Letter to Editor
Health System
Danial Fazilatpanah; Ali Shabestani Monfared; GholamReza Ataee; Seyed Alireza Javadinia
Abstract
Dear Editor, Armed conflicts represent a profound public health emergency, extending beyond immediate casualties to systematically dismantle healthcare infrastructure and disrupt care continuity for patients with chronic diseases. The 12-day military offense against Iran, commencing on June 13, ...
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Dear Editor, Armed conflicts represent a profound public health emergency, extending beyond immediate casualties to systematically dismantle healthcare infrastructure and disrupt care continuity for patients with chronic diseases. The 12-day military offense against Iran, commencing on June 13, 2025 (23 Khordad, 1404), precipitated a severe crisis within the nation's health system. Among the most vulnerable populations are cancer patients, whose survival is contingent upon uninterrupted access to advanced, time-sensitive therapies. Local reports and human rights organizations documented direct and indirect targeting of medical facilities, including Shahid Motahari Burn Hospital and Labbafinezhad Hospital in Tehran, Iran. The attacks affected over 80 cities and 90 counties, triggering massive internal displacement, crippling patient referral systems, and creating dangerous concentrations of patient populations in specific provinces. Consequently, countless cancer patients experienced critical delays, interruptions, or complete cessation of life-saving treatments, a known factor for increasing cancer-specific mortality across numerous malignancies (1).This situation mirrors findings from other conflict zones. In Ukraine, the destruction of oncology centers and disruption of supply chains for chemotherapeutic agents and radionuclides led to a dire deterioration in cancer outcomes (2). Similarly, conflicts in Iraq and Afghanistan resulted in the collapse of screening programs and a significant decline in early-stage cancer diagnosis, severely impacting survival rates (3). Pre-existing economic sanctions have also severely constrained Iran's access to essential chemotherapeutic drugs, radiopharmaceuticals, and spare parts for radiotherapy equipment. The recent conflict compounded this by introducing cyber-attacks that disabled electronic health records (EHR) and e-prescribing systems, further paralyzing clinical operations. Furthermore, the psychological trauma of war, including post-traumatic stress disorder (PTSD), anxiety, and depression, poses a significant barrier to treatment adherence and efficacy in cancer patients (4). Despite these challenges, Iranian healthcare workers demonstrated remarkable resilience in sustaining service delivery. However, this crisis underscores the urgent need for robust, pre-emptive measures to fortify healthcare systems against future shocks. We propose the following essential actions:Establishment of strategic stockpiles of essential oncology drugs (chemotherapy, supportive care agents, and vaccines) in secure, geographically dispersed locations.Investment in building hardened, conflict-resistant oncology and radiotherapy centers.Decentralization and redistribution of cancer care resources based on population density and projected internal migration patterns.Implementation of fail-safe, low-technology backup systems (e.g., paper-based records and prescriptions) for continuity of care during digital outages.Formalization of inter-provincial mutual aid agreements for emergency patient transfer and support.Integration of crisis-oriented psychiatric teams into oncology care pathways to address conflict-induced PTSD and anxiety. The 12-day war exposed a critical vulnerability in Iran's cancer care continuum. We call upon the international scientific community, humanitarian organizations, and global health leaders to advocate for the protection of healthcare infrastructure and the defenseless patients it serves. The targeting of medical facilities constitutes a gross violation of medical ethics and international humanitarian
Letter to the Editor
The Imposed War
Zahra Keyvanlo; Fatemeh Kokabisaghi; Hossein Ebrahimipour
Abstract
Dear Editor,
Economic sanctions, especially those that affect the supply chain of medicines, medical equipment, and financial resources of the health system, have consequences beyond the purely economic dimension and play a significant role in weakening the human resources infrastructure of the health ...
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Dear Editor,
Economic sanctions, especially those that affect the supply chain of medicines, medical equipment, and financial resources of the health system, have consequences beyond the purely economic dimension and play a significant role in weakening the human resources infrastructure of the health system. Reduced access to medicines and equipment causes greater work pressure on staff and increases burnout. Limited financial resources also affect the job security and real income of health workers and reduce their motivation to remain. This relationship shows that health human resources management cannot be possible without considering the impact of sanctions on financial resources and equipment.
Health human resources, also known as human resources for health (HRH) or health workforce, are among the core functions of the health system, and their extreme vulnerability under sanctions highlights the need for urgent attention to this issue. In recent years, the Ministry of Health has pursued policies such as a fair distribution program for specialist doctors in deprived areas, incentive packages for the retention of health professionals, and the development of educational capacities in needed fields. However, evidence suggests that these policies have not been sufficiently effective under sanctions and have faced serious obstacles in achieving their goals. Therefore, reviewing existing policies and designing new strategies to adapt to sanctions is an inevitable necessity.
Based on the findings of futures study conducted in Khorasan Razavi Province, sanctions have been classified among the most important factors affecting political stability and freedom, which, due to their significance and uncertainty, has been placed within the category of key uncertainties for the future of human resources for anesthesiologists. These factors directly and indirectly affect job motivation, quality of services, access to equipment and medicine, and most importantly, the decision-making of health elites to emigrate. In other words, sanctions have not only disrupted access to essential resources but have also caused disappointment in the future of work and weakened the professional status of the health workforce. In the aforementioned study, components such as migration and brain drain, access to equipment, and international cooperation have all been analyzed as factors dependent on sanctions and the political situation. It should be noted that the selection of anesthesiologists as the target group of the study was due to the significant shortage of this specialized group both nationwide and Khorasan Razavi Province, in particular. This shortage, which has also been confirmed in official reports of the Ministry of Health and provincial statistics, has direct effects on the provision of vital services in hospitals.
In general, sanctions affect human resources through the following channels:
Reduced access to medical equipment and vital drugs, especially in critical situations and emergency surgeries, leads to a decline in the quality of care and increased workload, a situation that ultimately exacerbates burnout among health personnel.
Weakening of job security and real income of health personnel due to inflation, currency market fluctuations, and restrictions on attracting international resources.
Increased emigration of health personnel due to a lack of promotion opportunities and scientific connections.
Weakening of equity in the distribution of human resources, especially in deprived areas, due to reduced incentives to remain in these areas.
Therefore, it is proposed that in formulating health human resources policies under sanctions, the following are taken into consideration:
Designing retention packages and incentive benefits commensurate with the economic pressure resulting from sanctions. In addition to indicators of political stability, international status, and economic resilience, attention should also be paid to the expectations of the workforce from the employer and from their jobs, as these components play a decisive role in maintaining motivation, improving productivity, and retention of the workforce, and complement the macro considerations in strategic human resources planning models.
Creating alternative scientific networks with like-minded countries in order to continue the scientific and professional growth of employees.
Using the capacity of immigrant elites to redesign policies and take advantage of reverse migration.
Establishing a Health Human Resources Policy Research Institute in the Ministry of Health to continuously monitor the health human resources situation and design flexible policies.
Thus, while acknowledging the existing efforts in human resources policymaking, it must be admitted that without reviewing and adapting to the conditions of sanctions, the continuity and effectiveness of these policies will not be guaranteed. This letter aims to remind the scientific community and health policymakers of the necessity of reviewing health human resources policies with a realistic and forward-looking perspective.
Review article
Traditional medicine
Shamim Shahrestani; Fereshteh Ghorat
Abstract
Background: Burns are common injuries in critical conditions such as natural disasters and wars, where limited access to medical facilities complicates their management. This article reviews medicinal plants effective in burn treatment from the perspective of Persian medicine and contemporary scientific ...
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Background: Burns are common injuries in critical conditions such as natural disasters and wars, where limited access to medical facilities complicates their management. This article reviews medicinal plants effective in burn treatment from the perspective of Persian medicine and contemporary scientific evidence, with an emphasis on their application in crisis situations.Materials and Methods: This narrative review was conducted by examining authoritative sources of Persian Medicine, including Al-Hawi, The Canon of Medicine, and Zakhireh Kharazmshahi. Scientific evidence for these plants was gathered through searching databases such as PubMed, Scopus, and Google Scholar. Inclusion criteria focused on the efficacy of medicinal plants in burn wound healing and their alignment with Persian Medicine sources.Results: This study identified Aloe vera, Plantago major, Malva sylvestris, Calendula officinalis, Myrtus communis, Glycyrrhiza glabra, Portulaca oleracea, Boswellia serrata, and Punica granatum as effective medicinal plants for burn wound healing in Persian Medicine literature. Scientific evidence demonstrated that these plants contain active compounds such as polysaccharides, flavonoids, and antioxidants, which promote burn healing through anti-inflammatory and antibacterial effects, collagen synthesis stimulation, and epithelialization mechanisms. Numerous clinical and animal studies confirmed their efficacy in reducing healing time and improving tissue quality.Conclusion: Medicinal plants, due to their accessibility, low cost, and minimal side effects, can serve as effective options for burn management under crisis conditions. However, further research is needed to standardize their application methods and develop appropriate treatment protocols.
Original Article
intensive care
Mojtaba Rad; Masoud Fallahi-Khoshknab; Farahnaze Mohammadi; Kian Nourozi; Hamidreza Kkankeh
Abstract
Background: Fear is often defined as an unpleasant and intense feeling caused by anticipation or awareness of danger. Since fear can affect the performance of nurses' duties, different strategies are used to reduce it. Therefore, this study was conducted to explore the experiences of fear and stress ...
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Background: Fear is often defined as an unpleasant and intense feeling caused by anticipation or awareness of danger. Since fear can affect the performance of nurses' duties, different strategies are used to reduce it. Therefore, this study was conducted to explore the experiences of fear and stress caused by COVID-19 on nurses' care.Materials and Methods: This study was a qualitative content analysis that was conducted during 2022-2023. Data were collected through in-depth semi-structured interviews with 22 participants conducted in Vasei Sabzevar and 22 Bahman Neyshabur hospitals. Participants were selected by purposive sampling, which continued until data saturation point. Then the data were analyzed by Lundman and Granheim method.Results: Two main classes and 5 subclasses were extracted from the data analysis: (1) fear of disease (subclasses: fear of death in patients, fear of nurses getting infected and fear of transmission of covid-19 to nurses’ families) and (2) trying to adapt (subclasses: trying to control patients' fear and nurses’ adaptation to fear).Conclusion: The findings indicated that both nurses and patients experienced significant fear during the Covid-19 pandemic. Fear in nurses had a negative impact on patient care before adaptation. It had also a negative effect on the healing process of the patients (high death rate due to fear). The strategies used by nurses to help patients to cope with their fear were mostly appropriate and effective, but insufficient. The strategies helped the nurses adapt to the existing conditions. Since the nurses were not sufficiently prepared for the emergence of such a crisis, solutions that can help nurses before and during the emergence of the disease are recommended.
Original Article
nurse education
Hamideh Goli; Sarina Ramtin; Zahra Parsaei Mehr; Masoud Hiteh; Ali asghar Jesmi; Mojgan Ansari
Abstract
Background and objective: Assessing clinical competence in undergraduate nursing students before entering clinical training is of great importance. The Objective Structured Clinical Examination (OSCE) is used as a valid tool in this field. This study aimed to design, implement, and evaluate a novel ...
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Background and objective: Assessing clinical competence in undergraduate nursing students before entering clinical training is of great importance. The Objective Structured Clinical Examination (OSCE) is used as a valid tool in this field. This study aimed to design, implement, and evaluate a novel method of conducting OSCE for nursing students at the Faculty of Nursing and Midwifery in Sabzevar, Iran.Materials and Methods: This quasi-experimental study used a pre-test-post-test design at two time points among 6th- and 8th-semester nursing students. The exam consisted of ten skill-based and scenario-driven stations, focusing on evaluating clinical skills and critical thinking. Data were analyzed in SPSS using a paired t-test.Results: Thirty-one nursing students participated in this study. The results showed that the mean scores of clinical skills and critical thinking significantly increased by the end of the 8th semester compared to the 6th semester (P=0.001).Conclusion: Changing the timing and structure of the OSCE, particularly before clinical placement, positively impacted students’ clinical and problem-solving skills. It is recommended that OSCE be conducted as a comprehensive assessment tool at the end of the 6th semester before students enter clinical training.
Original Article
Health System
Seyyed Ahmad Ahmadinasab; Azam Babaki Rad; Golbahar Akhundzadeh,; Mohsen Malekmohammadi
Abstract
Background: Considering the increasing challenges of the aging phenomenon and the need to adapt existing structures, this research aimed to design a model for the transformation of the health system in Iran using a data-driven approach.Materials and Methods: The present research is a qualitative ...
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Background: Considering the increasing challenges of the aging phenomenon and the need to adapt existing structures, this research aimed to design a model for the transformation of the health system in Iran using a data-driven approach.Materials and Methods: The present research is a qualitative study with an applied-developmental purpose, conducted using the grounded theory method. The participants in this study were experts in the field and were included in the study through purposive sampling.Results: The findings of the present study were classified into 159 open codes, 21 axial codes, and 4 selective codes, as follows: organizational, economic, biological, social, and infrastructure factors as causal conditions; aging as the main research category; environmental culture, governance and citizenship, social and family axis as contextual conditions; planning, policy-making and foresight, socio-cultural and peer support, the organizational management structural axis as intervening conditions; strategies including strengthening education and increasing health literacy of the elderly in the family, creating and developing regular physical activities; the creation and development of day centers and small nursing homes and the resulting outcomes included economic sustainability, reducing social costs, improving physical and mental health, increasing social participation, and providing identity to the elderly.Conclusion: Based on the results of the model, healthcare professionals can formulate strategies, predict infrastructure, implement desired health system transformation, and respond scientifically and appropriately to the aging phenomenon.
Original Article
Pharmacology
Akram Ghanbari Moghaddam; fatemeh yousefli; Nezami Hossein
Abstract
Background and Objective: Average medication consumption in Iran exceeds the global average, and self-medication is prevalent among the elderly due to the presence of chronic diseases. Given the vital role pharmacies play in the healthcare chain for the elderly, this study aimed to evaluate pharmacies ...
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Background and Objective: Average medication consumption in Iran exceeds the global average, and self-medication is prevalent among the elderly due to the presence of chronic diseases. Given the vital role pharmacies play in the healthcare chain for the elderly, this study aimed to evaluate pharmacies in Mashhad based on age-friendly city indicators.Materials and Methods: This cross-sectional descriptive-analytical study was conducted in community pharmacies in Mashhad in 2023. A convenience sampling method was applied. Data were collected using a standardized checklist adapted from validated sources (Bastani et al., 2017), covering four domains: physical environment, care services, pharmaceutical supply, and emotional support. To reduce self-report bias, all assessments were completed through independent on-site observations by trained external evaluators. Data were analyzed using SPSS software, applying Fisher’s exact test and the Mann–Whitney U test.Results: A total of 101 pharmacies were assessed, including 9 public and 92 private pharmacies. Most pharmacies were classified as having a moderate level of compliance with age-friendly standards (private: 53.26%, public: 66.67%). No significant association was found between ownership type and overall score (P > 0.05). However, public pharmacies scored significantly higher in the physical domain (P = 0.040).Conclusion: Implementing age-friendly pharmacy standards requires more than physical modifications and calls for systemic reforms in pharmaceutical services, targeted workforce training, and stronger health insurance and policy support.
Original Article
Emergency medicine
Yeganeh Salehi; Mostafa Rad; Simin Sharafi
Abstract
Background and objective: Emergency departments face challenges including overcrowding, long wait times, and high workload that negatively impact patient experience. Effective communication and negotiation with patients play a fundamental role in improving clinical outcomes and patient satisfaction. ...
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Background and objective: Emergency departments face challenges including overcrowding, long wait times, and high workload that negatively impact patient experience. Effective communication and negotiation with patients play a fundamental role in improving clinical outcomes and patient satisfaction. This study aimed to evaluate the effect of structured negotiation on patient experience in the emergency department.Materials and Methods: This randomized clinical trial was conducted on 70 patients presenting to Imam Reza Hospital emergency department in Birjand in 2025. Participants were randomly assigned to intervention (n=35) and control (n=35) groups. The intervention group received individual negotiation sessions lasting 10-15 minutes based on Botelho's negotiation model (1992), encompassing content, relationship levels, and problem-solving phases. The control group received routine care. The Picker Patient Experience Questionnaire (15-item version) was administered before and after intervention. Data were analyzed using MANCOVA.Results: The results of multivariate analysis of covariance showed that the structured negotiation had a significant effect on improving the overall patients experience compared to the control group. Also, the components of emotional support, respect for patient preferences, family involvement and continuity of care increased significantly (p<0.01). However, no significant difference was observed between the two groups in the components of information and education, care coordination, and physical comfort (p>0.05).Conclusion: Structured negotiation based on Botelho's model significantly improves patient experience in emergency departments, particularly in psychological and relational dimensions. Components such as information provision, care coordination, and physical comfort require organizational and systemic interventions beyond individual communication. Integrating negotiation skills training into Emergency Department staff development programs can effectively enhance patient-centered care.
Original Article
Psychology
Nasrin Hassanzadeh; Masoumeh Azmoudeh; Ali Eqbali; Akbar Rezaei
Abstract
Background: Anxiety is among the factors contributing to the onset of psoriasis. Therefore, the present study aimed to compare the effectiveness of mindfulness-based stress reduction with and without transcranial direct-current stimulation therapy on the anxiety of patients with psoriasis. Materials ...
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Background: Anxiety is among the factors contributing to the onset of psoriasis. Therefore, the present study aimed to compare the effectiveness of mindfulness-based stress reduction with and without transcranial direct-current stimulation therapy on the anxiety of patients with psoriasis. Materials and Methods: This semi–experimental study was conducted with a pre-test, post-test, and one-month follow-up design with a control group. The population included all patients with psoriasis referring to dermatologists in Tehran, Iran in 2024. Among them, 45 patients with psoriasis were selected by convenience sampling and were randomly assigned to 3 groups (n=15). The first experimental group received mindfulness-based stress reduction, the second experimental group received mindfulness-based stress reduction with transcranial direct-current stimulation therapy, and the control group was in the waiting list. The research instrument included the Beck Anxiety Inventory (BAI). The obtained data were analyzed using repeated measure of variance analysis (mixed design) with SPSS 23. Results: The findings showed that the effectiveness of mindfulness-based stress reduction with transcranial direct-current stimulation training intervention on anxiety was higher than mindfulness-based stress reduction training intervention (P<0.05). Conclusion: It can be concluded that mindfulness-based stress reduction with and without transcranial direct-current stimulation therapy interventions can be effective in improving anxiety of patients with psoriasis. It is recommended that therapists and counselors use these therapies for improving the anxiety of patients with psoriasis.
Case report
Gyneocology
ali moradi; Karim Aqerkakli; Maryam Abolghazi
Abstract
Background and objective: Cesarean section is generally considered a safe method of delivery. However, rare complications such as cecal rupture can lead to serious and life-threatening outcomes. Therefore, this study aimed to report a rare case of cecal rupture following cesarean section.Case report: ...
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Background and objective: Cesarean section is generally considered a safe method of delivery. However, rare complications such as cecal rupture can lead to serious and life-threatening outcomes. Therefore, this study aimed to report a rare case of cecal rupture following cesarean section.Case report: A 31-year-old female patient, ten days after undergoing a cesarean section (with a history of two previous C-sections), presented to the hospital with symptoms of abdominal pain, persistent fever, and decreased bowel movements. Clinical evaluations and imaging revealed septic peritonitis due to cecal rupture, necessitating laparotomy and colostomy placement. Treatment included broad-spectrum antibiotics, supportive medications and specialized nursing care.Conclusion: Following clinical care and pharmacological treatment, paraclinical test results indicated a relative improvement. Additionally, clinical symptoms such as abdominal pain and swelling subsided, and the patient’s fever resolved. Consequently, the patient was discharged.
Original Article
Microbiology
Mohammed Reza Salt; Ali Taj; Shaghayegh Shahrestani; Hadi lotfi
Abstract
Background: Hospital-acquired infections are a major challenge for health systems. Their importance is even greater in Intensive Care Units (ICUs) due to patients' critical conditions and the use of invasive procedures. This study aimed to evaluate the performance of ICU staff in infection prevention ...
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Background: Hospital-acquired infections are a major challenge for health systems. Their importance is even greater in Intensive Care Units (ICUs) due to patients' critical conditions and the use of invasive procedures. This study aimed to evaluate the performance of ICU staff in infection prevention and control and its related factors at Vasei Hospital in Sabzevar, Iran in 2024.Materials and Methods: This descriptive-analytical cross-sectional study was conducted on 90 nurses working in ICUs. Data were collected using a demographic questionnaire and an observational performance checklist and analyzed using SPSS 22 with independent t-tests, ANOVA, and Spearman's correlation coefficient.Results: The mean total performance score of the nurses was 37.15 (out of 100). Accordingly, 32.22% had poor performance and 67.78% had moderate performance; none were rated as having good performance. The highest adherence was observed in mask use (100%), while the lowest was related to gown use (91.1% poor performance) and performing suctioning (82.2% poor performance). The only factor significantly associated with performance was having completed an infection control training course (P<0.05). No significant relationship was found between performance and age, gender, marital status, or work experience.Conclusion: Nurses' performance was at a moderate level, and specialized training was the only improving factor. Therefore, designing continuous and targeted training programs, along with providing resources and supervision, is essential to improve performance and reduce hospital-acquired infections.
Review article
Educational
Mostafa Amiri; Nima Bahrainipour; Mobina Amiri; Abdurrashid Khazaei Feizabad
Abstract
Background and objective: Few studies have reported the interplay of emotional intelligence, second language acquisition and hippocampal mechanisms. This study offers a comprehensive investigation into the relationship between emotional intelligence (EQ) and second language acquisition (SLA), ...
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Background and objective: Few studies have reported the interplay of emotional intelligence, second language acquisition and hippocampal mechanisms. This study offers a comprehensive investigation into the relationship between emotional intelligence (EQ) and second language acquisition (SLA), with particular emphasis on the pivotal role of the hippocampus as a shared neurological substrate. Materials and Methods: Drawing on a systematic review of 45 empirical and theoretical studies published between 2018 and 2024, the findings demonstrate that emotional intelligence, through a constellation of complex neurological mechanisms, including the regulation of negative affect (e.g., language anxiety) and the enhancement of positive affect (e.g., learning enjoyment), creates optimal conditions for hippocampal functioning.Results: The evidence indicates that this process is mediated by pathways such as the modulation of limbic circuitry, attenuation of cortisol secretion, promotion of neurogenesis, and augmentation of synaptic neuroplasticity within the hippocampus.Conclusion: The results of this review hold implications for the development of pedagogical interventions informed by neuroscientific evidence, interventions that may substantially enhance the effectiveness of second language learning.