Publications by authors named "Maryam Aalaa"

23 Publications

  • Page 1 of 1

Empowering Health Care Providers and Self-management Education in Diabetes? A Scoping Review.

Int J Endocrinol Metab 2021 Jul 19;19(3):e111765. Epub 2021 Jul 19.

Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Context: There has been an increasing emphasis on the role of education in diabetes prevention and management, and shedding light on evidence gaps is mandatory for national action plans establishment.

Data Sources: This scoping review was part of the Iranian Diabetes Road Map project that used a systematic method based on the Arksey and O'Malley approach.

Results: After the screening, 173 articles were included, most of which were published in 2018 and focused on self-management. Most included articles were considered patient-related self-management/care/efficacy, while only a limited number of articles studied healthcare provider education and educational establishment. Additionally, a significant number of included studies were addressed virtual education, an issue as the strength of Iranian studies in diabetes education.

Conclusions: Education is an important part of diabetes, and specific needs for Iranian patients should be addressed in future studies. Paying attention to new topics and conducting high-quality interventional studies will help fill evidence gaps in this field in Iran.
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http://dx.doi.org/10.5812/ijem.111765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453654PMC
July 2021

Diabetic foot self-care practice in women with diabetes in Iran.

Diabetes Metab Syndr 2021 Sep-Oct;15(5):102225. Epub 2021 Jul 26.

Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background And Aims: The present study was conducted to determine the situation of foot self-care practice among Iranian women with diabetes.

Methods: In this cross-sectional study, 475 women completed the Diabetic Foot Self-Care Questionnaire (DFSQ) along with other questions. The overall and three components scores including personal care, podiatric care, and foot wearing, were calculated and their relationship with other factors was analyzed.

Results: The average total DFSQ score was 60.38 ± 9.9, and 16.98 ± 7, 5.95 ± 2.11, and 12.26 ± 3.95 for personal care, podiatric care, and footwear respectively. Education level, self-reported health status, and life satisfaction had a significant relationship with footwear score, and smoking and life satisfaction were related to personal care and podiatric care respectively. In Pearson regression, DM self-care was correlated with all three components and total DFSQ score. Also, depression and SCS (Social Capital Status) correlated with DFSQ scores except with personal self-care and footwear respectively. Body Mass Index (BMI) and Quality of Life (QoL) were significantly correlated with footwear and podiatric care scores.

Conclusion: In this study, the DFSQ result was almost acceptable, however, it highlights the importance of suitable interventions to establish better self-care practice among Iranian diabetic women.
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http://dx.doi.org/10.1016/j.dsx.2021.102225DOI Listing
July 2021

Social-capital determinants of the women with diabetes: a population-based study.

J Diabetes Metab Disord 2021 Jun 9;20(1):511-521. Epub 2021 May 9.

Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Introduction: Social-capital level contributes to clinical factors and health outcomes of patients suffering from diabetes. Considering the social determinants of type 2 diabetes patients could benefit to prevention of diabetes complications especially in women population. This study aims to determine social capital determinants in women with diabetes.

Methods: Four hundred and thirty-five women with diabetes take-part in this cross-sectional, multi-centric study. The data was completed by a demographic questionnaire and the Social Capital instrument (SC-IQ). This study is investigating demographic (age, gender, BMI, marital, educational and social-economic status), and lifestyle factors (physical activity, nutrition), Diabetes status (HbA1c Level, medications, complications, duration of diabetes), general health status (life satisfaction, self-rated health, physical activity, and depression) and Social capital items (Value of life, Tolerance of Diversity, Neighborhood network, Family and Friends Connections, Work connections, Community participation, Feeling of trust and Safety and Proactivity). The descriptive statistics and linear regression models were used to assess the associations between social capital and determinants.

Results: The mean age of participants was 50 (SD: 7.7), range 28-71 year. The mean social capital score was 77.8 (SD: 15.8). In linear regression analysis, results showed that women who had the greater score in total social-capital (ß: 3.7, SE: 1.5) and Feeling of trust and Safety (ß: 0.87, SE: 0.42) had vigorous physical activity and also women who had greater score in Neighborhood Connections had moderate physical activity in comparison with patients who had low physical activity. (ß: 0.67, SE: 0.26 and ß: 0.61, SE: 0.26).Also, the findings showed that women who had had a lower score in total social-capital (ß: 6, SE: 1.47), Community participation (ß: 1.44, SE: 0.37), Value of life (ß: 1.71, SE: 0.24), Family and Friends Connections (ß: 0.88, SE: 0.25) and proactivity (ß: 0.71, SE: 0.25) had depression in comparison with patients who had no depression. The findings revealed that instead of each year increase in the duration of diabetes, the total social-capital score had decreased about the half score (ß: 0.48, SE: 0.21).

Conclusions: Important social factors that make diabetes control are alterable to health interventions. The results of the current study suggest that social capital status may determine how effectively the women with diabetes have been managed. This initial finding permits subsequent experimental investigations to identify social strategies that can be valuable to improve diabetes control.
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http://dx.doi.org/10.1007/s40200-021-00772-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212190PMC
June 2021

The effects of dietary/herbal supplements and the serum levels of micronutrients on the healing of diabetic foot ulcers in animal and human models: a systematic review.

J Diabetes Metab Disord 2021 Jun 26;20(1):973-988. Epub 2021 May 26.

Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Purpose: Diabetic Foot Ulcer (DFU) is one of the common and serious complications in patients with Diabetes Mellitus (DM) worldwide. Given the considerable tendency of patients suffering from DFU to use the complementary therapies, the objectives of this study were to: (i) summarize the effects of dietary and herbal supplements on DFU characteristics and metabolic parameters in both animal models and clinical trials, and (ii) evaluate any links between the serum levels of micronutrients and DFU in observational studies.

Methods: A systematic search in five electronic databases including PubMed/Medline, Scopus, Web of Science, Embase, and Cochrane Library was conducted to find relevant English language published from 1990 until 31 December 2018.

Results: Of a total of 8603 studies, 30 eligible papers including animal studies ( = 15), clinical trials ( = 7), and observational works ( = 8) were included in the systematic review. We found that some dietary/herbal supplements and micronutrients had positive effects on the wound healing. However, limited evidence is existed. Also, lower serum levels of vitamin D, C, vitamin E, and selenium in patients with DFU were likely to increase the risk of DFU, leading to impaired wound healing.

Conclusion: Findings suggested that some dietary and herbal supplements such as Vitamin D, Magnesium, Vitamin E, Probiotic, Zinc, and Pycnogenol would be effective on wound healing of DFUs. However, further high-quality randomized controlled clinical trials and prospective cohort studies are needed to clarify the roles of micronutrients and other dietary and herbal supplements on the progress and treatment of DFU.
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http://dx.doi.org/10.1007/s40200-021-00793-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212333PMC
June 2021

The rationale behind systematic reviews in clinical medicine: a conceptual framework.

J Diabetes Metab Disord 2021 Jun 8;20(1):919-929. Epub 2021 Apr 8.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

A systematic review (SR) is a type of review that uses a systematic method to provide a valid summary of existing literature addressing a clear and specific question. In clinical medicine (CM), the concept of SR is well recognized, especially after the introduction of evidence-based medicine; The SR of randomized clinical trials (RCTs) is considered the highest level of evidence on therapeutic effectiveness. Despite the popularity of the SRs and the increasing publication rate of SRs in CM and other healthcare literature, the concept has raised criticisms. Many of proper criticisms can be due to the deviation of some existing SRs from the original philosophy and well-established rationale behind the concept of SR. On the other hand, many criticisms are misconceptions about SRs which still exist even several decades after introducing the concept. This article presents a conceptual framework for clarifying the rationale behind SR in CM by providing the relevant concepts and their inter-relations, explaining how methodological standards of an SR and its rationale are connected, and discussing the rationale under the three-section: SR as a type of synthetic research, SR as a more informed and less biased review, and SR as an efficient scientific tool.
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http://dx.doi.org/10.1007/s40200-021-00773-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212290PMC
June 2021

Diabetic foot care course: a quasi-experimental study on E-learning versus interactive workshop.

J Diabetes Metab Disord 2021 Jun 23;20(1):15-20. Epub 2021 Jan 23.

Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.

Background: Nurses, as multidisciplinary Diabetic Foot Care (DFC) team members, need to be trained in DF prevention and management. Regarding the increasing use of e-learning educational courses as the new learning strategy with potential benefits among health care providers, this study attempted to evaluate the educational effects of an e-learning course on DFC compared to that of an interactive workshop in the related knowledge attainment.

Methods: This was a quasi-experimental study compared two non-randomized groups consisting of nurses who attended an e-learning course (intervention group) and a face-to-face interactive workshop (control group) on DFC using a pre- and post-test design. The eligible nurses enrolled by convenience sampling. All five e-modules on DF prevention and care were the same for both groups. A value of <0.05 was considered as significant.

Results: The study findings indicated that both e-learning course and interactive workshop increased DFC knowledge among nurses. There is a significant difference between the learning level (after training) in the intervention and control groups ( < 0.01).

Conclusions: The findings suggest that the e-learning course of DF could be as effective as conventional educational methods. However, considering the time, cost savings and providing an opportunity to learn anytime and anywhere, of the e-learning course, it is recommend for the future and required that more health care providers be trained to use of distance learning.
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http://dx.doi.org/10.1007/s40200-020-00630-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212321PMC
June 2021

Evidence Gap and Knowledge Map of Physical Activity Research in Diabetes in Iran: A Scoping Review.

Int J Endocrinol Metab 2021 Apr 27;19(2):e110636. Epub 2021 Apr 27.

Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Context: The important role of physical activity in the prevention and management of diabetes necessitates a review of current research to shed light on gaps in national diabetes guidelines.

Evidence Acquisition: This scoping review was part of the Iran Diabetes Research Roadmap (IDRR) study. A systematic search was used based on the Arksey and O'Malley method consisting of six steps. The descriptive analysis was done with SPSS software. Additionally, VOS veiwer software was used to draw the knowledge map of the included studies.

Results: There were 169 articles included from the beginning of 2015 to the end of 2019 in Iran. Aerobic and resistance exercises were types of physical activity with more number of articles. Most of the included clinical studies were randomized clinical trials and had a level of evidence two. Also, there was more interest in outcomes such as glycemic control and insulin sensitivity, metabolic syndrome, metabolism, and cardiovascular health. The network of co-authorship was drawn, and "controlled study", "male", and "rat" were the most frequent keywords.

Conclusions: The number of Iranian diabetes researchers on physical activity is increasing, and the majority of clinical studies had a high level of evidence. With maintaining previous interests and investigations, there should be more emphasis on research in elderly and children age groups as evidence gap in Iran. Also, longitudinal cohort studies should be highlighted and Iranian researchers should be encouraged to participate in new topics of research worldwide.
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http://dx.doi.org/10.5812/ijem.110636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198613PMC
April 2021

Comparing peer education with TBL workshop in (EBM) teaching.

Med J Islam Repub Iran 2020 29;34:70. Epub 2020 Jun 29.

Center of Educational Research in Medical Science (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Science, Tehran, Iran.

Evidence-based medicine is one of the most important topics in medical sciences that requires a proper teaching method. Very few studies have evaluated EBM education outcomes through peers and TBL workshops. The purpose of this study was to compare the effect of evidence-based medicine (EBM) education through peers with TBL workshop method in medical students. This quasi-experimental study was conducted on 42 medical students of the Faculty of Medicine in Iran University of Medical Sciences (IUMS) in 2019 who were selected through convenience sampling. Students were divided into 2 experimental and control groups based on the randomized blocking method. The data collection tools were 2 questioners that evaluated EBM knowledge and satisfaction in both intervention and control groups. The knowledge of students was compared using pretest and posttest and their satisfaction was evaluated at the end of the TBL workshop and peer education. Data were analyzed by SPSS software and descriptive tests (t test and ANOVA), and significance level was set at 0.95. A significant difference was found between the level of basic knowledge (pretest) and secondary knowledge (posttest) in the EBM education through TBL workshop method compared to peer method. The average scores gained by students in TBL workshop were 3.8 more than the peer teaching method. The results of the Satisfaction Questionnaire were 74% in control group and 86% in the experimental group. EBM education through TBL workshop both increased students' knowledge and satisfaction compared to peer education. Thus, it can be concluded that providing EBM education by expert and qualified teachers through face to face teaching strategy can be effective in knowledge translation. However, peers can participate in educational sessions as facilitators.
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http://dx.doi.org/10.34171/mjiri.34.70DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500417PMC
June 2020

Telehealth for fighting the novel coronavirus: review of activities on Diabetes and Osteoporosis management in outbreak.

J Diabetes Metab Disord 2020 Jun 9:1-2. Epub 2020 Jun 9.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1007/s40200-020-00562-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280170PMC
June 2020

Conceptual map of diabetes education: necessity of establishing iran diabetes academy.

J Diabetes Metab Disord 2019 Dec 8;18(2):729-731. Epub 2019 Oct 8.

7Endocrinology Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Diabetes Mellitus as a one of common non communicable diseases needs to be managed using multidisciplinary and coordinated approach. Incidentally, Clinical practice guidelines along with Continuing Medical Education (CME) would be essential section in this approach. In this regard Iran Diabetes Academy (IDA) affiliated Endocrinology and Metabolism Research Institute (EMRI) of Tehran University of Medical Sciences (TUMS) was established in 2017. IDA intended to provide and deliver appropriate source of updated information for all health care providers in field of diabetes prevention, management and rehabilitation.
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http://dx.doi.org/10.1007/s40200-019-00441-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915169PMC
December 2019

A multidisciplinary team approach in Iranian diabetic foot research group.

J Diabetes Metab Disord 2019 Dec 9;18(2):721-723. Epub 2019 Nov 9.

1Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Jalale Ale Ahmad Av, Tehran, 1414713138 Iran.

Diabetic Foot (DF) as a common complication of Diabetes needs to intensive intervention for prevention, management and rehabilitation. In this regard the Iranian Diabetic Foot Research Group (IDFRG) of Diabetes Research Center of Endocrinology and Metabolism Research Institute (EMRI) of Tehran University of Medical Sciences (TUMS) with multi-disciplinary approach have begun its activity since 2014. The aim of this paper is introducing the IDFRG in four main categories including Education, Research, Knowledge Translation and Clinical Care. According to the strategic plan, Future activities would be considered as five following areas: National Diabetic Foot Research Network (NDFRN) Establishment, Podiatrist Curriculum Development, Iranian Diabetic Foot Registry System (IDFRS) Launch, DF guideline Implementation and last but not least DF Ward Establishment.
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http://dx.doi.org/10.1007/s40200-019-00450-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915241PMC
December 2019

The effectiveness of negative pressure wound therapy as a novel management of diabetic foot ulcers: an overview of systematic reviews.

J Diabetes Metab Disord 2019 Dec 25;18(2):625-641. Epub 2019 Nov 25.

3Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Diabetic foot ulcer (DFU) is one the serious disabling conditions in patients with diabetes. Several approaches are available to manage DFU including Negative Pressure Wound Therapy (NPWT). The objective of this overview is systematically reviewing the related reviews about the effectiveness, safety, and cost benefits of NPWT interventions.

Methods: In October 2018, electronic databases including Medline, Embase, Scopous, Web of Science, the Cochrane Library and Google scholar were searched for systematic reviews about the NPWT's effectiveness and safety in DFUs. The Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist was used for the appraisal of the systematic reviews. According to this checklist the studies were categorized as high, moderate, low and critically low quality.

Results: The electronic searches yielded 6889 studies. After excluding duplicates and those not fellfield the inclusion criteria, 23 systematic reviews were considered. The sample size of the reviews ranged between 20 and 2800 patients published since 2004 to 2018. Twenty systematic reviews (86.95%) included only randomized clinical trials (RCT). Regarding the AMSTAR-2 checklist, 7 studies were assigned to high quality, 8 were categorized as low quality and 8 studies belonged to the critically low quality groups. Accordingly, three, two and one out of seven high quality studies approved the effectiveness, safety and cost benefit of the NPWT therapy, respectively. However, some of them declared that there is some flaws in RCTs designing.

Conclusion: This overview illustrated that either systematic reviews or the included RCTs had wide variety of quality and heterogeneity in order to provide high level of evidence. Hence, well-designed RCTs as well as meta-analysis are required to shade the light on different aspects of NPWT.
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http://dx.doi.org/10.1007/s40200-019-00447-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6915190PMC
December 2019

Plantar pressure distribution in diverse stages of diabetic neuropathy.

J Diabetes Metab Disord 2019 Jun 11;18(1):33-39. Epub 2019 May 11.

Endocrinology and Metabolism Research Institute, Jalale Ale Ahmad Ave, North Kargar, Tehran, Iran.

Background: Diabetic Foot Ulceration in patients with diabetes could be associated with high plantar pressure caused by diabetes neuropathy. Therefore, it seems that one of the ways of identifying high-risk legs in diabetic patients with neuropathy would be characterization of elevated plantar pressure distributions.

Objective: Comparing the plantar pressure distribution in diabetic patients who suffered neuropathy with those without neuropathy.

Methods And Materials: Plantar pressure distribution was recorded in the following categories: 38 diabetic patients without neuropathy, 30, 40 and 34 patients with mild neuropathy, moderate and severe neuropathy respectively.

Results: Patients suffered from severe neuropathy suggested higher maximum peak plantar pressure at midfoot, heel, and medial forefoot. The peak pressure of midfoot was significantly different in the following categories as well: patient without neuropathy (32.3 ± 17.9 kPa), mild neuropathic (24.0 ± 17.9 kPa), moderate neuropathic (21.5 ± 12.6 kPa), and severe neuropathic (22.9 ± 10.7 kPa) groups ( = 0.02).

Conclusion: The progression of diabetic neuropathy would have been increased followed by the peak plantar pressure.
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http://dx.doi.org/10.1007/s40200-019-00387-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6582080PMC
June 2019

Influence of MTHFR gene variations on perceived stress modification: Preliminary results of NURSE study.

Med J Islam Repub Iran 2017 25;31:128. Epub 2017 Dec 25.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

High level of perceived stress in nurses is due to a genetic predisposition and environmental stressors. The aim of NURSE (Nursing Unacquainted Related Stress Etiologies) study was to investigate the association of C677T MTHFR gene polymorphism and stress perception among nurses. In this comprehensive study, 216 female nurses were recruited. Perceived stress was assessed using the Cohen Perceived Stress Scale (PSS). Genomic DNA was extracted from peripheral blood, and MTHFR genotype was detected by the polymerase chain reaction. MTHFR C677T genotype analysis revealed that half of the participants had normal C/C genotype, and the remaining half presented higher frequencies of C/T genotype (39.8%) compared to T/T genotype (10.2%). The mean±SD stress score in morning shift, night shift, and rotation was 15.39±4.75, 15.92±4.94, and 15.83±5.61, respectively (p= 0.7). Perceived stress score was more in highly educated group but it was not significant (p= 0.2). Distribution of different MTHFR genotypes in diverse groups revealed that in groups with more stress score, the frequency of heterozygote (C/T) and homozygote (T/T) genotypes increased. Data revealed that in low stress category, 87% of the participants had a normal genotype. However, in high stress category, 71.3% of the participants had a normal genotype. MTHFR genotype, independent of folate availability and probable confounding parameters, might be a potential risk factor of perceived stress among nurses.
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http://dx.doi.org/10.14196/mjiri.31.128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014759PMC
December 2017

Diabetic foot workshop: Improving technical and educational skills for nurses.

Med J Islam Repub Iran 2017;31. Epub 2017 Jan 27.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Diabetes mellitus as one of the most common metabolic disorders has some complications, one of the main ones is diabetic foot (DF). Appropriate care and education prevents 85% of diabetic foot amputations. An ideal management to prevent and treat diabetic foot necessitates a close collaboration between the health team members and the diabetic patient. Therefore, improving nurses' knowledge about DF care and advancement in the quality of care provided by the nurses could significantly improve diabetic foot prevention and management. Therefore, the aim of DF workshop was to improve technical and educational skills of the nurses to prevent and manage diabetic foot. Considering the vital role of the nurses in providing DF care, EMRI decided to conduct Diabetic foot workshop for them. The following five steps were designed for the 14 coordinating sessions in the workshop: Goals definition, deciding about attendees, location selection, creating agenda, and developing a follow-up plan. "Diabetic Foot Workshop for Nurses" provides appropriate training to DF nurses at the national level; and combining theory and practice in this workshop not only increases nurses' knowledge, but also improves their skills in the field of the diabetic foot. Providing education and care to patients by DF nurse specialists instead of general nurses could be an important output of this workshop, which may lead to DF prevention and amputation decrease in the long term.
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http://dx.doi.org/10.18869/mjiri.31.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473009PMC
January 2017

The Effectiveness of a Peer Coaching Education on Control and Management of Type 2 Diabetes in Women: A Protocol for a Randomized Controlled Trial.

Int J Community Based Nurs Midwifery 2017 Apr;5(2):153-164

Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Diabetes Education by Peer Coaching is a strategy which helps the patients with diabetes in the field of behavioral and emotional problems. However, the results of studies in this field in other countries could not be generalized in our context. So, the current study aimed to examine the effectiveness of Diabetes Education by Peer Coaching on Diabetes Management.

Methods: Outcome variables for patients and peer coaches are measured at baseline and in3,6 and 12 months. The primary outcome consisted of Fasting Blood Sugar (FBS) and HbA1c. Secondary outcomes included Blood Pressure (BP), Body Mass Index (BMI,) Waist-Hip Ratio (WHR), Lipid Profile, diabetes self-care activities, diabetes-related quality of life, depression, and Social Capital levels.Initial analyses compared the frequency of baseline levels of outcome and other variables using a simple Chi-square test, t-test and the Mann-Whitney- U test. Sequential measurements in each group were evaluated by two-way analysis of variance. If significant differences in baseline characteristics were found, analyses were repeated adjusting for these differences using ANOVA and logistic regression for multivariate analyses. Additional analyses were conducted to look for the evidence of effect modification by pre-specified subgroups.

Conclusion: The fact is that self-control and self-efficacy in diabetes management and treatment of diabetes could be important components. It seems that this research in this special setting with cultural differences would provide more evidence about peer-coaching model. It seems that if the peer-coaching model improves learning situations between patients with diabetes by offering one-on-one Diabetes Self Management Education, it could be an interactive approach to diabetic education. IRCT201501128175N3.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385238PMC
April 2017

Iran diabetes research roadmap (IDRR) study: a preliminary study on diabetes research in the world and Iran.

J Diabetes Metab Disord 2017 17;16. Epub 2017 Feb 17.

Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Backgrounds: Diabetes is one of the most common metabolic disorders worldwide. This study aim was to provide detail analysis of diabetes research output and its trend in Iran as well as in the world and compare them.

Methods: Data was retrieved from PubMed database using a suitable search strategy and application of proper operator "AND", "OR" and "NOT". All English documents published from 2008 to 2012 were included. Meeting abstract, letter to the editor, guidelines, consensus and reviews were excluded. Obtained documents for Iran and world were categorized in eleven groups including diabetes management, education, paediatrics, nutrition, epidemiology, diabetes complications, stem cells, gestational diabetes mellitus (GDM), psychiatrics, genetics and prevention and were compared.

Results: Total number of DM publications was 59513 for world and 648 for Iran. Trend of DM publications was increasing during the 5 years with a growth rate of 22.5% for world and 23.4% for Iran. Contribution of Iran in the world diabetes output reached 1.08 in 2012. The most and the least number of DM documents were related to complications and preventions, respectively both in Iran and the world. Three leading countries with highest proportion of RCTs (randomized clinical trial) to their total DM publications were Italy, Germany and Iran.

Conclusion: The most number of diabetes research was in the field of diabetes complication, management and genetics in the world as well as in Iran. During the 5-year period, despite of the world sanctions against Iran, diabetes research trend was increasing in Iran relatively parallel to the world research and sanction had no significant effect on Iran.
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http://dx.doi.org/10.1186/s40200-017-0291-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5316224PMC
February 2017

Writing qualitative article: It is time to quality improvement.

Med J Islam Repub Iran 2016 16;30:346. Epub 2016 Mar 16.

RN, PhD of Nursing, Associate Professor, Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran, & Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.

Précis: This debate article highlights some questions from critics of qualitative research. Planning for proper design, philosophical background, researcher as a research instrument in the study, trustworthiness and application of findings are main debates in this field. One of the issues that have been received little attention is report of qualitative inquiry. A qualified report can answer the critics. This requires that the qualitative articles cover all points about the selected method and rigourness of study conduct to convince policy makers, managers and all readers in different level.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898836PMC
July 2016

Barriers and facilitators of nursing research utilization in Iran: A systematic review.

Iran J Nurs Midwifery Res 2015 Sep-Oct;20(5):529-39

Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: According to professionalization in nursing profession, the nursing researches expanded dramatically and rapidly in a very short period. Research results showed improvement in quality of provided care by using research findings. But there is still a gap between nursing research and practice, which led scientists to explore the barriers and facilitators of research utilization that could affect the application of research results. The aim of this review was to appraise and synthesize evidences of studies about the facilitators and barriers to research utilization in Iranian nurses.

Material And Methods: A systematic review of quantitative and qualitative studies about the barriers and facilitators of nursing research utilization in Iran was undertaken.

Results: The results showed that items such as "The nurse is isolated from knowledgeable colleagues with whom to discuss the research," "There is insufficient time on the job to implement new ideas," "The nurse does not have time to read research," "The nurse does not feel she/he has enough authority to change patient care procedures," "The facilities are inadequate for implementation," "Physicians will not cooperate with implementation," and "The relevant literature is not compiled in one place" were rated as the main barriers.

Conclusions: The results of 10 studies about research utilization in Iran showed that the barriers and facilitators remained constant through time and across different locations. The rank orders of barriers and facilitators were the same approximately. The nurse managers and administrators could utilize the findings of this review to allocate human resources and other sources and promote nursing research utilization in clinical field.
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http://dx.doi.org/10.4103/1735-9066.164501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4598897PMC
October 2015

Clinical learning environments (actual and expected): perceptions of Iran University of Medical Sciences nursing students.

Med J Islam Repub Iran 2015 4;29:173. Epub 2015 Feb 4.

Associate Professor, PhD in Nursing. Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran & Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.

Background: Educational clinical environment has an important role in nursing students' learning. Any difference between actual and expected clinical environment will decrease nursing students' interest in clinical environments and has a negative correlation with their clinical performance.

Methods: This descriptive cross-sectional study is an attempt to compare nursing students' perception of the actual and expected status of clinical environments in medical-surgical wards. Participants of the study were 127 bachelor nursing students of Iran University of Medical Sciences in the internship period. Data gathering instruments were a demographic questionnaire (including sex, age, and grade point average), and the Clinical Learning Environment Inventory (CLEI) originally developed by Professor Chan (2001), in which its modified Farsi version (Actual and Preferred forms) consisting 42 items, 6 scales and 7 items per scale was used. Descriptive and inferential statistics (t-test, paired t-test, ANOVA) were used for data analysis through SPSS version 16.

Results: The results indicated that there were significant differences between the preferred and actual form in all six scales. In other word, comparing with the actual form, the mean scores of all items in the preferred form were higher. The maximum mean difference was in innovation and the highest mean difference was in involvement scale.

Conclusion: It is concluded that nursing students do not have a positive perception of their actual clinical teaching environment and this perception is significantly different from their perception of their expected environment.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431426PMC
June 2015

Sleep quality and associated factors among patients with chronic heart failure in Iran.

Med J Islam Repub Iran 2014 16;28:149. Epub 2014 Dec 16.

7. MD, PhD by research Students, Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences & Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Sleep disorders are common among patients with chronic heart failure (HF), and it can have a significant effect on patients' daily activities as well as their health. The purpose of this study was to assess sleep quality and its predictors in Iranian patients with chronic HF.

Methods: This cross-sectional study was conducted on a sample of 200 patients with HF in two hospitals of Tehran University of Medical Sciences from June to November 2009. These patients completed a demographic questionnaire, and their sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). One-way analysis of variance (ANOVA), Kruskal-Wallis test, t-test and Linear regression were used for data analysis.

Results: Seventy-nine percent of patients (n = 158) reported poor sleep quality (PSQI > 5). The range of global PSQI scores was 3-20. Also, a significant relationship was found between PSQI scores and patients' age (p<0.004), gender (p< 0.042), educational level (p< 0.001), occupational status (p< 0.038), number of hospitalizations (p< 0.005), type of referral (p< 0.001), non-cardiac diseases (p< 0.001), diuretic use (p< 0.021) and left ventricular ejection fraction (p< 0.015). Three predictors were identified using regression analyses with stepwise methods, and included age, type of referral and educational level.

Conclusion: The high prevalence of poor sleep quality highlighted the importance of sleep disorders in HF patients. There are many factors associated with sleep quality and sleep disorders that health providers should recognize for improved and effective management.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322339PMC
February 2015

Images in clinical medicine. Ectopic thyroid gland.

N Engl J Med 2012 Mar;366(10):943

Endocrinology and Metabolism Research Center of Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1056/NEJMicm1106077DOI Listing
March 2012

Images in clinical medicine. Papules on the eyelids, lips, and tongue.

N Engl J Med 2011 Mar;364(9):870

Endocrinology and Metabolism Research Center of Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1056/NEJMicm1003203DOI Listing
March 2011
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