Clinical Reasoning in Nursing Students

Abstract Introduction: Diagnosis and understanding of patient conditions require nurses 'clinical reasoning skills, as in the absence of this skill; the nurses will not be able to diagnose the patients' condition and will impose harmful consequences on the patient. The purpose of this study is to evaluate and compare the clinical reasoning skills of the nursing students at Shahid Beheshti University of Medical Sciences at the end of theoretical courses in medical-surgical nursing in 2018. Methods: In this descriptive-comparative study, 150 nursing students from freshmen, sophomores, and juniors studying at the Faculty of Nursing and Midwifery of Shahid Beheshti University of Medical Sciences were selected by stratified sampling method. Students in each year comprised one category and the total number of was 3, also the number of students per category was 50, and the total number of categories will be equal to 9. Data were collected using a researcher-made questionnaire employing Key Feature Problem (KFP) method and analyzed using descriptive statistics by SPSS V.20 software. Results: The results showed that there is a significant difference between the grades of third-year students and those in their first and second years of study (P <0.001). Based on the results, the clinical reasoning skill in the first year was poor (51.59 ± 0.06%), in the second year was very weak (48.41 ± 0.09%) and in third-year students was very weak (37.62 ± 0.88). Also, the average skill of clinical reasoning of all students was very weak with a mean percentage of 46.01%. Conclusions: The findings indicate that the level of students' clinical reasoning skills has been declined comparatively from freshmen to juniors. In general, the level of clinical skills in nursing students of Shahid Beheshti University of Medical Sciences is disappointingly low

Global prevalence of polypharmacy among the COVID-19 patients : A comprehensive systematic review and meta-analysis of observational studies

BACKGROUND: Polypharmacy has traditionally been defined in various texts as the use of 5 or more chronic drugs, the use of inappropriate drugs, or drugs that are not clinically authorized. The aim of this study was to evaluate the prevalence of polypharmacy among the COVID-19 patients, and the side effects, by systematic review and meta-analysis. METHODS: This study was performed by systematic review method and in accordance with PRISMA 2020 criteria. The protocol in this work is registered in PROSPERO (CRD42021281552). Particular databases and repositories have been searched to identify and select relevant studies. The quality of articles was assessed based on the Newcastle-Ottawa Scale checklist. Heterogeneity of the studies was measured using the I 2 test. RESULTS: The results of meta-analysis showed that the prevalence of polypharmacy in 14 studies with a sample size of 189,870 patients with COVID-19 is 34.6% (95% CI: 29.6-40). Studies have shown that polypharmacy is associated with side effects, increased morbidity and mortality among patients with COVID-19. The results of meta-regression analysis reported that with increasing age of COVID-19 patients, the prevalence of polypharmacy increases (p < 0.05). DISCUSSION: The most important strength of this study is the updated search to June 2022 and the use of all databases to increase the accuracy and sensitivity of the study. The most important limitation of this study is the lack of proper definition of polypharmacy in some studies and not mentioning the number of drugs used for patients in these studies. CONCLUSION: Polypharmacy is seen in many patients with COVID-19. Since there is no definitive cure for COVID-19, the multiplicity of drugs used to treat this disease can affect the severity of the disease and its side effects as a result of drug interactions. This highlights the importance of controlling and managing prescription drugs for patients with COVID-19

Ecological interaction between commercial fishes in the Persian Gulf

An ecosystem-based management fishery is a new way of looking at management of living resources. Trophic levels of basic food items, feeding habits, growth and mortality rate of 20 exploited fish species (including commercial and bycatch) are investigated in the Persian Gulf (from the provinces of Khuzestan, Bushehr and Hormozgan) from 2010 to 2012. The model considers trophic interactions among 12 functional group of the ecosystem involving Phytoplankton, Zeoplankton, Cephalopods, Shrimp, Infauna Benthos, Epifaunal Macrobenthos, Demersal Zoobenthos Feeders, Small Pelagic Planktivorous Fish, Benthoplagic Feeder, Piscivorous, Large Benthic Carnivores And Small Benthic Carnivores. In general 7452 of stomach contents samples were analyzed based on the weight and numerical method and were detected about 40 preys. The results demonstrated gaps in our knowledge on the food web structure. The mean trophic levels were varied from L. klunzingeri (2) to S. tumbil (4.64), while the total catch of some species were fluctuating widely. Result of our study showed that Total mortality varied between 0.45 per year (A. suppositus) to 9.5 per year (P. indicus) and food consumption rate also fluctuated by 1.9 (L. johni ) to 89 (L. lineolatus). The results indicated that some fish species including sardine, Anchovies, small carangids, S. stridens with high frequency in ecosystem, have been occupied in the food web as a wasp-waist. The model showed that most hunters groups live in middle levels in the food web such as N. japonicas, A. latus, P. kaakan, L. nebolusus, P. indicus and T. lepturus . Analysis the catch rate during 2001-2011 reveled that there is a clear trend of declining most of fish species catches in this research except for T. lepturus, P. kaakan and sparids which lead to upset the fundamental ecological balance of the Persian Gulf in future

The global, regional, and national burden of adult lip, oral, and pharyngeal cancer in 204 countries and territories:A systematic analysis for the Global Burden of Disease Study 2019

Importance Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning.Objective To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates.Evidence Review The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019.Findings In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia.Conclusions and Relevance In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Pharmacological treatment of depression

Depression affects 25% of the population each year. It has a huge impact on patient health, quality of life, and their daily activities, as well as on healthcare providers, payers, and employers. Despite decades of research and significant advances in the understanding of depression pathophysiology, it still remains one of the most difficult-to-treat disease. The current work is supposed to contribute to the body of knowledge available on the matter of treating affective disorders. The aim of this study is to give a brief overview of types and causes of depression and review the common antidepressant available. The novel agents are also discussed in this study.egységes, osztatlangyógyszerészango

Continuous estimation of speed and torque of induction motors using the unscented Kalman filter under voltage sag

Due to sensor limitations in some applications, induction motors state estimators are widely used in industries. One of the most powerful tools available for estimation is the Kalman filter. In this paper, unscented Kalman filter (UKF) and extended Kalman filter (EKF) is used to estimate the speed and torque of an induction motor. In the UKF algorithm, three types of unscented transformation (UT): basic, general and spherical types are presented and compared. It will be shown that the spherical UKF presents good estimation performance. Speed and torque Estimation approach is applied at both steady state conditions and at the time of sudden and rapid change in the motor input voltage. It will be shown that, EKF cannot trace the motor speed at the time of a large disturbance. Finally, experimental validation is presented to show the effectiveness of UKF for continuous estimation of torque and speed of induction motorsComo se veía las limitaciones en los sensores en algunas aplicaciones, los motores asíncronos estimadores de estado ya son ampliamente utilizados en las industrias. Una de las herramientas disponibles y más potentes es el filtro de Kalman. En el presente artículo el Filtro de Kalman Unscented (UKF en siglas en inglés) y el Filtro de Kalman Extendido(EKF) se usan para estimación de la velocidad y el par motor o torque de un motor de inducción. En el algoritmo de UKF, hay 3 tipos de la transformación “unscented” que son presentados y comparados: básica, general y esférica. Se muestra en ese artículo que el UKF esférico presentará una buena estimación. En materia de la estimación de la velocidad y el par motor, que son aplicados tanto en condiciones que están en estado estacionario como en los cambios repentinos y rápidos en el voltaje de entrada del motor. Y además va a mostrar que el EKF no es capaz de rastrear la velocidad del motor en el momento cuando hay una larga perturbación. Por último, la validación experimental es presentada para mostrar la eficacia del UKF de forma continua en la estimación del par motor y la velocidad de los motores asíncronos

Studying the Effectiveness of Using Intelligent Mining Machinery Systems on Health, Safety, and Environmental Parameters and Preventive Maintenance

Introduction: The goal of this study is to investigate how the development of technology has affected the industry (especially the mining industry). For this purpose, this paper examines the impact of intelligent mining machinery systems, including tire pressure monitoring systems (TPMS), dispatching systems, and vehicle health monitoring systems (VHMS), on health, safety, and environmental parameters and preventative maintenance. Material and Methods: This study is descriptive-analytical research that was conducted between time intervals before and after employing the intelligent mining machinery systems. Initially, parameters were identified using the Delphi method. These parameters include human accidents, equipment accidents, environmental incidents, warnings and fines in the domains of health, safety, and the environment, tire usage parameters, the shelf life of the tire, oil overfill, fuel consumption, failure rate, mean time between failures, and preventive maintenance compliance schedules in the domain of preventative maintenance. The effectiveness of using these systems was then assessed by comparing the state of the specified parameters before and after the introduction of the intelligent mining machinery systems. Results: The findings of this research indicate that using intelligent mining machinery systems will decrease equipment accidents by 33.3%, extend the useful life of tires by 7.1%, reduce fuel consumption by 14.6%, cut the mean time required to repair by 25.5%, and enhance preventive maintenance compliance schedules by 5.7%. The findings showed the effectiveness of the use of intelligent systems of mining machines was obtained as follows: reduction of equipment accidents by 33.3%, increasing the useful life of tires by 7.1%, reducing fuel consumption by 14.6%, reducing the average downtime of the car for repair by 25.5% and increasing compliance with the maintenance program by 5.7%. Conclusion: Utilizing intelligent mining machinery systems might have a positive impact on the safety of machines, reduce negative environmental effects like fuel consumption, and improve the maintenance of heavy machinery, which would lead to better mining conditions and lower costs

Design and evaluation of a smartphone app to teach students about body language and patient management

This semi-experimental research was carried out in 2021 by Ahvaz Jundishapur University of Medical Sciences' Dentistry Faculty. This article introduces the Body Language Patient Management application, which was developed using Android Studio software. It is an educational and decision-making support system. The perceptions of dental students about the information described in application and body language were assessed using a questionnaire based on a 4-part Likert scale. A total of 82 general students from the faculty of dentistry in Ahvaz were involved in the study and participated in all the activities of the study. Of the respondents, 60.97% (n = 50) were female students and 39.02% (n = 32) were male students. The average age of the students was 24 years ± 1.47. The pre-test and post-test findings were compared using a paired samples t-test. Using SPSS 24.0, the data was examined. P <0.05 was used as the significant threshold.The pre-test and post-test had mean scores of 4.40±1.35 and 6.34±1.79, respectively. The results of the statistical analysis demonstrated that the difference between the preand post-test mean scores was statistically significant (P< 0.05). According to this research, the gender of the students makes a big difference in how effective instructional software is. The created software enhanced students' knowledge in the areas of understanding patient body language and better patient management, which is accomplished more effectively by women than by men. Additionally, students have evaluated the significance of the benefits and effect of created instructional software