Letter to the Editor
Health System
Roghayeh Javan; Reza Forouzan
Abstract
Dear Editor in Chief,A crisis is defined as a sudden, tense, and unstable situation that requires immediate action to resolve. This situation can affect the individual and society and is usually accompanied by consequences such as damage, threats, and the creation of new needs. According to the head ...
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Dear Editor in Chief,A crisis is defined as a sudden, tense, and unstable situation that requires immediate action to resolve. This situation can affect the individual and society and is usually accompanied by consequences such as damage, threats, and the creation of new needs. According to the head of the Crisis Management Organization, Iran is among the ten most disaster-prone countries in the world.According to the National Guidelines for the Classification of Accidents and Disasters in the Health System, the classification of accidents is based on 5 indicators: number of deaths, number of injuries, geographical area by city and province, estimated economic damage, and number of people in need of assistance. It includes white, yellow, orange, and red levels, which, based on different levels, sometimes require the dispatch of forces from specific centers of the crisis area for crisis management. According to the criteria of the National Disaster and Emergency Management Center, the standard time for emergency personnel to reach a patient’s bedside in cities is set at 8 minutes and on the road at 15 minutes. It has been determined that increasing the speed of emergency personnel reaching a patient’s bedside is one of the most important factors in increasing the chances of survival for patients.Given the delays in intervention during the golden time until the arrival of specialized forces and official rescuers, as well as the mismatch between available resources and the forces needed at different levels of various crises, including war, it is essential to form and deploy trained local forces as immediate responders to reduce the response time, increase the chances of survival, and reduce the risks to life. In other countries, attention has been paid to the training and differentiation of the roles of immediate responders and first responders, and the need for public education programs for citizens in training immediate responders to reduce the effects and increase resilience in major crises. The results of the research analysis conducted by identifying the most vulnerable areas in the earthquake crisis scenario of Tehran Region 6 also indicate that advanced training and education of as many local forces in these areas and neighboring areas as possible, who can be dispatched to the place of demand in the shortest possible time, can play a significant role in the success of the operation.One of the challenges in achieving an effective crisis management system and its successful implementation is the use of social participation to reduce crises, which is recognized as a new and growing approach, which minimizes people’s vulnerability to disasters. The indicators of the importance of the role of the people, the participation of non-governmental organizations, public education, empathy, cooperation and intimacy, mass media in education, reflection of the real needs of the people by the mass media during the crisis, the use of indigenous people in the rescue and reconstruction process, the role of mass media in following up after the crisis, raising public awareness, encouraging people to participate, honesty and transparency of the media, commitment and social network have the highest coefficient of importance, respectively. Therefore, developing a spirit of cooperation and creating a motivation for participation among people is considered one of the clear ways to reduce vulnerability caused by natural disasters.In Iran, which is a country prone to crises in the world, the use of social participation and non-governmental organizations in training local and indigenous immediate responders will lead to a reduction in the time of presence of efficient forces within the golden time limit and, as a result, a reduction in life-threatening risks in the injured resulting from various crises, including war. In addition, this method will lead to an increase in social resilience and capacity building in maintaining health and reducing risks and mortality in the injured, given the limitations of purely governmental facilities. International experience in crisis-prone countries also confirms this point. Therefore, it is recommended that the necessary planning in this regard be made in the national crisis management plan.
Letter to the Editor (Policy Brief)
Health System
Marjan Vejdani; Marziyhe Meraji; Mehdi Varmaghani; Jamshid Jamali; Ali Vafaie Najar
Abstract
In response to demographic shifts and the growing demand for healthcare services, Electronic Prescribing Systems (EPS) have been globally adopted as an efficient alternative to paper-based prescriptions. This technology not only enhances patient safety by reducing medication errors and improving accuracy, ...
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In response to demographic shifts and the growing demand for healthcare services, Electronic Prescribing Systems (EPS) have been globally adopted as an efficient alternative to paper-based prescriptions. This technology not only enhances patient safety by reducing medication errors and improving accuracy, but also generates significant savings in time and administrative costs through process automation. The successful implementation of such systems requires continuous and comprehensive evaluation. However, the lack of a comprehensive and localized tool for holistic assessment has challenged evidence-based decision-making. To address this need, a mixed-methods study was conducted with the participation of key stakeholders (i.e., physicians, pharmacists, nurses, administrators, and patients themselves) to design and validate a comprehensive and reliable tool for evaluating electronic prescribing systems, comprising 11 main dimensions and 164 detailed items. In this policy brief, based on this tool, we propose recommendations for its application by policymakers, decision-makers, and senior healthcare managers, enabling it to serve as a roadmap for enhancing the quality, efficiency, and safety of the critical prescribing process.
Review article
AI
Fatemeh Borzoee; Narjes Heshmatifar; Yeganeh Salehi
Abstract
Background and Objective: In modern warfare characterized by high-velocity weapons, explosive devices, and missile attacks, the large number of casualties can overwhelm medical infrastructures far beyond their operational capacity. In recent years, there has been growing interest in the application ...
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Background and Objective: In modern warfare characterized by high-velocity weapons, explosive devices, and missile attacks, the large number of casualties can overwhelm medical infrastructures far beyond their operational capacity. In recent years, there has been growing interest in the application of artificial intelligence (AI) to improve the efficiency and effectiveness of healthcare delivery. Therefore, this systematic review aims to evaluate the effectiveness, challenges, and future directions of AI in casualty triage by synthesizing the existing evidence.Materials and Methods: In this systematic review, English-language articles were searched in PubMed, Scopus, Web of Science, Embase, IEEE Xplore, and the Cochrane Library using the keywords “Artificial Intelligence,” “Triage,” “Armed Conflict,” and their related terms, covering the period from 2015 to 2025. English-language observational studies, clinical trials, modeling studies, and algorithm-development research that examined the use of AI in military triage or analogous conflict-related settings were included. After duplicate removal using Rayyan.ai, a total of 189 articles were screened by title, abstract, and full text. Ultimately, 17 studies were included. Screening was performed independently by two reviewers, and discrepancies were resolved through consensus. Study quality was evaluated using CASP tools, and the selection process was reported according to the PRISMA flow diagram.Results: Among the 17 included studies, AI was primarily applied through machine-learning algorithms (such as Random Forest and XGBoost) and deep-learning methods in military triage and war-related crisis environments. Models based on vital signs demonstrated high accuracy in predicting massive transfusion requirements (AUC 0.98–0.987), detecting shock/hypovolemia (sensitivity up to 94%), and identifying the need for life-saving interventions (AUC 0.81). In medical imaging, YOLOv3/v7 and U-Net models improved the detection and segmentation of shrapnel/foreign bodies, achieving an mIoU of 0.73 and high diagnostic precision. Large language models (LLMs) such as ChatGPT and Google Bard showed 60–64% accuracy when applying START protocols in simulated mass-casualty incidents (MCIs), although they exhibited limited reproducibility and strong dependence on prompting. Overall, AI substantially enhances the accuracy and speed of triage; however, most studies rely on laboratory or simulated datasets, highlighting the need for real-world field validation.Conclusion: The responsible and ethical implementation of these technologies can significantly increase the speed, objectivity and accuracy of triage decisions. This is especially important in critical and short-term war situations, where large numbers of casualties can quickly overwhelm traditional medical systems.
Original Article
Nursing
Fatemeh Hesari; Ali asghar Jesmi; Tahereh Sadeghi; Nazanin Fekri; Zohre Sarchahi
Abstract
Background: This study aimed to compare the effects of two specific techniques (acupressure and vibrating bee) on the first-attempt success rate of intravenous IV catheterization and the pain intensity experienced by children during the procedure.Materials and Methods: This clinical trial was conducted ...
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Background: This study aimed to compare the effects of two specific techniques (acupressure and vibrating bee) on the first-attempt success rate of intravenous IV catheterization and the pain intensity experienced by children during the procedure.Materials and Methods: This clinical trial was conducted in 2024 at the Hakim Hospital Emergency Department in Neyshabur, Iran, and involved 84 children. Following inclusion/exclusion criteria, participants were randomly assigned into three equal groups (n=28, balanced by gender): Acupressure (LI4 point pressed for 5 minutes before IV insertion), Vibrating bee (applied for 5 minutes before IV insertion), and a control group (standard venipuncture). Data, including demographics and FLACC pain scores, were collected and analyzed using SPSS 26.Results: Statistical analysis revealed significant differences in pain intensity among the groups (P = 0.000). The vibrating toy bee method yielded lower pain scores compared to both the acupressure group (P = 0.004) and the control group (P = 0.000). Acupressure also proved more effective than the control group in reducing pain (P = 0.000). First-attempt success rates for catheter placement were 100% for the vibrating bee group, 96.4% for the acupressure group, and 78.6% for the control group, with no significant difference between acupressure and control (P = 0.051). The vibrating bee method demonstrated a significant overall advantage. Additionally, access time showed significant differences (P = 0.000), with the vibrating bee being the fastest, followed by acupressure, which was quicker than the control group (P < 0.0167).Conclusion: Both the vibrating bee and acupressure methods reduced pain during IV insertion; however, the Vibration bee is more effective and faster, achieving a higher success rate (100% vs. 96.4% and 78.6%).
Original Article
Psychology
Maryam Saeidisardabi; Seyed Esmaeil Hashemi; Abdozahra Naami
Abstract
Background and Objective: Given the vital role of nurses in providing healthcare services, their well-being requires attention. Accordingly, the present study aimed to investigate the effectiveness of assertiveness training on workplace incivility, interpersonal conflict, and voice behavior.Materials ...
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Background and Objective: Given the vital role of nurses in providing healthcare services, their well-being requires attention. Accordingly, the present study aimed to investigate the effectiveness of assertiveness training on workplace incivility, interpersonal conflict, and voice behavior.Materials and Methods: This quasi-experimental study was conducted with a pre-test-post-test design and a control group. The statistical population were all nurses working in one of the teaching hospitals of Mashhad, Iran. Using a multi-stage random sampling method, 40 nurses were selected and randomly assigned to two experimental and control groups, considering the inclusion criteria. The instruments used in this study included the Workplace Incivility Experience Scale and the Interpersonal Conflict and Voice Behavior Scale. In the experimental group, the intervention consisted of 8 sessions of assertiveness training, while the members of the control group received no intervention. Multivariate analysis of covariance was used to analyze the data.Results: The results showed that assertiveness training led to a significant reduction in the experience of workplace incivility (P≤0.001, η²=0.903) and interpersonal conflict (P≤0.001, η²=0.824), and a significant increase in voice behavior (P≤0.001, η²=0.763) in the experimental group compared to the control group.Conclusion: The findings demonstrate that assertiveness training is an effective intervention for healthcare organizations to mitigate workplace incivility and interpersonal conflict among nurses, while simultaneously promoting their voice behavior for improved patient safety and care quality.
Original Article
intensive care
Razieh Kaghazi; Majid Fallahi; Rezvan Rajabzadeh; Mostafa Rad
Abstract
Background and Objective: The emergency department is among the most stressful hospital environments. Emergency nurses face intense workloads and rapid decision-making demands, leading to high mental workload and fatigue, which can compromise care quality and their own well-being. Despite its potential ...
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Background and Objective: The emergency department is among the most stressful hospital environments. Emergency nurses face intense workloads and rapid decision-making demands, leading to high mental workload and fatigue, which can compromise care quality and their own well-being. Despite its potential as a protective factor, spiritual health has received little attention in this context. This study aimed to investigate the mediating role of spiritual health in the relationship between mental workload and fatigue among emergency nurses in Sabzevar, Iran in 2024-2025.Materials and Methods: A descriptive-analytical cross-sectional design was used, involving 157 emergency nurses from hospitals affiliated with Sabzevar University of Medical Sciences. Data were collected using the NASA Task Load Index, the Multidimensional Fatigue Inventory, the Paloutzian and Ellison Spiritual Health Scale, and a demographic questionnaire. Data analysis was performed in SPSS 26 using independent t-tests, ANOVA, Mann-Whitney, Kruskal-Wallis, and linear regression.Results: The mean mental workload was 54.35 ± 14.28, overall fatigue was 60.09 ± 8.35, and spiritual health was 72.96 ± 12.4. Mental workload showed a significant negative correlation with general, mental, and overall fatigue (p < 0.05). All fatigue dimensions were positively related with existential health and spiritual health (except general fatigue) (p < 0.001). However, no significant association was found between mental workload and spiritual health, so the hypothesized mediating role was not confirmed.Conclusion: The findings of the present study suggest that spiritual health does not mediate the impact of mental workload on fatigue in this population. Future research should explore other potential mediators in this complex relationship.
Review article
Health Economics
Ali Akbar Fazaeli; Hadi Lotfi; Alireza Ghorbani
Abstract
Background and Objective: Despite claiming to focus on government structures, economic sanctions have in practice widespread and sometimes catastrophic effects on public health and access to medicine and medical equipment in target countries. This review article aims to analyze the consequences ...
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Background and Objective: Despite claiming to focus on government structures, economic sanctions have in practice widespread and sometimes catastrophic effects on public health and access to medicine and medical equipment in target countries. This review article aims to analyze the consequences of sanctions, especially in the context of crises such as war, pandemics, or geopolitical tensions.Materials and Methods: This study followed the PRISMA 2020 guidelines for systematic reviews. A comprehensive search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, ProQuest, and SID for studies published between 2010 and 2025, focusing on studies about Iran and other countries affected by sanctions. A total of 1,023 records were identified. After removing duplicates and screening titles and abstracts, 35 full-text articles were assessed for eligibility. Based on predefined inclusion (direct relevance to sanctions and health, peer-reviewed, full-text available) and exclusion criteria (non-scientific reports, letters, and non-empirical papers), 13 high-quality studies were included in the final synthesis.Results: Sanctions have led to shortages of vital medicines, deterioration of medical equipment, and reduced quality of health services through banking restrictions, increased import costs, reduced international interactions, and disruptions in the supply chain. In countries such as Iran, Syria, Yemen and Venezuela, this situation has been exacerbated during periods of crisis, with consequences such as increased mortality, health inequalities and psychological and social harm. Iran’s experience shows that even systems with domestic production capacity are vulnerable to widespread and complex sanctions.Conclusion: Strengthening domestic capabilities, designing resilient strategies, facilitating humanitarian channels and systematically documenting the humanitarian consequences of sanctions seem essential to reduce harm.
Case report
Pediatric
Mitra Azra Aldaghi
Abstract
An 8-month-old infant, presented with vomiting, restlessness, and respiratory distress, appeared dehydrated and restless. The patient’s problem had started three days earlier and he was admitted to the hospital with worsening symptoms. Within a few hours of admission, she was transferred to the ...
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An 8-month-old infant, presented with vomiting, restlessness, and respiratory distress, appeared dehydrated and restless. The patient’s problem had started three days earlier and he was admitted to the hospital with worsening symptoms. Within a few hours of admission, she was transferred to the pediatric intensive care unit due to severe tachypnea and cyanosis. A portable radiograph was performed, which reported a large cyst in the lung.Due to the worsening of symptoms, she was placed on oxygen therapy with a hood and a gastric catheter was inserted, which resulted in abundant secretions containing milk and the patient’s distress improved.The next day, due to the persistence of symptoms, portable radiography was performed again. During the radiology, she had a seizure and apnea. She was connected to a ventilator and was diagnosed with a left diaphragmatic hernia and sent for surgery in Mashhad.
Original Article
nutrition
Akram Kooshki; Mohammad Bagheri; Seyed Majid Ghazanfari; Katayoun Samadi; Rahil Mahmoudi; Elaheh Foroumandi
Abstract
Background and Objective: The MIND diet index represents a dietary pattern based on the Mediterranean and DASH diets, developed to delay neurodegeneration. The aim of the present study was to investigate the association between the MIND diet index and cardiovascular risk factors in individuals with ...
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Background and Objective: The MIND diet index represents a dietary pattern based on the Mediterranean and DASH diets, developed to delay neurodegeneration. The aim of the present study was to investigate the association between the MIND diet index and cardiovascular risk factors in individuals with type 2 diabetes.Materials and Methods: In this retrospective study, data from participants with type 2 diabetes referred to Hafiz diabetes clinic in Sabzevar, Iran, were used. A 148-item Food Frequency Questionnaire (FFQ) was used to calculate the MIND diet index. The participants’ biochemical data (including fasting blood glucose and serum lipid profile), their demographic information and blood pressure levels were also recorded. The obtained data were analyzed using SPSS version 16.Results: A total of 183 individuals with type 2 diabetes entered the study. Among them, 42.1% were male and 57.9% were female, with the mean age 49.06 ± 7.97 years, and the mean body mass index (BMI) 28.91 ± 4.23 kg/m². The mean MIND diet score was 6.08 ± 3.87. There was an inverse correlation was observed between the MIND diet score and BMI. But no significant relationship was found between the MIND diet score and other cardiovascular risk factors.Conclusion: The results of this study showed that adherence to the MIND diet in individuals with type 2 diabetes is associated with reduced BMI.
Original Article
Physical Education
Ehsan Forutan; Saeid Shakerian; Rouhollah Ranjbar; Gholamhassan Jafarzadeh
Abstract
Background and Objective: Despite its widespread use in cancer treatment, doxorubicin induces lung inflammation and tissue damage by increasing TNF-α levels and activating NF-κB. On the other hand, swimming has been shown to reduce inflammation and improve tissue condition. This study ...
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Background and Objective: Despite its widespread use in cancer treatment, doxorubicin induces lung inflammation and tissue damage by increasing TNF-α levels and activating NF-κB. On the other hand, swimming has been shown to reduce inflammation and improve tissue condition. This study aimed to investigate the effect of swimming exercise on TNF-α and NF-κB levels in the lung tissue of male Wistar rats treated with doxorubicin.
Materials and Methods: In this experimental study, 24 adult male Wistar rats weighing 230 to 280 grams were randomly assigned into four groups of six: Group 1: resting control (C), Group 2: swimming control (SC), Group 3: doxorubicin resting (DR), and Group 4: doxorubicin swimming (DS). Doxorubicin (EBEWE Pharma, Austria, purity > 98%) was administered intraperitoneally once weekly for 6 weeks (total of 6 injections) at a dose of 5 mg/kg body weight. All swimming sessions were performed 24 hours after injection. The swimming training protocol lasted 6 weeks, 5 sessions per week. Water temperature was 35 ± 1°C, water depth 40 cm, and ambient temperature 23 ± 1°C. After each session, animals were dried at room temperature for 15 minutes. The last training session was performed 48 hours before tissue sampling, and the last injection was performed 72 hours before tissue sampling. SPSS-22 was used for statistical analysis using one-way ANOVA and Tukey's post hoc test.
Results: NF-κB levels in Group 4 (doxorubicin + swimming - DS) were significantly lower than those in Group 1 (resting control - C), Group 3 (doxorubicin resting - DR), and Group 2 (swimming control - SC) (p<0.01). Also, TNF-α levels in Group 4 (DS) were significantly lower than those in Groups 1 (C), 3 (DR), and 2 (SC) (p<0.01).
Conclusion: Swimming exercise combined with doxorubicin administration has a significant effect on reducing inflammatory factors (TNF-α and NF-κB). Therefore, exercise is recommended as an anti-inflammatory intervention.
Original Article
dentistry
Amir Moradi; Parasto Zarghami Moghadam; Peiman Alesheikh; Fatemeh Eshaghigorji; samaneh mollazadeh
Abstract
and Objective: An ideal oral rinse should exhibit potent antimicrobial activity while minimizing adverse effect on the mouth’s natural microflora. Therefore, the aim of this study was to investigate the combinational effects of the ethanolic extract of the Ferula gummosa and chlorhexidine mouthwash ...
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and Objective: An ideal oral rinse should exhibit potent antimicrobial activity while minimizing adverse effect on the mouth’s natural microflora. Therefore, the aim of this study was to investigate the combinational effects of the ethanolic extract of the Ferula gummosa and chlorhexidine mouthwash on the Streptococcus mutans biofilm structure.Materials and Methods: The roots of F. gummosa were collected, dried, and extracted via ethanol maceration. Then, different combinational concentrations of F. gummosa and chlorhexidine were prepared followed by an investigation of their antibacterial effects on Streptococcus mutans using disk-diffusion and well-diffusion methods. Also, the inhibitory effect on biofilm formation was assessed using the Crystal Violet assay. Analysis of data was done using SPSS-24 and the Kruskal-Wallis test; P≤0.05 was considered statistically significant.Results: The results of this study showed that ciprofloxacin, chlorhexidine mouthwash (100 mg/ml), and a combined concentration of chlorhexidine (80 mg/ml) and F. gummosa (20 mg/ml) exhibited the highest antibacterial effects against S. mutans in disc-diffusion, well-diffusion, and biofilm inhibition tests.Conclusion: Based on the results, the ethanolic extract of F. gummosa, whether administered alone or as a major component of the chlorhexidine combination, exhibited negligible antibacterial activity against S. mutans compared to chlorhexidine (100 mg/mL).
Original Article
Nursing
Sohila Hossin poor; Mojgan Ansari; Samira Foji
Abstract
Background and Objective: Length of stay (LOS) is considered one of the most important performance indicators in emergency departments. Therefore, this study aimed to determine the factors affecting LOS in the emergency department and hospital among injured motorcyclists in the west of Razavi Khorasan ...
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Background and Objective: Length of stay (LOS) is considered one of the most important performance indicators in emergency departments. Therefore, this study aimed to determine the factors affecting LOS in the emergency department and hospital among injured motorcyclists in the west of Razavi Khorasan Province, Iran, in 2023.
Materials and Methods: This descriptive-analytical study was conducted among patients injured in motorcycle-related traffic accidents who were admitted to Shahid Beheshti Educational, Research, and Treatment Center in Sabzevar during the first six months of 2023. A total of 244 patients were selected through convenience sampling. Analyzed in Stata version 17, relevant data were collected using a researcher-developed checklist.
Results: The mean age of the injured patients was 29.04 ± 17.19 years. Of the participants, 220 (90%) were male and 24 (10%) were female. The mean length of stay in the emergency department was 152.3 ± 103.9 minutes, while the mean hospital LOS was 2.6 ± 1.8 days. Hospital LOS was significantly associated with the need for surgery (p < 0.001). In addition, there was a significant relationship between emergency department LOS and head injuries (p = 0.009) and multiple trauma (p = 0.002).
Conclusion: Based on the results, improving diagnostic and therapeutic processes, accelerating consultations and specialized interventions, and providing greater attention to patients with severe and multiple injuries may reduce LOS and optimize hospital resource utilization.