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The CD147 / Cyp A interaction is a critical pathway in cancer types and an essential factor in entering the COVID-19 virus into the host cell. Melittin acts as an inhibitory peptide in cancer types by blocking the CD147/ Cyp A interaction. The clinical application of Melittin is limited due to weak penetration into cancer cells. TAT is an arginine-rich peptide with high penetration ability into cells widely used in drug delivery systems. This study aimed to design a hybrid peptide derived from Melittin and TAT to inhibit CD147 /Cyp A interaction. An amino acid region with high anti-cancer activity in Melittin was selected based on the physicochemical properties. Based on the results, a truncated Melittin peptide with 15 amino acids by the GGGS linker was fused to a TAT peptide (nine amino acids) to increase the penetration rate into the cell. A new hybrid peptide analog(TM) was selected by replacing the glycine with serine based on random point mutation. Docking results indicated that the TM peptide acts as an inhibitory peptide with high binding energy when interacting with CD147 and the CypA proteins. RMSD and RMSF results confirmed the high stability of the TM peptide in interaction with CD147. Also, the coarse-grained simulation showed the penetration potential of TM peptide into the DOPS-DOPC model membrane. Our findings indicated that the designed multifunctional peptide could be an attractive therapeutic candidate to halter tumor types and COVID-19 infection.

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OBJECTIVE: Considering the exponentially growing concerns about the increase of anal cancer rates in women with human papillomavirus (HPV) infection and cervical intraepithelial neoplasia, the authors evaluated concurrent anorectal and cervical cytology in women with positive and negative cervical smear tests. METHOD: The current investigation was designed as a cross-sectional study conducted in Arash Women's Hospital, Tehran, Iran, between November 2020 and November 2021. Cervical cytology, HPV test, and anal cytology samples were prepared. Then women with abnormal cervical cytology and/or positive high-risk HPV were referred to a colposcopy clinic for further evaluation. RESULTS: Five hundred and forty-three women were recruited during the study period. These women were divided into two groups of positive cervical cytology (n = 161) and negative cervical cytology (n = 382). There were no cases of anal intraepithelial neoplasia in either group. Negative anal cytology was reported in 99 (61.5%) of participants with a positive cervical cytology and 254 (66.7%) of participants with a negative cervical cytology. A total of 62 (38.5%) anal samples in the positive group and 127 (33.3%) in the negative group were unsatisfactory for further evaluation. CONCLUSION: We were unable to show any correlation between abnormal cervical cytology, dysplasia, or cervical high-risk HPV with anal abnormal cytology.

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Introduction: Implantable cardioverter defibrillator (ICD) plays a life-saving role via controlling malignant dysrhythmias. However, it may result in the incidence of psychological tensions in patients' lives, eventually leading to changes in their quality of life (QoL). To date, this association has remained unclear among Iranian population. Therefore, the present study aimed to determine the association between QoL and psychological issues in patients with ICD. Methods: Using convenience sampling method, this cross-sectional study was conducted on 96 patients referred to the pacemaker clinic of Shahid Faghihi hospital and Kowsar heart hospital affiliated to Shiraz University of Medical Sciences, Iran from September 2016 to January 2017. The data were collected using Depression, Anxiety, Stress Scale (DASS-21) and the Short Form-36 (SF-36) questionnaire, and analyzed in SPSS software version 13 using independent t-test, Pearson's correlation test, and ANOVA. Results: The mean (SD) score of patients' QoL was found to be 1672.02 (43.43). Moreover, the mean (SD) scores of depression, anxiety, and stress were 4.69 (0.46), 5.6 (0.47), and 7.51 (0.05), respectively indicating moderate depression, anxiety, and stress levels among the patients. A significant association was found between the patients' QoL and depression, anxiety, and stress. Conclusion: As an association was observed between the patients' QoL and depression, anxiety, and stress, performing some interventions to reduce the patients' psychological issues might improve their QoL.

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BACKGROUND: Caring is the essence of nursing, and nurses who are dissatisfied with their job are not able to perform optimal patient care. This study was conducted with the aim to determine the effect of education based on human care theory on nurses' caring behaviors and job involvement. MATERIALS AND METHODS: In this clinical trial, a total of 110 intensive care unit nurses from Nemazee Hospital, Shiraz, Iran, were randomly allocated to control and intervention groups. The intervention group received a 6-h workshop based on Watson's human care theory using a collaborative and role-playing approach and 1-month follow-up period through presenting weekly preplanned care and caregiving scenarios. The control group received routine hospital trainings. The data collection tools used were included in a demographic information form, and the Larson Caring Assessment Questionnaire, and Kanungo Job Involvement Questionnaire. Data were analyzed using Chi-square test, and independent and paired t-test in SPSS software. RESULTS: Majority of the participants were married women and had Bachelor of Science degree in Nursing. The participants' age ranged from 21 to 52 years. After the education, caring behaviors and job involvement scores significantly increased in the intervention group compared to the control group (p < 0.001). CONCLUSIONS: The findings suggest that a care workshop can be effective in improving care behaviors and job involvement. Therefore, we recommend more extensive research to determine the effectiveness of long-term intervention on nursing care behaviors.

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OBJECTIVES: To determine the relationship between ethical climate and burnout in nurses working in Intensive Care Units (ICUs). METHODS: This cross-sectional and multi-center study was conducted among 212 nurses working in adult ICUs of six hospitals affiliated to Shiraz University of Medical Sciences, Iran in 2019. The participants were selected using systematic random sampling technique. Data was collected using valid instruments of Olson's Hospital Ethical Climate Survey (HECS) and Maslach Burnout Inventory (MBI). RESULTS: Ethical climate was favorable (3.5±0.6). The intensity (32.2±12.4) and frequency (25.5±12.4) of burnout were high. Ethical climate had significant and inverse relationships with frequency of burnout (r =-0.23, p=0.001) and with intensity of burnout (r=-0.186, p=0.007). Ethical climate explained 5.9% of burnout. Statistically significant relationships were also found between these factors: age with ethical climate (p=0.001), work shifts with burnout (p=0.02), and gender and with intensity frequency of burnout in ICU nurses (p=0.038). The results of Spearman correlation coefficient showed significant and inverse relationships between ethical climate and job burnout (r=-0.243, p < 0.001). CONCLUSIONS: Nurses in ICUs perceived that ethical climate was favorable however, burnout was high. Therefore, burnout can be affected by many factors and it is necessary to support ICU nurses since they undertake difficult and complicated task. It is recommended to assess factors that increase burnout and adopt specific measures and approaches to relieve nursing burnout.

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Objective. To determine the relationship between ethical climate and burnout in nurses working in Intensive Care Units (ICUs). Methods. This cross-sectional and multi-center study was conducted among 212 nurses working in adult ICUs of six hospitals affiliated to Shiraz University of Medical Sciences, Iran in 2019. The participants were selected using systematic random sampling technique. Data was collected using valid instruments of Olson's Hospital Ethical Climate Survey (HECS) and Maslach Burnout Inventory (MBI). Results. Ethical climate was favorable (3.5±0.6). The intensity (32.2±12.4) and frequency (25.5±12.4) of burnout were high. Ethical climate had significant and inverse relationships with frequency of burnout (r =-0.23, p=0.001) and with intensity of burnout (r=-0.186, p=0.007). Ethical climate explained 5.9% of burnout. Statistically significant relationships were also found between these factors: age with ethical climate (p=0.001), work shifts with burnout (p=0.02), and gender and with intensity frequency of burnout in ICU nurses (p=0.038). The results of Spearman correlation coefficient showed significant and inverse relationships between ethical climate and job burnout (r=-0.243, p<0.001). Conclusion. Nurses in ICUs perceived that ethical climate was favorable however, burnout was high. Therefore, burnout can be affected by many factors and it is necessary to support ICU nurses since they undertake difficult and complicated task. It is recommended to assess factors that increase burnout and adopt specific measures and approaches to relieve nursing burnout.

Objetivo. Determinar la percepción de las enfermeras sobre el clima ético y el agotamiento laboral en las Unidades de Cuidados Intensivos (UCI). Métodos. Este estudio de corte transversal y multicéntrico se realizó con 212 enfermeros que trabajaban en UCI para adultos de seis hospitales afiliados a la Universidad de Ciencias Médicas de Shiraz, Irán, en 2019. Los participantes se seleccionaron mediante una técnica de muestreo aleatorio sistemático. Los datos se recolectaron a partir de la utilización de instrumentos Encuesta de Clima Ético en Hospitales (HECS) de Olson y el Inventario de Burnout de Maslach (MBI). Resultados. El clima ético fue favorable (3.5±0.6). La intensidad (32.2±12,4) y la frecuencia (25.5±12.4) del agotamiento fueron altas. El clima ético tuvo relaciones significativas e inversas con la frecuencia de Burnout (r=-0.23, p=0.001) y con la intensidad del burnout (r=-0.186, p=0.007). El clima ético explica el 5.9% del agotamiento. También se encontraron relaciones estadísticamente significativas entre edad y clima ético (p=0.001), turnos de trabajo y burnout (p=0.02), además de género y frecuencia de intensidad de burnout (p=0.038). El coeficiente de correlación de Spearman mostró relaciones significativas e inversas entre el clima ético y el agotamiento laboral (r=-0.243, p<0.001). Conclusión. Las enfermeras en las UCI percibieron que el clima ético era favorable, sin embargo, el desgaste fue alto. Por tanto, el burnout puede verse influido por muchos factores y es necesario apoyar a estas enfermeras que cumplen una tarea difícil y complicada. Se recomienda evaluar los factores que aumentan el agotamiento y adoptar medidas y enfoques específicos para aliviar el burnout de enfermería.

Objetivo. Verificar a diferença entre a percepção dos enfermeiros sobre o clima ético e o desgaste no trabalho em Unidade de Terapia Intensiva (UTI). Métodos. Este estudo transversal e multicêntrico foi realizado com 212 enfermeiras que trabalham na UTI adulto de seis hospitais afiliados à Universidade de Ciências Médicas de Shiraz, Irão, em 2019. Os participantes foram selecionados por meio de uma técnica de amostragem aleatória sistemática. Os dados foram coletados usando os instrumentos Enquete de Clima Ético em Hospitais (HECS) de Olson e o Inventário Burnout de Maslach (MBI). Resultados. O clima ético era favorável (3.5±0.6). A intensidade (32.2±12.4) e a frequência (25.5±12.4) de exaustão foram altas. O clima ético teve relações significativas e inversas com a frequência de Burnout (r=-0.23, p=0.001) e com a intensidade de Burnout (r=-0.186, p=03007). O clima ético explica 5,9% do esgotamento. Também foram encontradas relações estatisticamente significativas entre: idade e clima ético (p=0.001), turnos de trabalho e Burnout (p=0,02), além de gênero e frequência da intensidade do Burnout (p=0.038). O coeficiente de correlação de Spearman mostrou relações significativas e inversas entre clima ético e Burnout (r=-0243, p<0.001). Conclusão. As enfermeiras das UTIs perceberam que o clima ético era favorável, porém, o desgaste foi alto. Portanto, o Burnout pode ser influenciado por diversos fatores e é necessário apoiar essas enfermeiras que cumprem uma tarefa difícil e complicada. Recomenda-se avaliar os fatores que aumentam o Burnout e adotar medidas e abordagens específicas para aliviar o Burnout da enfermagem.

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INTRODUCTION: Cardiac arrest happening outside the hospital, specifically in rural regions that are more distant from health centers, is a crucial issue in the health of individuals in those regions. Therefore, the ability of residents in those regions to do cardiopulmonary resuscitation (CPR) is very important in preventing death among people. This study aimed at determining the effect of basic CPR training on the adults' knowledge and performance in rural areas. METHODOLOGY: This quasi-experimental study was conducted on 92 adults from rural areas of Shouraab Kohmareh-Sorkhi in Fars province, Iran, in September and October 2018. The samples were selected and divided into two groups using the simple random method. The data were collected using a demographic information form, knowledge questionnaire, and an observational checklist of CPR performance devised by the researcher. Basic teaching of CPR for the intervention group included two hours of oral teaching using lecture and question and answer as well as two hours of practical teaching using demonstration, practice on a manikin, provision of feedback, and correction of errors. The data were entered into the SPSS statistical software, version 21 and were analyzed using descriptive statistical tests, Kolmogorov-Smirnov test, independent t-test, chi-square test, Wilcoxon signed-rank test, and Mann-Whitney test. FINDINGS: The study results revealed that the intervention group's mean score of knowledge was significantly greater after the intervention (6.78±1.23) compared to that at baseline (2.78±1.74) and compared to the control group (3.24±1.84) (p<0.001). Additionally, the intervention group's mean score of performance was significantly greater after the intervention (8.22±1.65) than that before the intervention (0.8±0.77) and compared to the control group (1.17±0.71) (p<0.001). CONCLUSION: According to the study findings, the villagers' performance and knowledge could be enhanced by teaching basic CPR techniques. TRIAL REGISTRATION NUMBER: IRCT20150714023199N3; date registered: 2018-05-06.

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BACKGROUND: Proper education can improve the quality of life. Multimedia as an interactive educational method and booklet as a traditional one have their own unique effects. This study aimed at compare the interactive multimedia and booklet methods at the time of discharge on the quality of life of kidney transplant patients. METHODS: In this single-blind interventional study, 80 patients from Bouali Hospital, Shiraz, from September 2017 until June 2018 were selected by convenience sampling, and then divided into two groups (booklet and interactive multimedia) by block randomization. Intervention for the first group included short and long-term care information in the form of a booklet, and an interactive multimedia CD with the same content for the second group. Quality of life was assessed by kidney transplant questionnaire (KTQ) at the time of discharge and after two months. Adherence to education was verified by phone. The data were analyzed through SPSS v.24 software using independent and paired t-tests. Plt;0.05 was considered significant. RESULTS: The mean overall quality of life score in both groups increased significantly, P=0.044 for the booklet group and P=0.039 for the multimedia group. In emotional, fatigue, uncertainty/fear domains, both groups showed improvement after the intervention (P<0.05). However, in physical symptoms and appearance domains, differences were not significant, before and after education. After intervention, no significant difference was observed between the two groups in the overall and specific domains of quality of life score (P=0.437). CONCLUSION: Both methods had positive impacts on the quality of life and emotional, fatigue and uncertainty/fear domains. Trial Registration Number: IRCT201608272950N1.

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BACKGROUND: Understanding the impact of delivery mode on neonatal morbidity becomes essential in the context of rising Caesarian delivery rates. AIMS: We aimed to compare the selected outcomes in neonates born by low-risk planned Caesarian delivery versus planned normal vaginal delivery (NVD). METHODS: This prospective cohort study examined early, and late neonatal complications among 1071 neonates born through low-risk planned Caesarian delivery and 1367 neonates born through planned NVD, in Fars, Islamic Republic of Iran, during 2012-2014. RESULTS: Gestational age of neonates born through Caesarian delivery was significantly lower than their counterparts in NVD group. Accordingly, babies' birth weights were 3166 (±442.4) grams in Caesarian delivery group and 3213 (±454.8) grams in NVD group. Normal skin colour at birth was more prevalent in the Caesarian delivery group compared to the NVD group (85% vs. 81.3%, P = 0.04). No significant differences were detected between the two groups regarding birth trauma, birth height and head circumference, and developing infection, icterus and convulsion during neonatal period. Also, height and weight at two years of age did not significantly differ in both groups. CONCLUSION: The results of this study show that neonates born by Caesarian delivery and NVD had the same early and late outcomes.

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PURPOSE: This pilot study aimed to evaluate the effect of an 8-weeks-yoga intervention on quality of life and upper extremity edema volume in women with breast cancer related lymphedema. METHODS: This was a controlled trial with pre-post design. A total of 40 women with breast cancer related lymphedema were randomly assigned into an intervention or control groups. The intervention group participated in a yoga exercise class for 8 weeks, in a twice a week instructor-led practice and once a week home practice. Outcomes were EORTC QLQ_C30 to measure quality of life, and water displacement volume-meter to measure upper extremity edema volume. The outcomes were evaluated at baseline, 4th and 8th week. Data were analyzed using SPSS. RESULTS: Four weeks after the intervention, a significant difference was observed between the groups with respect to role functioning of quality of life (P = 0.03). Eight weeks after the intervention, a significant difference was observed between groups concerning physical and emotional functioning of quality of life (P < 0.05). The changing trend in physical, role, emotional, and cognitive functioning had increased, and in some scales such as fatigue, pain, insomnia, and financial difficulties the scores were reduced in the intervention group. Regarding edema volume, no significant difference was found between both groups on the 4th and 8th week after the intervention (P > 0.05). CONCLUSION: As yoga exercise might improve physical, role, and emotional functioning of quality of life as well as reduce fatigue, pain, and insomnia, using this intervention can be suggested amongst women with breast cancer related lymphedema.

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BACKGROUND: Self-management (SM) as a dynamic process enables Ulcerative colitis (UC) patients to live with this chronic illness. The present study aimed to investigate the effect of SM education on self-efficacy (SE) and quality of life (QoL) in patients with UC. METHODS: This randomized controlled clinical trial study was conducted on 64 patients with UC from December 2016 to February 2017 at Motahari clinic, Shiraz. Patients were randomly divided into two groups of intervention and control. The education program included six 90-minute sessions in 3 weeks and one month telephone follow-up. Before, immediately and one month after the intervention, the participants filled out the Strategies Used by People to Promote Health (SUPPH) for SE, and the Inflammatory Bowel Disease Questionnaire-9 (IBDQ-9) for Qol. Then, data were entered into SPSS 18.0 and analyzed using independent samples t-test, Chi-square, repeated measures ANOVA and Pearson's correlation coefficient. RESULTS: A significant increase was observed in terms of the overall mean score for SE and its dimensions in the intervention group (P<0.001). These scores were significantly higher than those of the control group (P<0.001), except for positive attitude (P=0.15). The scores for overall Qol and its dimensions significantly increased in the intervention group immediately and one month after the intervention (P<0.001), and the difference between the two groups was significant (P<0.001). There was a significant positive correlation between SE and Qol (r=0.32, P=0.01). CONCLUSION: SM improved the SE and Qol in patients with UC. SM educatoin is recommended in nursing care of patients with UC. Trial Registration Number: IRCT2016092429823N1.

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BACKGROUND: Cirrhosis is a chronic and progressive disease that causes various complications for patients due to disturbance of the liver's usual function. Self-efficacy refers to an individual's belief in one's ability to perform the necessary behaviors to achieve one's goals. Self-management is also an important criterion for long-term change in behavior. The present study aimed to investigate the effect of self-management training on self-efficacy of patients suffering from liver cirrhosis. METHODS: This randomized controlled clinical trial was conducted on 74 patients with liver cirrhosis randomly assigned to an intervention (receiving self-management training) and a control group (routine care) from 2012 to 2013. The data were collected in the transplantation center affiliated to Shiraz University of Medical Sciences. Self-management training was performed in six 90-minute sessions twice a week. Besides, the intervention group was followed up for a month via telephone. Levo self-efficacy questionnaire was filled out by the patients before, immediately after, and one month after the intervention. Then, the data were entered into the SPSS statistical software (v. 16) and analyzed using independent t-test, Chi-square test, and repeated measures ANOVA. RESULT: At the beginning of the study, no statistically significant difference was found between the two groups regarding self-efficacy (P=0.18). However, the total score of the questionnaire and those of all its dimensions significantly improved in the intervention group immediately and one month after training self-management skills (P<0.001). The mean score of self-efficacy was 102.24±7.79 and 76.78±9.49 in the intervention and control groups, respectively. On the other hand, no statistically significant difference was observed in the control group's self-efficacy immediately and one month after the intervention (P=0.6). CONCLUSION: The results showed that the self-management program resulted in improvement of self-efficacy in the patients with liver cirrhosis. Therefore, this supportive strategy could be useful in patients with chronic illnesses for improvement of care and prevention of complications.

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BACKGROUND: Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection in Intensive Care Units (ICUs) which increases the length of ICU stay, duration of mechanical ventilation, and mortality. The present study used an oral care protocol and compared the effects of two different concentrations of chlorhexidine on reduction of oropharyngeal colonization and VAP. MATERIALS AND METHODS: This study was performed on 114 patients from trauma, surgery, neurosurgery, and general ICUs randomly allocated to two groups under oral care with 0.2% and 2% chlorhexidine solution. A multidisciplinary team approved the oral care protocol. Data was collected using a demographic information form, APACHE IV form, Beck oral assessment scale, mucosal-plaque assessment scale, and oropharyngeal swab culture. RESULTS: The results showed a significant reduction in VAP (p=0.007) and oropharyngeal colonization (p=0.007) in the group under oral care with 2% chlorhexidine solution compared with the other group. However, no significant difference was found between the two groups in terms of oropharyngeal adverse effects (p=0.361). CONCLUSION: Oral decontamination with 2% compared to 0.2% chlorhexidine is a more effective method in the prevention of VAP and reduction of oropharyngeal colonization (especially gram-positive).

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BACKGROUND: Stomatitis is the most common complication of chemotherapy. This study aimed to assess the effect of aloe vera solution on stomatitis and its pain intensity in patients undergoing chemotherapeutic procedures. METHODS: In this randomized controlled clinical trial, 64 patients with Acute Myeloid Leukemia and Acute Lymphocytic Leukemia undergoing chemotherapy were randomly divided into a control and an intervention group. The intervention group patients were asked to wash their mouths with 5 ml of aloe vera solution for two minutes three times a day for 14 days. The control group patients, however, used only the ordinary mouthwashes recommended in hematologic centers. The patients' mouths were examined by two assistants on days 1, 3, 5, 7, and 14. The intensity of stomatitis was recorded according to WHO stomatitis intensity checklists and pain was evaluated using Visual Analog Scale. The data were analyzed by SPSS statistical software, version 18. RESULTS: The results showed that aloe vera solution mouthwash significantly reduced the intensity of stomatitis and its pain in the intervention group compared to the control group. On the first day, no significant difference was found between the two groups regarding the mean intensity of stomatitis (P=0.178) and pain (P=0.154). However, a significant difference was observed between the two groups in this regard on other days (days 3-14: P=0.001 for stomatitis intensity, P=0.001 for pain). CONCLUSIONS: Aloe vera solution can improve the patients' nutritional status, reduce stomatitis and its pain intensity, and increase the patients' satisfaction. Trial Registration Number IRCT2014092819318N1.

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BACKGROUND: Advances in treatment and critical care have largely improved the survival following burns; therefore, the importance of quality of life in burn patients is an issue beyond question. The aim of this study was to determine the effects of Orem self-care program on Quality of Life of burn patients. METHODS: A randomized clinical trial study was conducted on 110 eligible burn patients who were selected using easy sampling method and allocated randomly into two groups of experiment and control. The instrument for data collection was a questionnaire, containing demographic and burn information and burn-specific health scale-brief (BSHS-B) questionnaire. For the experiment group, 5 sessions of theoretical training and 75-90 minutes of practical training were accomplished. The quality of life of the patients with burns was assessed in three phases by the BSHS-B questionnaire. The data were analyzed in SPSS-17 using Chi-square test, Fisher's exact test, Independent t-test and repeated measurement multivariate test. RESULTS: After one month and two months of the use of self-care model, the quality of life of the cases improved from 73.33% to 83.78% and 98.12%, respectively (P<0.001). But the changes in the quality of life of the patients in the control group were not statistically significant (P>0.05). CONCLUSION: Based on the obtained results of this study, designing and implementing a self-care program based on Orem's model and the needs of burn patients will improve their quality of life. Therefore, it is recommended that this program should be considered as a part of treatment program for these patients. Trial Registration Number : 2013042112129N1.

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BACKGROUND: Inappropriate diagnosis and treatment of pain, agitation, and delirium (PAD) in intensive care settings results in poor patient outcomes. We designed and used a protocol for systematic assessment and management of PAD by the nurses to improve clinical intensive care unit (ICU) outcomes. MATERIALS AND METHODS: A total of 201 patients admitted to 2 mixed medical-surgical ICUs were randomly allocated to protocol and control groups. A multidisciplinary team approved the protocol. Pain was assessed by Numerical Rating Scale and Behavioural Pain Scale, agitation by Richmond Agitation Sedation Scale, and delirium by Confusion Assessment Method in ICU. The Persian version of the scales was prepared and tested for validity, reliability, and feasibility in a preliminary study. The patients in the protocol group were managed pharmacologically according to the protocol, whereas those in the control group were managed according to the ICU routine. RESULTS: The median (interquartile range) for the duration of mechanical ventilation in the protocol and control groups was 19 (9.3-67.8) and 40 (0-217) hours, respectively (P = .038). The median (interquartile range) length of ICU stay was 97 (54.5-189) hours in the protocol group vs 170 (80-408) hours in the control group (P < .001). The mortality rate in the protocol group was significantly reduced from 23.8% to 12.5% (P = .046). CONCLUSION: The current randomized trial provided evidence for a substantial reduction in the duration of need to ventilatory support, length of ICU stay, and mortality rates in ICU-admitted patients through protocol-directed management of PAD.

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OBJECTIVE: Saffron (Crocus sativus L.) has shown beneficial aphrodisiac effects in some animal and human studies. The aim of the present study was to assess the safety and efficacy of saffron on selective serotonin reuptake inhibitor-induced sexual dysfunction in women. METHODS: This was a randomized double-blind placebo-controlled study. Thirty-eight women with major depression who were stabilized on fluoxetine 40 mg/day for a minimum of 6 weeks and had experienced subjective feeling of sexual dysfunction entered the study. The patients were randomly assigned to saffron (30 mg/daily) or placebo for 4 weeks. Measurement was performed at baseline, week 2, and week 4 using the Female Sexual Function Index (FSFI). Side effects were systematically recorded. RESULTS: Thirty-four women had at least one post-baseline measurement and completed the study. Two-factor repeated measure analysis of variance showed significant effect of time × treatment interaction [Greenhouse-Geisser's corrected: F(1.580, 50.567) = 5.366, p = 0.012] and treatment for FSFI total score [F(1, 32) = 4.243, p = 0.048]. At the end of the fourth week, patients in the saffron group had experienced significantly more improvement in total FSFI (p < 0.001), arousal (p = 0.028), lubrication (p = 0.035), and pain (p = 0.016) domains of FSFI but not in desire (p = 0.196), satisfaction (p = 0.206), and orgasm (p = 0.354) domains. Frequency of side effects was similar between the two groups. CONCLUSIONS: It seems saffron may safely and effectively improve some of the fluoxetine-induced sexual problems including arousal, lubrication, and pain.

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AIM: This paper reports an investigation of the approaches to study and learning of nursing and midwifery students at a school of nursing and midwifery in Iran. BACKGROUND: Current knowledge suggests that students approach their studies in surface, deep or strategic manners. Students' approaches to study have an important impact on their academic success. Awareness of their approaches to study and factors that affect their choices is important for curriculum planners as well as nurse and midwife educators. METHODS: A cross-sectional design was used with a convenience sample of nursing and midwifery students in all 3 years of study at one university in Iran. The validated Persian translation of Entwistle and Ramsden's Approaches and Study Skills Inventory was administered in a classroom context in 2003. RESULTS: Sixty-four per cent (95% CI; 57-72%) of nursing and 63% (95%; CI 50-75%) of midwifery students adopted a deep approach. The use of a surface approach was negatively correlated to the stage of study for midwifery but not nursing students. There was also a statistically significant positive correlation between level of interest in the field of study and use of strategic approach for both nursing and midwifery students. Grade point average for the nursing students adopting the strategic approach was statistically significantly higher than for those adopting deep or surface approach. The grade point average for midwifery students adopting strategic approach was statistically significantly higher than that for those adopting deep approach, but not different from the grade point average of those adopting surface approach. CONCLUSION: Our findings suggest that adoption of strategic or deep approaches to learning was associated with better educational outcome, as indicated by higher grade point averages. Moreover, the findings emphasize the impact of students' interest in their field on their academic success. Therefore, the adoption of factors which foster deep or strategic approaches and activities which increase students' interest should lead to improved academic outcomes.

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