MODERN CARE JOURNAL
Year:2025 | Volume:22 | Issue:3|Papers Count:8

Background: Postoperative mobilization is a crucial aspect of nursing care, and delays in mobilization can lead to numerous adverse outcomes. Objectives: This study aimed to investigate the effect of the initial mobilization time following laparoscopic cholecystectomy on patient pain and bowel motility. Methods: This cross-sectional and descriptive study was conducted with 94 patients scheduled for elective laparoscopic cholecystectomy at the general surgery clinic of a university hospital between November 2022 and March 2023, who met the research criteria. Data were collected using the personal information form and the Visual Pain Scale. A P-value of < 0.05 was considered statistically significant. Results: A sustainable, moderately significant relationship was found between the initial mobilization time after surgery and the first gas discharge and first defecation status (r = 0.502, P < 0.00; r = 0.503, P < 0.05, respectively). As the mobilization time decreased, the times for first gas discharge and defecation also decreased. Additionally, a moderately significant statistical relationship was observed between the initial mobilization time after surgery and pain levels at the 8th and 24th hours, as well as the number of analgesics used (r = 0.510, P < 0.05; r = 0.502, P < 0.00; r = 0.574, P < 0.05, respectively). As the mobilization time decreased, both the pain level and the amount of analgesics used decreased. Conclusions: The study determined that the initial mobilization time of participants after surgery positively affected bowel motility, reduced pain, and decreased the amount of analgesics used.

Background: Mothers of children with type 1 diabetes often experience significant stress and anger. Spirituality is a promising source of support and an important dimension of self-care. Objectives: To determine the effect of spirituality-based self-care on the stress and anger of mothers of children with type 1 diabetes. Methods: A clinical trial was conducted in 2024 at the Diabetes Center of Imam Reza (AS) Specialized Clinic in Zabol, Iran. Seventy mothers were randomly assigned to experimental (n = 35) and control (n = 35) groups. Data collection tools included a demographic questionnaire, the Parenting Stress Index, and the Spielberger Anger Expression Scale. The experimental group received a spirituality-based self-care training package over six sessions, while the control group received routine care. Stress and anger levels were measured before the intervention and three months afterward. Data were analyzed using chi-Square, or Fisher's Exact test, and independent t-tests via IBM SPSS version 23. Results: There was no significant difference in pre-test stress scores between groups (P = 0.220). Post-intervention stress scores also showed no significant difference (102.25 ± 6.22 vs. 99.25 ± 8.77; P = 0.104). Pre-test anger scores were not significantly different (P = 0.880); however, post-intervention anger scores differed significantly between groups (121.28 ± 5.97 vs. 134.20 ± 7.05; P < 0.001). Conclusions: Spirituality-based self-care interventions can effectively reduce anger in mothers of children with type 1 diabetes. Integrating such training into nursing practice is recommended. However, this intervention alone was insufficient to reduce stress, indicating the need for additional support strategies.

Background: Inducing analgesia in patients is a primary goal of anesthesia, achieved through various methods and drugs. Objectives: The present study compares the block quality and complications associated with different doses of Marcaine and fentanyl during spinal anesthesia for leg fracture surgery in opium abusers. Methods: In this randomized clinical trial, 80 patients with a history of opium abuse, classified as American Society of Anesthesiology (ASA) class I or II, who presented with leg fractures at Vali-Asr Hospital in 2020 - 2021, were selected through convenience sampling and randomly assigned to two groups. Group A (40 patients) received 15 mg of Marcaine and 10 μg of fentanyl intrathecally. Group B (40 patients) received 12.5 mg of Marcaine and 25 μg of fentanyl intrathecally. The duration of sensory block, incidence of nausea, vomiting, shivering, itching, and duration of painlessness were recorded on a checklist for both groups. Data were analyzed using chi-square and independent t-test in SPSS version 21 software (P = 0.05). Results: Eighty leg fracture patients participated. There were no significant differences in age, gender, or anesthesia class between the two groups. The duration of motor block return was significantly longer in group A compared to group B (115.23 ± 42.71 vs. 63.35 ± 24.5 minutes) (P < 0.001). Group B had a longer duration of analgesia (148 ± 27 minutes) compared to group A (90 ± 34 minutes). There was no significant difference in complications (nausea, vomiting, shivering, and itching). Visual Analog Scale (VAS) scores were lower in group B than in group A (P < 0.001). Group A had significantly higher average pethidine consumption compared to group B. Conclusions: Higher fentanyl doses resulted in less pain without increasing complications. This method is recommended for spinal anesthesia in addicted patients.

Background: Trauma is a significant issue in public health and emergency care, with decision-making being a critical component of the care system. Objectives: This study aimed to evaluate the effect of webinar training on chest trauma management using two methods — lecture-based and scenario-based — on the clinical decision-making skills of emergency medical technicians (EMTs). Methods: In this interventional study, 50 EMTs were randomly assigned to two groups: A lecture-based webinar group and a scenario-based webinar group. A researcher-developed pre-test questionnaire was distributed via WhatsApp. Subsequently, a 4-hour webinar training session was conducted using the Adobe Connect platform. Immediately following the training, the questionnaire was redistributed to both groups via WhatsApp. Data were analyzed using SPSS version 22, employing Fisher's exact test, independent samples t-test, and paired t-test, with a significance level set at 0.05. Results: The mean score of decision-making skills prior to the intervention did not differ significantly between the lecture and scenario groups (P = 0.76). However, post-intervention, the increase in the mean score of decision-making skills was greater in the scenario-based group (7.44 ± 5.8 points) compared to the lecture group (3.44 ± 3.9 points), with this difference being statistically significant (P = 0.007). Conclusions: The findings suggest that scenario-based training, even in a virtual format, is a more effective method than traditional training approaches. Nonetheless, further studies are recommended to validate these results.

Background: Depression, anxiety, and stress are common issues observed among patients undergoing hemodialysis. Objectives: The present study was conducted to determine the effect of foot reflexology massage on stress, anxiety, depression, and serum cortisol levels among hemodialysis patients. Methods: A double-blind randomized controlled trial was conducted on 57 patients undergoing hemodialysis. The patients were randomly assigned to either a control group or an experimental group. The Depression Anxiety Stress Scale (DASS-21) was used to measure stress, anxiety, and depression in the sessions before and after the intervention. Serum cortisol levels were also measured between 7:30 and 8:00 a.m. before and after the intervention. Foot reflexology and simple foot massage were performed three times per week for four weeks, with each session lasting 15 minutes for each foot rotationally in the intervention and control groups, respectively. Results: There was no significant difference between the intervention group and the control group in terms of the mean scores of cortisol, stress, anxiety, or depression before the intervention. However, the differences in the mean scores of stress (P < 0.0001), anxiety (P = 0.01), depression (P < 0.0001), and cortisol (P < 0.0001) in the intervention group significantly decreased compared to those in the control group. Conclusions: This study showed that foot reflexology can reduce cortisol levels, stress, anxiety, and depression among hemodialysis patients.

Background: Adolescent self-harm is an escalating public health issue, frequently associated with challenges in personality organization and exposure to cyberbullying. Objectives: This study examines the direct and indirect relationships among personality organization, cyber-victimization, and self-harm behaviors in adolescents, emphasizing the mediating role of emotion regulation difficulties. Methods: Utilizing a descriptive correlational design, we employed multi-stage cluster random sampling to recruit 356 adolescents (65.17% female, 34.83% male) from Tehran in 2024. Data were gathered using validated instruments: The Self-harm Behavior Questionnaire, Personality Organization Questionnaire, Difficulties in Emotion Regulation Scale-Short Form, and Cyber-victimization Scale. Structural equation modeling (SEM) was performed using AMOS software to explore variable relationships. Results: The results indicated significant positive associations between personality organization (primitive psychological defenses: 24.76 ± 6.33; identity diffusion: 22.92 ± 5.14; reality testing: 40.46 ± 9.79, cyberbullying (cyber aggression: 15.41 ±4.10); cyber victimization: 16.96 ± 4.18, and self-harm behaviors: 6.06 ± 1.88 (all P < 0.001). Emotion regulation difficulties (e.g., lack of clarity: 6.77 ± 2.49); non-acceptance: 9.41 ± 2.92 significantly mediated the relationships between personality organization, cyberbullying, and self-harm (P < 0.001). Conclusions: These findings highlight that compromised personality organization and cyber-victimization are strong predictors of self-harm, with emotion regulation difficulties acting as a crucial mediator. Interventions focused on enhancing emotion regulation skills may reduce the risk of self-harm in adolescents, presenting a promising strategy for prevention and support.

Context: Cervical cancer (CC) is a significant global health issue primarily associated with human papillomavirus (HPV) infection. While most HPV infections resolve spontaneously, persistent infections can lead to chronic inflammation and the development of precancerous lesions. High-risk HPV types, particularly HPV-16 and HPV-18, are notably linked to the majority of CC cases, establishing a clear causal relationship between HPV infection and CC through extensive epidemiological studies. Evidence Acquisition: The databases of PubMed, Scopus, Web of Science, and Google Scholar were utilized for the search. Papers without a time limit until 2024 were included, encompassing clinical studies, review articles, systematic reviews, and meta-analyses. The following keywords were systematically employed to identify relevant publications for this comprehensive review: "HPV", "pathogenesis", "immune response", "immune evasion", "cervical cancer", "diagnostic methods", "prevention", and "treatment". Results: The study reveals that while most HPV infections are transient, persistent infections significantly elevate the risk of developing CC over time. Screening methods such as Pap smears and HPV vaccination are crucial for early detection and prevention. The incorporation of sensitive biomarkers for early-stage detection is essential for effective management of CC. Conclusions: Cervical cancer is largely preventable, highlighting the need for increased awareness and access to vaccination and screening programs to reduce incidence and mortality rates globally. Ongoing research into HPV's pathogenicity is vital for developing targeted prevention strategies against CC.

Introduction: Bronchogenic cysts are congenital cystic lesions that arise due to abnormalities during the embryonic development of the tracheobronchial tree. When located in close proximity to the trachea, they may lead to significant respiratory symptoms. Case Presentation: A 21-year-old female patient presented with persistent cough and intermittent dyspnea. Thoracic imaging revealed a cystic lesion measuring 3.8 × 5.8 × 4.4 cm located in the right paratracheal region. During uniportal video-assisted thoracoscopic surgery (u-VATS), a tracheal rupture occurred while dissecting the lesion. The tracheal injury was successfully repaired with primary suturing without conversion to open surgery, and the cyst was completely excised. Histopathological examination confirmed the diagnosis of a bronchogenic cyst. The patient was discharged uneventfully on the third postoperative day. Conclusions: The u-VATS is a safe and effective approach for the surgical management of bronchogenic cysts, offering advantages not only in diagnosis and treatment but also in the management of intraoperative complications. This case highlights the feasibility and novelty of managing intraoperative tracheal injury using the u-VATS approach, which offers a less invasive yet effective alternative in thoracic surgical emergencies.