A study of the correlation between ventilator associated pneumonia and mortality rate of traumatic in patients in intensive care units

Background: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection among the traumatic in-patients in Intensive Care Units (ICUs). Trauma is a risk factor for the incidence of VAP, yet, the association between VAP and outcome is not clear in traumatic in-patients in ICUs. This study investigated the correlation between ventilator-associated pneumonia and mortality rate of traumatic in-patients in ICUs in Be'that Hospital in Hamedan, western Iran.Methods: This observational prospective study was conducted in the ICU of Be'that Hospital, Hamedan, Iran, during 1 year (March 2013 until February 2014). The population under study included traumatic in-patients aged less than 18 year who were in need of invasive mechanical ventilation for more than 48 h with APACHE SCORE II of less than 25. They were studied for the incidence or lack of incidence of VAP.Results: Of 154 patients under study, 114 cases (74%) suffered from multiple traumata, 32 cases (20.8%) were affected with head trauma, 5 cases (3.2%) sustained spinal cord injury, and 3 cases (1.9%) suffered from thoracic trauma. Also, 47 cases (30.5%) were affected with VAP. Compared to the non-VAP group, the patients in VAP group had longer ICU stay (18.5±6.21 days vs. 9.21±2.91 days, P<0.001), longer intubation time (13.7±4.7 days vs. 6.06±2.05 days, P<0.001), longer mechanical ventilation time (12.9±5.1 days vs. 5.7±1.9 days, P<0.001), and more repeated intubations (1.2±0.50 vs. 1±0.0, P<0.001). There was no statistically significant difference between the two groups with respect to APACHE SCORE II (14.8±2.3 vs. 14.9±2.9). Additionally, there was no significant difference between the two groups regarding mortality rate (10.6 vs. 5.6, P=0.215).Conclusions: VAP caused longer ICU stay, increased intubation time, increased mechanical ventilation time, and more repeated intubations in traumatic in-patients, yet, it did not increase mortality rate in these patients. Patients with spinal cord and thoracic traumata are at risk for affliction with VAP.

The Methodological Quality Assessment of Published Papers based on Family-Centered Empowerment Model: A Scientometric Study

Background: According to the widespread prevalence of different chronic diseases, nurses need to know the choices, necessities, and abilities of patients. The study purpose was to investigate the methodological quality of published papers based on Family-Centered Empowerment Model (FCEM). Methods: This study was a systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used to retrieve all national and international studies in the field of FCEM. The final papers were reviewed for different methodological dimensions using three quantitative scales: Jadad, Consolidated Standards of Reporting Trials (CONSORT) 2010, and Newcastle-Ottawa, and qualitative scale of Cochrane risk of bias. Findings: In the initial search, 644 papers were retrieved; following PRISMA screening guideline, 47 relevant papers were recognized. Jadad scale scores showed that one study received a score of 5 and 33 received a score of less than 3. Consort scale scores indicated that four studies were scored 7 and the same number were scored less than 5. The Newcastle-Ottawa scale scores showed that 13 studies were scored 8, and 4 were scored less than 4. The five dimensions of Cochrane's risk of bias scale are detailed in the paper. Conclusion: The methodological quality of applied studies based on the FCEM was relatively good, but their reporting style and quality were inadequate

Effect of empowerment program based on the health belief model on the activity daily living of patients' with acute coronary syndrome: A clinical trial

Introduction: Cardiovascular diseases are major cause of early disability in the community workforces; in addition to the patient, it affects other family members and even the community. The aim of the study was to explore the effect of empowerment program according to the health belief model (HBM) on the activity daily living (ADL) of patients with acute coronary syndrome (PACS). Materials and Methods: The double-blinded-randomized-controlled clinical-trial was conducted on the 70-PACS in the year 2016-2017. Patients were randomly assigned in the intervention and control groups by convenience sampling and random allocation with quadric-blocks. Considerably, at the first, the ADL questionnaire was filled-out in the two groups, then, for the intervention group, the empowerment program according to the HBM in 7-session and for the control group, the usual care was conducted. Immediately, one and three months later, the questionnaire was filed out in the two groups, again. Results: The mean and standard deviation of ADL of patients immediately after intervention in the intervention were 3.2 ± 3.48 and in the control groups were 0.03 ± 1.47. The two groups were matched according to the demographic information (P>0.05). The comparison of changes in the ADL in the two intervention and control groups showed that the changes in the post-intervention than the pre-intervention were significantly higher in the intervention than the control group (P <0.001). Conclusion: The results of the study showed that the empowerment program according to the HBM could increase the ADL of patients with acute coronary syndrome. © 2019, Semnan University of Medical Sciences. All rights reserved

Serum vitamin D level was not associated with severity of ventilator associated pneumonia

Background and Objective. Vitamin D deficiency is considered one of the most common nutritional deficiencies associated with weakened immune system and increased likelihood of sepsis. The current study was conducted to investigate the association between serum vitamin D level and the severity and prognosis of ventilator associated pneumonia (VAP) in inpatients in intensive care unit (ICU)

The effect of intravenous magnesium sulfate infusion on reduction of pain after abdominal hysterectomy under general anesthesia: a double-blind, randomized clinical trial

Background: Post-surgical pain is a physiological response to tissue trauma that produces unpleasant physiological effects with manifestations on various organic systems. Objective: According to the effect of magnesium sulfate on the N-methyl-d-aspartate (NMDA) receptor, this study examined the effect of magnesium sulfate on the reduction of pain and the mean amount of narcotics consumed by patients after abdominal hysterectomies. Methods: This double-blind clinical trial study was performed on 60 patients who had undergone abdominal hysterectomies in Shahid Sadoughi Hospital in Yazd, Iran, from 2013 to 2015. The patients were divided randomly into two groups of 30 members each. All of the patients received 2 mg of Midazolam and 2 mcg/kg of Fentanyl as the induction of anesthesia with propofol (2-2.5 mg/kg) and Atracurium 0.5 mg/kg was conducted. All of the patients received 5 mg of intravenous morphine 30 min after induction of anesthesia. Afterwards, the study group received 50 mg/kg of magnesium sulfate in 500 cm3 of Ringer’s serum during the 20 minutes, and 500 cm3 of Ringer’s serum was administered to the members of the placebo group. Visual analogue scale VAS scores were evaluated to reach the minimum difference of 0.8 in mean pain score Results: The results of this study indicated that the mean pain scores immediately after surgery and at 1, 2, 6, and 12 hr after surgery were lower in the study group than in the placebo group. The mean value of narcotic consumption at all measured time points was higher in the placebo group. No significant differences were found between two groups concerning drug complications. Conclusion: The results of this study indicated that the intravenous injection of magnesium sulfate can reduce pain, reduce morphine consumption, and reduce the side effects of morphine in patients after surgery. Funding: This study was funded by Shahid Sadoughi University of Medical Sciences, Yazd, Iran Clinical trial registration: The trial was registered at the Thai Clinical Trials Registry (http://www.clinicaltrials.in.th) with the registration ID: TCTR20160308001. Funding: This study was funded by Shahid Sadoughi University of Medical sciences, Yazd, Ira

Prevention of Stress Related Mucosal Disease with Intermittent

Background: This study aimed to compare intermittent intravenous (IV) pantoprazole and ranitidine for control of gastric acid secretion and the possible prevention of Upper Gastrointestinal Bleeding (UGIB) in critical care patients. Methods: This was a randomized, double blind clinical trial study of IV pantoprazole (40 mg every12 hour) or intermittent IV ranitidine (50 mg bolus every 8 hour) in patients at risk for UGIB. The primary endpoint was gastric pH. UGIB was measured as secondary endpoint. Results: ninety two Critical care patients were enrolled. Gastric pH was well controlled by two study drugs. Gastric pH increased in pantoprazole group than in the ranitidine group (4.40±0.39 versus 3.32±0.28; P=0.000). Upper GI bleeding was higher in ranitidine group than pantoprazole group (4/46 versus 2/46; P=0.404). Conclusion: This  study  indicates  that  intermittent  IV pantoprazole  compared  with  bolus  IV ranitidine, more effectively controls gastric pH and may prevent UGIB in high risk critical care patients without the development of tolerance

Cardiac Injury in COVID-19: A Systematic Review

© 2021, The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG. Coronavirus 2019 (COVID-19) is responsible for the current pandemic which has already resulted in considerable mortality worldwide. This systematic review was conducted to summarize the results of the published articles assessing the incidence of heart diseases in patients infected with COVID-19. The electronic databases Scopus, Web of Science, Pubmed, Science Direct, and ProQuest were used to search for potentially relevant articles. Articles published from Dec 2019 to April 2020 were included. All cross-sectional, retrospective or prospective observational cohort and case-control studies were selected which reported the incidence or prevalence of myocardial injury, myocardial infarction, or cardiovascular disease in patients with confirmed COVID-19 infection. Based on the inclusion criteria, 12 articles were selected. The incidence of cardiac injury was reported in 8 articles and 8 articles focused on the cardiovascular outcomes of COVID-19 infection. The incidence of new cardiac injury was reported to be 7.2–77% in live and dead patients, respectively. The results showed that patients with cardiac injury had worse outcomes including higher mortality than those without cardiac injury. The most common cardiac injury outcomes were shock and malignant arrhythmias. The most common radiographic findings in patients with cardiac injury were multiple mottling and ground-glass opacities in the lungs (64.6%). A significant number of patients with cardiac injury required noninvasive mechanical ventilation (46.3%) or invasive mechanical ventilation (22.0%). Acute respiratory distress syndrome was seen in 58.5%, acute kidney injury in 8.5%, electrolyte disturbances in 15.9%, hypoproteinemia in 13.4%, and coagulation disorders in 7.3% of patients with cardiac injuries. In addition, survival days were negatively correlated with cardiac troponin I levels (r = −0.42, 95%, p = 0.005). The results of this review showed that myocardial injury in patients with COVID 19 has a poor prognosis. Hence, cardiac investigation and management in these patients are crucial

Effect of a Multistage Educational Skill-Based Program on Nurse’s Stress and Anxiety in the Intensive Care Setting: A Randomized Controlled Trial

Background. Psychological problems such as stress and anxiety are prevalent among working nurses in the intensive care units (ICUs). This study was aimed at investigating the effects of three skill-based educational programs on stress and anxiety among critical care nurses. Methods. Using a randomized controlled trial, 160 nurses were assigned to four groups including one control and three intervention groups. A standard skill-based educational program was delivered to three intervention groups using booklet, booklet+oral presentation, and booklet+oral presentation+clinical teaching over a period of one month to reduce different types of stress and anxiety. The control group received routine education only. Perceived stress, state anxiety, trait anxiety, and work-related stress were assessed at baseline and three times after the intervention (15 days, 3 months, and 21 months). Repeated-measure analysis of variance was used for data analysis. Results. There was no significant change in the control group in terms of study variables during follow-up assessments, whereas measures of stress and anxiety were reduced after intervention in the trial groups except trait anxiety. Nurses in the mixed-method group (booklet+oral presentation+clinical teaching) showed less stress and anxiety during follow-ups. Although the stress and anxiety scores decreased in the first and second follow-ups, there was no significant reduction in the third follow-up. Conclusions. To improve the mental health and performance of the intensive care unit nurses, knowledge-based and skill-based training programs seem useful. Continuous training may help to maintain the effectiveness of these programs over time

Effect of the Specific Training Course for Competency in Doing Arterial Blood Gas Sampling in the Intensive Care Unit: Developing a Standardized Learning Curve according to the Procedure’s Time and Socioprofessional Predictors

Background. Standardization of clinical practices is an essential part of continuing education of newly registered nurses in the intensive care unit (ICU). The development of educational standards based on evidence can help improve the quality of educational programs and ultimately clinical skills and practices. Objectives. The objectives of the study were to develop a standardized learning curve of arterial blood gas (ABG) sampling competency, to design a checklist for the assessment of competency, to assess the relative importance of predictors and learning patterns of competency, and to determine how many times it is essential to reach a specific level of ABG sampling competency according to the learning curve. Design. A quasi-experimental, nonrandomized, single-group trial with time series design. Participants. All newly registered nurses in the ICU of a teaching hospital of Tehran University of Medical Sciences were selected from July 2016 to April 2018. Altogether, 65 nurses participated in the study; however, at the end, only nine nurses had dropped out due to shift displacement. Methods. At first, the primary checklist was prepared to assess the nurses’ ABG sampling practices and it was finalized after three sessions of the expert panel. The checklist had three domains, including presampling, during sampling, and postsampling of ABG competency. Then, 56 nurses practiced ABG sampling step by step under the supervision of three observers who controlled the processes and they filled the checklists. The endpoint was considered reaching a 95 score on the learning curve. The Poisson regression model was used in order to verify the effective factors of ABG sampling competency. The importance of variables in the prediction of practice scores had been calculated in a linear regression of R software by using the relaimpo package. Results. According to the results, in order to reach a skill level of 55, 65, 75, 85, and 95, nurses, respectively, would need average ABG practice times of 6, 6, 7, 7, and 7. In the linear regression model, demographic variables predict 47.65 percent of changes related to scores in practices but the extent of prediction of these variables totally decreased till 7 practice times, and in each practice, nurses who had the higher primary skill levels gained 1 to 2 skill scores more than those with low primary skills. Conclusions. Utilization of the learning curve could be helpful in the standardization of clinical practices in nursing training and optimization of the frequency of skills training, thus improving the training quality in this field. This trial is registered with NCT02830971

Effectiveness of Curcumin on Outcomes of Hospitalized COVID-19 Patients: A Systematic Review of Clinical Trials

Despite the ongoing vaccination efforts, there is still an urgent need for safe and effective treatments to help curb the debilitating effects of COVID-19 disease. This systematic review aimed to investigate the efficacy of supplemental curcumin treatment on clinical outcomes and inflammation-related biomarker profiles in COVID-19 patients. We searched PubMed, Scopus, Web of Science, EMBASE, ProQuest, and Ovid databases up to 30 June 2021 to find studies that assessed the effects of curcumin-related compounds in mild to severe COVID-19 patients. Six studies were identified which showed that curcumin supplementation led to a significant decrease in common symptoms, duration of hospitalization and deaths. In addition, all of these studies showed that the intervention led to amelioration of cytokine storm effects thought to be a driving force in severe COVID-19 cases. This was seen as a significant (p &lt; 0.05) decrease in proinflammatory cytokines such as IL1&beta; and IL6, with a concomitant significant (p &lt; 0.05) increase in anti-inflammatory cytokines, including IL-10, IL-35 and TGF-&alpha;. Taken together, these findings suggested that curcumin exerts its beneficial effects through at least partial restoration of pro-inflammatory/anti-inflammatory balance. In conclusion, curcumin supplementation may offer an efficacious and safe option for improving COVID-19 disease outcomes. We highlight the point that future clinical studies of COVID-19 disease should employ larger cohorts of patients in different clinical settings with standardized preparations of curcumin-related compounds