BackgroundClinical training is an integral part of nursing education; however, some studies have shown that it is not always efficient.ObjectivesThis study aimed to find out the factors that can impede nursing students’ clinical learning.Materials and MethodsIn this qualitative study, data were collected via reflective journal writing. Purposeful sampling was used, and 12 senior nursing students were recruited to the study. The data were analyzed using a content analysis method.ResultsThree main categories were derived, including inappropriate communication, ineffective role models, and theory-practice gaps. Students perceived that inappropriate communication between instructors, staff members, and students had the greatest impact on student learning. The competence of clinical instructors and staff is an important factor affecting students’ training. The clinical learning environment does not always integrate theory and practice together.ConclusionsNursing students did not experience effective clinical learning. Having expert instructors and supportive communication are important factors in creating a clinical learning environment.

Background COVID-19 may cause respiratory distress syndrome and death. Treatment of COVID-19 to prevent complications remains a priority. Our investigation sought to determine whether combination of spironolactone and sitagliptin could reduce mortality for inpatient with SARS-CoV-2 infection. Methods This single blind, 4-arms, prospective randomized clinical trial was conducted at Shiraz and Bushehr University of Medical Sciences hospitals between December 2020 and April 2021. We randomized hospitalized adult patients with COVID-19 pneumonia into four groups: control, combination therapy, sitagliptin add on, or spironolactone add on. The primary outcome was the clinical improvement of the patients in the hospital as measured on an eight-point numerical scale. The secondary outcomes included intubation, ICU admission, end organ damages, CT findings and paraclinical information. Results 263 admitted patients were randomly assigned to control group (87 patients), combination group (60 patients), sitagliptin group (66 patients) and spironolactone group (50 patients). There were no significant differences in baseline characteristics, except for higher age in control group. The intervention groups, especially combination therapy, had better clinical outcomes (clinical score on 5th day of admission was 3.11 ± 2.45 for controls, 1.33 ± 0.50 for combination, 1.68 ± 1.02 for sitagliptin, and 1.64 ± 0.81 for spironolactone; with p-value = 0.004). However, the mortality rate was lower in patients who received spironolactone (21.84% control, 13.33% combination, 13.64% sitagliptin, 10.00% spironolactone; p-value = 0.275). Our intervention reduced lung infiltration but not the area of involvement in lung. Conclusion Sitagliptin and spironolactone can potentially improve clinical outcomes of hospitalized COVID-19 patients.

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Multiple Myeloma (MM) is a neoplastic proliferation of plasma cells involving mainly bone and bone marrow. However, extra-skeletal spread in the form of plasmacytomas is also very common, which usually manifests as localized extramedullary collection of malignant Plasma cells. This paper is a report on gastric involvement of plasma cell infiltration, also known as gastric plasmacytoma.