Background: Recent studies suggest that hydrocortisone, Vitamin C, and thiamine alone or in combination may improve the clinical outcomes of patients with septic shock. The aim of this study is the effects of this combination therapy on clinical outcome and sepsis biomarkers in patients with septic shock. Materials and Methods: Fifty-eight consecutive patients suffering septic shock were randomly assigned into two groups receiving the combination therapy of hydrocortisone (50 mg/6 h, intravenously), Vitamin C (1.5 g/6 h in 100 ml normal saline or DW5%, intravenously), and thiamine (200 mg/12 h in 50 ml normal saline or DW5%, intravenously) or placebo for up to 4 days. Results: The decline in procalcitonin, lactate, and leukocyte count 72 h after the initiation of treatment was significantly greater in the intervention as compared to the control group. The intervention group has a significantly lower sequential organ failure assessment score 72 h after treatment ( P < 0.001). The mean duration of vasopressor dependency was shorter in the intervention group ( P = 0.039). In-hospital death occurred in 10.3% of the patients who received combination therapy and 37.9% in the control group ( P = 0.014). Conclusion: The administration of the triple combination of hydrocortisone, thiamine, and Vitamin C appeared to be effective in improving the clinical outcomes of patients with septic shock and of reducing vasopressor requirements with a significant increase in the rate of improvement of sepsis biomarkers.

The present study aimed at investigating the Iranian women's experiences of spousal abuse. The study followed a qualitative and phenomenological research design. 23 Iranian women age-ranged between 17 and 58 formed the sample population of the research. The seven-step Colaizzi procedure was applied for data analysis. The following 5 main themes were developed. The first main theme was deprivation; the second main theme was humiliation; the third main theme was forgotten love; the fourth main theme was assault; and the fifth main theme was patriarchy. All these five themes represented the women's life experiences of spousal abuse.

Introduction: The establishment of a healthy relationship between healthcare professionals is required for resolving healthcare issues. The professional relationship between physicians and nurses are quite decisive and vital factor for patient care. Therefore, the purpose of this study was to examine the quality of relationship between physicians and nurses in hospitals affiliated with Zanjan University of Medical Sciences, Iran. Methods: In this descriptive-analytic study, a cross-sectional method was used. Nurses working in hospitals affiliated with Zanjan University of Medical Sciences, Iran were selected randomly. A demographic data and a 32-item questionnaire related to the professional relationship between physicians and nurses were used for data collection. Of 160 nursing staff 96 nurses returned the questionnaire. Descriptive and analytical statistics were used for data analysis via the SPSS software. Results: About 75.8% of the nurses were female and 76.8% held a bachelor's degree. Also, 86.4% of them had rotational shift works. Many of them (66.2%) held below 15 years of work experience and 59.5% received no reward to make a relationship with physicians. Moreover, 76.8% of the samples mentioned that non-existence of fixed work shifts and extra shifts created stressful and tedious conditions leading to ineffective nurse-physician relationships. Conclusions: There were major shortcomings within nurse-physician relationships. Hence, the promotion of physicians' knowledge on nurses' career and nurses' welfare is required for advancing professional relationships between nurses and physicians.

This study aimed at assessing the effects of spiritual care (SC) on fatigue and pain among patients with cancer receiving chemotherapy. This randomized controlled trial was conducted in 2018. Participants were 145 patients with cancer consecutively recruited from a large-scale public hospital in Zanjan, Iran, and randomly allocated to an intervention (n = 72) group and a control (n = 73) group through block randomization. Participants in the intervention group received SC for 3 days. The Fatigue Severity Scale and a visual analog scale were, respectively, used for fatigue and pain assessments before and after the study intervention. Chi-square test and the independent t test as well as the analysis of covariance were employed to analyze the data. The pretest mean score of fatigue was 5.18 ± 1.36 in the intervention group and 5.03 ± 1.29 in the control group with no significant between-group difference (P = .529). The posttest mean score of fatigue was 3.75 ± 1.05 in the intervention group and 4.80 ± 1.16 in the control group and the between-group difference was significant (P < .001). The pretest mean score of cancer-related pain in these groups was 2.64 ± 0.98 and 2.46 ± 1.22, which changed to 1.51 ± 1.006 and 2.32 ± 1.70, respectively, at posttest. The between-group difference respecting the mean score of pain was insignificant at pretest (P = .389) and significant at posttest (P = .001). Spiritual care is effective in significantly reducing fatigue and pain among patients with cancer receiving chemotherapy. Nurses and other health care providers can use SC to manage fatigue and pain of patients with cancer.

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