Impalement Thoracoabdominal Trauma Secondary to Falling on Metallic (Iron) Bars: An Extremely Rare and Unique Case

Introduction: Penetrating thoracoabdominal injuries are potentially life threatening due to the associated hemorrhagic shock and visceral injury. Through and through penetrating injury with polytrauma is rarely encountered. Case Presentation: Here we report on a 25-year-old male with penetrating thoracoabdominal injury caused by a metallic (iron) bar projecting from a pillar of a construction site after he fell down from a height. Conclusions: Anesthetic and surgical management was difficult due to the inability to position in supine and rapidly progressing hemorrhagic shock. Surgical management for extraction of this iron bar and intensive monitoring and resuscitation resulted in an uneventful successful outcome

Cardiovascular patients� experiences of living with pacemaker: Qualitative study

BACKGROUND: A pacemaker implantation is considered major life event for cardiovascular patients, so they will probably have very interesting experiences of living with this device. The aim of this study was to explore the experiences of cardiovascular patients living with the pacemaker. METHODS: In this qualitative study, 27 patients were chosen through purposive sampling to achieve data saturation, and their experiences were examined using semi-structured interviews. The patients� statements were recorded with their consent and analyzed using content analysis method. RESULTS: Participants� experiences included three main themes: �Problems and limitations,� �feeling and dealing with pacemaker�, and �sources of comfort� and 10 sub-themes including: physical problems, financial problems, social problems, the first encounter, the feeling of living with the pacemaker, how to cope with pacemaker, satisfaction with pacemaker, good family support, hospital and hospital staff performance, and role of religious beliefs. CONCLUSION: Planning to solve social problems, identifying and changing feelings of patients using pacemakers, reinforcing the resources of comfort especially family support seem to be necessary steps for improving quality of life and impact of using pacemaker. © 2015 Isfahan University of Medical Sciences(IUMS). All rights reserved

Breast cancer screening barriers from the womans perspective: A meta-synthesis

Background: The principal aim of health service providers in the field of breast cancer is to detect and treat lesions at an appropriate time. Therefore, identification of barriers to screening can be very helpful. The present study aimed to systematically review the qualitative studies for extracting and reporting the barriers of screening for breast cancer from the womans perspective. Materials and Methods: In this systematic review; Pubmed, Google Scholar, Ovid Scopus, Cochrane Library, Iranmedex, and SID were searched using the keywords: screening barriers, cancer, qualitative studies, breast and their Persian equivalents, and the needed data were extracted and analyzed using an extraction table. To assess the quality of the studies, the Critical Appraisal Skills Programme (CASP) tool was used. Results: From 2,134 related articles that were found, 21 articles were eventually included in the study. The most important barriers from the point of view of 1,084 women were lack of knowledge, access barriers (financial, geographical, cultural), fear (of results and pain), performance of service providers, women's beliefs, procrastination of screening, embarrassment, long wait for getting an appointment, language problems, and previous negative experiences. Articles' assessment score was 68.9. Conclusions: Increasing women's knowledge, reducing the costs of screening services, cultural promotion for screening, presenting less painful methods, changing beliefs of health service providers, provision of privacy for giving service, decreasing the waiting time, and providing high quality services in a respectful manner can be effective ways to increase breast cancer screening

Accuracy of Endosonography in the Diagnosis of Obstructive Jaundice

Background and Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) has been used as the method of choice in assessment of obstructive jaundice for a long time. Recently, the development of endoscopic ultrasonography (EUS) has attracted the attention of clinicians as an alternative accurate, safe and cheap method to replace the ERCP procedures performed only for diagnostic purposes. Methods: In this study, 100 patients underwent endoscopic ultrasonography in Digestive Disease Research Center, Shariati Hospital. The patients were divided into two groups: 1) those with operable periampullary tumors who were referred to the surgeons, 2) other patients. The final diagnosis made after ERCP and operative removal of the mass was considered as the gold standard and was compared with accuracy of endoscopic ultrasonography. Results: The overall accuracy of endoscopic ultrasonography in the diagnosis of obstructive cholestasis was 92.0%. Sensitivity and specificity of this method in diagnosis of choledocholithiasis were 95.2% and 96.4% respectively. The corresponding values for diagnosis of periampullary tumors were 96.2% and 95.8%. Conclusion: In this study the accuracy of EUS in diagnosis of obstructive jaundice and its sensitivity and specificity for diagnosis of choledocholithiasis and periampullary tumors were high. Therefore, it could be concluded that endoscopic ultrasonography is a reliable diagnostic tool for extrahepatic cholestasis. Keywords: Endoscopy; Endosonography; Obstructive Jaundice; Jaundic

Attitudes and Knowledge of Iranian Nurses about Hospice Care

CONTEXT: Due to expansion of chronic diseases and increase of health care costs, there is a need for planning and delivering hospice care for patients in their final stages of life in Iran. The aim of the present study is to investigate the knowledge and attitudes of nurses about delivering hospice care for End of Life (EOL) patients. MATERIALS AND METHODS: This cross-sectional study was conducted in 2012 with a sample size of 200 nurses that were selected by convenient (available) sampling. The data collection instrument was a self-administered questionnaire whose validity was approved by experts' opinions and its reliability was approved by test-retest method. RESULTS: Among all participants of this study, 87% were female. The mean age of nurses was 32.00 ± 6.72. From all respondents 62% stated that they have no knowledge about hospice care and 80% declared that need for hospice care is increasing. Most of the participants felt that, appropriate services are not presented to patients in the final stages of their lives. About 80% believed that hospice care leads to reduction of health care costs, improvement of physical, mental and social health of patients and finally improvement of the quality of health care services. There was a significant relationship between age, employment history and level of education of nurses and their attitude and knowledge about how this service is provided. CONCLUSION: In view of the increase in chronic illnesses and the costs of caring, the need for provision of hospice care is felt more and more every day. However the awareness level of nurses about these services is low. Therefore the need for including these issues in nursing curriculum and holding scientific courses and seminars in this field is needed

Evaluation of mechanical ventilation mean duration and its predicting factors during transhiatal esophagectomy in patients with esophageal cancer

Background: Esophagenctomy is the principle treatment for esophageal and gastroesophageal junction malignancies. Postoperative respiratory failure and other respiratory problems like athelectasis and severe hypoxia occur frequently after esophageal cancer surgeries. Such patients mostly need ICU care and mechanical ventilation. The aim of present study was to evaluate mean duration of mechanical ventilation and its predictor factors during esophageal resection in middle and distal esophageal cancers. Methods: This cross sectional analytic study performed in Al Zahra hospital, Isfahan on medical records of 70 patients with middle and distal esophageal cancer operated by transhiatal method in Department of Thoracic Surgery. Patient's age, sex, tumor location, duration of mechanical ventilation, duration of operation, spirometry findings (FEV1), weight loss, need for transfusion, and serum albumin level on admission extracted from medical charts. Finally all data were analyzed by SPSS16 using chi-square and t tests. Finding: Patient's mean age was 60.71 ± 11.81 years and 64.3 of them were men. Pathologically, 43 patients (61.4) and 26 patients (37.1) were diagnosed by SCC and adenocarcinoma respectively. Totally frequency of complications were 41.4, and 7.1 of subjects were died within first 30 days. 15 patients (21.4) were mechanically ventilated after surgery with mean duration of 1.34 day. Mean duration of mechanical ventilation showed no association with intraoperative pleural rapture, intraoperative blood transfusion, anastomosis leakage, type of pathology, postoperative anastomotic stricture, and empyema. However mean duration of mechanical ventilation were significantly higher in died patients within 30 days after surgery, reintubated subjects, patients with serum albumin level of less than 3.5 g/dl, and patients with less than 2 liter FEV1. Among quantitative variables, only FEV1 were associated with mean duration of mechanical ventilation. Conclusion: As our data showed hypoalbuminemia (which reflects subsequent malnutrition) and less than 2 liter FEV1 is correlates with prolonged mechanical ventilation (and probably more mortality) it is recommended to improve nutritional condition as well as pulmonary function preoperatively to shortened duration of mechanical ventilation and prohibit mortality rate