Aliakbar Keykha - Academia.edu (original) (raw)
Papers by Aliakbar Keykha
Journal of Military Medicine, Jul 19, 2021
Background and Aim: Front-line medical teams are experiencing unprecedented stressors as a result... more Background and Aim: Front-line medical teams are experiencing unprecedented stressors as a result of the COVID-19 pandemic. In the face of these pressures, teamwork has become both more important and more challenging. During the crisis, people trying to work together who may not have done so under 'normal' conditions. Therefore, this study will be conducted to investigate the attitudes and barriers to teamwork from the perspective of intensive care unit nurses in the COVID-19 pandemic. Methods: In this descriptive-analytical study from October 2020 to January 2021, 97 nurses working in intensive care units were selected according to the inclusion criteria. The data collection tool was a standard questionnaire to assess the attitude towards teamwork and assessment of barriers to teamwork, which was completed by the participants after validity and reliability. Data were analyzed using descriptive statistics and independent t-test in SPSS software version 25. Results: The mean score of nurses' attitude to teamwork was 127.82 ± 10.4. The amount of barriers in the workplace for optimal teamwork was reported by 54 (55.67%) high, 32 (32.3%) low and 11 (11.34%) unimpeded. Most barriers to teamwork were reported with nursing managers, organization managers, consulting physicians and therapists and the least barriers were reported with radiology staff and nurses. Conclusion: The performance of nursing managers and the weakness of intra-group relationships are the most important barriers to teamwork in the pandemic situation. In order to provide quality teamwork in the pandemic situation, job descriptions and plans should be provided by the managers of the organization and nurses should receive adequate training in this field.
Journal of Caring Sciences, Sep 28, 2021
Introduction: Oropharyngeal colonization with pathogenic organisms contributes to the development... more Introduction: Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Oral hygiene care (OHC) is a very effective method for reducing the risk of VAP in these patients. This study aimed to evaluate recent OHC strategies to decrease VAP. Methods: Randomized clinical trials (RCTs) published in the PubMed, Scopus, Embase, Cochrane Library, and Web of Science databases from inception to September 10, 2020 were reviewed to compare the effects of selective oropharyngeal decontamination (SOD) on the incidence of VAP in adult patients requiring mechanical ventilation. Results: Out of a total of 1098 articles reviewed, 17 eligible studies were included for final analysis. The results showed that the use of chlorhexidine for oropharyngeal decontamination reduces the incidence of VAP. However, it had a small effect on gram-negative resistant bacteria. Also, it was observed that the combined use of colistin and chlorhexidine was more effective than chlorhexidine alone in preventing VAP. The results of studies on the use of toothbrushes to reduce the incidence of pneumonia are unclear since they used chlorhexidine at the same time. However, tooth brushing is one of the best ways to maintain oral hygiene. Using povidoneiodine, Nanosil, and non-absorbable topical antibiotics reduced the incidence of VAP, while Iseganan did not show a significant effect in this regard. Conclusion: The prophylactic use of topical bactericidal agents in critically-ill patients is effective in reducing the incidence of VAP. However, the use of non-absorbable topical antibiotics is more effective than other methods in oropharyngeal decontamination.
Journal of Education and Health Promotion
Journal of Military Medicine, 2021
Background and Aim: Front-line medical teams are experiencing unprecedented stressors as a result... more Background and Aim: Front-line medical teams are experiencing unprecedented stressors as a result of the COVID-19 pandemic. In the face of these pressures, teamwork has become both more important and more challenging. During the crisis, people trying to work together who may not have done so under 'normal' conditions. Therefore, this study will be conducted to investigate the attitudes and barriers to teamwork from the perspective of intensive care unit nurses in the COVID-19 pandemic. Methods: In this descriptive-analytical study from October 2020 to January 2021, 97 nurses working in intensive care units were selected according to the inclusion criteria. The data collection tool was a standard questionnaire to assess the attitude towards teamwork and assessment of barriers to teamwork, which was completed by the participants after validity and reliability. Data were analyzed using descriptive statistics and independent t-test in SPSS software version 25. Results: The mean ...
Journal of Caring Sciences, 2021
Introduction: Oropharyngeal colonization with pathogenic organisms contributes to thedevelopment ... more Introduction: Oropharyngeal colonization with pathogenic organisms contributes to thedevelopment of ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Oralhygiene care (OHC) is a very effective method for reducing the risk of VAP in these patients.This study aimed to evaluate recent OHC strategies to decrease VAP.Methods: Randomized clinical trials (RCTs) published in the PubMed, Scopus, Embase,Cochrane Library, and Web of Science databases from inception to September 10, 2020 werereviewed to compare the effects of selective oropharyngeal decontamination (SOD) on theincidence of VAP in adult patients requiring mechanical ventilation.Results: Out of a total of 1098 articles reviewed, 17 eligible studies were included for finalanalysis. The results showed that the use of chlorhexidine for oropharyngeal decontaminationreduces the incidence of VAP. However, it had a small effect on gram-negative resistant bacteria.Also, it was observed that the combined use of colisti...
Ambient Science, Jul 1, 2018
was obtained with the number IR.ZAUMS.REC.1393.1266, and the study was conducted according to the... more was obtained with the number IR.ZAUMS.REC.1393.1266, and the study was conducted according to the Declaration of Helsinki principles (WHO, 2013). The ethical considerations of this study were related to the patients' autonomy, conf identiality, and anonymity during the study period and the study's publication.
Biomedical Research and Therapy, May 26, 2020
Background: Pulmonary regurgitation (PR) is often known as an acquired condition after surgical c... more Background: Pulmonary regurgitation (PR) is often known as an acquired condition after surgical correction of tetralogy of Fallot (TOF). Therefore, the present study aimed to compare the use of monocusp valve (MV) implantation and transannular patch (TAP) angioplasty on PR and right ventricular (RV) failure following surgery to repair TOF. Methods: This prospective randomized clinical trial (RCT) was performed on a total number of 60 patients undergoing reconstructive surgery on TOF. For this purpose, TAPs without and with monocusp reconstruction were used in Group I (n = 30 patients) and Group II (n = 30 patients), respectively. Then, echocardiographic parameters, mortality rates, and clinical data from pediatric intensive care unit (PICU) were evaluated during a follow-up period for both groups. Results: Out of the 60 patients undergoing surgery and evaluated, 39 individuals were male (65%) and the rest were female (n = 21 patients, 35%). No significant difference was observed in terms of age, body weight, body surface area (BSA), mortality rate, and ejection fraction (EF) between the two study groups. The findings revealed that the number of patients with severe PR was higher in the group receiving TAP angioplasty. Furthermore, the difference between the two groups with regards to severity of PR was significant (p = 0.012). Conclusion: It was concluded that MV reconstruction of TOF is effective in reducing pulmonary artery (PA) and pulmonary valve (PV) insufficiency.
نشریه پرستاری و مراقبت های ویژه, May 10, 2020
انعکاس امید, Feb 16, 2019
Background: Pain management programs in the case of patients with loss of consciousness could be ... more Background: Pain management programs in the case of patients with loss of consciousness could be advantageous inasmuch as they reduce the use of sedatives, prevent long hospitalization, and diminish the cost of treatment, medications, and hospitalization. Objectives: The present study aims to evaluate the effect of pain management algorithm on pain intensity in patients with loss of consciousness who had been hospitalized in an intensive care unit (ICU) in 2017. Methods: In this randomized single-blind clinical trial, 90 patients with loss of consciousness who were under mechanical ventilation and admitted to the ICU of Khatam al-Anbiya Hospital, Zahedan were chosen through convenience sampling. Using permuted block randomization, the subjects were then assigned into intervention and control groups. Pain management algorithm was implemented in the intervention group for 24 hours during the morning shift between 8 a.m. and 10 a.m., during the evening shift between 3 p.m. and 5 p.m., and during the night shift between 10 p.m. and midnight. On the other hand, participants in the control group only received the routine care provided in the ward. Pain intensity was measured and recorded in both groups before and after the intervention. The tools used in this study included a demographic information form and the Behavioral Pain Scale (BPS). The data were analyzed in SPSS 15 using descriptive statistics, paired and independent t-tests, and chi-square. Results: There was no significant difference between the two groups in terms of gender, age, marital status, and the infused medications. The mean value of pain intensity in patients of the intervention group decreased after receiving the intervention for three shifts, and a significant difference was detected in the mean of this value before and after implementing the intervention. Conversely, the difference of the same variable in the control group was not significant before and after the intervention. In addition, the two groups significantly differed with regard to the mean changes of pain intensity during each of the three shifts (P < 0.001). Conclusions: Implementation of the pain management algorithm can significantly improve pain management in patients with loss of consciousness.
Archives of anesthesiology and critical care, Aug 18, 2020
Background: It is widely accepted that increased prevalence of antibiotic resistance of pathogens... more Background: It is widely accepted that increased prevalence of antibiotic resistance of pathogens grown in the respiratory system in intensive care unit (ICU) patients is a very serious problem causing expansion of mortality. The most important strategy to prevent the occurrence and appropriate solution to control the antibiotic resistance is to thoroughly investigate the pattern of resistance in the studied ward. Therefore, the purpose of this study was to determine the antibiotic resistance pattern of organisms isolated from endotracheal tube secretions of patients admitted to ICU of Khatam-Al-Anbia Hospital at Zahedan in Iran. Methods: In the present retrospective and descriptive cross-sectional study, the medical records of patients hospitalized during 2013-2018 were included by census method and then selected based on inclusion criteria (n=1387). The required data, including age, gender, type of microorganism isolated from endotracheal tube cultures, antibiotic resistance and sensitivity, duration of intubation and cause of hospitalization, were recorded for each patient. Finally, the data were analyzed by descriptive statistics using SPSS 16 software. Results: Mean age of patients was 44.66 ± 21.39 years and mean duration of intubation was 17.96 ± 10.99 days. Stroke was the most common cause of hospitalization with a prevalence of 553 patients (49%). The prevalence of positive culture of endotracheal tube secretions was 1128 (81.3%) of which 71.5% were male (n=807) and 28.5% were female (n=321). The cultures of endotracheal tube secretions resulted in 933 (82.7%) gram-negative bacteria, 191 (16.9%) grampositive bacteria and 4 (0.4%) mixed isolates. The most prevalent gram-negative bacterium was Acinetobacter baumannii (37.2%) with the highest and lowest antibiotic resistance to Meropenem (95.1% resistance) and colistin (99.5% sensitivity), respectively. In addition, the most prevalent gram-positive bacterium was Staphylococcus epidermidis (50.3%) with the highest and lowest antibiotic resistance to Meropenem (85.7% resistance) and Vancomycin (92.2% sensitivity). Conclusion: The findings of the present study illustrate that there was widespread bacterial resistance to respiratory tract infections in our ICU patients. Due to the high sensitivity of gram-negative bacteria to colistin, the use of antibiotic combination with colistin in the control of pulmonary infections caused by these organisms can be a good choice. In addition, in the case of gram-positive bacteria, the highest
Archives of Anesthesia and Critical Care
Background: The intensive care unit is one of the most specialized hospital units that need nurse... more Background: The intensive care unit is one of the most specialized hospital units that need nurses with a high level of skill and experience. The leave of experienced nurses from this unit reduces the quality of nursing care and imposes heavy costs on the health care system. This study aimed to investigate the reasons for nurses' intention to leave the ICU. Methods: This cross-sectional study was performed on 247 nurses in the ICU affiliated with Zahedan, Tehran, and Mashhad University of Medical Sciences, Iran, from 2018 to 2021. Nurses were included in the study by Census sampling method based on inclusion criteria. They completed a four-part questionnaire including demographic variables, Job Satisfaction Survey (JSS), intention to leave, and reasons for intention to leave the ICU. Data were analyzed with SPSS software using descriptive-analytic statistics, Chi-square, independent t-test, one-way ANOVA, and Pearson correlation. The significance level was considered less than 0...
Biomedical Research and Therapy, 2018
Background & Aim: Drug abusers have much lower pain threshold, in a way that the duration of the ... more Background & Aim: Drug abusers have much lower pain threshold, in a way that the duration of the effect of anesthesia on controlling their pain is still not fully known. Therefore, this study aimed to compare the duration of spinal anesthesia induced with bupivacaine between drug-dependent and non-dependent individuals. Methods: This quasi-experimental study was conducted on two 60-member groups consisting of drug-dependent and non-dependent patients undergoing lowerlimb orthopedic surgery. Patients were selected via simple convenience sampling and underwent a similar procedure of spinal anesthesia using the same needle and medicine by an anesthesiologist, who was unaware of the patients' placement in the study groups. After surgery, the duration of patients' anesthesia was correspondingly measured in both groups and compared using the independent t-test. Results: In this research study, no significant difference was observed between the groups in terms of age and gender. Th...
Medical - Surgical Nursing Journal, 2019
Background: Pain management programs in the case of patients with loss of consciousness could be ... more Background: Pain management programs in the case of patients with loss of consciousness could be advantageous inasmuch as they reduce the use of sedatives, prevent long hospitalization, and diminish the cost of treatment, medications, and hospitalization. Objectives: The present study aims to evaluate the effect of pain management algorithm on pain intensity in patients with loss of consciousness who had been hospitalized in an intensive care unit (ICU) in 2017. Methods: In this randomized single-blind clinical trial, 90 patients with loss of consciousness who were under mechanical ventilation and admitted to the ICU of Khatam al-Anbiya Hospital, Zahedan were chosen through convenience sampling. Using permuted block randomization, the subjects were then assigned into intervention and control groups. Pain management algorithm was implemented in the intervention group for 24 hours during the morning shift between 8 a.m. and 10 a.m., during the evening shift between 3 p.m. and 5 p.m., and during the night shift between 10 p.m. and midnight. On the other hand, participants in the control group only received the routine care provided in the ward. Pain intensity was measured and recorded in both groups before and after the intervention. The tools used in this study included a demographic information form and the Behavioral Pain Scale (BPS). The data were analyzed in SPSS 15 using descriptive statistics, paired and independent t-tests, and chi-square. Results: There was no significant difference between the two groups in terms of gender, age, marital status, and the infused medications. The mean value of pain intensity in patients of the intervention group decreased after receiving the intervention for three shifts, and a significant difference was detected in the mean of this value before and after implementing the intervention. Conversely, the difference of the same variable in the control group was not significant before and after the intervention. In addition, the two groups significantly differed with regard to the mean changes of pain intensity during each of the three shifts (P < 0.001). Conclusions: Implementation of the pain management algorithm can significantly improve pain management in patients with loss of consciousness.
Although it is obvious that many advantages and disadvantages of cesarean and vaginal delivery ar... more Although it is obvious that many advantages and disadvantages of cesarean and vaginal delivery are known, selecting the best delivery method by women requires numerous investigations and training. This study aimed to examine factors associated with of the delivery type in pregnant women admitted to Zahedan hospitals. The present descriptive-analytical study was conducted on 400 women who had vaginal or cesarean childbirth delivery. To collect the data, demographic, attitude and awareness questionnaires were employed. The mean age of the study participants was 27.7 years and their mean age of marriage was 19.6. There was no significant relationship between the age and delivery type. Chi-square analysis (Pearson correlation coefficient) revealed no significant correlation between education level and delivery type (P = 538). Mean scores of awareness for the vaginal and cesarean delivery groups were 27.4 and 29.5, respectively. In this regard, the difference observed was not significant...
Background: The pain induced by intravenous injection of propofol is controlled using a variety o... more Background: The pain induced by intravenous injection of propofol is controlled using a variety of methods, but there is no consensus in choosing the best effective method. Therefore, this study was conducted to compare premedication injections of magnesium sulfate, ketamine and lidocaine on pain induced by intravenous injection of propofol. Methods: The present double-blind clinical trial was conducted on 150 patients with elective orthopedic surgery under general anesthesia. The patients were randomly assigned into three groups of 50; Group I: 2 cc magnesium sulfate 20%, Group II: 2 cc Ketamine at a dose of 0.1mg/kg and Group III: 2 cc lidocaine 2% at a dose of 0.05mg/kg. One minute after injecting the drugs, 2mg/kg intravenous propofol was injected in all groups and then a trained unaware expert evaluated the severity of subsequent pain using a Numeric Pain Rating Scale. Results: The mean age of the patients was 39.3±12.3 years, and the mean weight was 67.4±11.5 kg. The patients ...
Background: Pediatric tonsillectomy is associated with major complications such as severe postope... more Background: Pediatric tonsillectomy is associated with major complications such as severe postoperative pain. Hence, this study aimed to compare the effect of acetaminophen suppository administered before and after surgery on the pain severity of tonsillectomy. Methods: The present double-blind clinical trial was performed on 100 children undergoing tonsillectomy, who were randomly divided into two groups of 50 receiving respectively rectal acetaminophen 40 mg/kg preoperatively (Group 1) and postoperatively (Group 2). Results: The first group consisted of 28 boys and 22 girls, and the second group had 26 boys and 24 girls. According to Chi-square test, there was no significant difference in terms of gender in the two groups (p=0.668). Comparison of pain scores with repeated measures ANOVA showed lower pain severity in the first group at all hours compared with the second group. Conclusion: The preoperative use of acetaminophen suppository significantly controls the pain after tonsil...
Background: Weaning from mechanical ventilation is one of the main stages of treatment as well as... more Background: Weaning from mechanical ventilation is one of the main stages of treatment as well as applying a tool that can predict the success in weaning is very important. This study aimed to evaluate the success rate of weaning from ventilator in patients admitted at the Intensive Care Unit (ICU) using Burn’s Wean Assessment Program (BWAP) checklist. Methods: The present analytical cross-sectional study was carried out on 100 mechanical ventilation-dependent patients connected to the ventilator for more than 72 hours. All patients were selected by simple available sampling based on purposive sampling method and examined by BWAP checklist and were weaned from ventilator by obtaining scores over 18. Results: The total number of patients participating in the study was 100, 71 males and 29 females. There was no significant relationship between gender and success or failure of weaning process based on chi-square test (p<0.784). There was no relationship between weight and the result...
Biomedical Research and Therapy, 2018
Background: Co-administration of drugs with synergistic effects is considered as one of the metho... more Background: Co-administration of drugs with synergistic effects is considered as one of the methods to increase the effectiveness of intrathecal anesthesia and to reduce the need for injectable analgesics. The purpose of this study was to investigate the efficacy of intrathecal midazolam on enhancing the analgesic effect of fentanyl in patients undergoing lower limb surgery. Materials: The present double-blinded clinical trial was conducted on 90 candidate patients undergoing lower limb orthopedic surgery in 2017 at Khatam-Al-Anbiya Hospital in the city of Zahedan, Iran. To this end, the patients were selected via convenience sampling method and then randomly divided into three groups. Afterwards, 3 cc of 0.5% hyperbaric Marcaine was injected intrathecally in the first group, 3 cc of Marcaine + 25 ug of fentanyl was administered to the second group, and 3 cc of Marcaine + 25 ug of fentanyl + 1 mg of midazolam was administered to the third group (the final volume of all three syringe...
Biomedical Research and Therapy, 2020
Background: Pulmonary regurgitation (PR) is often known as an acquired condition after surgical c... more Background: Pulmonary regurgitation (PR) is often known as an acquired condition after surgical correction of tetralogy of Fallot (TOF). Therefore, the present study aimed to compare the use of monocusp valve (MV) implantation and transannular patch (TAP) angioplasty on PR and right ventricular (RV) failure following surgery to repair TOF. Methods: This prospective randomized clinical trial (RCT) was performed on a total number of 60 patients undergoing reconstructive surgery on TOF. For this purpose, TAPs without and with monocusp reconstruction were used in Group I (n = 30 patients) and Group II (n = 30 patients), respectively. Then, echocardiographic parameters, mortality rates, and clinical data from pediatric intensive care unit (PICU) were evaluated during a follow-up period for both groups. Results: Out of the 60 patients undergoing surgery and evaluated, 39 individuals were male (65%) and the rest were female (n = 21 patients, 35%). No significant difference was observed in ...
Journal of Military Medicine, Jul 19, 2021
Background and Aim: Front-line medical teams are experiencing unprecedented stressors as a result... more Background and Aim: Front-line medical teams are experiencing unprecedented stressors as a result of the COVID-19 pandemic. In the face of these pressures, teamwork has become both more important and more challenging. During the crisis, people trying to work together who may not have done so under 'normal' conditions. Therefore, this study will be conducted to investigate the attitudes and barriers to teamwork from the perspective of intensive care unit nurses in the COVID-19 pandemic. Methods: In this descriptive-analytical study from October 2020 to January 2021, 97 nurses working in intensive care units were selected according to the inclusion criteria. The data collection tool was a standard questionnaire to assess the attitude towards teamwork and assessment of barriers to teamwork, which was completed by the participants after validity and reliability. Data were analyzed using descriptive statistics and independent t-test in SPSS software version 25. Results: The mean score of nurses' attitude to teamwork was 127.82 ± 10.4. The amount of barriers in the workplace for optimal teamwork was reported by 54 (55.67%) high, 32 (32.3%) low and 11 (11.34%) unimpeded. Most barriers to teamwork were reported with nursing managers, organization managers, consulting physicians and therapists and the least barriers were reported with radiology staff and nurses. Conclusion: The performance of nursing managers and the weakness of intra-group relationships are the most important barriers to teamwork in the pandemic situation. In order to provide quality teamwork in the pandemic situation, job descriptions and plans should be provided by the managers of the organization and nurses should receive adequate training in this field.
Journal of Caring Sciences, Sep 28, 2021
Introduction: Oropharyngeal colonization with pathogenic organisms contributes to the development... more Introduction: Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Oral hygiene care (OHC) is a very effective method for reducing the risk of VAP in these patients. This study aimed to evaluate recent OHC strategies to decrease VAP. Methods: Randomized clinical trials (RCTs) published in the PubMed, Scopus, Embase, Cochrane Library, and Web of Science databases from inception to September 10, 2020 were reviewed to compare the effects of selective oropharyngeal decontamination (SOD) on the incidence of VAP in adult patients requiring mechanical ventilation. Results: Out of a total of 1098 articles reviewed, 17 eligible studies were included for final analysis. The results showed that the use of chlorhexidine for oropharyngeal decontamination reduces the incidence of VAP. However, it had a small effect on gram-negative resistant bacteria. Also, it was observed that the combined use of colistin and chlorhexidine was more effective than chlorhexidine alone in preventing VAP. The results of studies on the use of toothbrushes to reduce the incidence of pneumonia are unclear since they used chlorhexidine at the same time. However, tooth brushing is one of the best ways to maintain oral hygiene. Using povidoneiodine, Nanosil, and non-absorbable topical antibiotics reduced the incidence of VAP, while Iseganan did not show a significant effect in this regard. Conclusion: The prophylactic use of topical bactericidal agents in critically-ill patients is effective in reducing the incidence of VAP. However, the use of non-absorbable topical antibiotics is more effective than other methods in oropharyngeal decontamination.
Journal of Education and Health Promotion
Journal of Military Medicine, 2021
Background and Aim: Front-line medical teams are experiencing unprecedented stressors as a result... more Background and Aim: Front-line medical teams are experiencing unprecedented stressors as a result of the COVID-19 pandemic. In the face of these pressures, teamwork has become both more important and more challenging. During the crisis, people trying to work together who may not have done so under 'normal' conditions. Therefore, this study will be conducted to investigate the attitudes and barriers to teamwork from the perspective of intensive care unit nurses in the COVID-19 pandemic. Methods: In this descriptive-analytical study from October 2020 to January 2021, 97 nurses working in intensive care units were selected according to the inclusion criteria. The data collection tool was a standard questionnaire to assess the attitude towards teamwork and assessment of barriers to teamwork, which was completed by the participants after validity and reliability. Data were analyzed using descriptive statistics and independent t-test in SPSS software version 25. Results: The mean ...
Journal of Caring Sciences, 2021
Introduction: Oropharyngeal colonization with pathogenic organisms contributes to thedevelopment ... more Introduction: Oropharyngeal colonization with pathogenic organisms contributes to thedevelopment of ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Oralhygiene care (OHC) is a very effective method for reducing the risk of VAP in these patients.This study aimed to evaluate recent OHC strategies to decrease VAP.Methods: Randomized clinical trials (RCTs) published in the PubMed, Scopus, Embase,Cochrane Library, and Web of Science databases from inception to September 10, 2020 werereviewed to compare the effects of selective oropharyngeal decontamination (SOD) on theincidence of VAP in adult patients requiring mechanical ventilation.Results: Out of a total of 1098 articles reviewed, 17 eligible studies were included for finalanalysis. The results showed that the use of chlorhexidine for oropharyngeal decontaminationreduces the incidence of VAP. However, it had a small effect on gram-negative resistant bacteria.Also, it was observed that the combined use of colisti...
Ambient Science, Jul 1, 2018
was obtained with the number IR.ZAUMS.REC.1393.1266, and the study was conducted according to the... more was obtained with the number IR.ZAUMS.REC.1393.1266, and the study was conducted according to the Declaration of Helsinki principles (WHO, 2013). The ethical considerations of this study were related to the patients' autonomy, conf identiality, and anonymity during the study period and the study's publication.
Biomedical Research and Therapy, May 26, 2020
Background: Pulmonary regurgitation (PR) is often known as an acquired condition after surgical c... more Background: Pulmonary regurgitation (PR) is often known as an acquired condition after surgical correction of tetralogy of Fallot (TOF). Therefore, the present study aimed to compare the use of monocusp valve (MV) implantation and transannular patch (TAP) angioplasty on PR and right ventricular (RV) failure following surgery to repair TOF. Methods: This prospective randomized clinical trial (RCT) was performed on a total number of 60 patients undergoing reconstructive surgery on TOF. For this purpose, TAPs without and with monocusp reconstruction were used in Group I (n = 30 patients) and Group II (n = 30 patients), respectively. Then, echocardiographic parameters, mortality rates, and clinical data from pediatric intensive care unit (PICU) were evaluated during a follow-up period for both groups. Results: Out of the 60 patients undergoing surgery and evaluated, 39 individuals were male (65%) and the rest were female (n = 21 patients, 35%). No significant difference was observed in terms of age, body weight, body surface area (BSA), mortality rate, and ejection fraction (EF) between the two study groups. The findings revealed that the number of patients with severe PR was higher in the group receiving TAP angioplasty. Furthermore, the difference between the two groups with regards to severity of PR was significant (p = 0.012). Conclusion: It was concluded that MV reconstruction of TOF is effective in reducing pulmonary artery (PA) and pulmonary valve (PV) insufficiency.
نشریه پرستاری و مراقبت های ویژه, May 10, 2020
انعکاس امید, Feb 16, 2019
Background: Pain management programs in the case of patients with loss of consciousness could be ... more Background: Pain management programs in the case of patients with loss of consciousness could be advantageous inasmuch as they reduce the use of sedatives, prevent long hospitalization, and diminish the cost of treatment, medications, and hospitalization. Objectives: The present study aims to evaluate the effect of pain management algorithm on pain intensity in patients with loss of consciousness who had been hospitalized in an intensive care unit (ICU) in 2017. Methods: In this randomized single-blind clinical trial, 90 patients with loss of consciousness who were under mechanical ventilation and admitted to the ICU of Khatam al-Anbiya Hospital, Zahedan were chosen through convenience sampling. Using permuted block randomization, the subjects were then assigned into intervention and control groups. Pain management algorithm was implemented in the intervention group for 24 hours during the morning shift between 8 a.m. and 10 a.m., during the evening shift between 3 p.m. and 5 p.m., and during the night shift between 10 p.m. and midnight. On the other hand, participants in the control group only received the routine care provided in the ward. Pain intensity was measured and recorded in both groups before and after the intervention. The tools used in this study included a demographic information form and the Behavioral Pain Scale (BPS). The data were analyzed in SPSS 15 using descriptive statistics, paired and independent t-tests, and chi-square. Results: There was no significant difference between the two groups in terms of gender, age, marital status, and the infused medications. The mean value of pain intensity in patients of the intervention group decreased after receiving the intervention for three shifts, and a significant difference was detected in the mean of this value before and after implementing the intervention. Conversely, the difference of the same variable in the control group was not significant before and after the intervention. In addition, the two groups significantly differed with regard to the mean changes of pain intensity during each of the three shifts (P < 0.001). Conclusions: Implementation of the pain management algorithm can significantly improve pain management in patients with loss of consciousness.
Archives of anesthesiology and critical care, Aug 18, 2020
Background: It is widely accepted that increased prevalence of antibiotic resistance of pathogens... more Background: It is widely accepted that increased prevalence of antibiotic resistance of pathogens grown in the respiratory system in intensive care unit (ICU) patients is a very serious problem causing expansion of mortality. The most important strategy to prevent the occurrence and appropriate solution to control the antibiotic resistance is to thoroughly investigate the pattern of resistance in the studied ward. Therefore, the purpose of this study was to determine the antibiotic resistance pattern of organisms isolated from endotracheal tube secretions of patients admitted to ICU of Khatam-Al-Anbia Hospital at Zahedan in Iran. Methods: In the present retrospective and descriptive cross-sectional study, the medical records of patients hospitalized during 2013-2018 were included by census method and then selected based on inclusion criteria (n=1387). The required data, including age, gender, type of microorganism isolated from endotracheal tube cultures, antibiotic resistance and sensitivity, duration of intubation and cause of hospitalization, were recorded for each patient. Finally, the data were analyzed by descriptive statistics using SPSS 16 software. Results: Mean age of patients was 44.66 ± 21.39 years and mean duration of intubation was 17.96 ± 10.99 days. Stroke was the most common cause of hospitalization with a prevalence of 553 patients (49%). The prevalence of positive culture of endotracheal tube secretions was 1128 (81.3%) of which 71.5% were male (n=807) and 28.5% were female (n=321). The cultures of endotracheal tube secretions resulted in 933 (82.7%) gram-negative bacteria, 191 (16.9%) grampositive bacteria and 4 (0.4%) mixed isolates. The most prevalent gram-negative bacterium was Acinetobacter baumannii (37.2%) with the highest and lowest antibiotic resistance to Meropenem (95.1% resistance) and colistin (99.5% sensitivity), respectively. In addition, the most prevalent gram-positive bacterium was Staphylococcus epidermidis (50.3%) with the highest and lowest antibiotic resistance to Meropenem (85.7% resistance) and Vancomycin (92.2% sensitivity). Conclusion: The findings of the present study illustrate that there was widespread bacterial resistance to respiratory tract infections in our ICU patients. Due to the high sensitivity of gram-negative bacteria to colistin, the use of antibiotic combination with colistin in the control of pulmonary infections caused by these organisms can be a good choice. In addition, in the case of gram-positive bacteria, the highest
Archives of Anesthesia and Critical Care
Background: The intensive care unit is one of the most specialized hospital units that need nurse... more Background: The intensive care unit is one of the most specialized hospital units that need nurses with a high level of skill and experience. The leave of experienced nurses from this unit reduces the quality of nursing care and imposes heavy costs on the health care system. This study aimed to investigate the reasons for nurses' intention to leave the ICU. Methods: This cross-sectional study was performed on 247 nurses in the ICU affiliated with Zahedan, Tehran, and Mashhad University of Medical Sciences, Iran, from 2018 to 2021. Nurses were included in the study by Census sampling method based on inclusion criteria. They completed a four-part questionnaire including demographic variables, Job Satisfaction Survey (JSS), intention to leave, and reasons for intention to leave the ICU. Data were analyzed with SPSS software using descriptive-analytic statistics, Chi-square, independent t-test, one-way ANOVA, and Pearson correlation. The significance level was considered less than 0...
Biomedical Research and Therapy, 2018
Background & Aim: Drug abusers have much lower pain threshold, in a way that the duration of the ... more Background & Aim: Drug abusers have much lower pain threshold, in a way that the duration of the effect of anesthesia on controlling their pain is still not fully known. Therefore, this study aimed to compare the duration of spinal anesthesia induced with bupivacaine between drug-dependent and non-dependent individuals. Methods: This quasi-experimental study was conducted on two 60-member groups consisting of drug-dependent and non-dependent patients undergoing lowerlimb orthopedic surgery. Patients were selected via simple convenience sampling and underwent a similar procedure of spinal anesthesia using the same needle and medicine by an anesthesiologist, who was unaware of the patients' placement in the study groups. After surgery, the duration of patients' anesthesia was correspondingly measured in both groups and compared using the independent t-test. Results: In this research study, no significant difference was observed between the groups in terms of age and gender. Th...
Medical - Surgical Nursing Journal, 2019
Background: Pain management programs in the case of patients with loss of consciousness could be ... more Background: Pain management programs in the case of patients with loss of consciousness could be advantageous inasmuch as they reduce the use of sedatives, prevent long hospitalization, and diminish the cost of treatment, medications, and hospitalization. Objectives: The present study aims to evaluate the effect of pain management algorithm on pain intensity in patients with loss of consciousness who had been hospitalized in an intensive care unit (ICU) in 2017. Methods: In this randomized single-blind clinical trial, 90 patients with loss of consciousness who were under mechanical ventilation and admitted to the ICU of Khatam al-Anbiya Hospital, Zahedan were chosen through convenience sampling. Using permuted block randomization, the subjects were then assigned into intervention and control groups. Pain management algorithm was implemented in the intervention group for 24 hours during the morning shift between 8 a.m. and 10 a.m., during the evening shift between 3 p.m. and 5 p.m., and during the night shift between 10 p.m. and midnight. On the other hand, participants in the control group only received the routine care provided in the ward. Pain intensity was measured and recorded in both groups before and after the intervention. The tools used in this study included a demographic information form and the Behavioral Pain Scale (BPS). The data were analyzed in SPSS 15 using descriptive statistics, paired and independent t-tests, and chi-square. Results: There was no significant difference between the two groups in terms of gender, age, marital status, and the infused medications. The mean value of pain intensity in patients of the intervention group decreased after receiving the intervention for three shifts, and a significant difference was detected in the mean of this value before and after implementing the intervention. Conversely, the difference of the same variable in the control group was not significant before and after the intervention. In addition, the two groups significantly differed with regard to the mean changes of pain intensity during each of the three shifts (P < 0.001). Conclusions: Implementation of the pain management algorithm can significantly improve pain management in patients with loss of consciousness.
Although it is obvious that many advantages and disadvantages of cesarean and vaginal delivery ar... more Although it is obvious that many advantages and disadvantages of cesarean and vaginal delivery are known, selecting the best delivery method by women requires numerous investigations and training. This study aimed to examine factors associated with of the delivery type in pregnant women admitted to Zahedan hospitals. The present descriptive-analytical study was conducted on 400 women who had vaginal or cesarean childbirth delivery. To collect the data, demographic, attitude and awareness questionnaires were employed. The mean age of the study participants was 27.7 years and their mean age of marriage was 19.6. There was no significant relationship between the age and delivery type. Chi-square analysis (Pearson correlation coefficient) revealed no significant correlation between education level and delivery type (P = 538). Mean scores of awareness for the vaginal and cesarean delivery groups were 27.4 and 29.5, respectively. In this regard, the difference observed was not significant...
Background: The pain induced by intravenous injection of propofol is controlled using a variety o... more Background: The pain induced by intravenous injection of propofol is controlled using a variety of methods, but there is no consensus in choosing the best effective method. Therefore, this study was conducted to compare premedication injections of magnesium sulfate, ketamine and lidocaine on pain induced by intravenous injection of propofol. Methods: The present double-blind clinical trial was conducted on 150 patients with elective orthopedic surgery under general anesthesia. The patients were randomly assigned into three groups of 50; Group I: 2 cc magnesium sulfate 20%, Group II: 2 cc Ketamine at a dose of 0.1mg/kg and Group III: 2 cc lidocaine 2% at a dose of 0.05mg/kg. One minute after injecting the drugs, 2mg/kg intravenous propofol was injected in all groups and then a trained unaware expert evaluated the severity of subsequent pain using a Numeric Pain Rating Scale. Results: The mean age of the patients was 39.3±12.3 years, and the mean weight was 67.4±11.5 kg. The patients ...
Background: Pediatric tonsillectomy is associated with major complications such as severe postope... more Background: Pediatric tonsillectomy is associated with major complications such as severe postoperative pain. Hence, this study aimed to compare the effect of acetaminophen suppository administered before and after surgery on the pain severity of tonsillectomy. Methods: The present double-blind clinical trial was performed on 100 children undergoing tonsillectomy, who were randomly divided into two groups of 50 receiving respectively rectal acetaminophen 40 mg/kg preoperatively (Group 1) and postoperatively (Group 2). Results: The first group consisted of 28 boys and 22 girls, and the second group had 26 boys and 24 girls. According to Chi-square test, there was no significant difference in terms of gender in the two groups (p=0.668). Comparison of pain scores with repeated measures ANOVA showed lower pain severity in the first group at all hours compared with the second group. Conclusion: The preoperative use of acetaminophen suppository significantly controls the pain after tonsil...
Background: Weaning from mechanical ventilation is one of the main stages of treatment as well as... more Background: Weaning from mechanical ventilation is one of the main stages of treatment as well as applying a tool that can predict the success in weaning is very important. This study aimed to evaluate the success rate of weaning from ventilator in patients admitted at the Intensive Care Unit (ICU) using Burn’s Wean Assessment Program (BWAP) checklist. Methods: The present analytical cross-sectional study was carried out on 100 mechanical ventilation-dependent patients connected to the ventilator for more than 72 hours. All patients were selected by simple available sampling based on purposive sampling method and examined by BWAP checklist and were weaned from ventilator by obtaining scores over 18. Results: The total number of patients participating in the study was 100, 71 males and 29 females. There was no significant relationship between gender and success or failure of weaning process based on chi-square test (p<0.784). There was no relationship between weight and the result...
Biomedical Research and Therapy, 2018
Background: Co-administration of drugs with synergistic effects is considered as one of the metho... more Background: Co-administration of drugs with synergistic effects is considered as one of the methods to increase the effectiveness of intrathecal anesthesia and to reduce the need for injectable analgesics. The purpose of this study was to investigate the efficacy of intrathecal midazolam on enhancing the analgesic effect of fentanyl in patients undergoing lower limb surgery. Materials: The present double-blinded clinical trial was conducted on 90 candidate patients undergoing lower limb orthopedic surgery in 2017 at Khatam-Al-Anbiya Hospital in the city of Zahedan, Iran. To this end, the patients were selected via convenience sampling method and then randomly divided into three groups. Afterwards, 3 cc of 0.5% hyperbaric Marcaine was injected intrathecally in the first group, 3 cc of Marcaine + 25 ug of fentanyl was administered to the second group, and 3 cc of Marcaine + 25 ug of fentanyl + 1 mg of midazolam was administered to the third group (the final volume of all three syringe...
Biomedical Research and Therapy, 2020
Background: Pulmonary regurgitation (PR) is often known as an acquired condition after surgical c... more Background: Pulmonary regurgitation (PR) is often known as an acquired condition after surgical correction of tetralogy of Fallot (TOF). Therefore, the present study aimed to compare the use of monocusp valve (MV) implantation and transannular patch (TAP) angioplasty on PR and right ventricular (RV) failure following surgery to repair TOF. Methods: This prospective randomized clinical trial (RCT) was performed on a total number of 60 patients undergoing reconstructive surgery on TOF. For this purpose, TAPs without and with monocusp reconstruction were used in Group I (n = 30 patients) and Group II (n = 30 patients), respectively. Then, echocardiographic parameters, mortality rates, and clinical data from pediatric intensive care unit (PICU) were evaluated during a follow-up period for both groups. Results: Out of the 60 patients undergoing surgery and evaluated, 39 individuals were male (65%) and the rest were female (n = 21 patients, 35%). No significant difference was observed in ...