Context: Cancer pain in a complicated situation for patients with breast cancer. Researchers suggested to use complementary and alternative method in order to reduction pain and side effects in these patients. Aims: This study was aimed to investigate the effectiveness of mindfulness integrated with cognitive behavioral therapy (MiCBT) on perceived pain and pain self-efficacy in patients with breast cancer. Settings and Design: In this clinical trial study, a semi-experimental method was used. Patients with breast cancer were recurred from cancer clinic of a hospital of Mashhad University of Medical Sciences. Material and Methods: Twenty-four patients with breast cancer selected through purposive sampling method and randomly assigned with permutation blocks in two groups of intervention (n = 12) and control (n = 12). The groups were assessed by demographic questionnaire, Perceived Pain Scale, and Pain Self-efficacy Scale before, immediate, and 1 month after the intervention. Participants in the interventional group received MiCBT for 8 weeks. Statistical Analysis Used: Data were analyzed using descriptive methods and multivariate analysis of covariance. Results: The results showed that the interventional group had a significant decrease in perceived pain (P > 0.05). The pain self-efficacy of patients significantly increased in comparison to the control group in posttest and follow-up stage (P < 0.05). Conclusion: According to the results, it can be concluded that using integrated therapy with mindfulness has been effective in reducing pain and enhancing pain self-efficacy in breast cancer patients. Therefore, it can be an adequate complementary therapy for patients with breast cancer.

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Context: Caregiver burden is high in schizophrenia. Self-efficacy is an emotional and behavioral response to such stressors. Aims: The aim of the study is to determine the relationship between self-efficacy and the perceived' burden among schizophrenic patients' caregivers. Setting and Design: A total of 384 schizophrenic patients' caregivers referring to a psychiatry Clinic in Sari, Iran, were selected via convenient sampling, for this descriptive correlational study. Materials and Methods: The caregivers filled the demographic questionnaire (the patient and the caregivers), the Zarit burden interview, and the general self-efficacy scale. Statistical Analysis Used: Using SPPS 20 software, the demographics of the caregivers were compared using Chi-square tests for categorical data and t- tests for continuous data. Pearson's correlation and regression method were applied after normality testing (P > 0.05). Results: Among 40.5%, 38.7%, and 7.7% of the caregivers, the burden was mild-to-average, average-to-severe, and highly severe, respectively. The mean of caregivers' self-efficacy and burden was 28.79 ± 5.60 and 40.11 ± 13.60, respectively. Furthermore, the burden had significant relationship with the patient's disease duration and income, caregiver's educational level, job, economic status, and relationship with the patient (P < 0.05). Besides, the caregivers' self-efficacy had meaningful relationship with the patient's gender, income potential, housing status, and with the caregiver's age, gender, educational level, job, housing status, economic status, and relationship with the patient (P < 0.05). The relationship between caregivers' burden and self-efficacy was significantly negative (r = −0.445, P = 0.001). Conclusion: When the self-efficacy increases, the caregiver's burden decreases. The importance of economic status of the caregivers and the patient requires special attention.

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Context: Happiness is important for all age groups; however, it is more highlighted in elders. Aims: The aim of the current study was to determine the effect of group singing on the happiness of older people. Setting and Design: In this quasi-experimental study, sixty participants selected among elderly referred to two Day Care Centers of Mazandaran. Materials and Methods: Samples were assigned to two groups of intervention (n = 30)and control (n = 30). The intervention group was assigned into three groups of 10. Each group selected a song from the list of songs and performed it for 10 min. This process was repeated one more time. The intervention was performed two times a week, for 3 weeks. In the control group, no intervention was performed and the elderly received the usual care. The happiness score of both groups, before and 1 month after the end of the intervention, was measured using the Oxford Happiness Inventory. Statistical Analysis Used: Data were analyzed using independent t-test, Chi-square test, and ANCOVA. Results: Before intervention, the mean scores of happiness in the intervention and control groups were 4.38 ± 0.48 and 4. 53 ± 0.26, respectively (P = 0.138). One month after intervention, the mean scores of happiness in the intervention and control groups were 4.77 ± 0.37 and 4.35 ± 0.18, respectively (P = 0.004). Conclusion: The results of this study showed that group singing was effective on the happiness of the elderly. More studies in day-care centers and other settings, especially nursing homes, are recommended. Implementation of such measures is recommended in the day-care centers.

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Context: Urinary tract infection (UTI) is the most common hospital-acquired infection. Around 80% of UTIs are associated with urinary catheters. Aims: The aim of this study was to review and to describe epidemiology and approaches for the prevention and management of catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients. Settings and Design: A narrative review of studies was undertaken. Materials and Methods: A review of PubMed, Google Scholar, Medline, and CINAHL databases were conducted to identify peer-reviewed, English language, and studies published between 1999 and 2018. Related papers were reviewed with using standard keywords. The research was conducted on epidemiology and management of CAUTI in the ICU. Of the 186 English publications, 36 were duplicates. Statistical Analysis Used: Quality assessments, data extractions, and analysis were completed on all included studies. Results: The prevalence of UTI in the ICU is directly related to the widespread use of urethral catheter (32.2%). Guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections for CAUTI. Conclusions: Further studies are needed due to the importance and high prevalence of these infections. We recommend the opportunity to increase any strategy able to reduce the incidence of infections related to urinary catheterization and its consequences in ICUs.

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Context: Spinal muscular atrophy (SMA) is a neuromuscular disease which, in addition to physical disability, causes psychological and social problems for patients and their families. If physiological and mental disorders continue to persist for a long time, it leads to serious deterioration in the patient's physical condition, influences the treatment process, and prevents the outcome of the therapies. Aims: The aim of this study was to explore the lived experiences of patients with SMA. Setting and Design: In this qualitative study, a total of six participants (five patients and one patients' wife) were selected by purposive sampling method. Material and Methods: Data were collected by semi-structured interview. Eleven interviews were conducted and analyzed by Colaizzi's descriptive phenomenological approach. Statistical Analysis Used: Data were analyzed by One Note soft ware version 14.0 with Colaizzi's descriptive phenomenological approach. Results: Two main themes – “tragic life” and “vague future” – emerged from data analysis. They had four categories including “physical and psychological problems,” “limitations and lost opportunities,” “concerns,” and “uncertain future.” Conclusions: These patients experienced a lot of physical and psychological impairments in their life. They have many concerns and lost some opportunities. Therefore, policymakers and authorities should support these patients for participating as an effective members in the society, consequently their feeling improve by getting independent.

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Context: Cardiac function of patients with acute myocardial infarction (MI) plays a central role in their prognosis. Aims: The purpose of this study was to model the cardiac function of these patients based on Type-D personality and the mediating role of negative emotions (anger, depression, and anxiety) in this relationship. Setting and Design: This correlational study was performed using the structural equation modeling method, and specifically the regression equations (combination of path analysis and second-order factor analysis). Material and Methods: The study population was the patients with acute ST-segment elevation MI (STEMI) who were hospitalized at Mazandaran Cardiovascular Hospital and underwent under primary percutaneous coronary intervention treatment in 2017 and 2018. Using Mueller's formula modeling formula (1996) based on a sample size-to-free parameter ratio, the sample size was calculated to 220 patients were chosen by the purposive method. Data were collected using Denollet'sType-DScale-14, the Spielberger's state-trait anxiety inventory, short-form of the beck depression inventory-13, and Spielberger's state-trait anger expression inventory-2. Statistical Analysis Used: Data analysis was performed using SPSS-18 and AMOS 23. Results: Type-D personality can directly predict of the cardiac function of patients with acute STEMI. This variable also predicts the the cardiac function of these patients via the mediation of negative emotions (anger, depression, and anxiety). Conclusion: Type-D personality affects the incidence and prognosis of myocardial infarction via negative emotions. It is, therefore, recommended to screen the susceptible populations for this personality type.

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Context: Using of varied teaching methods may be effective in motivating to learn better. Aims: The present study aimed to compare the effect of teaching based on team-based learning (TBL) and group discussion methods on academic motivation and learning of operating room students in the technology of gastrointestinal surgery lesson in Qom University of Medical Sciences. Settings and Design: This semi-experimental study was conducted among two groups of continuous and discontinuous undergraduate course students of operating room in Qom University of Medical Sciences in 2016–2017. The sampling method was the census. A combination of the TBL method and lecture was conducted randomly among group of continuous undergraduate course students (21 persons) and group discussion among discontinuous undergraduate course students (14 persons). Material and Methods: Hartler's motivation questionnaire completed by the students at the first and last semesters. The test was also carried out immediately after the end of the term and four months after that. Statistical Analysis Used: Data were analyzed using frequency, percent, and independent and paired t-test in SPSS 13 software. Results: Comparison of educational motivation score in both groups before and after the intervention was not significant (P > 0.05). Academic motivation, after the intervention, was significant in both groups (P > 0.05). Comparison of scores did not differ between the two groups immediately after training and 4 months later (P > 0.05). Conclusions: Considering the lack of significant difference between TBL and group discussion in learning and increasing the level of academic motivation of students due to the use of these two methods, it is suggested that TBL and the group discussion replace with the common teaching methods, including lectures.

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Context: The basis of anxiety disorders in cognitive and emotional fields can be effective in coping strategies to anxiety. Aims: This research aimed to investigate the mediating role of emotional distress tolerance in relationship between self-discrepancy with anxiety in people suffering from special phobias. Settings and Design: The present study was a correlational research with structural equation modeling. Materials and Methods: The statistical population of this study was all individuals suffering from specific phobia disorders in the 5^th Azar Hospital in Gorgan City. The sample size selection, which was made by Loehlin method (2004), was 220 persons suffering from anxiety disorder referring to Psychiatric Clinics of 5 Azar Hospital in Gorgan City and was investigated by purposeful sampling. Data gathering tools included Distress Tolerance Scale, self-discrepancy questionnaire, and Spielberger State-Trait Anxiety Inventory. Statistical Analysis Used: The collected data were analyzed using structural regression equations using SPSS 18 and Amos 23 software. Results: The findings showed that the research model is fit and overall, 42% of the anxiety could be explained through emotional stress tolerance and self-discrepancy, and emotional distress tolerance has a mediating role in relationship self-discrepancy with anxiety. Conclusions: The results of this research emphasized the necessity of self-discrepancy as well as the role of mediator of emotional distress tolerance in anxiety in people suffering from special phobias, which can provide applied templates for improving the psychological state of anxious individuals with therapists and counselors.

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