Kheizaran Miri

Patients receiving hemodialysis (HD) often experience fatigue and reduced quality of life due to the chronic physical and psychological burden of treatment. Non-pharmacological interventions, such as Progressive Muscle Relaxation (PMR) and Physical Exercise (PE), show promise in alleviating these symptoms. This study aimed to compare the effects of PMR and PE on subjective well-being and fatigue in patients with HD. An individually randomized parallel-group trial was conducted with 66 patients receiving hemodialysis recruited from two centers in Mashhad, Iran. Participants were randomly assigned to either the PMR group (n = 34) or the PE group (n = 32). The PMR group received structured relaxation training, while the PE group performed selected stretching and balance exercises over four weeks. Outcomes were assessed using the Multidimensional Fatigue Inventory (MFI) and the Subjective Well-being Scale (SWS) before and after the intervention. Both interventions led to highly significant improvements in all domains of subjective well-being (emotional, psychological, and social) and the Total Subjective Well-being score from baseline (p < 0.001). Crucially, the PMR group achieved a significantly higher Total Subjective Well-being score post-intervention compared to the PE group (p = 0.03; Cohen's d = 0.57). Fatigue levels also decreased significantly in both groups (p < 0.001), although the difference between the PMR and PE groups was not statistically significant (p = 0.12). Furthermore, demographic factors, including employment status and HD frequency, significantly influenced total well-being. Both PMR and PE are practical and viable non-pharmacological strategies for enhancing subjective well-being and reducing fatigue in patients with HD. However, the PMR intervention demonstrated a superior effect on the overall subjective well-being score. Future studies should investigate the combination of these approaches for optimal patient rehabilitation.Trial Registration: This study was registered in the Iranian Registry of Clinical Trials (IRCT) with the unique identifier IRCT20201227049856N1 on 2021-02-15. The trial record can be accessed on the official IRCT website: https://irct.behdasht.gov.ir/trial/53463 .

Chronic kidney disease affects 10–15% of the global population, with hemodialysis causing significant thirst and xerostomia due to fluid restrictions. These symptoms impair quality of life and treatment adherence. While ultrafiltration (UF) and sodium profiling have been studied separately, their combined effect remains understudied, particularly in Middle Eastern populations. We conducted a randomized crossover trial with 20 ESRD patients comparing: (1) ascending/descending UF with linear sodium reduction (150→138 mmol/L) versus (2) conventional HD with constant UF/sodium (140 mmol/L). Participants completed 16 sessions per protocol with washout periods. Outcomes were measured using validated Thirst Questionnaire (5-item) and Xerostomia Inventory (11-item), both showing excellent reliability (Cronbach’s α > 0.7/>0.8). The intervention group showed significant improvements versus conventional HD: 44% reduction in thirst scores (36.5 vs. 64.5, p < 0.001). 22% lower xerostomia (19.0 vs. 24.4, p = 0.002). 73% fewer hypotension episodes (15% vs. 55%, p < 0.05). These benefits are mechanistically linked to improved hemodynamic stability achieved through synergistic sodium and ultrafiltration profiling. This approach, which maintains plasma osmolality and intravascular volume, offers a practical, cost-neutral solution for symptom management. This approach significantly ameliorates patient-reported thirst and xerostomia and reduces intradialytic hypotension, offering a practical, cost-neutral strategy to enhance treatment tolerability. This approach should be adopted in routine practice, particularly for the growing ESRD population. Future studies should explore personalized strategies and long-term effects. Trial registration: This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20180429039463N5) on 07/01/2023. https//irct.behdasht.gov.ir/trial/67,695.

Open-heart surgery is considered as a major treatment for severe coronary artery stenosis with some possible post-operative complications. The successful implementation of the first phase of cardiac rehabilitation (CR) program can make a fall in incidence of these clinical complications. In this study, we aimed to determine the effects of the first phase of cardiac rehabilitation program on quality of recovery (QoR) in patients after coronary artery bypass graft surgery (CABG) based on augmented reality techniques. The clinical trial, conducted from April 2020 to January 2021 at Ghaem Hospital in Iran, involved 60 ICU patients post-open-heart surgery, divided into treatment and control groups. The treatment group used a software-based phase-1 cardiac rehabilitation program featuring videos and images, while the control group followed a standard rehabilitation routine. Data was analyzed using SPSS, employing descriptive statistics and tests such as the Student’s t-test, Mann-Whitney U test, and Chi-square test. According to the findings of this study, the mean overall QoR score indicated an increase for both treatment and control groups in ICU admission/discharge time. But, patients in the treatment group had a statistically significant increase in comparison with non-significant changes in the control group (P < 0.001). The study found that using augmented reality for early-stage rehabilitation in the ICU can enhance recovery quality for patients after coronary artery bypass graft surgery. Hence, AR technology could be integrated into various stages of cardiac rehabilitation. This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20200203046361N1) on 16/02/2020.

The Objective Structured Clinical Examination (OSCE) is a crucial assessment tool for evaluating learners’ ability to apply theoretical knowledge in practical clinical situations. It is widely accepted by both students and educators, and the costs associated with conducting OSCE assessments vary depending on the field of study, how it is implemented, staffing needs, standardized patients, and duration of the examination. This study examines the expenses related to administering OSCEs in medical universities. Conducted from June to September 2023; this mixed-method study elucidated the cost intricacies of executing a two-day OSCE with 14 eight-minute stations for 100 nursing students. This process unfolds in two phases: a qualitative segment comprising text reviews and 45-minute in-depth interviews with faculty members and OSCE experts, leading to the development of a validated checklist, followed by a quantitative phase in which the tool was distributed to 25 faculty members and 5 specialists for completion. The examination costs were delineated into three primary components: time, human resources, equipment, consumables, and necessary supplies. In 2023, the total implementation cost of the OSCE for 100 students across 14 clinical stations was $1028.07, with an estimated per-learner cost of $37.50. Human resources incurred the highest expenditure ($1649.37); while supply costs were relatively lower ($1072.17). Educational infrastructure expenses were excluded because the study focused on the Nursing and Midwifery Faculty’s Clinical Skills Center. Various factors influence OSCE costs, including national production capabilities of medical supplies, institutional credibility, governance status, examination frequency, student demographics, assessor composition, station count, course content, and examinee volume. The insights derived from this comprehensive examination are significant as entry benchmarks for healthcare systems and higher-level academic evaluations. Understanding OSCE cost dynamics facilitates resource optimization and assessment strategy refinement, thereby improving medical education efficacy.

Angiography is associated with anxiety, stress, and changes in patients’ vital signs. The role of the liaison nurse is to bridge gaps and solve problems between departments, thereby preventing the occurrence of undesired complications during patient transfers. Proper preparation of patients by the liaison nurse may lead to an improvement in the hemodynamic status of patients. The present study was conducted to investigate the effect of liaison nurse on hemodynamic status during transfer process to angiography. This randomized controlled trial was conducted from December 2019 to March 2020 on 62 patients who were candidates for elective angiography at Imam Reza Hospital in Mashhad. Participants were selected using a convenience sampling method and then randomly assigned to either the control or intervention group using a lottery system. In the intervention group, patients benefited from the presence of a liaison nurse from the moment the transfer order was issued by the doctor. Tools used included a demographic information questionnaire and a hemodynamic signs checklist. Data were analyzed using SPSS 25 with independent T-tests, paired T-tests, Wilcoxon, Mann-Whitney test, chi-squared, and Fisher’s exact test. Following the intervention, the mean systolic blood pressure, heart rate, and respiratory rate in the intervention group were found to be significantly lower than those in the control group (p < 0.05). In contrast, the mean body temperature, diastolic blood pressure and the percentage of arterial blood oxygen saturation did not exhibit a statistically significant difference between the two groups (p > 0.05). The liaison nurse role emerges as a valuable strategy for enhancing patients’ hemodynamic stability, and its implementation can have a positive impact on patient outcomes in hospital settings.