Search

Background & Aim The use of mechanical ventilation devices as a supportive respiratory system for hospitalized patients in intensive care units is often accompanied by the inability of alert patients to establish verbal communication. This study aims to determine the impact of patient communication software on facilitating communication for mechanically ventilated patients in the intensive care unit. Methodology This clinical trial was conducted with two groups, each comprising 60 alert, mechanically ventilated patients hospitalized in medical universities in Mashhad, from December 2022 to January 2023. Patients were randomly assigned to the intervention and control groups. In the intervention group, communication with the patient was established using specially designed software, while in the control group, conventional methods were used to identify patient needs. Data collection tools included a demographic questionnaire and the Ease of Communication Scale. SPSS software (version 20) was utilized for data analysis, employing chi-square, independent t-test, Mann–Whitney, Wilcoxon and paired t-tests. Cohen's d was also used to evaluate the magnitude of the effect size. Results The composition of the groups, including gender and marital status, was comparable, as was their baseline demographic and clinical characteristics (age, gender, education level, marital status, underlying diseases, airway type, hospital stay length, sedative medication, and mechanical ventilation duration), with no significant differences found ( p > 0.05). Before the intervention, there was no difference in communication ease scores between the groups. Post-intervention, the intervention group showed significantly improved communication ease scores compared to the control group ( P

Background & Aim: With advancements in treatment and an increase in the prevalence of diseases, the number of patients requiring mechanical ventilation in intensive care units (ICUs) continues to rise each year. The ABCDE bundle is a multi-component, evidence-based approach designed to improve patient outcomes in the ICU. This study aimed to determine the effect of the ABCDE bundle on the risk of pressure ulcers, deep vein thrombosis and delirium in patients undergoing mechanical ventilation. Methods & Materials: This randomized, single-blind clinical trial was conducted between September 2021 and January 2022. The sample included 100 patients undergoing mechanical ventilation in the ICU department of Imam Reza Hospital in Mashhad, who were randomly assigned to either the intervention or control group using block randomization. The intervention group received the ABCDE bundle over a period of 7 days. The control group received routine care. The criteria for assessing complications included the risk of pressure ulcers and deep vein thrombosis (DVT), evaluated at the end of the intervention and on days 0, 1, 3, 5, and 7. The study utilized several assessment tools: the COMHON Index for pressure ulcers, the Wells Deep Vein Thrombosis Scale, and the Delirium Evaluation Tool in the Intensive Care Unit (CAM-ICU). Data analysis was performed using SPSS software version 20, employing chi-square, Mann-Whitney, and independent t-tests. Results: A decrease in the average pressure ulcer risk score was observed in the intervention group on day seven (P

Background & aim: Some studies have called into question medical students' competency in neonatal resuscitation. Therefore applying standard training methods has been recommended. This study compared the effect of Structured Clinical Instruction Module (SCIM) and video-assisted Instructor -led training (ILT) in accelerating and retention of students’ knowledge and skill in neonatal resuscitation.Methods: In this experimental study 48 nursing and midwifery students of Mashhad University of Medical Sciences, Mashhad Iran, who did not attended in any related education, were allocated in SCIM, VT and control group through stratified randomization. In SCIM group, after lecture, six groups of students rotated through six stations, trained and practiced under supervision of six instructors. In VT group after lecture an instructional video presented then students repeated the video and discussed its content with each other and instructor. Before, after and one month following workshops all students participated in an OSCE to assess their cognitive, technical and behavioral skills. Paired t-test and One-way ANOVA were used for data analysis.Results: In post-test, both groups of SCIM and VT had better performance than control group (p

Introduction. The diagnostic evaluation of the emergency severity index (ESI) in the triage of patients with cardiopulmonary complaints has a high sensitivity but a low specificity in the emergency department (ED). Therefore, triage scales with more accurate diagnostic evaluation are required. As a result, accuracy of the SINEH triage scale (SinTS) and the ESI was compared to compare mistriage of critically ill patients with cardiopulmonary complaints. Methods. This descriptive, analytical and cross-sectional study was conducted between December 2022 and April 2023. In this study, two nurses independently examined each patient using two triage scales. The admission unit and length of hospital stay were also recorded. The outcome was classified as high-risk admission (cardiac care unit and intensive care unit) and low-risk admission (internal unit or discharge from the ED). Undertriage and overtiage were defined as high-risk admission with triage level 3 and 4 and low-risk admission with triage level 1 or 2, respectively. A panel of experts evaluated content validity of SinTS and kappa designating agreement on relevance reported. The inter-rater reliability of two scales was also reported. Results. Finally, the study included 145 patients. The average age of the patients studied was 61.35 years. SinTS has a total mistriage of 29.63%, with 4.13% being undertriage and 25.5% being overtriage. In ESI, the total mistriage is 66.8%, with 1.3% being undertriage and 65.5% being overtriage. The undertriage of the two scales did not differ significantly by admission unit (p=0.26), but the overtriage of the two methods did (p=0.001). The sensitivity, specificity, and accuracy of SinTS were 86.3%, 63.37%, and 72.27%, respectively, while those of ESI were 95.4%, 5.94%, and 32.79%, respectively. Conclusion. SINEH triage scale has achieved the optimal accuracy in recognizing the acuity of the patients with chest pain and dyspnea by using SpO2, pressure of end-tidal carbon dioxide, troponin I, and peak expiratory flow. When triaging patients with chest pain and dyspnea, SinTS may exhibit a higher level of accuracy compared to ESI. More research is needed to improve accuracy of triage scales in patient with cardiopulmonary complaints.

Abstract Background Cardiopulmonary resuscitation skill have a direct impact on its success rate. Choosing the right method to acquire this skill can lead to effective performance. This investigation was conducted to compare the effect of Real-time feedback and debriefing by video recording on basic life support skill in nursing students. Methods This quasi-experimental study was performed on 67 first year nursing students. First, a theoretical basic life support (BLS) training session was held for the all participants, at the end of session the pre-test was taken. Students were randomly assigned to two groups. A 4-hour practical BLS training session was conducted in the real - time feedback group as well as the debriefing by video recording group, and at the end of the training, a post-test was taken from each group. Each group received a post-test. Data were analyzed using SPSS 25 software. Results Results showed a significant difference between mean (SD) of debriefing by video recording group in pre-test and post-test (p

Background: The Emergency Severity Index (ESI) may not recognize high-risk patients with heart failure (HF) efficiently.Aim: This study aimed to compare the diagnostic validity and mistriage rates of the ESI plus the Capnometer (Capno) and ESI alone among dyspneic patients with HF.Method: This quasi-experimental group (random assignment) study was conducted within April 2019-February 2020. Patients were randomly assigned to the ESI+Capno and ESI groups. Triage levels, resources used, disposition and door to an electrocardiogram, and physician visit were compared among patients admitted to the Cardiac Care Unit (CCU), the Cardiac Unit (CU), or discharged from the ED. Interobserver agreement (Kappa) was used to assess the reliability of the ESI.Results: In this study, 65 HF patients were assigned to the ESI+Capno (n=36) and ESI (n=29) groups. The undertriage rates were 0% and 10% and the overtriage rates were 10% and 31% in the ESI+Capno and ESI groups, respectively. Sensitivity, specificity, and accuracy to recognize high-risk HF patients were 100%, 60%, and 90% for the ESI+Capno group and 62.5%, 42.86%, and 48.36% for the ESI group.Implications for Practice: The addition of Capno to the ESI increased the validity of triage decisions to recognize high-risk HF patients, compared to the ESI alone. It is recommended that decisions regarding triage HF patients be made after that an End-tidal Co2 is considered into the decision-making process.

Introduction: After abdominal surgery, the patients who are separated from mechanical ventilation and provided with oxygen therapy via a T-piece are at risk for respiratory complications. Therefore, they need additional respiratory support. This study aimed to evaluate the effects of manual hyperinflation (MHI) on pulmonary function after weaning. Methods: This randomized clinical trial included 40 patients who had undergone abdominal surgery and were receiving oxygen via a T-piece. Patients were selected from the intensive care units (ICU) of two hospitals in Mashhad, Iran. The subjects were randomly allocated to intervention (MHI) and control groups. Patients in the MHI group were provided with three 20-minute MHI rounds using the Mapleson C, while the control group received routine cares. Tidal volume (Vt), Rapid Shallow Breathing Index (RSBI), and the ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) were measured before the intervention, as well as 5 and 20 minutes after the intervention. Atelectasis prevalence was assessed before and 24 hours after the intervention. Data were analysed by SPSS software version 13. Results: At baseline, there were no significant differences between the groups regarding Vt, RSBI, P/F ratio, and atelectasis rate. No significant difference was also found between the groups regarding atelectasis rate 24 hours after the intervention. However, at both posttests, Vt, RSBI, and P/F ratio in the MHI group were significantly better than the control group. Conclusion: In patients with artificial airway and spontaneous breathing, MHI improves pulmonary function.

Background and aims: Family caregivers have significant role in managing psychiatric emergencies in the time interval between their request for emergency medical services (EMS) and ambulance arrival at the emergency scene. This study aimed at assessing the effects of educational short message service (SMS) messages about emergency scene management (ESM) on perceived stress and satisfaction among the family caregivers of patients with mental disorders who requested EMS. Methods: This randomized controlled trial was conducted in 2019–2020 using a two-group posttest-only design. Participants were sixty family caregivers of patients with mental disorders in Mashhad, Iran, who called the EMS center and requested EMS. They were continuously recruited and randomly allocated to an intervention or a control group. Participants in the control group received routine educations, while participants in the intervention group received routine educations and SMS-based educations about ESM. Data were collected using a demographic questionnaire, a researcher-made caregiver satisfaction questionnaire, and the Cohen’s Perceived Stress Scale. Data analysis was performed via the SPSS software (v. 25.0). Results: Most participants were female (53.3%) and their mean age was 44.30±13.03 years. The mean score of perceived stress in the intervention group was significantly less than the control group (P=0.001), while the mean score of caregiver satisfaction in the intervention group was significantly more than the control group (P=0.001). Conclusion: SMS-based education about ESM is effective in significantly reducing perceived stress and enhancing satisfaction among the family caregivers of patients with mental disorders.

Background: Hemodialysis patients experience pains induced by cannulation of an arteriovenous (AV) fistula. The effect of mirror therapy on patients’ pain severity has not been investigated in individuals living with hemodialysis. Aim: The purpose of the present study was to investigate the effect of mirror therapy on AV fistula cannulation-related pain severity in hemodialysis patients. Method: This study was conducted on 30 hemodialysis patients admitted to two hospitals in Mashhad, Iran, during 2018. Pain severity was measured using the Visual Analogue Scale for pain. Results: The mean pain scores in the control session (pre-intervention phase), non-adaptive phase (immediately after looking in the mirror), and adaptive phase (ten minutes after looking in the mirror) were 4.8±1.1, 3.9±1.1, and 2.6±1.22, respectively. The results showed a statistically significant difference between the given sessions (P Implications for Practice: Mirror therapy could be effective in reducing AV fistula cannulation-related pain severity in hemodialysis patients.

Introduction: It is unclear whether the Emergency Severity Index (ESI) can identify high-risk patients with Chronic Obstructive Pulmonary Disease (COPD). This study aims to compare the mistriage rates of the ESI plus the Peak Expiratory Flowmeter (PEF) approach and ESI approach among dyspneic patients with COPD. Methods: This study was a randomized clinical trial conducted between July and October 2018. We randomly assigned COPD patients with dyspnea to the ESI + PEF or ESI groups. Triage levels, disposition rates, number of resources used, and time to first physician contact were compared in patients admitted to the Intensive Care Unit (ICU), the Pulmonary Care Unit (PU), or discharged from the ED. Reliability of the ESI was evaluated by using the interobserver agreement (Kappa). Results: Seventy COPD patients were equally assigned to the ESI + PEF and ESI groups. The under-triage rates were 11.42% and 0%, the over-triage rates were 31.42% and 2.85% in the ESI and ESI + PEF groups, respectively. The triage levels of the patients admitted to the ICU (2 vs. 3), the PU (2 vs. 4), or discharged from the ED (3 vs. 2) were significantly different between the ESI + PEF and ESI groups. Conclusions: Addition of PEF to the ESI provides a more accurate method for triaging COPD patients compared to ESI alone. We recommend using PEF for the triage of COPD patients in the ED. Keywords: Dyspnea, Chronic obstructive pulmonary disease, Triage, Emergency severity index, Emergency

Background: Several complications may occur in patients after coronary artery bypass grafting (CABG) leading to decreased self-efficacy. Rehabilitation training is the best method for reducing the complications and increasing self-efficacy. Various educational techniques lead to different rehabilitation results and levels of self-efficacy. Improving these measures requires the selection of the most appropriate educational technique. Aim: This study aimed to compare the effect of two media-based and face-to-face cardiac rehabilitation training methods on self-efficacy in patients undergoing CABG. Method: This clinical trial was conducted among 60 patients, who were randomly assigned into two groups, in Imam Reza Hospital, Mashhad, Iran, 2017. Cardiac rehabilitation training program was implemented face-to-face or using a researcher-made multimedia upon admission, discharge, at the start of cardiac rehabilitation, and at the end of the 10th session for half-hour. A researcher-constructed questionnaire on self-efficacy was completed by the participants in the mentioned stages. Data analysis was performed in SPSS software, version 16. Results: The mean ages of the participants in the face-to-face and multimedia groups were 56.0±8.1 and 57.5±7.3 years old, respectively. No significant difference was observed in the self-efficacy scores of the patients upon admission (P=0.36). However, there was a significant difference between the groups at the post-intervention stage (P

Patients with end-stage renal disease (ESRD) encounter various challenges following kidney transplantation, which should be managed appropriately. These problems can be partly controlled by considering spirituality as one of the care components. Regarding this, the aim of this study was to investigate the relationship between coping and spiritual health in the renal transplant recipients. This descriptive correlational study was conducted on 169 patients referring to the Organ Transplantation Center at Montasserieh Hospital in Mashhad, Iran. The study population was selected through convenience sampling method. The data were collected using demographic characteristics form, Renal Transplant Coping Scale by Valizadeh et al. (2015), and Spiritual Health Questionnaire developed by Khorashadizadeh et al. (2015). The mean scores of coping and spiritual health were 321.2±15.3 and 123.3±6.2, respectively, which were desirable. There was a significant linear relationship between coping and spiritual health mean scores (P˂0.001, r=0.37). Based on the findings, the reinforcement of spiritual beliefs in patients could be a strategy to promote their coping level.

Introduction: Diabetes mellitus is a risk factor for cardiovascular disease. Some recent studies have shown an association between diabetes and out-of-hospital cardiac arrest incidence and survival. We aimed to investigate whether there is an association between the presence of diabetes mellitus and survival after cardiopulmonary resuscitation (CPR) in patients with an in-hospital cardiac arrest. Methods: A cross-sectional study was conducted during the period of January to February 2014, among 80 cases of cardiopulmonary arrest in patients at Qaem hospital of Mashhad, Iran. A code 99 was announced after a cardiac arrest was identified, and CPR was performed by the cardiac arrest team. Twenty four hour survival was compared in diabetic and non-diabetic patients who had a return to spontaneous circulation after CPR. We used SPSS statistics for Windows version 16 for data analysis. Results: The return to spontaneous circulation in the diabetic group was not significantly lower than for the non-diabetic group (42.9% versus 61.0% [P = 0.15]). However, the 24-hour survival in the diabetic group was significantly lower than for the non-diabetic group (19.0% versus 44.1% [P = 0.04]). Conclusion: The presence of diabetes mellitus is associated with a significantly lower rate of survival after CPR.

Background: Neglecting the pain assessment in intensive care unit (ICU) patients with decreased level of consciousness (LOC) can lead to inappropriate pain management. Implementation of a pain management protocol may contribute to avoiding such negligence. Aim: This study aimed to determine the effect of using a pain monitoring protocol on the pain intensity of ICU patients with decreased LOC. Method: This clinical trial was conducted on 60 nurses and 120 patients in the surgical ICUs of Imam Reza and Ghaem hospitals, Mashhad, Iran, 2016. The nurses in the intervention group were trained about pain management protocol in three 20-minute sessions (each session for 10 nurses). Before and after two weeks of training, the patients' pain intensity was monitored using the Nonverbal Pain Scale (NVPS) for three months during the resting-state, suctioning, and dressing change. The patients in the control group received routine nursery care. Data analysis was performed using independent and paired t-tests in the SPSS software version 22. Results: The nurses in the intervention and control groups had a mean age of 38.1±6.4 and 41.2±7.1 years, respectively. The results of independent t-test demonstrated no difference between overall pain intensity (P=0.08), pain intensity during resting-state (P=0.11), suctioning (P=0.23), and dressing change (P=0.06) scores among two groups before the intervention, however after the intervention, there was a significant reduction in the intervention group in comparison to the control group in all mentioned aspects (P

Background: Chest compression with adequate depth and number is one of the main indicators of high-quality cardiopulmonary resuscitation (CPR). Nevertheless, no proper counting technique is suggested to provide sufficient number of massages. Aim: To compare the effects of three techniques of chest compression counting on the quality of CPR and rescuer fatigue. Method: Inthis clinical trial, 30 rescuers (divided into three groups) performed all the three techniques of chest compression counting (without counting [common], alternate [counting from 1 to 10], and continuous [counting from 1 to 100]) in 90 different resuscitation events at Ghaem Hospital of Mashhad, Iran, in 2015. Rescuer fatigue was evaluated using visual analogue scale to evaluate fatigue, and quality of massage was evaluated by the level of end-tidal CO2 (ETCO2); massage was calculated in minutes. Data was analyzed in SPSS using ANOVA and Friedman test. Results: The mean age of the rescuers was 30.6±6.8 years. Based on Kruskal-Wallis test results, common, continuous, and alternate techniques were in descending order of fatigue level, and the common, alternate, and continuous techniques were in descending order of number of massages. In addition, according to ANOVA, the highest ETCO2 levels were observed in the alternate, continuous, and common techniques, respectively; the difference between the techniques was significant (P

Objective: To develop decision-support tools to identify patients experiencing sudden cardiac arrest (SCA). Methods: Eighty calls related to SCA were content analyzed, and the contextual patterns that emerged were organized into a checklist. Two researchers independently analyzed the recorded calls and compared their findings. Eighteen dispatchers scored 20 cases (which included SCA and non-SCA cases) both with and without the checklist. Correct responses for each case and agreement among dispatchers have been reported. Results: Eighty audio files (total time, 96 min) were analyzed, and a total of 602 codes were extracted from the text and recordings. The caller’s tone of voice and presence or absence of background voices, calling for an ambulance and giving the dispatcher the address promptly, and description of the primary complaint and respirations accounted for 38%, 39%, and 23% of all codes, respectively. A 15-item complementary checklist has been developed. The mean percentages of correct responses were 66.9%+27.96% prior to the use of checklist and 80.05%+10.84% afterwards. Results of the independent t test for checklist scores showed that statistically significant differences were present between the SCA and non-SCA cases (t=5.88, df=18, p=0.000). Conclusion: Decision support tools can potentially increase the recognition rate of SCA cases, and therefore produce a higher rate of dispatcher-directed CPR.

Background: Postoperative pulmonary complications (PPC) are of the major reasons for death. Prolonged mechanical ventilation (PMV) and delayed extubation are leading to the incidence of more seriously complications. The effect of hyperinflation has not been investigated in control of these complications in patients who have been weaned from mechanical ventilation and are undergoing T-tube support. Aim: Investigation of MHI effect on oxygenation of patients following abdominal surgery and T-tube support. Method: This clinical trial was performed on 40 patients undergoing abdominal surgery and T-tube support hospitalized in intensive care units of hospitals in Mashhad, Iran, in 2015-2016. The participants were divided randomly into two experimental and control groups. In the experimental group, MHI technique was performed using Mapleson circuit for three twenty-minute periods. The control group received routine hospital care. The two groups were compared for PaO2, PaCO2 and SpO2 before intervention, 5 and 20 minutes after intervention. Data were analyzed using SPSS software. Results: The mean age was 66.7±8.3 and 67.5±9.0 years in experimental and control groups, respectively. In intergroup comparison using independent t-test, the mean PaCO2, PaO2 and SpO2 had no significant differences in the experimental group before the intervention. However, the means SpO2 and PaO2 at 5 and 20 minutes after intervention were significantly higher in the experimental group (p

Introduction and Aims The main cause of death in the adult population in the industrialized world is sudden cardiac arrest. The first purpose of cardiopulmonary resuscitation is return of spontaneous circulation. Post cardiopulmonary resuscitation cares are fifth stage of American Heart Association cardiopulmonary resuscitation that less take into consideration. Therefore, the present study was conducted with the aim of “24 Hour Survival Rate and it’s determinants in patients with Successful Cardiopulmonary Resuscitation in Ghaem Hospital of Mashhad”. Materials and Methods In this descriptive and analytical study, 80 cases of CPR were selected by convenience sampling in Ghaem hospital of Mashhad. After confirming of cardiac arrest by a resident physician in the wards and declaration of code 99, were performed cardiopulmonary resuscitation by CPR team. Rate of 24 hour survival was determined in patients that had return of spontaneous circulation by form the researcher’s observations. Data were collected and analyzed using of descriptive statistics (frequency, mean, standard deviation) and inferential statistics (Fishers, Chi-square, logistic regression) and SPSS software version of 16. Results Mean and standard deviation of age patients was 67.3±1.5 year. In 45 patients (56.2%), was achieved return of spontaneous circulation. The rate of 24 hour survival was in 30 patients that cardiopulmonary resuscitation on them was successful. The chi-square test, showed that is significant differences between 24 hour survival with sex and diabetes in patients (P

Background & aim: Neonatal resuscitation training is mandatory for the staff providing maternity and neonatal services in order to ensure competence during the academic period. This study was conducted to assess the neonatal resuscitation skills of nursing and midwifery students. Methods:In this study, the skills of 48 nursing and midwifery students were assessed, using Objective Structured Clinical Examination (OSCE), which consists of seven “stations”, lasting 28 minutes. In station 1, students’ knowledge was assessed. In stations 2-7, students’ skills in the initial steps of resuscitation, positive pressure ventilation, intubation, chest compression, medication prescription and management of cardiopulmonary resuscitation were assessed. Time management and students’ re-evaluation of the infant were also assessed. The total score of OSCE was calculated to be 236. Also, students’ self-evaluation regarding their competence in neonatal resuscitation and their satisfaction with OSCE were evaluated, using two self-structured questionnaires. Results: The mean score of students’ skills in neonatal resuscitation was 97.85±23.15 out of 236. On average, students obtained 38%, 49%, 20% and 72% of the total score in the initial steps of resuscitation, positive pressure ventilation, intubation and chest compression, respectively. Also, the students obtained 45%, 29% and 56% of the total score in prescribing medications (drug dosage and route of administration), management skills in advanced resuscitation and knowledge on neonatal resuscitation, respectively. Students’ self-confidence was lower than half of the optimal score, and their satisfaction with OSCE was high. Conclusion: The students’ skills in neonatal resuscitation were lower than expected. As competence in this area is of high significance for the improvement of neonatal outcomes, holding training workshops through applying novel training methods is recommended.

Introduction: For maintaining the continuity of care and improving the quality of care, effective inter-shift information communication is necessary. Any handover error can endanger patient safety. Despite the importance of shift handover, there is no standard handover protocol in our healthcare settings. Methods In this one-group pretest-posttest quasi-experimental study conducted in spring and summer of 2011, we recruited a convenience sample of 56 ICU nurses. The Nurses’ Safe Practice Evaluation Checklist was used for data collection. The Content Validity Index and the inter-rater correlation coefficient of the checklist was 0.92 and 89, respectively. We employed the SPSS 11.5 software and the Mc Nemar and paired-samples t test for data analysis. Results: Study findings revealed that nurses’ mean score on the Safe Practice Evaluation Checklist increased significantly from 11.6 (2.7) to 17.0 (1.8) (P < 0.001). Conclusion: using a standard handover protocol for communicating patient’s needs and information improves nurses’ safe practice in the area of basic nursing care.