively. There was no significant difference in the total score of sleep quality and some of its dimensions between the intervention and control groups (p<0.05).
Conclusion: Increasing blood volume delivered to the dialyzer has improved hemodialysis patients' sleep quality, and this improvement seems to be clinically significant.

Aims: Burns and wounds caused by it are a global injury. Finding natural ingredients to accelerate wound healing in patients with fewer side effects could be valuable. This study aimed to determine the effect of oral Centella asiatica extract on the healing of pain and wound of burn in patients.
Materials & Methods: This study is a clinical trial in which 76 patients hospitalized in the burn department were randomly divided into two intervention (n=38) and control (n=38) groups. The intervention group, in addition to the usual antibiotic treatments, received capsules containing 200mg of Centella asiatica twice daily, and the control group received capsules containing 200mg of starch twice daily. Data collection tools were Bates-Jensen Wound Assessment tool and Visual Analog Scale. Patients' pain and wound healing status were examined at different time of the study.
Findings: The mean burn pain score showed a significant improvement in the intervention group compared to the control group (p<0.001). The average wound healing score did not show significant improvement in the intervention group compared to the control group (p=0.561). However, size (p=0.023), the degree of destruction of the underlying tissues (p=0.032), the amount of necrotic tissue (p=0.015), and the amount of granulation tissue (p=0.001) improved significantly in the intervention group. In addition, the peripheral tissue edema in the control group decrease significantly compared to the intervention group (p=0.008).
Conclusion: Oral extract of Centella asiatica reduces pain in burn patients. However, it does not affect wound healing, although it improves some wound healing indicators.