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Showing 47 results for Subject: General

Nayereh Khadem, Nahid Zirak, Ghasem Soltani, Nahid Sahebdelfar, Alireza Sepehri Shamloo, Saeed Ebrahimzadeh,
Volume 1, Issue 1 (10-2013)

 Introduction: The aim of this study is to compare the efficacy of epidural versus entonox methods for labor analgesia in nulliparous women. 

Methods: This randomized controlled trial was performed on 84 nulliparous women with - pregnancy admitted to Imam Reza Hospital in 10 May 2010- 10 May 2011. 

They were randomly divided into two groups 42 women inhaled entonox in active phase at the beginning of each contraction, and for 42 cases, epidural catheter was inserted and analgesic substance was injected and it was increased adjusted with contraction progressing by bupivacaine combined with fentanyl. The rate of pain was measured with pain scores (minimum pain 0 and maximum pain 10).

 Results: In epidural analgesia, pain score was lower in all stages of labor than entonox analgesia 42% of cases had no pain, while as in entonox group, pain has been decreased 4 scores in 7% of cases and there was no complete analgesia. Duration of different stages of labor was not statistically different between two groups (P=0.89). Cesarean rate was similar in two groups. First and five minute Apgar were not statistically different between two groups (P=0.87, P=0.75, respectively). 

Conclusions: Epidural analgesia with more relief in labor pain is the desired method. This method doesn’t cause more cesarean rate or prolonged labor duration. Although Entonox decreases labor pain in first stage, but doesn’t affect on second stage and fetus Apgar.  

Minoo Yaghmaei, Shahram Amini, Mojgan Mokhtari, Farshid Arbabi Kalate, Atefeh Tabriznia Tabriz,
Volume 1, Issue 1 (10-2013)

 Introduction: Several mehods have been proposed to alleviate pain after hysterectomy. Pre-emptive analgesia has been used to relieve pain following abdominal hysterectomy with conflicting results. This study was performed to evaluate the efficacy of pre-incision skin infiltration of Lidocaine in relieving postoperative pain in patients undergoing abdominal hysterectomy. 

Methods: 60 patients with ASA class of I or II scheduled for abdominal hysterectomy were recruited for the study. The patients were randomly assigned to receive pre-incision skin infiltration of either lidocaine or normal saline. The patients were evaluated with respect to postoperative pain scores and analgesic requirements in the first two postoperative days. They were also asked for satisfaction regarding the pain relief intervention.

Results: The patients were similar with respect to demographic characteristics. Patients in the saline group complained of more pain than the lidocaine group in the recovery room(p<0.001). However, the patients were similar with respect to postoperative pain scores and analgesic requirements. They were also similar regarding satisfaction rates during the first 24 hours postoperatively.

 Conclusions: We conclude that pre-incision skin infiltration of lidocaine is not effective in reducing postoperative pain following abdominal hysterectomy and does not affect the patients’ satisfaction. 

Ali Jangjoo, Kamran Aminian, Reza Shojaeian,
Volume 1, Issue 1 (10-2013)


Objective(s): Appendicitis remains the most common condition in the pediatric population requiring emergency abdominal operation. Management of acute simple appendicitis is well described but controversy remains as to the optimal treatment of complicated appendicitis. Common complications of acute appendicitis include: localized peritonitis and abscess formation, flegmon and general peritonitis.


Methods: In this prospective study we have evaluated the results of aggressive therapy in management of complicated appendicitis in children in Sarvar pediatric hospital of Mashhad, Iran.


Results: Among 60 children with acute complicated appendicitis male to female ratio was 4:1 and mean age was 7.18±2.17 years. 60% were operated via low mid line incision and 40% by Rocky Davis incision. The most common final diagnosis was appendicular abscess that was observed in 34 patients. Primary wound closure was performed in 96.7% and placement of drain in peritoneal cavity in right lower quadrant was done only in 13.3%. Safe appendectomy was performed in all 60 cases and post operative complications included two cases with wound infection and 4 cases with Chronic abdominal pain that were managed conservatively. Only one patient was re admitted and underwent re-laparotomy because of bowel obstruction.


Conclusions: according to our findings the current non operative approach to complicated appendicitis in children needs a revision.


Ali Jangjoo, Mostafa Mehrabi Bahar, Leila Mohajerzadeh, Mohsen Aliakbarian, Masoumeh Nouri, Mehdi Jabbari Nooghabi,
Volume 2, Issue 1 (3-2014)

Introduction: Transhiatal esophagectomy is a widely accepted approach for palliative resection of subcarinal esophageal cancers. This study was designed to evaluate the necessity of routine thoracostomy tube insertion in this technique. 

Methods: This descriptive study was conducted on 123 consecutive patients with esophageal cancers undergoing transhiatal esophagectomy from March 2001 to February 2005. Chest tube insertion was performed according to our defined criteria. Thoracostomy tube would be inserted intraoperatively, if the estimated amount of bleeding was more than 200 ml. In patients with unilateral or bilateral diffuse haziness in chest-x-ray representative of considerable fluid collection, and symptomatic patients with each amount of pleural fluid, it would be inserted postoperatively.  

Results: Thoracostomy tube was intraoperatively inserted in 41 cases (33.3%). Among other 82 patients only 19 cases (15.4%) required chest tube during admission period. There was significant relation between intraoperatively and postoperatively inserted thoracostomy tubes (p<0.001). There was no statistically relation between chest tube insertion and hospital mortality (p=0.71). The mortality rate didn’t show a significant relation with the amount of chest tube drainage (p=0.056).

Conclusions: Routine intraoperative chest tube insertion is not necessary for all patients following THE, and it should be limited to the patients with significant intrathoracic bleeding. 

Malihe Zanguoie, Mahboobe Zanguoie, Reza Zanguoie, Tolyat Maryam,
Volume 2, Issue 2 (9-2014)

Introduction: Nowadays, spinal anesthesia is associated with few complications in many surgical practices especially the elective caesarean which is taken as a suitable replacement for general anesthesia. Different drugs are used for spinal anesthesia. This study aims to compare lidocaine 5% in combination with meperidine 5% plus lidocaine 5% for spinal anesthesia in non-emergency cesarean patients.

 Methods: This is a double-blind clinical trial that Was performed on fifty full term pregnant women, physical status I or II, presenting for non-emergency cesarean section under spinal anesthesia were randomly divided into two groups with 25 in each. All patient received IV 15 ml/kg Ringers solution 15 minutes prior to block. For spinal anesthesia, patients were given either 5% Meperidine 1.25 mg/kg or 5% heavy Lidocaine 60-75 mg intrathecally. The sensory blockade in all except two patients in Lidocaine group and one patient in Meperidine group, who required sedation and analgesia during surgery, was adequate for cesarean section. Data were analyzed by spss software.

 Results: Post-operation analgesia duration was 342.5±18.5 minutes in the lidocaine plus meperidine group and was 131.6±15 minutes in the lidocaine group. The mean difference of blood pressure before and 15 min after blockage was not significant in the lidocaine group and lidocaine plus meperidine group.

 Conclusions: It seems that lidocaine-meperidine combination has stronger medical effects than lidocaine used alone. Besides, the combination can be a proper drug for spinal anesthesia given the longer analgesia duration and lack of significant complications for the patient or adverse effects on the baby. 

Sajjad Noorshafiee, Ghodratollah Maddah, Kiarash Ghazvini, Saeed Niazmand, Monavvar Afzal Aghaee, Samaneh Sajadi, Mohsen Abdollahi, Abbas Abdollahi,
Volume 2, Issue 2 (9-2014)

 Introduction: Bacterial translocation is defined as the passage of bacteria from intestinal tract to the extraintestinal organs such as the peritoneum and blood circulation. The aim of this study is to examine bacterial translocation (regarding type of bacteria and effect of time of obstruction on bacterial translocation) from intestinal lumen to the peritoneum and viscera in acute, simple mechanical, small bowel obstruction in rats. 

 Methods: In this cohort study, thirty female Wistar rats were divided into three groups with two subgroups, each sub-group containing 5 rats. The 1st group consisted of two sham-operated and non-operated control subgroups. The 2nd group was the IO-24 group, and the 3rd group was the IO-48 group in which the interval between producing intestinal obstruction and the second laparotomy was 24 h and 48 h respectively. Each subgroup was divided into two subgroups of partial and complete obstruction. The data was analyzed using Fisher’s exact test and K2 test in SPSS. 

 Results: The most common types of bacteria were E. coli in aerobic culturing and bacteroid in anaerobic culturing. However, as the time of obstruction increased, the pattern of bacterial translocation changed to anaerobic bacteria.

 Conclusions: Our study showed that with increased time of obstruction, pattern of bacterial translocation changed from aerobic to anaerobic. Enterococci were the most common type of bacteria in an aerobic group. 

Shahnaz Tabiee, Zahra Amouzeshi, Seyyed Abolfazl Vagharseyyedin,
Volume 2, Issue 2 (9-2014)

  Introduction: As a key member of the healthcare workforce, nurses play an important role in patient care. N ursing care performance, especially sterilization, is of significant importance in provision of health and prevention of complications such as hospital infections. This study aimed to investigate nurses’ performance concerning sterilization while performing nursing techniques in ICU wards of educational hospitals affiliated to Birjand University of Medical Sciences.

  Methods: In this descriptive-analytic study, 36 nurses working in the ICU ward were selected by census method. A researcher-made observational checklist with three choices for each item was designed to check the sterilization techniques used by nurses in terms of obtaining intravenous (IV) access (10 items), suctioning of the endotracheal tube (7 items), and dressing (8 items).For each technique, a total score of≥75% was considered as good, between 50-75% as moderate, and <50% as poor performance. Content validity was used to confirm the validity of the checklist, and Cronbach’s alpha was calculated 0.67 to confirm its reliability. Data were analyzed in SPSS (version 16) using independent t-test at the significant level of P<0.05.

  Results: Mean score in the suction technique (out of 21) was 15.3±0.88 for which 8.3% of participants had good and 91.7% had moderate performance. As for the dressing technique, the mean score (out of 24) was 18.1±0.68 for which 46.4% of participants had good and 53.6% had moderate performance. Mean score in the obtaining IV access (out of 30) was 18.64±1.03 for which 100% of participants had moderate performance. No poor technical performance was observed, nor was there a Significant differences between the participants’ demographics and their performance.

  Conclusions: Nurses’ performance concerning sterilization techniques used in the ICU wards was moderate. Considering the results, periodic re-education programs are suggested to improve nurses’ performance.

Toba Kazemi, Ahmad Amouzeshi, Nahid Borna, Gholam Reza Sharifzadeh, Zahra Amouzeshi,
Volume 2, Issue 2 (9-2014)

 Introduction: Causes of death vary globally, and they depend regionally on lifestyle and socio-cultural factors. The purpose of this study was to determine accident-related mortality in Southern Khorasan Province, Iran, in the year 2010. 

Methods: This descriptive-analytical study involved all the death cases in the year 2010 in Southern Khorasan. The data were collected from the death registration system, and were classified and analyzed according to the codes of the 10th revision of the International Classification of Deaths (ICD). 

Results: From among the 3,792 deaths in 2010, n=633 (16.7%) were accident-related. Of accident-related deaths, 73.6% (n=450) of the deceased persons were male. The highest rate of mortality belonged to Summer (July 23 to Aug 22) (n=203 32.1%). The median age in accident-related deaths was 36.6±21.9 years with the minimum age of 5 days and maximum age of 92 years. The leading cause of mortality was traffic accidents (52.1%) and violence (18%). The median age of the deceased women in accidents was significantly higher than men (P<0.048) and in rural persons more than urban people (P=0.02), with Surgical complications as the least frequent cause of death.

Conclusions: Since road traffic accidents rank first in accident-related mortality, it is recommended to have measures to improve road safety as well as quality and safety of vehicles, and to establish strict rules for those who disobey traffic rules. 

Reza Abdi, Elahe Bijari,
Volume 3, Issue 3 (10-2015)

Pancoast tumor accounts for 3%-5% of all non-small cell lung carcinomas. This tumor has a distinct clinical presentation through local invasion and the resulting clinical entity called Pancoast syndrome. This syndrome includes severe shoulder pain, arm pain, and Horner’s syndrome andatrophy of forearm and hand muscles. The differential diagnosis of arm and shoulder pain is extensive. Thoracic outlet syndrome and cervical disk disease are commonly mistaken for the Pancoast syndrome in the early clinical course. Diagnosis of Pancoast tumor is often late, and misdiagnosis is a common problem that can affect the prognosis. Therefore, Pancoast tumor should always be considered in differential diagnosis of radicular pain of the upper extremity.

We report a case of 55-year-old man who was admitted with right side severe pain in the back of the neck, shoulder and arm with numbness and tingling sensation in the medial aspect of the forearm and 4th and 5th fingers. These symptoms had initiated from 17 months ago, and the patient was treated for cervical discopathy and frozen shoulder.

Ahmad Amouzeshi, Seyedeh Masome Hosseini, Abbas Javadi, Fateme Norozian, Nazanin Zamanian, Yahya Mohammadi, Somaye Jomefourjan, Zahra Amouzeshi, Mahmoud Kohan,
Volume 3, Issue 3 (10-2015)

Introduction: Anxiety and depression are among major problems encountered by most patients after cardiac surgery. They can have serious consequences for patients’ quality of life, physical and psychological morbidity, and follow-up treatments. Accordingly, the present study was conducted to determine the status of depression and the associated factors in coronary artery bypass grafting (CABG) patients hospitalized in cardiac surgery ward of Imam Reza Hospital of Mashhad in 2013.

Methods: The current investigation is a descriptive, cross-sectional study for which all patients undergoing CABG surgery were selected using the census method. The subjects included inpatients hospitalized in Imam Reza (AS) Hospital of Mashhad from April 2013 to March 2014. The data was collected using the demographic characteristics form as well as Beck Depression Inventory (BDI-II). Analysis of data was conducted with SPSS (version 16) using paired t-test, independent t-test, ANOVA and Pearson correlation coefficient. The significance level was set at P<0.05.

Results: The mean score of depression after cardiac surgery was 31.5±10.60 and 29.3±10.55 for male and female patients, respectively. From among the patients, 64.4% suffered from severe depression after surgery, while 32.1% had moderate depression. No statistically significant relationship was found between age, sex, marital status, employment status, and education level on the one hand and post-operative depression score on the other hand.

Conclusions: As regards the high rates of pre-surgical and post-surgical depression in patients undergoing CABG, effective communication with patients and patient training are recommended as critical components of nursing care to reduce depression.

Mohammad Reza Mofatteh, Seddigheh Meghdadi, Gholamreza Sharifzadeh, , Mohammad Mehdi Hassanzadeh Taheri,
Volume 3, Issue 3 (10-2015)

Introduction: Tonsillectomy is one of the most common surgeries all over the world and is performed by various methods. This study aimed to investigate the complications of bipolar electrocautery method of tonsillectomy.

Methods: This cross-sectional study was performed on 234 patients, 114 female and 120 male individuals. The mean age of the patients was 12.2±8.3 (min=3 and max=58.2) years. Some parameters including duration of surgery, intraoperative blood loss, postoperative hemorrhage, severity of pain were measured 4 and 24 hours after operation. The data were analyzed by SPSS software (Version 15) using Mann-Whitney, Kruskal-Wallis and Spearman tests. P values less than 0.05 were considered significant.

Results: In our study, the mean duration of surgery was 12.7±4.5 minutes, mean intraoperative blood loss was 36.6±10.8 ml, and postoperative hemorrhage was observed in 3.4 % of patients. The mean pain scores 4 hours after operation were 2.1±0.7 and 2.7±0.8 for age groups below and over 10 years old respectively, while these scores were 2.4±0.8 and 3.2±1 after 24 hours of operation for them respectively with the difference being significant (p < 0.05). Furthermore, duration of surgery correlated significantly with intraoperative blood loss (r=0.1 and P=0.01) and pain 4 hours after operation (r=0.1 and p=0.004).

Conclusions: In our study, mean intraoperative blood loss, postoperative hemorrhage, and duration of surgery were greater than what has been reported in the majority of previous studies.

Zahra Amouzeshi, Narges Soltani, Narjes Khatoon Taheri, Majid Zare Bidaki, Seyed Ali Reza Mousavi, - Manizhe Nasirizade, Farzaneh Safajou,
Volume 4, Issue 1 (1-2016)

Introduction: The use of e-learning and computer-aided methods is rapidly on the rise in medical and nursing education. Therefore, given the conflicting findings and lack of systematic clinical trials on comparison of the effects of e-learning and traditional methods in nursing education, this study aimed to assess the effects of offline e-Learning on cognitive learning (levels of knowledge, comprehension, and application) in the Fluid and Electrolyte Imbalances course among nursing students.

Methods: This is a quasi-experimental study with a two-group, post-test-only design. A total of 52 third-semester nursing students were selected by convenience sampling method. Course contents were presented during 6 weeks by lecture and question and answer (Q & A) in the traditional learning group and by offline e-Learning in the second group. Afterwards, the students’ cognitive learning (knowledge, comprehension, and application) was assessed using a 23-item questionnaire on Fluid and Electrolyte Imbalances course. The obtained data were analyzed in SPSS (version 16) using Mann-Whitney, t-test, Chi-square, Fisher's Exact Test, and analysis of two-way variance. The significant level was considered as P < 0.05.

Results: The mean score of cognitive learning was significantly higher in the traditional learning group (14.1±1.9) than in the e-learning group (12.4±2.2) (P=0.006). The difference was also significant in the domain of knowledge (P<0.001), but insignificant in comprehension (P=0.097) and application (P=0.892) domains.

Conclusions: According to the results, the method of teaching e-learning, alongside traditional teaching method is recommended.

Seyed Yoosef Javadmoosavi, Raeisoon Mohammad Reza,
Volume 4, Issue 1 (1-2016)

This article has no abstract.
Drafting a scientific paper is both challengingand exciting. A paper reports our findings toscholars and contributes to application of the findings.

Ayob Akbari, Reza Abdi, Somaye Jomefourjan, Mojtaba Gholami,
Volume 4, Issue 3 (7-2016)

Introduction: Pethidine is commonly used to treat shivering after general anesthesia (GA), yet respiratory depression may subsequently occur. Warming methods such as warm fluids and/or humid-warm oxygen inhalation can reduce shivering after GA. This randomized clinical trial aimed to compare the effects of three different methods on the reduction of shivering and their hemodynamic and respiratory side-effects in patients undergoing abdominal surgery.
Methods: Eighty-seven patients undergoing abdominal surgery by GA were randomly assigned into three groups (two intervention groups versus the pethidine group). Patients in warmed intravenous fluids group received warmed ringer serum (38 °C). The patients in the combined warming group received warmed ringer serum (38 °C) and humid-warm oxygen, and patients in the pethidine group received intravenous pethidine only. The hemodynamic parameters of patients were collected and analyzed.
Results: The elapsed time of shivering in the warmed intravenous serum group, the combined warming group and the pethidine group were 7±1.5 min, 6±1.5 min, and 2.8±0.7 min, respectively, where the difference was statistically significant (P < 0.05). In the pethidine and combined warming groups, the pulse rate (PR) and systolic blood pressure (SBP) increased, whereas the diastolic blood pressure (DBP) decreased. As for the warmed intravenous serum group, pulse rate, DBP and SBP decreased (P >0.05). The mean respiratory rate (RR) decreased in the pethidine group (from 16 to 15). The mean RR increased (from 16.2 to 16.8) in the combined warming groups, and the differences were statistically significant (p<0.05).
Conclusions: The combined warming method reduces the shivering length, while the hemodynamic parameters (PR, BP) remain stable and respiratory depression does not occur. Therefore, it can be used to prevent hypothermia and reduce shivering after general anesthesia.
Ahmad Amouzeshi, Mahtab Dolatabadi, Samaneh Nakhaee, Mahmood Hosseinzadeh Maleki, Omid Mehrpour,
Volume 5, Issue 1 (9-2017)

Introduction: Opium addiction is a social and health problem in many parts of the world, including Iran. The exact effects of this substance on the cardiovascular system and postoperative complications are not clear And the results of studies in this regard are also contradictory, Therefore, the present study aims to compare short-term mortality After coronary artery bypass surgery In two groups Opium consumer And non-consumer was done.
Methods: This cross-sectional study was performed on 194 patients who were hospitalized during September 2013 to September 2015 In Valiasr Hospital of Birjand, they were under CABG operations conducted. In this study, short-term mortality)Hospital and a month After discharge) Through existing records And phone calls were reviewed. All data were analyzed by SPSS 22 software and analyzed using descriptive and inferential statistics.
Results: Of the 194 patients who had undergone surgery twenty-three patients (12.2%) used opioid Among them, In the form of Inhaler, 13 patients (56.5%) orally And 3 patients (13%) was a combination of orally and inhaled. In general, there is a case of mortality during surgery And 7 cases (77.77%) of mortality occurred in the Hospital ward. During the one month follow up, There was a death case. Among the non-addicted patients164 case were alive and 7 died And among addicted patients as well 22 cases were alive And there was a death case. Finally, the results showed, No statistically significant difference between the mortality after surgery, Blood lipids, and diabetes, In two groups Opium consumer And non-consume(p>0/05). But hypertension in the non-addicted group was significantly higher (p <0.05).
Conclusions: Based on the results of this study, there was no significant relationship between opioid dependence and short-term mortality in patients after CABG surgery. Due to low sample size and cross-sectional study, The design of cognitive studies with higher sample sizes seems to be necessary in order to discover causal relationships.
Habibollah Rezaei, Shahram Shayan, Zahra Amouzeshi, Amrollah Roozbehi, Jafar Nikbakht, Bahareh Bahmanbijari, Amin Beigzadeh,
Volume 5, Issue 1 (9-2017)

Introduction: The health system development plan is currently one of the most fundamental changes in Iran. The purpose of this study was to determine the amount of attention to the components of change in health Development plan from the Viewpoint of staff in Al-Zahra hospital in Isfahan and Afzalipour hospital in Kerman in 2015.
Methods: In this quasi-experimental study , the staff of Al-Zahra hospital in Isfahan and Afzalipour hospital in Kerman were selected by convenience sampling method. Data were collected using a researcher-made questionnaire and its validity and reliability were taken into account. Data were analyzed by SPSS version 21 and two-way multivariate analysis of covariance was used as appropriate at a significant level of p <0.05.
Results: The average rate of attention to the components of change in three factors namely "support and planning", "training and counseling", and efficiency" Were respectively 3.93±0.63, 2.91±0.86 and 2.3±0.69. The overall mean of attention to change components was 2.83±2.52.
Conclusions: The mean of the total score showed that less attention has been paid to the components of change in the Health Development Plan. We suggest conducting a national survey to identify faulty components and elements in order to take corrective measures.
Hakimeh Malaki Moghadam,
Volume 5, Issue 3 (11-2017)

Dear Editor-in-chief of the Journal of Surgery and Trauma
An article titled: (Evaluation of the results of direct laryngoscopy of patients with larynx and hypopharynx signs and lesions in ENT specialized medical centers of Birjand city) Which was published by Mr. Mofaateh et al. In issue No. 1-2, Volume 4-2016 (1), Thanks and respect to the cherished writers, a few points are worth mentioning:
1) In the results section, The first form is listed as the frequency distribution. Therefore, the total relative percentage of frequencies should be 100, which is more than 100 here.
2) This problem is also seen in the first paragraph of page 20. The word "frequency distribution" does not seem to fit.
3) The most common type of lesion in the second paragraph of page 19 is the foreign object (foreign object), which is not listed in Table 1. Table 1 lists the most common transglottic lesions. The sample size is 165, while the frequency for the locus of the lesion is 239 (Table 1). In the first paragraph of page 20, the place of residence variable is significant, but a significant amount is listed in Table 2, 0.24, which is not significant.
Shahnaz Tabiee, Seyyed Abolfazl Vagharseyyedin, Gholam Ali Riyahii Nokandeh, Fatemeh Sheikhy,
Volume 5, Issue 3 (11-2017)

Introduction: Growing incidence of cardiovascular disease and various treatment procedures, including coronary artery bypass graft surgery, is a stressful experience for the patient and the family. The multiple complications of surgery during hospitalization can have impacts on the patient comfort, which may require comfort-centered nursing care. Studies in this regard report conflicting results concerning the effects of these interventions. Considering the importance of nursing care and its impact on elimination of the needs and reduction of the patient's problems in cardiac surgery, this study was designed to determine the effect of comfort-centered nursing care, including reflective massage and education, on the comfort of patients undergoing coronary artery bypass grafting (CABG).
Methods: In this randomized clinical trial, 70 CABG patients were selected with convenience sampling method and allocated into intervention and control groups via permuted block randomization. The data collection tools comprised of demographics form and Hospice Comfort Questionnaire (HCQ) the reliability of the latter was calculated by Cronbach's alpha as 0.75. Initially, the prevalent needs of the patients were determined including pain in the sternum, anxiety, lack of awareness of post-operative care, sleep disturbance. Also, disruptions in comfort were assessed using the HCQ. The intervention group received the comfort-centered care program once a day for 6 days. The program included foot reflective massage and education to patients, whereas the controls received the routine cares. In the end of the sixth session, both groups completed the comfort questionnaire. Data were analyzed by SPSS software version 23 using descriptive (mean, standard deviation, frequency and percentage) and inferential statistics (independent t, Mann-Whitney U, and Wilcoxon). The significant level was set at P <0.05.
Results: The mean of comfort score increased in the intervention group after intervention (P <0.001). Also, in the control group, the mean score of comfort and its dimensions significantly improve after intervention (P <0.001). However, the mean scores of changes in comfort and its dimensions was not significantly different in the intervention and control groups after intervention relative to before intervention (P >0.05).
Conclusions: This study reported significant increase of comfort in both groups, positive effect of care implementation and nurse`s presence on better communication with patient and comfort in critical conditions after surgery.
Tooba Kazemi, Navid Rabiee, Ehsan Akbari, Mrs Najme Azimifar, Nahid Azdaki,
Volume 5, Issue 3 (11-2017)

Acutepancreatitis can infrequently be a life-threatening complication of hypertriglyceridemia. Rarely, hypertriglyceridemia can originate from an inborn genetic error in lipoproteins metabolism. This condition can be manifested by very high serum triglyceride levels (>1000 mg/dl) and a more severe and lethal form of pancreatitis. Here, we present a case of acute pancreatic which was found out to be a complication of an undiagnosed familial hypertriglyceridemia who died in spite of receiving conventional care and treatment. Focus is on the importance of considering infrequent etiologies of acute pancreatitis and application of more effective treatments.

Azadeh Ebrahimzadeh, Majid Zare Bidaki, Hasan Karbasi, Sanaz Khosravi, Bita Bijari,
Volume 5, Issue 3 (11-2017)

Background and aim: Culture-positive infections include a broad range of nosocomial infections in the intensive care unit (ICU). Investigation and control of these infections is a global priority which aims to minimize infections in order to reduce mortality, decrease the length of stay in the hospital and also significantly reduce the cost of treatment. The aim of this study was investigation of culture-positive infections and the risk factors in patients admitted to the ICU of Imam Reza (AS) hospital in Birjand.
Methods: In this cross-sectional study (descriptive-analytical), all patients admitted to the ICU at Imam Reza hospital in 2015 were enrolled in the study. The patients’ blood, urine, wounds and sputum samples were taken to culture upon their admission and CSF cultures were performed when needed. People who initially had positive cultures, as well as those who were pre-treated with antibiotics, as well as those who or their family were not agree to participate, were excluded from the study. In culture negative cases, 48-72 hours after admission, cultures were repeated. Risk factors such as underlying disease, age, gender, duration of hospitalization and the use of catheters were evaluated in positive samples. Data analysis was performed by SPSS v 18 software and using Chi-square test.
Results: A total of 669 people with an average age of 46.12 ± 26.08 years were enrolled in the study. The average length of stay was 4.8 ± 8.11 days. The incidence rate of nosocomial infection in patients was 68 (10.2%). Respiratory infection with 79.3% was the most common source of infection. Surgical wound infection with 44.1% and urinary tract infection with 23.5% were the next common types of infection, respectively. The most common isolated bacteria from urinary tract infections were Escherichia coli and Pseudomonas while coagulase-negative staphylococcus and Klebsiella were the most common isolated bacteria from other types of infections. There was a significant relationship between the incidence of  nosocomial infections with age, duration of hospitalization and risk factors such as central catheters, endotracheal tube, ventilator, chest tube, NG TUBE , ventilator and tracheostomy (P<0.05).
Discussion and conclusion: According to the results of this study, more attention should be paid to the patients with culture -positive infections and also reducing the risk factors. It is also recommended to avoid any unnecessary interventions in the ICU. In addition, in case of need for catheterization, care and hygiene practices are essential in order to prevent infections.

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