Journal of Education and Health Promotion

Abstract BACKGROUND: Anxiety is the most common health problem and the second leading cause of
disability worldwide. Patients undergoing surgery often experience anxiety. It is necessary to use
appropriate interventions to achieve the best results. The aim of this study is to develop, implement,
and evaluate of anxiety management program for gynecological surgery patients under spinal
anesthesia.
MATERIALS AND METHODS: This participatory action research will be conducted through four
phases; problem identification, planning, action, and evaluation phases in the Gonbad‑e‑Kavous
Shahada, hospital in northeastern of Iran. These phases will be guided based on the Promoting
Action on Research Implementation in Health Services framework. Participants will be included using
purposive sampling method. We will use both of qualitative (semi‑structured interview, observation)
and quantitative (questionnaire) approaches for data collection through the study.
CONCLUSION: For anxiety management of patients, context‑based interventions should be
performed. Combination of multidimension approach based on health‑care providers, patients, and
environment will have an effect to solve the problem in the clinical setting.

Abstract BACKGROUND: Sleep disturbances as a major health problem are common in patients hospitalized 
in critical care units. This study examined the effects of a team‑based care plan on the quality of sleep 
in patients hospitalized in a cardiac surgery intensive care unit (CSICU) of a multidisciplinary hospital.
MATERIALS AND METHODS: In this clinical trial, 100 patients with cardiac surgery were selKMected 
through convenience sampling and then nonrandomly allocated to the intervention and or the control 
group. A plan of care with the recommendation of all intensive care unit care teams was designed 
and then applied. In this study, the Richards‑Campbell Sleep Questionnaire was used to evaluate 
sleep quality. Patients in the intervention group received the care plan for two consecutive nights. 
The study’s national approval code is IRCT2017091915512N2. Collected data were analyzed using 
SPSS software (v. 21), and by paired, independent t, Chi‑square, and Fisher’s exact tests.
RESULTS: Quality of sleep in patients admitted to the CSICU is significantly improved by noise 
reduction both in the first and second nights. Moreover, the team‑based care plan requires good 
coordination between all team members taking care of cardiac surgery patients admitted to the 
CSICU (P < 0.001).
CONCLUSIONS: The team‑based care plan significantly improves the quality of sleep. It may be 
due to the close coordination between all team members to avoid sleep disturbances.

Abstract BACKGROUND: As pediatric surgeries are rising and current methods to reduce perioperative 
anxiety are lacking in preschool children. The purpose of this study was to determine the effect of 
video games on preoperative anxiety in 3‑ to‑6‑year old of a sample of Iranian children undergoing 
elective surgery children.
MATERIALS AND METHODS: In the current quasi‑experimental pretest posttest design, after 
standard translation, the modified Yale preoperative anxiety scale was administered to 102 children 
undergoing surgery from December 2016 to August 2017 in Kermanshah, Iran. Children are assigned 
to an intervention or control group. Each child’s anxiety was measured at two points at the time of 
arrival and after waiting for 20 min in the holding area. Data were analyzed by SPSS, version 22. The 
Chi‑square, independent t‑test, and paired t‑test at the significance level of P < 0.05 were performed.
RESULTS: There was no significant difference between the mean anxieties in control 
group (42.58 ± 18.54) and intervention group (46.11 ± 14.09) before the game (P = 0.282). However, 
after playing the video game in control groups (53.26 ± 18.00) and game groups (34.88 ± 10.81), 
there was a significant difference in favor of the video game (P < 0.001).
CONCLUSION: Findings of the present study suggest that approved video game by experts 
to decrease mean preoperative anxiety in 3‑ to‑6‑year‑old children. Therefore, video games 
recommended to be implemented at the preventive level in hospital.

Abstract Artificial intelligence (AI) is the future of surgery. Technological advancements are taking place at 
an incredible pace, largely due to AI or AI‑backed systems. It is likely that there will be a massive 
explosion or “Cambrian explosion” of AI in our everyday life, largely aided by increased funding 
and resources spent on research and development. AI has also significantly revolutionized the 
medical field. The concept of machine learning and deep learning in AI is the crux of its success. In 
surgical practice, AI has numerous applications in the diagnosis of disease, preoperative planning, 
intraoperative assistance, surgical training and assessment, and robotics. The potential automation 
of surgery is also a possibility in the next few decades. However, at present, augmentation rather 
than automation should be the priority. In spite of the allure of AI, it comes with its own price. A robot 
lacks the “sixth sense” or intuition that is crucial in the practice of surgery and medicine. Empathy 
and human touch are also inimitable characteristics that cannot be replaced by an AI system. Other 
limitations include the financial burden and the feasibility of using such technology on a wide scale. 
Ethical and legal dilemmas such as those involving privacy laws are other issues that should be 
taken under consideration. Despite all these limitations, with the way technology is progressing, it 
is inevitable that AI and automation will completely change the way we practice surgery in the near 
future. Thus, this narrative review article aims to highlight the various applications and pitfalls of AI 
in the field of surgery.

Abstract BACKGROUND: Although surgical techniques have been improving, preoperative anxiety is still
a challenge in preoperative care and is known as an expected response experienced by patients
waiting to undergo surgery. The present study aimed to compare preoperative anxiety levels in three
educational hospitals in Kerman.
MATERIALS AND METHODS: This cross‑sectional study was conducted in three educational
hospitals in Kerman, Iran, from December 2017 to May 2018. The participants were 100 patients from
each hospital (300 patients in sum) who were selected through the convenience sampling method.
Sampling was not restricted to sex and type of surgery. The 40‑item Spielberger State‑Trait Anxiety
Inventory was administered to the patients to assess the level of preoperative anxiety experienced
by them. Bivariate linear regression models were used to compare the preoperative state anxiety
levels based on the patients’ demographic information. A multivariate linear regression model was
used to determine the predictors of preoperative state anxiety.
RESULTS: The participants were 149 males and 151 females with a mean age of 36.38 (12.75)
years (age range: 12–79 years). Almost two‑third of the patients showed upper‑middle symptoms
of state anxiety (n = 197, 65.7%) followed by upper‑middle symptoms of trait anxiety (40% and
49.3%, respectively). There was a significant relationship between the patient’s sex and state
anxiety (P = 0.05) and also between trait anxiety and state anxiety (P ≤ 0.001). It was shown that
train anxiety could predict state anxiety before surgery (B: 0.53, 95% confidence interval: 0.44, 0.62;
P ≤ 0.001).
CONCLUSION: The results of the present study confirmed the presence of preoperative anxiety in
a sample of Iranian patients. Although the anxiety scores were not very high, organizing intervention
and training programs to control and reduce preoperative anxiety among patients seems essential.

Abstract BACKGROUND: Morbid obesity is rising around the world. Surgery is a selective treatment
intervention for it. Since most of the surgeons use weight loss for evaluating of the morbid obesity
surgical outcomes and paying attention to the the quality of life (QOL) and body image evaluation
are rare, this study aimed to assess the QOL and body image in pre‑ and postsurgery with other
interventions.
MATERIALS AND METHODS: This case–control study was done on 200 morbidly obese
patients (n = 100 in each group) who referred to the obesity clinic in Shiraz. The data were collected
by Body Image Concern Inventory and 12‑item Short Form Survey. The data were analyzed by
t‑test, Pearson correlation coefficient test, analysis of variance, and regression analysis. P = 0.05
was considered as significant.
RESULTS: The paired t‑test showed a significant difference in mean scores of body image (P < 0.001)
and all dimensions of the QOL (P < 0.001) in the case and control groups. In the case group, there
was a significant difference between the mean scores of the QOL and the different categories of
body mass index (BMI) in postsurgery (P < 0.05) and the different mean scores of body image and
the different categories of BMI in pre- and postsurgery wasn’t significant (P > 0.05). Age was a
predictor variable for the QOL of morbidly obese persons after surgery (P < 0.001). After surgery,
men showed better QOL than women (P < 0.001).
CONCLUSION: Final results indicated that body image and QOL defects caused by obesity could be
more improvement after surgery. This study can promote health‑care team’s knowledge about holistic
supporting of all dimensions’ QOL of obese individuals. It is suggested that supporting interventions
should be done as effective methods of maintenance for effects of weight loss methods such as surgery.