Block Permutation Research Articles

Xyla-P Cream vs. Lidocaine Spray: Impact on Patient Satisfaction, Anxiety, Cooperation, and Pain in Spinal Anesthesia for Cesarean Section

Background: One of the fundamental principles of medical interventions is to avoid causing pain to patients, and childbirth is no exception. With the rising prevalence of cesarean sections, addressing factors that may diminish maternal satisfaction is crucial. Spinal anesthesia, the most common method for cesarean sections, faces challenges such as patient anxiety. To mitigate pain associated with needle insertion, various methods, including lidocaine spray and Xyla-P cream, have been recommended. Objectives: This study aimed to evaluate the effectiveness of lidocaine spray and Xyla-P cream in reducing pain during needle insertion for spinal anesthesia in cesarean sections. Methods: This randomized, placebo-controlled interventional study included 263 pregnant women at 37 weeks or more of gestational age who were candidates for elective cesarean sections. Participants were randomly assigned to intervention and control groups using a block permutation technique. In intervention group 1, 10 g of Xyla-P cream was applied 30 minutes before spinal anesthesia. In intervention group 2, three puffs of 10% lidocaine spray were used. The control group received three puffs of water spray ten minutes before anesthesia. Pain intensity and anxiety were assessed using the Visual Analog Scale (VAS), and maternal cooperation was scored by the anesthesiologist. Results: The mean age of the participants was 30 years, and 21% had no prior history of cesarean section. There was no significant difference in pain, anxiety, satisfaction, and cooperation between the Xyla-P and lidocaine groups. However, in the group receiving lidocaine, satisfaction (P-value: 0.001) and cooperation (P-value: 0.019) improved significantly compared to the placebo group, whereas anxiety increased significantly compared to the placebo group (P-value: 0.045). Conclusions: Lidocaine had a positive effect on maternal satisfaction with spinal anesthesia and, compared to the placebo, led to significant improvements in maternal satisfaction and cooperation. In light of these findings, lidocaine emerges as a more appropriate choice than Xyla-P cream.

Hardware Implementation of a 2D Chaotic Map-Based Audio Encryption System Using S-Box

This paper presents a hardware-based audio encryption system using a 2D chaotic map and dynamic S-box design implemented on an Artix-7 FPGA platform. Three distinct chaotic maps—logistic–fraction (2D-LF), logistic–sine (2D-LS), and fraction–sine (2D-FS)—were investigated and implemented on an FPGA. The 2D-LF map was employed in the encryption system for its throughput and power efficiency performance. The proposed encryption system benefits from the randomness of chaotic sequences for block permutation and S-box substitution to enhance the diffusion and confusion properties of the encrypted speech signal. The system’s encryption strength is validated through performance evaluations, using the mean squared error (MSE), signal-to-noise ratio (SNR), correlation coefficients, and NIST randomness tests, which confirm the unpredictability of the encrypted speech signal. The hardware implementation results show a throughput of 2880 Mbps and power consumption of 0.13 W.

Comparing the Effects of Lavender Aromatherapy and Mindfulness-Based Cognitive Therapy on Sexual Function in Women in Iran

ObjectiveTo compare the effects of aromatherapy with lavender and mindfulness-based cognitive therapy for sexuality (MBCT-S) on female sexual function. DesignRandomized controlled trial. SettingHealth centers in Roudan city, Iran. ParticipantsSixty married women, ages 18 to 45 years, were recruited using the Female Sexual Function Index (FSFI). Participants were selected from health centers in 2022 via convenience sampling. Intervention and MeasurementsUpon their completion of a demographic checklist and the FSFI as a pretest, participants were divided into three groups, including lavender aromatherapy (n = 20), MBCT-S (n = 20), and control (n = 20) through random selection with permutation blocks. All groups completed FSFI as a posttest. Data were analyzed by SPSS 26 using chi-square, Wilcoxon, Kruskal–Wallis, and Mann–Whitney statistical tests. ResultsThere was no statistically significant difference among the three groups before the intervention (p = .652), but there was a significant difference among them after the intervention (p = .001). There was a significantly positive difference between the intervention groups and the control group (p < .001). A significant relationship was observed among the three groups in sexual desire, pain, satisfaction, lubrication, and arousal. The mean scores of the posttest in sexual desire, pain, satisfaction, and lubrication were positively higher in the MBCT-S group than in the aromatherapy group, and both intervention groups showed the same effect for sexual arousal. Aromatherapy and counseling had no significant effect on improving sexual orgasm. ConclusionMBCT-S can be used to improve many aspects of female sexual function, except for orgasm disorders; aromatherapy may improve sexual arousal.

A cluster algebra approach to presentations of the monoid of uniform block permutations

A cluster algebra approach to presentations of the monoid of uniform block permutations

A Reversible Data-Hiding Method for Encrypted Images Based on Adaptive Quadtree Partitioning and MSB Prediction

To address the vulnerability of the widely used block permutation and co-XOR (BPCX) encryption algorithm in reversible data-hiding in the encrypted domain (RDH-ED), which is susceptible to known-plaintext attacks (KPAs), and to enhance embedding capacity, we propose a novel technique of reversible data-hiding in encrypted images (RDH-EI). This method incorporates adaptive quadtree partitioning and most significant bit (MSB) prediction. To counteract KPAs, we introduce pixel modulation specifically targeting pixels within blocks of the same level during the encryption phase. During data embedding, we utilize tagging bits to indicate the state of the pixel blocks, capitalizing on pixel redundancy within those blocks to augment embedding capacity. Our experimental results demonstrate that our method not only achieves reversibility and separability but also significantly boosts embedding capacity and method security. Notably, the average embedding rate across the 10,000 images tested stands at 2.4731, surpassing previous methods by 0.2106 and 0.037, respectively.

Comparison of the effect of heparin, reteplase, and taurolock in the prevention of thrombosis in hemodialysis catheters.

One of the complications of using catheters is the occurrence of thrombosis, which can be dangerous for patients. The main objective of this study is to compare the effect of heparin, reteplase, and taurolock in the prevention of thrombosis in hemodialysis catheters. The present study is a clinical trial, in which the effect of three drugs, heparin, reteplase, and taurolock, in the prevention of thrombosis in hemodialysis catheters, has been investigated. The research units were studied in two intervention and control groups. The stratified random allocation method was used to assign patients to five groups (control, Heparin 50, Heparin 1000, reteplase, and taurolock), with strata based on the patient's age (20-70 years), gender, and duration of dialysis. Within each stratum, patients were also assigned to groups using the randomized block permutation method and a random number table tool. To prevent bias, this study is triple-blinded. This means that the patient, the thrombosis assessor, and the statistical analyst are unaware of the type of intervention received by the patient. Gender (p < 0.999), age distribution (p = 0.774), and duration of dialysis (p = 0.875) showed no statistically significant relationship with thrombosis. However, significant differences were observed among the five groups regarding thrombosis incidence. The relative risk of thrombosis in the Heparin 50, Heparin 1000, reteplase, and taurolock groups compared to the control group was 92.5%, 92.2%, 98.2%, and 89% lower, respectively. Our study underscores the efficacy of heparin, reteplase, and taurolock in preventing thrombosis in hemodialysis catheters. While all three drugs demonstrated efficacy, the Heparin 50 group exhibited the highest relative risk reduction. These findings suggest that heparin, particularly at a low dose, should be considered a standard prophylactic treatment in hemodialysis patients.

Reversible Data hiding based on Three-Level Hierarchical Embedding with Histogram Mapping in Encrypted Images

This paper proposes a reversible data-hiding (RDH) approach based on a three-level hierarchical embedding with histogram mapping in encrypted images for a cloud environment. The proposed approach uses two-level encryption followed by the three-level hierarchical embedding process. The two-level encryption uses an intra-inter block permutation with an exclusive OR operation. In the three-level hierarchical embedding two predictors namely strong predictor and weak predictor are estimated. The strong predictor is used in level 1 embedding, while the weak predictor is used in level 2 embedding. A histogram mapping is then performed on the location map obtained during the level 1 and level 2 embedding process and is then compressed using the Huffman coding. The compressed location map information is then further embedded as the level 3 embedding process. In the extraction phase, the compressed location map information is first extracted, then the level 2 data followed by the level 1 data. The evaluation of the proposed data embedding approach is done using the Bossbase and Bows-2 datasets that result in an embedding rate of 3.806 bpp and 3.513 bpp respectively.

Multicentre, randomised controlled trial of physiological-based cord clamping versus immediate cord clamping in infants with a congenital diaphragmatic hernia (PinC): statistical analysis plan

BackgroundInfants born with congenital diaphragmatic hernia (CDH) are at high risk of respiratory insufficiency and pulmonary hypertension. Routine practice includes immediate clamping of the umbilical cord and endotracheal intubation. Experimental animal studies suggest that clamping the umbilical cord guided by physiological changes and after the lungs have been aerated, named physiological-based cord clamping (PBCC), could enhance the fetal-to-neonatal transition in CDH. We describe the statistical analysis plan for the clinical trial evaluating the effects of PBCC versus immediate cord clamping on pulmonary hypertension in infants with CDH (PinC trial).DesignThe PinC trial is a multicentre, randomised controlled trial in infants with isolated left-sided CDH, born ≥ 35.0 weeks of gestation. The primary outcome is the incidence of pulmonary hypertension in the first 24 h after birth. Maternal outcomes include estimated maternal blood loss. Neonatal secondary outcomes include mortality before discharge, extracorporeal membrane oxygenation therapy, and number of days of mechanical ventilation. Infants are 1:1 randomised to either PBCC or immediate cord clamping using variable random permutated block sizes (4–8), stratified by treatment centre and estimated severity of pulmonary hypoplasia (i.e. mild/moderate/severe). At least 140 infants are needed to detect a relative reduction in pulmonary hypertension by one third, with 80% power and 0.05 significance level. A chi-square test will be used to evaluate the hypothesis that PBCC decreases the occurrence of pulmonary hypertension. This plan is written and submitted without knowledge of the collected data. The trial has been ethically approved.Trial registrationClinicalTrials.gov NCT04373902 (registered April 2020).

On the security of JPEG image encryption with RS pairs permutation

Recently, a JPEG encryption scheme with RS (run/size) pairs multi-permutation and block permutation has been proposed, which mainly improves security by extracting the expected number of RS pairs for global permutations that need overflow processing. However, it still has the risk of information leakage under the chosen plaintext attack. This is because the limited embedding capacity in overflow processing makes the overflow blocks (OBs) less. On the one hand, a few OBs make the sketch generated by non-zero coefficients count after RS pair multi-permutation visually indistinguishable from the original sketch. On the other hand, a few OBs limit the number of extracted RS pairs that can participate in global permutation, so there are many partially extracted blocks (PEBs) containing unextracted RS pairs. More PEBs make the accuracy of the estimated block permutation sequence high, because the unique plaintext block can be constructed as long as there is an unextracted RS pair in an encrypted block. Simulation results show that the correct ratio of block permutation sequence is not less than 60 %. The highest and average PSNRs between the attacked sketch and the original one reach up to 47.07 dB and 27.42 dB, respectively.

Preventive Effect of a 7-Week App-Based Passive Psychoeducational Stress Management Program on Students.

Passive psychoeducation is an easily accessible and cost-effective self-guided intervention that does not use elements of active psychotherapies or require homework. The present study aimed to investigate the acceptability and efficacy of a 7-week app-based passive psychoeducation stress management program to promote adaptive emotion regulation and coping skills in university students (i.e., 80% psychology students). Participants were tested via Lime-Survey® at pre- and post-test with the Depression Anxiety Stress Scale-21 (DASS-21), the Response Styles Questionnaire (RSQ), and the Emotion Regulation Questionnaire (ERQ). A stratified permutation block randomization by age, gender, and the DASS-21 stress subscale was performed. Each week, the psychoeducation group (n = 123) received different psychoeducation modules. At the end of each module, participants answered questions about their satisfaction with each module and adherence to psychoeducation. The control group (n = 130) received no intervention. The psychoeducation program led to a significant improvement in the adaptive emotion regulation strategy: "reappraisal" (p = 0.004) and a significant reduction in the dysfunctional coping style: "symptom-related rumination" (p = 0.01) but not to a significant reduction in depression, anxiety, and stress scores compared to the control group. Thus, the present study might demonstrate a preventive effect of an app-based passive psychoeducation program in students with low clinically relevant psychopathological symptoms.

Energy-efficient scheduling model and method for assembly blocking permutation flow-shop in industrial robotics field

Implementing green and sustainable development strategies has become essential for industrial robot manufacturing companies to fulfill their societal obligations. By enhancing assembly efficiency and minimizing energy consumption in workshops, these enterprises can differentiate themselves in the fiercely competitive market landscape and ultimately bolster their financial gains. Consequently, this study focuses on examining the collaborative assembly challenges associated with three crucial parts: the body, electrical cabinet, and pipeline pack, within the industrial robot manufacturing process. Considering the energy consumption during both active and idle periods of the industrial robot workshop assembly system, this paper presents a multi-stage energy-efficient scheduling model to minimize the total energy consumption. Two classes of heuristic algorithms are proposed to address this model. Our contribution is the restructuring of the existing complex mathematical programming model, based on the structural properties of scheduling sub-problems across multiple stages. This reformation not only effectively reduces the variable scale and eliminates redundant constraints, but also enables the Gurobi solver to tackle large-scale problems. Extensive experimental results indicate that compared to traditional workshop experience, the constructed green scheduling model and algorithm can provide more precise guidance for the assembly process in the workshop. Regarding total energy consumption, the assembly plans obtained through our designed model and algorithm exhibit approximately 3% lower energy consumption than conventional workshop experience-based approaches.

Security analysis of a reversible data hiding scheme in encrypted images by redundant space transfer

Redundant space transfer (RST) encryption can effectively enhance the security and embedding capacity of reversible data hiding in encrypted images. To demonstrate the security risks of RST encryption in the cloud environment, according to the known plaintext image and marked encrypted image(MEI) pairs, this paper proposes a known plaintext attack (KPA) based on hamming-weight of bit block. The proposed KPA method includes two stages. The first stage is to find the correct ciphertext image. For possible block sizes, all possible ciphertext images of MEI are reconstructed by deleting the embedded secret data. The Hamming weight image (HWI) of plaintext and all possible ciphertext images is calculated in m×8n domain (m, n is the image size). When the histogram distance between the plaintext HWI and a possible ciphertext HWI is the minimum, the correct ciphertext image is found. The second stage is to estimate the permutation keys. The bit block characteristic matrix (BBCM) is defined by using that the bit values of plaintext and ciphertext remain unchanged in the process of RST encryption. Based on the intersection of BBCM’s index set, the block permutation key is directly estimated. Then, the bit plane permutation key in each image block is further estimated. Experimental results show that for RST encryption, when the block size is not less than 3 × 3, the block permutation and bit plane permutation key can be estimated in less than 3 min by using one pair of plain–ciphertext. The estimation accuracy of block permutation key is more than 50%, and the estimation accuracy of bit plane permutation key is 10% for Qin’s RST algorithm, most of the content information of the ciphertext image is leaked.

Effect of Pilates on Anxiety, Depression, and Anthropometric Indices of Women with Type 2 Diabetes

Background: Type 2 diabetes mellitus (T2DM) is prevalent among overweight or obese women. Due to the chronic nature of diabetes, individuals with this condition often experience psychological complications, such as anxiety and depression. This study aimed to investigate the effects of Pilates exercises on anthropometric indices, anxiety, and depression in women with diabetes attending diabetes clinics in Zahedan, Iran. Methods: This two-group quasi-experimental study with pre-test and post-test assessments included 60 female patients diagnosed with T2DM who attended diabetes clinics in Zahedan within March 2021 and July 2022. The participants were selected using convenience sampling and then randomly assigned to either the Pilates exercise group or the control group using a random allocation method with permutation blocks. Initially, anthropometric indices, including body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR), were measured, and the Hospital Anxiety and Depression Scale was completed by both groups. The intervention group participated in Pilates exercises three times a week for 8 weeks, with each session lasting 60 minutes and supervised by a Pilates exercise expert. The control group received routine care at the diabetes clinic, including diet counseling and medication adjustments. After 8 weeks, the data were collected again and statistically analyzed using SPSS 22 software. The significance level was set at P &lt; 0.05. Results: Significant differences were observed in anxiety scores before and after the intervention (13.33 ± 2.6 and 3.2 ± 5.41, respectively; P = 0.001), depression scores (11.9 ± 2.61 and 2.56 ± 1.85, respectively; P = 0.001), and anthropometric indices (P &lt; 0.05). Waist circumference (96.20 ± 9.86 and 92.25 ± 8.56, respectively; P = 0.001), BMI (27.75 ± 1.99 and 26.67 ± 2.03, respectively; P = 0.001), and WHR (0.97 ± 0.06 and 0.93 ± 0.17, respectively; P = 0.001) all showed significant improvements. Conclusions: Exercise is a crucial non-pharmacological intervention in the management of diabetes. The results of this study demonstrate that Pilates exercises can effectively reduce anxiety and depression while improving anthropometric indices in women with T2DM. Therefore, it is recommended to incorporate Pilates exercises as a method to reduce anxiety and depression and enhance anthropometric indicators in this population.

Impact of Spiritual End-of-Life Support on the Quality of Life for Leukemia Patients.

Objective: Patients with leukemia suffer from significant psychological, spiritual, and social symptoms. Therefore, the current research aimed to study the impact of spiritual end-of-life support on the quality of life for leukemia patients. Method : To this end, the present quasi-experimental research with a pre-test and post-test design was performed. The sample included 60 cancer patients randomly assigned to intervention and control groups through the method of permutation block. The experimental group received spiritual support intervention for eight sessions of 60 minutes, while the control group received no intervention. Patients filled out the questionnaire of World Health Organization Quality of Life. The World Health Organization conducts a three-phase assessment to measure the quality of life. These phases include a pre-test, which is conducted before any intervention takes place. Then comes the post-test, which occurs after the intervention. Finally, there is a follow-up assessment conducted two months after the post-test. The obtained results were analyzed by repeated-measures analysis and independent samples t-test using SPSS software. Results: The findings from the repeated measures analysis revealed that there was a statistically significant interaction between time and group (P = 0.01). In other words, being compared to the control group, the spiritual support significantly increased the life quality of the patients in the experimental group. The experimental group witnessed a sustained enhancement in the quality of life for a period of two months following the intervention (follow-up, P = 0.01). Conclusion: Ultimately, the provision of spiritual support has the potential to enhance the overall well-being of individuals approaching the end of their lives, offering solace and aiding them in comprehending the true essence and purpose of their existence.

Secure image encryption algorithm using chaos-based block permutation and weighted bit planes chain diffusion

Aiming at the problem of insufficient security of image encryption technology, a secure image encryption algorithm using chaos-based block permutation and weighted bit planes chain diffusion is proposed, which is based on a variant structure of classical permutation-diffusion. During the permutation phase, the encryption operations of dividing an image into sub-block, block scrambling, block rotation and block inversion, negative-positive transformation, color component shuffling are performed sequentially with chaotic sequences of plaintext association. In the chain diffusion stage, different encryption strategies are adopted for the high and low 4-bit planes according to the weight of image information. Theoretical analyses and empirical results substantiate that the algorithm conforms to the cryptographic requirements of confusion, diffusion, and avalanche effects, while possessing excellent numerical statistical properties with a large cryptographic space. Therefore, the cryptanalysis-propelled security enhancement mechanism proposed in this paper effectively amplifies the aptitude of the algorithm to withstand cryptographic attacks.

Cryptanalysis of iterative encryption and image sharing scheme based on the VQ attack

Reversible data hiding in encrypted images (RDHEI) is widely employed to protect privacy in images stored on cloud storage. Recently, Yu et al. [22] proposed an effective image encryption scheme called iterative encryption and image sharing (IEIS), which is highly compatible with RDHEI. In this study, we analyze the characteristics of IEIS and present a cryptanalysis scheme based on vector quantization (VQ) attack. To capture the pixel-changing pattern of an image block, the concept of pixel difference matrix (PDM) is introduced. VQ attack is subsequently utilized to estimate the ciphertext block. Furthermore, we employ a well-trained convolutional neural network (CNN) based discriminator to identify the proper block permutation sequence within the secret key space. Experimental results demonstrate the efficacy of our proposed cryptanalysis scheme. Based on our study, we conclude that the IEIS scheme raises security concerns.

JPEG image encryption with grouping coefficients based on entropy coding

In the existing JPEG image encryption schemes, the block feature values that can be used to reduce key search space are either difficult to be changed or need to be changed through overflow processing which leads to low generality and high encryption runtime. To change block feature values without overflow processing, a novel JPEG image encryption scheme is proposed. For AC encryption, the complete and end AC groups based on undivided RSV (run/size, value) (ACG-URSV) are permuted separately to change different features. Complete ACG-URSV containing different number of RSVs is used to change the non-zero coefficients count (NCC) and energy of AC coefficients (EAC). End ACG-URSV containing the zero coefficients after position of last non-zero AC coefficient (PLZ) is mainly used to change PLZ. Besides, the intra-block RSV permutation and block permutation are used to further destroy correlation. For DC encryption, the positive DC prediction error (PDC-PE) groups modulo encryption is proposed to avoid overflow processing. The experimental results show that this paper reduces encryption runtime by more than half, improves generality by at least 20%. When quality factor of 90, the average change rates of NCC, EAC and PLZ values are increased by 96.28%, 11.68% and 29.15%, respectively.

The Effect of Education through Telenursing on the Caregiver Burden among Family Caregivers of COVID-19 Patients: A Randomized Clinical Trial

Purpose. Family caregivers are under a lot of burden during the treatment of patients with COVID-19. This study aimed at determining the effect of education through telenursing on the caregiver burden among family caregivers of COVID-19 patients. Design and Methods. This was a randomized clinical trial that was performed on 66 caregivers of COVID-19 patients discharged from Vasei Hospital, Sabzevar, Iran, during 6 months from March to August 2021. The research units were selected using the convenience sampling method and were randomly allocated to two groups, intervention and control, by using permutation blocks. The training workshop and telenursing were conducted in the experiment group, and the control group received only usual care. Novak and Guest care burden scale and demographic questionnaire were collected online by caregivers before and one month after the intervention. Data were analyzed by using SPSS version 24 and paired t-test, independent t-test, Fisher’s exact test, chi-square tests, and covariance analysis. The significance level of the tests was considered to be 5%. Findings. After training the intervention group, the mean caregiver burden before and one month after the intervention was significantly decreased compared to the control group ( p &lt; 0.001). The groups show a significant difference only in terms of educational resources ( p = 0.005). The results of analysis of covariance for the total caregiver burden score in post-test indicated that the mean values of the caregiver burden score between the two groups were statistically significant ( p &lt; 0.05). Practice Implications. Telenursing has suggested that health care managers put the telenursing process by creating appropriate policies and careful planning.

Chaos-based block permutation and dynamic sequence multiplexing for video encryption

This paper proposes a video security transmission enhancement algorithm based on block permutation and dynamic multiplexing sequences encryption based on 4D autonomous hyperchaotic system. Firstly, we employ the block permutation encryption and diffusion confusion encryption module, which is based on dynamic multiplexing chaotic sequences, to encrypt the plaintext and obtain the ciphertext. Subsequently, the hash value of this round’s ciphertext is utilized to generate the chaotic key, produced by the multiplexing sequence of this round after mathematical processing. Then, the key is used to generate the chaotic sequence to confuse the N-th of the multiplexed sequence, and the next round of multiplexed sequence is obtained. If the current round of chaotic sequence has been completely confused, the chaotic sequence is re-generated to generate a new multiplex sequence by using the key generated by the current round key and the initial key. Finally, the above steps are repeated for the encryption of each frame of the video. Compared with the traditional permutation coding algorithm, it increases the difficulty of estimation or recognition while ensuring efficiency, and effectively improves the avalanche effect of the algorithm. Through frame by frame ciphertext closed-loop feedback, it has the ability to resist known plaintext attack and selected plaintext attack. The results show that the scheme has high security and significant diffusion characteristics, and can effectively resist various common cryptographic attacks.

Impact of spiritual care programs on stroke patients' death anxiety: A randomized controlled trial

BackgroundPost-stroke disabilities, particularly in the first days and weeks, may lead to death anxiety and increase spiritual needs, so receiving spiritual care is important. Therefore, this study investigated the impact of spiritual care programs on stroke patients' death anxiety. MethodsThis randomized controlled trial study was conducted on 89 stroke patients at Besat Hospital, Hamadan, Iran, between November 2022 and May 2023. According to inclusion criteria and the Modified Rankin Scale through the random permutation block sampling, participants were allocated to the experimental (N = 45) and control (N = 44) groups. The spiritual care program was held in six consecutive daily sessions (45–60 min each), including identifying spiritual needs, religious care, spiritual care, psychological-spiritual care, and supportive-spiritual care and evaluating the program. At baseline, immediately, and one month after the intervention, participants completed the demographic characteristics form and the Templer Death Anxiety Questionnaire. ResultsAt baseline, the between-group difference in death anxiety mean scores of stroke patients was non-significant (P = 0.104), while immediately and one month after the intervention, the between-group difference was significant (P<0.001). Moreover, in the experimental group, stroke patients' average death anxiety decreased significantly from the baseline to one month after the intervention (P<0.001), while in the control group was not observed a significant difference (P = 0.073). LimitationsEarly fatigue among patients, completing self-report questionnaires, and anxiety related to COVID-19. ConclusionAccording to the results of this study, it is recommended that nurses provide spiritual care as part of stroke patients' holistic care plans to reduce their death anxiety.