Clinical Features of Patients with Probable 2019 Novel Coronavirus Infected Pneumonia in Rasht, Iran: A Retrospective Case Series

BACKGROUND: Coronavirus disease-19 (COVID-19) is the first pandemic infectious disease caused by a novel coronavirus. Viral pneumonia is a severe complication of COVID-19. AIM: Due to the high prevalence of this disease globally, especially in Iran, the aim of this study was to determine the clinical features of seven patients with probable COVID-19 infected pneumonia in Rasht, North Iran. MATERIALS AND METHODS: In this retrospective case series study, we described the clinical, laboratory, and radiological features of seven patients with probable COVID-19 infected pneumonia at Razi Hospital, Rasht, north of Iran, from February 27 to March 16, 2020. RESULTS: In this study, the most common clinical symptoms during hospitalization in patients with COVID-19 were poor appetite (seven cases), dehydration (seven cases), cough (six cases), dyspnea (six cases), fatigue (six cases), fever above 38°C (five cases), myalgia (five cases), Chills (five cases), feeling fever (five cases), sore throat (five cases), and nausea (five cases), respectively. The average body temperature in these patients was 39.32°C. In laboratory findings, erythrocyte sedimentation rate was elevated in three patients. Contrary to most of the evidence, C-reactive protein was not elevated in five patients. All patients received antibiotic and antiviral medications and received symptomatic treatment. Finally, four patients responded to the treatments and were discharged from the hospital; two patients were still hospitalized and only one patient died. CONCLUSION: Patients with COVID-19 associated pneumonia can be treated by evaluating and implementing appropriate therapeutic management. However, at the moment the disease progression for patients with COVID-19 cannot be accurately predicted

The Effect of Preoperative Oral Melatonin on Postoperative Pain after Lumbar Disc Surgery: A Double-Blinded Randomized Clinical Trial

BACKGROUND: Despite advances in surgical and anesthesiology techniques, many patients continue to experience postoperative pain after lumbar disc surgeries. The aim of this study was to investigate the effect of preoperative oral melatonin on the severity of postoperative pain after lumbar laminectomy/discectomy. METHODS: In this double blinded randomized controlled clinical trial 80 patients undergoing an elective mini-open microdiscectomy surgery at Imam Khomeini educational hospital in Sari, Iran, were selected and randomly assigned into one of four groups. Patients in group A, B, C, and D received 3, 5 and 10 mg melatonin or placebo tablets one hour before surgery, respectively. Using the visual analogue scale (VAS) the severity of pain, nausea and vomiting, pruritus, and use of narcotics were assessed immediately after surgery and before leaving the post-anesthesia care unit, 6, 12 and 24 hours postoperatively. RESULTS: In all three groups receiving melatonin at all three different doses, postoperative pain was significantly less than the placebo group (P<0.01). There were no statistically significant differences in postoperative pain level between the three groups receiving melatonin (P>0.05). The amount of opioid received by the patients within 24 hours after surgery had statistically significant differences within the groups (P=0.043, F=2.58). The results of post hoc analysis in terms of postoperative pain intensity showed statistically significant differences between the two groups receiving melatonin at a dose of 5 mg and the placebo group (P= 0.04). No serious side effects reported in four groups. CONCLUSION: The use of oral melatonin with a dose of 5 mg, 1 hour before the surgery as an inexpensive method can effectively reduce pain intensity as well as the amount opioid use after lumbar laminectomy and discectomy

A Cross-Sectional Study Examining the Correlation between Nocturnal Melatonin Level and Sleep Quality in Patients Admitted To the Cardiac Care Unit

BACKGROUND: Quality of sleep, as a basic need, is an important factor for surviving patients in hospitals. Many factors may contribute to disturbing patients sleep, such as continuous ambient light, is required for healthcare providers to monitor patients. Ambient light can influence patients' quality of sleep due to melatonin secretion. AIM: Study aimed to determine the correlation between nocturnal melatonin levels and sleep quality in patients admitted to the Cardiac Care Units (CCU). MATERIAL AND METHODS: This cross-sectional study was done on inpatients of CCUs at Amir-Almomenin Hospital in Kordkoy city, a cardiac referral hospital in the northeastern of Iran in 2015. Sixty-eight inpatients were selected through convenience sampling. Before data gathering light level of CCUs was measured every one hour in 2 days, the quality of nocturnal sleep was investigated through Verran and Snyder-Halpern (VSH) Sleep Scale at the second night of admission urinary melatonin level was measured at the same night in all urine excreted between 22:00 pm and 07:00 am. RESULTS: The mean and standard deviation (SD) score of sleep quality in three dimensions of sleep disturbance, sleep effectiveness and sleep supplementation were 336.6 ± 149.9, 269.0 ± 82.2, and 175.2 ± 30.7, respectively. Also, the mean and SD of nocturnal urinary melatonin levels was 323.02 ± 136.21 pg/ml. There was not a significant correlation between level of nocturnal melatonin and three domains of sleep quality; sleep disturbance (r = 0.005, P = 0.968), sleep effectiveness (r = 0.090, P = 0.464), and sleep supplementation (r = -0.037, P = 0.763). CONCLUSION: According to the result, most CCUs patients suffer from sleep disturbance. However, there was no correlation between the level of melatonin and sleep quality. There is a need for recognising the reasons for sleep disturbances in Cardiac Care Units. It is imperative for care providers to be able to recognise the causes of sleep disturbances and to modify environmental factors such as ambient light to improve sleep quality in hospitalised patients

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Barriers to and Facilitators of Research Utilization among Iranian Nurses: a Literature Review

Introduction: Research utilization (RU), is an important strategy to promote the quality of patient care. The aim of this study was to present a comprehensive literature review describing barriers and facilitators of RU among Iranian nurses. Methods: Literature review was undertaken using the international databases including Pub Med/Medline, Scopus, Science Direct, and Google Scholar. Also, Persian electronic databases such as Magiran, SID and Iran Medex were searched up to May 2014. The search was limited to articles in the English and Persian languages that evaluate the barriers or facilitators of RU among Iranian nurses. Results: A total of 11 articles were in the final dataset. The most important barriers to RU among Iranian nurses were related to the organization factors such as inadequate facilities; insufficient time on the job, lack of authority, physician cooperation, and administrative support. The most frequent facilitators of RU were education in enhancing nurses knowledge and skills in research evaluation, support from knowledgeable nursing colleagues and nursing faculty in the clinical setting, access to an expert committee for clinical appraisal, improving skills in English language and searching for articles, sufficient economic resources to carry out research, and having access to more facilities such as internet. Conclusion: Iranian nurses encounter with the same difficulties as to other countries regarding RU; while setting related barriers were the predominant obstacles to RU among them. Therefore, health managers are expected to plan appropriate strategies to smooth the progress of RU by nurses in their practice

The Missing Position in Practice: A Neglected Issue in Community Health Nursing in Iran

Global social and economic changes have not only led to substantial increases in elderly populations but also the manifestation of numerous degenerative and chronic diseases, and new patterns of disease caused by occupational hazards, environmental pollution and accidents.1,2 Today, public health concerns related to quality care, cost of medical services and low access to health care centers have led to a shift in the paradigm of healthcare from the traditional care settings to community centers.1 With regards to the same points, the health systems in a society must acquire the capabilities required for better meeting the ever-growing demands resulting from these changes.3 In order to meet these increasing needs and to raise the overall healthcare level of its communities, the Islamic Republic of Iran has envisioned short- and long-term plans within the framework of the 2025 Horizon Plan in various fields of research, education and provision of healthcare services.4 In line with this aim, the office of the High Commissioner for medical planning in the country has recently revised the educational curriculum for the Master’s course of community health nursing and has drawn outlines in order to focus the career position of their graduates on a community-oriented approach, in places such as healthcare centers, hospitals, rehabilitation centers, schools, addiction treatment centers, emergency services and natural disaster committees, and in all other organizations needing the services of community health nurses. Moreover, according to the vision drawn out in this plan, in the next ten years (by 2025) the graduates of community health nursing must be able not only to meet the changing needs of Iranian society, but also clearly attain regional and global standards in nursing education and offer effectual service to all members of the society.5 In addition, in most countries of the world, keeping such curriculum visions in mind, curriculum designers facilitate the career position of community health nurses so that they can give care to individuals, families and communities. Furthermore, the number of these nurses working outside the hospital in the community at large has increased substantially, and the community is called their clients.1 While in Iran, community health nurses after graduating with Master’s degree are in practice faced with an absence of specifically defined job positions even though the curriculum has designated the correct future occupational status. Therefore, Iranian community health nurses are mostly forced into employment in clinical settings or educational centers and do not have the ability like their counterparts in other countries to find a job and start serving at health centers which, as mentioned above, are predetermined before graduation.6 Now, in view of the above mentioned points, considering the absence of suitable tools for directing these community health nurses to their appropriate occupational and professional positions, this question arises that to what extent the devised long-term objectives (Horizon 2025) of the Islamic Republic can be achieved. It is recommended that the present process of employing community health nurses should be revised so that it facilitates their real occupational and professional positions resulting in providing better services to their clients

Patient education among nurses: bringing evidence into clinical applicability in Iran

The aim of this study was to present acomprehensive review of the literatures describingbarriers and facilitators of patient education (PE)perceived by Iranian nurses in order to explainclinical applicability of patient education. Methods.Review of the literature was undertaken using theinternational databases including PubMed/Medline,Scopus, ScienceDirect, as well as Google Scholar. Also,Persian electronic databases such as Magiran, SID andIranMedex were searched. Electronic databases weresearched up from conception to September 2014 usingsearch terms: “patient education”, “ patients education”,“patient teaching”, “patient training”, “nurse”, “nurses”, “ nursing”, “ and “Iran”. Only studies wereincluded that were related to barriers and facilitatorsof PE among Iranian nurses. Results. Twenty-sevenstudies were included. The main influential barrierswere categorized into three major areas: 1) Nurserelatedfactors: nursing shortage 2) Administrationrelatedfactors: unsupportive organizational culture, and3) Patient-related factors: low compliance. The mostperceived facilitators were recognized as “increasing,selecting and training special nurses for providing PE”and “providing PE courses for nurses and appropriatefacilities for PE”. Conclusion. Iranian nurses encounterbarriers in PE, and the most frequently encounteredbarriers were related to administration factors. Thesefindings have implications for administrators andmanagers in health settings. In order to promotePE among nurses, administrators should create asupportive environment and use effective strategies tosmooth the progress of PE by nurses in their practice inorder to ensure optimal outcomes for patients.Objetivo. Identificar as barreiras e facilitadores da educação do paciente (EP) percebida pelas enfermeiras iranianas com o fim de explicar a aplicabilidade clínica da educação ao paciente. Métodos. Revisão da literatura que se levou a cabo utilizando as bases de dados internacionais PubMed-Medline, Scopus, ScienceDirect e Google Scholar. Ademais, se realizaram buscas nas bases de dados electrónicas persas Magiran, SID e IranMedex. Se realizaram buscas desde a criação das bases de dados até setembro de 2014 usando os termos de busca: “educação do paciente”, “educação de pacientes”, “ensinamento do paciente”, “treinamento do paciente”, “enfermeira”, “enfermeiras”, e “Irã”. Só se analisaram os estudos relacionados com as barreiras e facilitadores de EP entre enfermeiras iranianas. Resultados. Se incluíram 27 estudos. As principais barreiras foram classificadas em três grandes áreas: 1) Fatores relacionados com a enfermagem: escassez deste recurso humano, 2) Fatores relacionados com a administração: inapropriada cultura organizacional y 3) Fatores relacionados o paciente: baixo cumprimento. Os facilitadores mais percebidos foram reconhecidos como “o aumento, a seleção e formação especial das enfermeiras para proporcionar EP” e “disponibilidade de cursos de EP para as enfermeiras e a disponibilidade de instalações adequadas brindar o EP”. Conclusão. As enfermeiras iranianas encontram barreiras na EP, sendo as mais frequentes as relacionadas com fatores da gestão dos recursos. Estes resultados têm implicações para os administradores e diretivos das instituições de saúde, pois para promover que as enfermeiras em sua prática brindem a EP, se deve criar um ambiente de apoio e utilizar estratégias eficazes com o fim de garantir resultados ótimos nos pacientes.Objetivo. Identificar las barreras y facilitadores de la Educación del Paciente (EP) percibida por las enfermeras iraníes con el fin de explicar la aplicabilidad clínica de la educación al paciente. Métodos. Revisión de la literatura que se llevó a cabo utilizando las bases de datos internacionales PubMed-Medline, Scopus, ScienceDirect y Google Scholar. Además, se realizaron búsquedas en las bases de datos electrónicas persas Magiran, SID e IranMedex. Se realizaron búsquedas desde la creación de las bases de datos hasta septiembre de 2014 usando los términos de búsqueda: “educación del paciente”, “educación de pacientes”, “enseñanza del paciente”, “entrenamiento del paciente”, “enfermera”, “enfermeras”, e “Irán”. Solo se analizaron los estudios relacionados con las barreras y facilitadores de EP entre enfermeras iraníes. Resultados. Se incluyeron 27 estudios. Las principales barreras se clasificaron en tres grandes áreas: 1) Factores relacionados con la enfermería: escasez de este recurso humano, 2) Factores relacionados con la administración: inapropiada cultura organizacional y 3) Factores relacionados el paciente: bajo cumplimiento. Los facilitadores más percibidos se reconocieron como “el aumento, la selección y formación especial de las enfermeras para proporcionar EP” y “disponibilidad de cursos de EP para las enfermeras y la disponibilidad de instalaciones adecuadas para brindar el EP”. Conclusión. Las enfermeras iraníes encuentran barreras en la EP, siendo las más frecuentes las relacionadas con factores de la gestión de los recursos. Estos resultados tienen implicaciones para los administradores y directivos de las instituciones de salud, pues para promover que las enfermeras en su práctica brinden la EP, se debe crear un ambiente de apoyo y utilizar estrategias eficaces con el fin de garantizar resultados óptimos en los pacientes