Morphine in Plasma and Cerebrospinal Fluid of Patients Addicted to Opiates Undergoing Surgery: High-performance Liquid Chromatography Method

Background: The prevalence of opium addiction among Iranians is considerable. Since endogenous opioid systems may be altered as a consequence of addiction, it is very important to determine the plasma and cerebrospinal fluid (CSF) levels of morphine in Iranian patients addicted to opiates who will undergo surgery.Methods: We obtained CSF and plasma samples from 50 volunteers with an established opioid addiction pattern. Samples were analyzed using high-performance liquid chromatography (HPLC). Additionally, frequency of nausea and vomiting, baseline heart rate (BHR), and systolic blood pressure (SBP) were recorded within the surgery and postoperatively during a 10-min interval.Findings: 84% of participants were men with a median age of 39.08 years. Mean score of body mass index (BMI) was 23.30 and most of the participants (46%) used opium in its traditional inhaled form. A higher concentration of morphine in blood was found in comparison with CSF (P < 0.001) in relation to the way of use. However, no statistically significant differences were found in relation to the type of addictive substance. No other association was found between the levels of morphine and the clinical characteristics of the patients. Moreover, results revealed no difference between hemodynamic-related data with blood and CSF level in opium-dependent patients.Conclusion: Quantification of plasma and CSF morphine, both immediately before initiation of surgery and subsequently on recovery room, showed that although clinical efficacy of systemic morphine was poor in addicted patients, it had no effect on patients’ hemodynamic variable and following complications after surgery

Implementing the Internship Educational Method, a Step to Reduce the Gap between Theory and Practice, Experience of Undergraduate Nursing Students: A Qualitative Content Analysis Study

Background: An internship project can be considered as a useful step for nursing interns in the transition period and bridge the theory-practice gap in nursing. Since the acquisition of professional competence and skills by students is essential, the present study attempted to provide a deep understanding of nursing students’ experiences.Methods: This study was conducted using a qualitative content analysis approach in the School of Nursing of Kerman University of Medical Sciences in 2020. The participants in the research sample were senior undergraduate nursing students who were selected using purposive sampling. The data were collected through semi-structured interviews with the participants and each interview lasted 60 to 90 minutes. A total of 27 interviews were conducted with 25 students. The collected data were analyzed using a qualitative content analysis method (Graneheim & Lundman, 2004). MAXQDA 20 software was also used to analyze the qualitative data.Results: The core category that emerged from the analysis of qualitative data was “implementing an internship program; a step to bridge the theory-practice gap”, which was divided into three main categories: “transferring knowledge and experiences”, “promoting the cooperation between the faculty members and the hospital staff”, and “improving the process of clinical care”.Conclusion: Internship programs that are considered a new training technique can increase cooperation between nursing schools and contribute to promoting nursing knowledge in nurses by supporting students and promoting their scientific skills