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Background In the treatment process of hospitalized patients with COVID-19, one of the threatening complications is pulmonary complications such as barotrauma. Objective This study aims to investigate the prevalence of barotrauma in COVID-19 patients admitted to intensive care units (ICU) of two hospitals in Rasht, Iran. Methods This retrospective study was conducted on COVID-19 patients admitted to the ICUs of Razi and Poursina hospitals in Rasht in 2020. Their files were studied, and their demographic/clinical data and pulmonary complications were extracted using a checklist by an anesthesia resident. Results Out of 140 patients, 81(57.9%) received non-invasive mechanical ventilation and 59(42.1%) had invasive ventilation. Barotrauma was observed in 9 cases (6.4%), 8(88.9%) in the form of pneumothorax and one (11.1%) in the form of both pneumothorax and subcutaneous emphysema. The results showed that the incidence of barotrauma was significantly higher among patients who received invasive mechanical ventilation (P=0.003). No significant difference was observed among patients received noninvasive ventilation (P>0.05). Conclusion The prevalence of barotrauma among COVID-19 patients in the study hospitals is low, which indicates the proper performance of the attending physicians and compliance with the standard guidelines. [ABSTRACT FROM AUTHOR] more...

Background: A high workload may negatively impact the surgical team's performance and jeopardize patient safety. The aim of this study was to measure the workload of the surgical team across different surgical roles, specialties, and techniques in several hospitals. Methods: This cross-sectional multicenter study was performed in the operating rooms of eight teaching hospitals affiliated with Isfahan University of Medical Sciences, Iran. At the conclusion of each surgical procedure, all members of the surgical team completed the Surgery Task Load Index (SURG-TLX) questionnaire to assess workload levels. Descriptive statistics, analysis of variance (ANOVA), and Pearson correlations, were performed to compare surgical roles, specialties, techniques, and surgical time on workload overall and by subscale. Results: A total of 409 workload questionnaires were obtained from 76 surgical teams or cases, involving 346 surgical team members. The total workload among all participants was 32.41 ± 17.21. Surgical complexity, physical demands, and mental demands were the highest workload subscales and distraction was the lowest workload subscale. Cardiovascular specialty had a higher workload compared to other specialties. Open techniques resulted in a higher workload compared to minimally invasive techniques. Surgical technologists who act in both the role of circulating and scrub nurse (C&Ss) experienced the highest workload, followed by surgical residents and surgeons. Conclusions: The results of the study showed that the workload for some members of the surgical team is disproportionately high and is influenced by factors such as specialty, technique, role, and surgical duration. By knowing the distribution of workload among the members of the surgical team, efforts can be made to optimize the team members' workload. [ABSTRACT FROM AUTHOR] more...

Background: Emerging COVID-19 pandemic has posed numerous ethical challenges to frontline healthcare professionals. Objectives: This study aimed to explain the ethical challenges experienced by physicians and nurses in caring for COVID-19 patients during the early phases of the pandemic. Methods: This qualitative study was conducted using by content analysis approach. Twenty-two semi-structured in-depth interviews were conducted with l8 physicians and nurses working in medical centers and hospitals of the public or private sectors, in Tehran, the capital of Iran, from July to October 2020. The Graneheim and Lundman approach was applied to analyze the data. MAXQDA10 software was used to facilitate the data analysis process. Results: The ethical challenges are categorized into four categories (and 11 subcategories), including poor professional care, preference for public interests over individual care, difficult decision-making, and moral distress. Most participants experienced poor professional care, non-compassionate care, lack of family-centered care, being forced to choose, lack of emotional and anger control and coping skills, an undermined ethical climate, and emotional fatigue during the early phases of the pandemic. Conclusions: The findings indicate the attenuation of professional care and the need to develop evidence-based ethical and clinical guidelines concerning the resulting insights. In addition, devising appropriate interventions is recommended for their psycho-emotional support. [ABSTRACT FROM AUTHOR] more...

Background: Iran was one of the first countries to be affected by COVID-19. Identifying factors associated with the severity of COVID-19 is effective in disease management. This study investigated the epidemiological and clinical features and factors related to the severity of COVID-19 in one of the less privileged areas in Iran.Methods: In a multi-center study, all patients admitted to Zahedan University of Medical Sciences hospitals in southeastern Iran were investigated from February 29 to April 31, 2020. Demographic, epidemiological, and clinical data of patients were extracted from medical records. Bivariate and multivariate logistic regression models were used to explore the risk factors associated with the severity of COVID-19.Results: Among the 413 patients, 55.5% were male, and 145 (35.10%) were in a severe condition at admission time. Multivariate analysis showed that the adjusted odds of the disease severity increased in patients with older age (OR 2.27; 95% CI 1.41-3.65), substance abuse (OR 2.49; 95% CI 1.14-5.43), having one underlying disease (OR 1.52; 95% CI 0.90-2.55), having two underlying disease (OR 2.31; 95% CI 1.19-4.50), and having three or more underlying disease (OR 2.60; 95% CI 1.19-5.66).Conclusions: COVID-19 was more severe in older patients, patients with a history of substance abuse, and patients with the underlying disease. Understanding the factors affecting the disease severity can help the clinical management of COVID-19, especially in less privileged areas where fewer resources are available. [ABSTRACT FROM AUTHOR] more...