Effects of Intraluminal Vancomycin in Decreasing Central Venous Catheter Infection

Background: Central venous catheters (CVC) are important intravenous routes, that nowadays they can be used for various reasons including resuscitation management, intravenous feeding, chemotherapy drugs, and blood transfusions. Due to the special importance and increasing usage of these catheters lengthening the duration of these catheters are very important. Infections are the most common cause of removal of this catheter.Methods: In this prospective study (cohort), 80 patients with central venous catheter were divided into two groups. In the first group Vancomycin once per day injected inside catheter equal to their intraluminal volume and remained for 2 h, then catheter was aspirated and washed. But in control group catheter was washed only with normal saline. Finally, catheter infection rates in the two groups were compared.Results: In the group that used intraluminal Vancomycin, catheter infection was ‎observed in 3 cases and was confirmed by blood culture, but in none of them ‎catheter infection agent was not Gram-positive cocci.‎ In control group, 18 cases of catheter infection were confirmed by culture that in 16 cases were caused by Gram-positive cocci that in 14 cases catheter was removed, and in 2 cases of catheter infection, infectious agent was Staphylococcus epidermidis which catheter maintained with appropriate antibiotics.Conclusions: Use of the intraluminal Vancomycin significantly reduces the rate of infection and thus increase the survival rate of CVC

The Effect of Ticlopidine on Early Arteriovenous Fistula Thrombosis: A Randomized Clinical Trial

Background: Arteriovenous (AV) fistula is the first choice of a long-term vascular access for hemodialysis, but there is a 20-30% probability of thrombosis in the 1st month after its creation. Ticlopidine is a potent drug, which inhibits both primary and secondary platelet aggregation. This study is performed to evaluate the effect of ticlopidine in the prevention of AV fistula.Methods: Totally 124 patients in need of an AV fistula were divided into two groups after creation of their fistula. In the first group, we prescribed ticlopidine for 62 patients, and in the second group, 62 patients received placebo. The two groups were compared to see if their fistulas are patent or thrombotic after 1 and 3 months.Results: Of the 62 patients who received ticlopidine, four had fistula thrombosis, while in 62 patients who received placebo, 16 had fistula thrombosis (P = 0.003). This shows the significant effect of ticlopidine in the prevention of thrombosis in AV fistulas. Also, we compared age, sex, and the fistula location in the ticlopidine and placebo groups, and these attributes had no significant difference between the two groups (P > 0.050).Conclusions: Considering the significant value of ticlopidine in the prevention of AV fistula thrombosis, it can be recommended after the surgery if there is no contraindication for its use

Near infrared spectroscopy : novel signal processing methods and applications

Oxygen is a critical component in living organisms and its concentration in tissue is an important parameter indicative of tissue metabolism, level of activity and health condition. As a result, measuring oxygen concentration in the tissue is essential in many clinical and research applications. Near Infrared Spectroscopy (NIRS) is a non invasive method of measuring tissue oxygenation using diffusion of light in the tissue. NIRS as a safe, non invasive and low cost monitoring technology has been used in a wide range of applications including monitoring muscle and brain oxygenation, brain computer interface and rehabilitation. The motivation for this thesis has been to develop new signal processing methods and to investigate potential new applications for NIRS. One major characteristic of NIRS is its sensitivity to movement of the target tissue during the measurement. The effects of movements, known as motion artifacts, have limited clinical applications of NIRS in ambulant patients as well as experimental applications of NIRS monitoring in areas such as exercise science and sports medicine. In this thesis, we present a new method of reducing the effect of motion artifacts on NIRS signal using Discrete Wavelet Transform (DWT). One of the areas of application which can significantly benefit from reduction of motion artifacts is NIRS-based wearable sensors. In particular, a potential and unexplored application of NIRS is providing a monitoring method for people with bladder control problems, which occurs in a variety of conditions including spinal cord injury and stroke. We investigate the application of NIRS for detection of bladder filling to capacity using a wearable wireless monitoring sensor which can be used to warn the subject once the bladder content reaches a predefined percentage of the full capacity. NIRS can be used as a functional neuroimaging method to identify brain activations during practice of a motor/cognitive task. One important question in this field is how the activated brain areas are interconnected. We thus investigate the use of phase information in NIRS channels to identify cortical connections and in particular, show the applicability of this approach in identifying language network in human infants.Applied Science, Faculty ofElectrical and Computer Engineering, Department ofGraduat

Prioritization and Selection Agility Capability Using Fuzzy TOPSIS and Fuzzy DEA Approach

Different methods for prioritization and selection of agility capabilities are presented. And most of them are compensatory multi-criteria decision making methods. With Compensation methods in some cases sufficiently accurate and precise results are not achieved. Because of the weakness of an agility, capabilities in one criteria will be offset by strengths in other criteria. In this paper, using the technique of data envelopment analysis an approach for prioritizing agility capabilities is offered. This method has higher accuracy compared with previous methods. This study was conducted in two successive stages. Agility drivers have been identified in the first stage, and in the second phase the required capabilities to meet the drivers, are prioritized. Firstly, based on three criteria of difficulties, the impact on the activities of the organization and intensity of change, organizational agility drivers ranked and key drivers are selected. The fuzzy TOPSIS and fractional programming techniques are used. Secondly, using the fuzzy DEA technique agility capabilities derived from the research literature base on their impact on key agility drivers are assessed and prioritized. Method presented in one piece construction of state-owned industries has been examine

Primitive Neuroectodermal Tumour Invading the Inferior Vena Cava

n the present report, we describe our experience with a 44-year-old male with abnormal retroperitoneal primitive neuroectodermal tumours (PNETs) in our hospital, who was operated on with a spindle cell neoplasm diagnosis

The Role of Moral Intelligence of Emergency Physicians in Predicting Satisfaction of Patients

زمینه و هدف: نقش مهم هوش اخلاقی در تغییر نگرش افراد نسبت به رفتارهای مختلف و توجه به اهمیت این متغیر در مشاغل مختلف و به ویژه در حرفه پزشکی به دلیل تماس دائمی و مستقیم با مراجعان انسانی ضروری به نظر می‌رسد. بنابراین تحقیق حاضر با هدف بررسی نقش هوش اخلاقی پزشکان شاغل در اورژانس در پیش‌بینی رضایتمندی بیماران مراجعه‌کننده به بیمارستان‌های شهر اردبیل انجام شده است. مواد و روش‌ها: مطالعه حاضر به روش توصیفی ـ ‌‌‌تحلیلی و به صورت مقطعی صورت گرفت. جامعه آماری این مطالعه کلیه پزشکان و بیماران مراجعه‌کننده به بخش اورژانس بیمارستان‌های شهر اردبیل بودند که تعداد 56 پزشک شاغل در 4 بیمارستان آموزشی شهر و 392 بیماران متناظر آن‌ها با استفاده از روش نمونه‌گیری در دسترس انتخاب شدند. برای جمع‌آوری داده‌های این مطالعه از پرسشنامه هوش اخلاقی Lennik & Kiel (2005 م.) و مقیاس رضایتمندی بیماران سلامی و سموعی (1390 ش.) استفاده شد. داده‌های جمع‌آوری‌شده با استفاده از آزمون‌های آماری توصیفی و تحلیلی، توسط نرم‌افزار آماری SPSS 22 تجزیه و تحلیل شدند. یافته‌ها: یافته‌های به دست‌‌آمده از این تحقیق نشان داد که همبستگی مثبت و معنی‌داری بین هوش اخلاقی پزشکان و رضایتمندی بیماران وجود دارد (528/0=r، 001/0=p). همچنین نتایج تحلیل رگرسیون نشان داد که هوش اخلاقی پزشکان می‌تواند 6/26 درصد از رضایتمندی بیماران را پیش‌بینی کند (001/0p<). ملاحظات اخلاقی: در فرایند اجرای این تحقیق کلیه ملاحظات اخلاقی مربوط به مطالعات انسانی مانند کسب رضایت آگاهانه و توضیح در مورد محرمانه‌ماندن مشخصات شرکت‌کنندگان در پژوهش رعایت گردید. نتیجه‌گیری: با توجه به نتیجه حاصل از تحقیق حاضر می‌توان گفت که هوش اخلاقی پزشکان عاملی مهم در رضایت مراجعان از خدمات درمانی دریافتی است، لذا پیشنهاد می‌شود تا در دوره‌های آموزشی پزشکان از آموزش مهارت‌هایی مانند آموزش نحوه برقراری ارتباط، همدلی، مسؤولیت‌پذیری و شفقت درمانی استفاده شود.Background and Aim: Considering the important role of moral intelligence in changing people's attitudes towards different behaviors, it seems necessary to pay attention to the importance of this variable in different jobs especially in the medical profession due to constant and direct contact with human clients. Therefore, the purpose of the present study was to investigate The Role of Moral Intelligence of Emergency Physicians in Predicting Satisfaction of Patients Referred to Ardabil Hospitals. Materials and Methods: The present study was a descriptive-analytical and cross-sectional study. The study population consisted of all physicians and patients referring to the emergency department of Ardabil hospitals. In this study, 56 physicians working in 4 teaching hospitals of Ardabil city and 392 corresponding patients were selected by Available sampling method. For data collection Lennick and Kiel’s (2005) Moral Intelligence Questionnaire and Salami S & Samouei (2012) Patient Satisfaction Questionnaire were used. Data were analyzed by Pearson correlation coefficient and multivariate regression using SPSS 22 statistical software. Findings: The obtained data from this study showed that there is a significant positive correlation between physicians 'moral intelligence and patients' satisfaction (r=0.528, p=0.001). Also, the results of regression Analysis showed that physicians 'moral intelligence can predict the 26/6 percentage of patients' satisfaction (p<0/001). Ethical Considerations: In the process of conducting this research, all ethical considerations related to human studies such as obtaining informed consent and maintaining the confidentiality of the participants in the research were observed. Conclusion: According to the results of the present study, it can be said that moral intelligence is an important factor in patients' satisfaction of received medical services, therefore, it is suggested that skills training such as communication enrichment, empathy, responsibility and compassion therapy be used in physicians' training courses.   Cite this article as: Seyed Ahadi SM, Molaei B, Ayadi N, Molavi P, NaderMohammadi M. The Role of Moral Intelligence of Emergency Physicians in Predicting Satisfaction of Patients. Med Ethics J 2020; 14(45): e25

Near-Infrared Spectroscopic Screening for Bladder Disease in Africa: Training Rural Clinic Staff to Collect Data of Diagnostic Quality

Background. While near-infrared spectroscopy (NIRS) has recognized relevance for developing countries, biomedical applications are rare. This reflects the cost and complexity of NIRS and the convention of comprehensive training for accurate data collection. In an international initiative using transcutaneous NIRS to screen for bladder disease in Africa, we evaluated if interactive training enabled clinic staff to collect data accurately. Methods. Workshop training in a Ugandan medical clinic on NIRS monitoring theory; bladder physiology and chromophore changes occurring with disease; device orientation; device positioning over the bladder, monitoring subjects during voiding; and saving/uploading data. Participation in patient screening followed with observation, assistance, and then data collection. Evaluation comprised conduct of serial independent screenings with analysis if saved files were of diagnostic quality. Results. 10 individuals attended 1-hour workshops and then 0.5–3.0 hours of screening. Five then felt able to conduct screening independently and all collected data were of diagnostic quality (>5 consecutive patients); all had participated in screening for >1.5 hours (6+ subjects); less participation allowed competent assistance but not consistent adherence to the monitoring protocol. Conclusion. A simplified NIRS system, small-group theory/orientation workshops, and >I.5 hours of 1 : 1 training during screening enabled clinic staff in Africa to collect accurate NIRS data

Extracting instantaneous respiratory rate from multiple photoplethysmogram respiratory-induced variations

In this study, we proposed a novel method for extracting the instantaneous respiratory rate (IRR) from the pulse oximeter photoplethysmogram (PPG). The method was performed in three main steps: (1) a time-frequency transform called synchrosqueezing transform (SST) was used to extract the respiratory-induced intensity, amplitude and frequency variation signals from PPG, (2) the second SST was applied to each extracted respiratory-induced variation signal to estimate the corresponding IRR, and (3) the proposed peak-conditioned fusion method then combined the IRR estimates to calculate the final IRR. We validated the implemented method with capnography and nasal/oral airflow as the reference RR using the limits of agreement (LOA) approach. Compared to simple fusion and single respiratory-induced variation estimations, peak-conditioned fusion shows better performance. It provided a bias of 0.28 bpm with the 95% LOAs ranging from -3.62 to 4.17, validated against capnography and a bias of 0.04 bpm with the 95% LOAs ranging from -5.74 to 5.82, validated against nasal/oral airflow. This algorithm would expand the functionality of a conventional pulse oximetry beyond the measurement of heart rate and oxygen saturation to measure the respiratory rate continuously and instantly

Endovascular Repair of Supra-Celiac and Abdominal Aortic Pseudo Aneurysms Concomitant with a Right Atrial Mass in a Patient with Behçet’s Disease: A Case Report

Behcet’s disease is a rare immune mediated systemic vasculitis which besides it’s more frequent involvement of eyes and skin,   sometimes present with aortic pseudo aneurysm and more rarely cardiac inflammatory masses.A 51-year-old patient with Behçet’s Disease presented with two symptomatic aortic pseudoaneurysms concomitant with a right atrial mass. Computed tomography (CT) revealed one supra-celiac and another infrarenal aortic pseudoaneurysms. Echocardiography showed a large mobile mass in the right atrium. Both pseudoaneurysms were successfully excluded simultaneously via endovascular approach with Zenith stent-grafts, and the atrial mass was surgically removed 10 days later. Post-implant CT showed successful exclusion of both pseudo-aneurysms, patency of all relevant arteries, and patient is now asymptomatic and has returned to normal lifestyle. Multiple pseudoaneurysms concomitant with a right atrial mass can be an initial manifestation of Behçet’s disease. Endovascular repair can be a good treatment option for the pseudoaneurysms