Entry Criteria Research Articles

Heart failure clinic inclusion and exclusion criteria: cross-sectional study of clinic’s and referring provider’s perspectives

ObjectivesThere are substantial variations in entry criteria for heart failure (HF) clinics, leading to variations in whom providers refer for these life-saving services. This study investigated actual versus ideal HF...

Frequency of Persistent Opioid Use 6 Months After Exposure to IV Opioids in the Emergency Department: A Prospective Cohort Study

BackgroundAs rates of opioid use disorder in the general population have increased, some have questioned whether IV opioids should be used routinely for treatment of acute severe pain in the emergency department (ED). ObjectivesWe determined the incidence of persistent opioid use among opioid-naïve patients exposed to IV opioids in the ED. MethodsThis was a prospective observational cohort study conducted in two EDs in the Bronx, NY. Opioid-naïve adults with severe pain who received IV opioids in the ED were followed-up 6 months later by telephone interview and review of the state opioid prescription database. We defined persistent opioid use as filling 6 or more prescriptions for opioids in the 6 months following the ED visit or an average of one prescription per month. ResultsWe screened 1555 patients. Of these, 506 patients met entry criteria and provided analyzable data. Morphine was the IV opioid most frequently administered in the ED (478, 94%), followed by hydromorphone (20, 4%). Of the 506, 8 (2%) received both IV morphine and hydromorphone and 63 (12%) participants were prescribed an opioid for use after the ED visit. One patient/506 (0%) met our apriori criteria for persistent opioid use within 6 months. ConclusionAmong 506 opioid naïve ED patients administered IV opioids for acute severe pain, only one used opioids persistently during the subsequent 6 months.

First classification criteria for diseases caused by calcium pyrophosphate deposition (CPPD)-Translation, explanation and assessment

For diseases caused by calcium pyrophosphate deposition (CPPD), validated classification criteria were previously lacking. In this article the recently developed and validated classification criteria are translated, explained, and assessed. In recent years a multinational research group developed classification criteria for CPPD disease with the support by the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR), following an established method. The developed criteria were finally validated in an independent cohort. The translation and annotation of the new first classification criteria were carried out in an iterative procedure in consensus with the authors. The presence of a crowned dens syndrome or calcium pyrophosphate crystals in the synovial fluid in patients with pain, swelling or sensitivity of the joints (entry criterion) is sufficient for the classification as CPPD disease, where the symptoms cannot be completely explained by another rheumatic disease (exclusion criterion). If these symptoms are not present, a count of more than 56 points based on weighted criteria comprised of clinical features and the results of laboratory and imaging investigations can be included for classification as a CPPD disease. These criteria had a sensitivity of 92.2% and a specificity of 87.9% in the derivation cohorts (190 CPPD cases and 148 mimics), whereas the sensitivity was 99.2% and the specificity 92.5% in the validation cohorts (251 CPPD cases and 162 mimics). The ACR/EULAR classification criteria 2023 of a CPPD disease will facilitate clinical research in this field. The use in the clinical routine will show how practical the criteria are.

A Comparative Study of Virtual Education Challenges Across Semesters for Laboratory Science Students

Background: Virtual education is planned learning in which learning and teaching usually take place in separate environments. In this research, the challenges of using virtual education in different academic years for laboratory science students are investigated during the days of COVID-19. Methods: The research population consisted of 143 laboratory science students, who were selected based on the entry criteria using a stratified random method. The data collection tool was a researcher-made questionnaire. Exploratory factor analysis was used to determine the dimensions of the questionnaire, and Cronbach’s alpha coefficient was utilized to check the internal consistency of the questions. The results were analyzed using SPSS 26. Results: Most of the students participating in this study were girls, between the ages of 18 and 20, and in the 4th semester. The mean standard deviation of the overall score of the virtual education problem questionnaire was 53.57 (17.41). In addition, the highest score in the aspect of academic conditions and motivation was 64.86 (19.73), and the lowest score in universal access to the Internet was 25.45 (54). Conclusion: The technical factor and the overall score of the virtual education problem questionnaire were significantly higher in male students than in female students. Further, the average scores of the questionnaire of virtual education problems and all the dimensions of the questionnaire, including conditions and overall motivation, were significantly higher in younger students than in older students.

Safety and Efficacy of Bone Marrow and Adipose Tissue-Derived Mesenchymal Stem Cells for the Treatment of Ischemic Stroke: A Systematic Review.

Neurological diseases, including ischemic stroke, are considered a big challenge for public health due to their high prevalence and lack of definitive and effective treatments. Addressing these issues requires innovative therapeutic approaches and among the limited methods available, stem cells have shown promise in improving central nervous system repair by enhancing myelin regeneration and neuronal recovery. To advance this field of research, this systematic review aims to assess the safety and effectiveness of mesenchymal stem cells (MSCs) derived from both bone marrow and adipose tissue for the treatment of ischemic stroke. This study conducted a systematic review in the electronic databases PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar to assess the efficacy and safety of MSCs generated from bone marrow and adipose tissue for the treatment of ischemic stroke. It was extracted without a time limit until April 2023. The studies were then transferred to the information management program (EndNote) and duplicates were eliminated. The remaining studies were then examined using the entry and exit criteria and the 3 stages of primary, secondary, and qualitative evaluation, and finally, the results of the final studies were extracted. According to the initial search in the desired databases, 1028 possible related articles were identified and transferred to the information management software (EndNote). After removing 390 duplicate studies, 608 studies were excluded based on inclusion and exclusion criteria. Finally, 37 final studies were included in the systematic review process. Based on the investigations, it was evident that the administration of MSCs derived from both bone marrow and adipose tissue holds significant promise as an effective and safe treatment approach for ischemic stroke. The results consistently showed acceptable outcomes in the studies and this evidence can be recommended for the clinical application of this treatment. Also, the findings of this study report that the use of adipose tissue and bone marrow MSCs in the treatment of ischemic stroke can be used as a practical method.

Therapeutic effect of ferrous sulfate in diabetic patients with iron deficiency anaemia: a randomised controlled trial.

Iron deficiency anaemia (IDA) and diabetes mellitus (DM) are most prevalent disease, that diabetic patients are more prone to IDA. Therefore, the main aim of this study was to investigate the relationship between patients with diabetes and IDA in relation to taking iron pills daily and every other day to reduce the effects related to it. Ninety-one participants were enroled and randomly divided into two groups, with a final analysis cohort of 72 patients. The primary focus was on changes in serum Hb and Ferritin levels. The screening phase lasted 24 weeks, leading to 72 eligible participants meeting the criteria for entry into the study. Additionally, the study examined alternations in Hb and Hb A1C levels after treating patients with iron deficiency. The Hb and ferritin level contrasts between groups were not significant (P = 0.096 and P = 0.500, respectively). The relationship between Hb A1C and Hb levels before and after treatment was positive and significant (r 2 = 0.187). The results of the present study show that although the effectiveness of using oral iron supplements did not have a significant difference in terms of increasing haemoglobin and ferritin, the use of oral iron once every other day was more effective than the use of oral iron every day, and also in this study Like other studies, this result concluded that there is a negative correlation between Hb A1C and Hb, and to check the status of Hb A1C in diabetics, the level of Hb should be considered first.

Diagnosis of Fever Source Following Tonsillectomy and Adenoidectomy in the Pediatric Emergency Department.

This study aimed to describe the epidemiology and diagnoses of children with postoperative fever (a temperature of 38°C or higher) during the week after tonsillectomy and/or adenoidectomy and to assess the yield of the laboratory tests and otolaryngologist consultations of these patients in the pediatric emergency department (ED). We conducted a retrospective cohort study that included all children who presented with fever to the pediatric ED of a tertiary university-affiliated medical center between May 2017 and April 2020 during the week after a tonsillectomy and/or adenoidectomy. There were 94 patients who fulfilled study entry criteria during the 3-year study period, representing a 6% rate of postoperative fever for combined tonsillectomy and adenoidectomy and 3% for adenoidectomy alone. Only 9 patients (<10% of the total) were classified as having bacterial infection, whereas the most common cause for the fever was pneumonia diagnosed by chest radiography. None had surgical site infection. There was no significant difference in blood test findings of patients diagnosed with a bacterial infection and patients with a presumed viral infection or an inflammatory response to surgery. The results of this investigation revealed that the source of fever of the overwhelming majority of children who were referred to the pediatric ED for fever after undergoing tonsillectomy and/or adenoidectomy was pneumonia as determined by chest radiography, which can be performed in an outpatient setting. Blood tests and otolaryngologist consultations were not contributory in classifying the source of fever, questioning the value of their routine use in these patients.

Determinants of Guideline-Directed Medical Therapy Implementation During Heart Failure Hospitalization

BackgroundDespite evidence that guideline-directed medical therapies (GDMTs) improve outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF), implementation remains suboptimal. ObjectivesThe purpose of this study was to measure GDMT implementation during acute HFrEF hospitalization, evaluate the association between socioeconomic factors and GDMT implementation, and assess the association of GDMT utilization with subsequent clinical events. MethodsRetrospective determination of GDMT utilization using a modified optimal medical therapy (mOMT) score (which accounts for specific contraindications to drugs) during unplanned HF hospitalization of consecutive adult patients with new-onset or previously diagnosed HFrEF from 2017 to 2018. Outcomes included discharge mOMT score, association between socioeconomic factors and GDMT implementation (assessed using both the Mann-Whitney U test for binary variables and the Kruskall-Wallace for nonbinary variables), composite outcome 1-year all-cause mortality and 1-year HF readmission, and each component as a function of discharge mOMT score (assessed using univariate and multivariable Cox proportional hazards regression models). ResultsOf 391 patients fulfilling entry criteria (of which 152 [38.9%] had new-onset HFrEF), only 49 (12.5%) had a perfect or near-perfect discharge mOMT score. Black patients and those experiencing homelessness had significantly lower discharge mOMT scores. Higher discharge mOMT score is associated with a lower rate of composite endpoint events, particularly in patients with new-onset HFrEF. Overall, a 0.1-increase in the mOMT score resulted in a 9.2% reduction in the composite endpoint. ConclusionsSuboptimal implementation of GDMT during HF hospitalization is widespread and is associated with a worse outcome. Black patients and patients experiencing homelessness were less likely to have GDMT optimized.

Words of Chinese Origin in the OED: Misinformation and Attestation

Abstract Recent decades have seen small batches of Chinese loanwords and words from Chinese English entering the Oxford English Dictionary (OED). Meanwhile, a muddle of misinformation on the dictionary’s inclusion of certain Chinese-origin words has occurred again and again in various Chinese media forms. The present study examines the extent to which these uninformed news stories are associated with prominent features of the OED. In order to assess the possibility of including the words mentioned in the pieces of misinformation, the study explores the current treatment of Chinese-origin words in the OED and adopts Diamond’s (2016) four criteria for entry, namely evidence of usage, longevity, naturalization, and lexicographical significance. Although the words examined are inadequate in meeting all criteria for inclusion, the misinformed new stories attest to an awareness of Chinese influence on the English lexicon and evidence the reception and reputation of the OED in Chinese media and culture. Moreover, the bits of false news reports expose lexicographers to new knowledge of some prospective candidates for lexicographical inclusion.

Study on the Impact of Depression on the Quality of Life of Patients With Psoriasis

Introduction: Psoriasis is a chronic condition with a strong impact on the daily life of patients, especially on relationship life. This paper aims to clarify the impact of depression on the quality of life of patients with moderate psoriasis. Methods: A cross-sectional study was conducted on 16 participants with psoriasis from April to May 2023. Patients with psoriasis vulgaris completed self-administered questionnaires which include demographic characteristics, Hamilton Depression Rating Scale (HAM-D) and Dermatological Life Quality Index (DLQI). Data were collected both physically, during periodic checks and online by email. Only 16 patients met the eligibility criteria for study entry. All patients included in the study had moderate psoriasis vulgaris. Exclusion criteria for participation in the study was: current use of psychotropic medications. severe comorbidities or chronic medical conditions and visual, auditory, linguistic, or cognitive impairments. Results: After completed the Hamilton Depression Rating Scale (HAM-D) half of them 8 (50%) had a score lower than 8 (minimal depression) and the other half 8 (50%) between 8-16 (mild depression). 14 (87.5%) of the participants had a DLQI score of more than 10, indicating severe impairment in their quality of life. The results obtained showed a positive correlation between Dermatological Life Quality Index (DLQI) andHamilton Depression Rating Scale (HAM-D). Conclusions: Depressive manifestations significantly influence the quality of life of psoriasis patients analyzed. A multidisciplinary approach in treating the patient with psoriasis is indispensable because it is not only necessary to manage a disease or a "case", but also to manage a patient.

Evaluation of RNase therapy in systemic lupus erythematosus: a randomised phase 2a clinical trial of RSLV-132

BackgroundCirculating, extracellular RNA is the primary trigger of type I interferon in systemic lupus erythematosus (SLE), and interferon is known to play a central pathogenic role in the disease. RSLV-132...

P873 Ustekinumab Real World Evidence Study (UndieS): Assessing the suitability of patients treated in routine clinical care for participation in the pivotal phase 3 clinical trial

Abstract Background Phase 3 randomised controlled trials (RCTs) are recognised as the gold standard for measuring the efficacy of new medicines and are essential for licensing new products. To maximise internal validity, RCTs recruit a highly selected, carefully defined group of participants, whereas patients treated in routine practice are much more heterogeneous. We set out to describe the real-world use of ustekinumab and assess the proportion of treated patients who would have been eligible for the relevant registration studies. Methods UndieS is a UK-based, multicentre, prospective, observational study investigating the effectiveness of ustekinumab in 593 Crohn’s disease patients. Objective evidence of active Crohn’s disease (biochemical or endoscopic) and/or failure or intolerance to another therapy were the only entry criteria. Within the limits of the study, we compared participants’ characteristics with the eligibility requirements of the UNITI clinical trial programme. The pragmatic modified Harvey-Bradshaw Index (mHBI), shown to correlate to CDAI score, was used in UndieS. No endoscopic follow up information was collected. Results 82% of patients treated in this real-world study would not have been eligible for participation in the UNITI programme. Eight RCT eligibility criteria would each be expected to exclude at least 10% of the real-world patient population (figure 1). A low disease activity score was the eligibility criterion most frequently expected to render UndieS participants ineligible for the UNITI programme with 61% of predicted CDAI scores (i.e. estimated from mHBI) falling below the threshold for RCT eligibility, despite 80% of those treated having objective evidence of inflammation and 55% failed/ were intolerant to an alternative therapy. Only 13% of participants were using corticosteroids at baseline. 59% of UndieS participants had previously failed or been intolerant to at least one anti-TNFα medication. For those who would have been ineligible for the RCT based on laboratory tests, an elevated ALT was the commonest abnormality among UndieS participants. The requirements for multiple venepunctures and pregnancy avoidance were the most relevant impediments for UndieS patients, with 28% of females of childbearing potential not willing to agree to the specified conditions. Conclusion Within the limitations of this study, we have demonstrated a significant disparity between participants in phase 3 RCTs and patients treated in routine clinical care. This questions the applicability of efficacy studies to real world clinical practice. Data from high quality, observational studies should complement findings from RCTs to support decision makers. Future work will investigate whether outcomes differ according to RCT eligibility.

Medicines optimization prior to discharge in patients admitted to hospital with heart failure.

Approximately half of patients with heart failure and a reduced ejection fraction (HeFREF) are discharged from hospital on triple therapy [angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs), beta-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs)]. We investigated what proportion of patients are on optimal doses prior to discharge and how many might be eligible for initiation of sacubitril-valsartan or sodium-glucose co-transporter-2 inhibitors (SGLT2Is). Between 2012 and 2017, 1277 patients admitted with suspected heart failure were enrolled at a single hospital serving a local community around Kingston upon Hull, UK. Eligibility for sacubitril-valsartan or SGLT2I was based on entry criteria for the PIONEER-HF, DAPA-HF, and EMPEROR-Reduced trials. Four hundred fifty-five patients had HeFREF with complete data on renal function, heart rate, and systolic blood pressure (SBP) prior to discharge. Eighty-three per cent of patients were taking an ACE-I or ARB, 85% a BB, and 63% an MRA at discharge. More than 60% of patients were eligible for sacubitril-valsartan and >70% for SGLT2I. Among those not already receiving a prescription, 37%, 28%, and 49% were eligible to start ACE-I or ARB, BB, and MRA, respectively. Low SBP (≤105mmHg) was the most frequent explanation for failure to initiate or up-titrate therapy. Most patients admitted for heart failure are eligible for initiation of life-prolonging medications prior to discharge. A hospital admission may be a common missed opportunity to improve treatment for patients with HeFREF.

Frontotemporal disorders: the expansive panoply of syndromes and spectrum of etiologies.

Frontotemporal lobe disorders (FTD) are amongst the most common brain neurodegenerative disorders. Their relatively covert, frequently subtle presentations and diverse etiologies, pose major challenges in diagnosis and treatments. Recent studies have yielded insights that the etiology in the majority are due to environmental and sporadic causes, rather than genetic in origin. To retrospectively examine the cognitive and behavioral impairments in the veteran population to garner the range of differing syndrome presentations and etiological subcategories with a specific focus on frontotemporal lobe disorders. The design is a retrospective, observational registry, case series with the collection of epidemiological, clinical, cognitive, laboratory and radiological data on people with cognitive and behavioral disorders. Inclusion criteria for entry were veterans evaluated exclusively at Orlando VA Healthcare System, neurology section, receiving a diagnosis of FTD by standard criteria, during the observation period dated from July 2016 to March 2021. Frontotemporal disorders (FTD) were delineated into five clinical 5 subtypes. Demographic, cardiovascular risk factors, cognitive, behavioral neurological, neuroimaging data and presumed etiological categories, were collected for those with a diagnosis of frontotemporal disorder. Of the 200 patients with FTD, further cognitive, behavioral neurological evaluation with standardized, metric testing was possible in 105 patients. Analysis of the etiological groups revealed significantly different younger age of the traumatic brain injury (TBI) and Gulf War Illness (GWI) veterans who also had higher Montreal Cognitive Assessment (MOCA) scores. The TBI group also had significantly more abnormalities of hypometabolism, noted on the PET brain scans. Behavioral neurological testing was notable for the findings that once a frontotemporal disorder had been diagnosed, the four different etiological groups consistently had abnormal FRSBE scores for the 3 principal frontal presentations of (i) abulia/apathy, (ii) disinhibition, and (iii) executive dysfunction as well as abnormal Frontal Behavioral Inventory (FBI) scores with no significant difference amongst the etiological groups. The most common sub-syndromes associated with frontotemporal syndromes were the Geschwind-Gastaut syndrome (GGS), Klüver-Bucy syndrome (KBS), involuntary emotional expression disorder (IEED), cerebellar cognitive affective syndrome (CCA), traumatic encephalopathy syndrome (TES) and prosopagnosia. Comparisons with the three principal frontal lobe syndrome clusters (abulia, disinhibition, executive dysfunction) revealed a significant association with abnormal disinhibition FRSBE T-scores with the GGS. The regression analysis supported the potential contribution of disinhibition behavior that related to this complex, relatively common behavioral syndrome in this series. The less common subsyndromes in particular, were notable, as they constituted the initial overriding, presenting symptoms and syndromes characterized into 16 separate conditions. By deconstructing FTD into the multiple sub-syndromes and differing etiologies, this study may provide foundational insights, enabling a more targeted precision medicine approach for future studies, both in treating the sub-syndromes as well as the underlying etiological process.

Design and validation of a Questionnaire on the factors influencing self-care behaviors in patients with Multiple sclerosis (QFASMS)

BackgroundMultiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system (CNS). Since MS does not have a definitive cure, individuals affected by it need to adapt and coordinate with their chronic illness in order to fulfill their duties and responsibilities. The first step in helping patients to better care for and manage their illness is to engage in self-care behaviors. This study was conducted with the aim of design and validation of a questionnaire on the factors influencing self-care behaviors in patients with Multiple sclerosis.MethodsThis cross-sectional study was conducted on Multiple sclerosis patients in Iran in 2023. The age range of patients varied between 22 and 52 years. Having MS disease, passing one year of the disease duration, living in Mashhad city, having informed consent to participate in the study and not completing the questionnaire were the entry and exit criteria of the study.ResultsThis study was conducted on 500 patients with multiple sclerosis. Based on the results of psychometrics (face, content and construct validity), the number of questions was reduced from 120 to 47 questions and 73 questions were eliminated. Finally, the questionnaire was approved with 47 questions and 4 subscales of understanding the symptoms of the disease (9 questions), tendency to conscious and targeted care (21 questions), laziness in care (8 questions) and tendency to receive therapy services (9 questions). Cronbach's alpha and McDonald's omega index for all questionnaire questions were 0.877 and 0.881, respectively.ConclusionsBased on the results of this questionnaire, 47 questions and 4 subscales can be used to measure the factors influencing the adoption of self-care behaviour’s in patients with multiple sclerosis.

Patient satisfaction with the management of refractory and unexplained chronic cough in Canada: Results from a national survey.

Chronic cough (persisting for ≥8 weeks) is a common disorder affecting approximately 5 to 10% of adults worldwide that is sometimes refractory to treatment (refractory chronic cough [RCC]) or has no identifiable cause (unexplained chronic cough [UCC]). There is minimal information on the patient's experience of RCC/UCC in Canada. The aim of this study was to evaluate the patient journey and perceptions related to RCC/UCC management in Canada. Our exploratory study included Canadians in the Leger Opinion Panel and focused on individuals with RCC or UCC. Key entry criteria were: age ≥18 years, cough on most days for ≥8 weeks, no smoking within 1 year, no serious respiratory disease or lung cancer, and not taking angiotensin-converting enzyme inhibitors. Individuals who met entry criteria were invited to complete an approximately 30-minute online survey with questions on demographic characteristics, healthcare professional (HCP) interactions, diagnosis of underlying conditions, current treatments, and satisfaction with HCPs and chronic cough therapies. A total of 49,076 individuals completed the chronic cough screening questionnaire (July 30, 2021 to September 1, 2021): 1,620 (3.3%) met entry criteria for RCC or UCC, and 1,046 (2.1%) completed the online survey (mean age of 45 years, 61% female). Most respondents (58%) reported their chronic cough was managed by a general practitioner (GP). Forty-four percent of respondents did not have a diagnosis of an underlying condition for their cough. Breathing tests (39%) and chest imaging (34%) were the most common diagnostic tests. Cough suppressants (18%) were the most frequent current treatment. Respondents were moderately satisfied with their HCPs, but more than half considered their treatment ineffective and 34% had considered no longer seeking medical attention because of a lack of treatment success. Individuals with RCC/UCC in Canada are largely unsatisfied with the effectiveness of treatment. Additional HCP education and new treatment options are needed to improve patient satisfaction.

Effectiveness of the Self-Harmonization Counseling Model Based on the Sharing Approach in Reducing Mother-Adolescent Conflicts: A Case Study

Objective: This study aims to evaluate the effectiveness of the self-harmonization counseling model based on the sharing approach in reducing mother-adolescent conflicts. Methods and Materials: The research method was quasi-experimental, employing case studies. For this purpose, three mother-adolescent pairs, characterized by non-sharing, high-conflict mothers, were selected in 2022 from Tehran using purposive sampling based on entry criteria. Over the course of eight 60-minute sessions, they underwent counseling using a sharing-focused self-harmonization model. Mothers and adolescents completed the Parent-Adolescent Conflict Questionnaire by Asadi Younesi et al. (2011) at baseline and intervention stages, while only mothers responded to the Sharing Lifestyle Questionnaire by Esmaeili et al. (2022) during these phases. Additionally, before treatment, both mothers and adolescents filled out the General Health Questionnaire GHQ-28 (Goldberg &amp; Hillier, 1979). Data were analyzed using visual plotting, reliable change index, and percentage of improvement formula. Findings: The results indicated that the overall percentage of improvement in conflict post-intervention from the perspectives of parents and adolescents was 58.11% and 42.17% for the first participant, 47.01% and 37.13% for the second participant, and 28.29% and 27.75% for the third participant, respectively. Also, the increase in sharing by mothers was 62.23%, 51.88%, and 34.76% for the first, second, and third participants, respectively. These values represent successful short-term counseling outcomes. Conclusion: Therefore, the self-harmonization model based on the sharing approach provides an opportunity for mothers to foster self-harmonization across various dimensions by adopting a sharing attitude and implementing productive strategies, thereby experiencing reduced conflicts with their adolescents. The findings can be utilized by counselors in the fields of family and adolescent.

The concept of succession evasion: An invisible behavior in the organization.

The opposite of succession planning is a new concept called succession evasion; A deep understanding of this concept helps to correct the training process of competent staff in nursing management. This study was conducted with the aim of explaining succession evasion as a new concept in nursing management; Also, as an invisible aspect of organizational behavior in the field of management. The current research was conducted using a qualitative approach and conventional content analysis methods. The participants included nursing managers selected using the purposeful sampling method based on the entry and exit criteria. The code of research ethics and required permits were received. The method of semi-structured interviews was used to collect data, and the time of the interviews varied between 39 and 90 minutes. All data was recorded and transcribed. The method proposed by Graneheim and Lundman was used for data analysis. Guba and Lincoln's criteria were used for the accuracy and robustness of the data. MAXQDA software was used for data management. The subcategories related to succession planning included "Fear of succession planning," "Talent suppression," "Belief in the permanence of the position," and "Obstructing the growth of others." Succession evasion as an undesirable organizational behavior had four primary categories, fear of succession planning, talent suppression, belief in-Popsition stability, and obstruction to the growth of others. It is recommended to use the findings of this study in the context of further explanation of the concept of succession evasion as the opposite of succession planning in future research, and also, to use this concept for planning nursing management.

Comparison of the Effectiveness of Short-Term Intensive Dynamic Psychotherapy (ISTDP) and Schema Therapy for Mothers on Social Anxiety in Children Aged 5 to 6

Objective: Social anxiety disorder is among the most common disorders during childhood and adolescence. The present study aimed to compare the effectiveness of short-term intensive dynamic psychotherapy (ISTDP) and schema therapy for mothers on social anxiety in children aged 5 to 6 years in Shahin Shahr. Methods and Materials: This research was a quasi-experimental study with a pre-test, post-test, and follow-up design, including a control group. The research population consisted of all mothers of children aged 5 to 6 years with social anxiety in Shahin Shahr in 2023, from which 45 individuals were purposively selected based on scoring two standard deviations above the mean on the Spence Children's Anxiety Scale (Parent Version) and other entry criteria of the study, and were randomly assigned to two experimental groups and one control group (each containing 15 individuals). One experimental group received 10 weekly sessions of 90 minutes of schema therapy, while the second experimental group underwent 10 weekly sessions of 90 minutes of short-term intensive dynamic psychotherapy (ISTDP). The control group did not receive any intervention. The research tool was the Spence Children's Anxiety Scale (Parent Version, 1999), completed by the mothers at three stages: pre-test, post-test, and a 3-month follow-up. The obtained data were analyzed using repeated measures ANOVA, mixed-design ANOVA, and Bonferroni post-hoc tests with SPSS software version 24. Findings: The results showed that both treatments were effective in improving children's social anxiety (P&lt;0.01), but the effectiveness of schema therapy for mothers on improving children's social anxiety was greater (P&lt;0.01), and the effectiveness of both treatments was sustained until the end of the follow-up period. Conclusion: Both treatment methods, especially schema therapy for mothers, are effective in improving social anxiety in children and can be utilized.

Effectiveness of Therapist-Assisted Couple Therapy on Psychological Well-being, Negotiation Increase, and Aggression Reduction in Women Victims of Partner Violence

Objective: The current study was conducted to determine the effectiveness of therapist-assisted couple therapy on psychological well-being, negotiation increase, and aggression reduction in women victims of partner violence. Methods and Materials: This research was a quasi-experimental study with a pre-test, post-test design with a control group. The study population included couples visiting counseling and psychotherapy centers in Qom city during the second half of the year 2021, among whom 30 couples were randomly assigned to two groups after controlling for entry criteria: the therapist-assisted intervention (15 couples) and the control group (15 couples). Research instruments included the Conflict Tactics Scale by Straus et al. (1979) and the Psychological Well-being Scale by Ryff (1989), administered to the female victims of violence in three stages: pre-test, post-test, and follow-up. The intervention group received an educational package by Aghayousefi et al. (2020) over eight sessions, while the control group did not receive any intervention. Data were analyzed using repeated measures analysis of variance. Findings: Results indicated that therapist-assisted couple therapy was effective in reducing aggression, increasing negotiation, and enhancing the psychological well-being of women victims of violence (P&lt;0.05), with these effects being stable at the follow-up stage. Conclusion: The findings suggest that therapist-assisted couple therapy is an appropriate method for resolving conflicts and improving psychological well-being.