جستجوی مقالات مرتبط با کلیدواژه « Intensive Care Units » در نشریات گروه « پزشکی »

Antimicrobial stewardship studies are essential to prevent microbial resistance, ensure proper antimicrobial use, and reduce treatment costs. This study aimed to examine the prescription trends of eight costly antimicrobial agents, including carbapenem (imipenem/meropenem), voriconazole, vancomycin, liposomal amphotericin B, colistin, linezolid, teicoplanin, and caspofungin, at Ganjavian hospital in Dezful.

This cross-sectional study collected prescription forms for the eight targeted antimicrobials from March 2018 to March 2020. The recorded data included patient information, microbiological findings, infection sites, and details of antimicrobial use.

The analysis of 200 patients revealed that the most common infection sites were the bloodstream (41%), respiratory system (24.5%), and unidentified sources (13%). The majority of patients were admitted to internal wards (29.5%), general intensive care units (25.5%), and neonatal intensive care units (13%). The predominant bacterial isolates were Escherichia coli (19.5%), Acinetobacter baumannii (14.5%), Pseudomonas aeruginosa (12.5%), and Staphylococcus aureus (11.5%). Multidrug-resistant (MDR) bacteria caused 53% of infections, and 33.5% were caused by bacteria resistant to all tested antimicrobials.

MDR bacteria pose a significant challenge, underscoring the critical need for nosocomial infection control, antimicrobial stewardship, and continuous monitoring of antimicrobial resistance patterns in this medical center.

Respiratory failure following COVID-19 can lead to the death of COVID patients. Monitoring these patients during their ventilation is essential. The present study investigated the effect of measuring esophageal pressure in preventing barotrauma while receiving Noninvasive Positive Pressure Ventilation (NIPPV) in patients with COVID-19.

The present study is a single-blind clinical trial conducted on patients with COVID-19 hospitalized in the Intensive Care Unit (ICU). The patients were divided into two groups; one group had their esophageal pressure measured while receiving NIPPV, their ventilation was adjusted based on this pressure, and the second group was only ventilated according to anesthesia protocols. Finally, the data was entered into SPSS V.23 software and analyzed according to the study’s objectives.

The results of the present study showed that the incidence of subcutaneous emphysema-type barotrauma in the Esophageal Pressure (EP) monitoring group was lower than in the non-Esophageal Pressure (nEP) monitoring group. Also, the IPAP level in the EP group was lower than in NEP. The incidence of complications such as abdominal bloating and gavage intolerance was lower in EP than in NEP. The blood oxygen level in NEP was higher than in EP, but there was no significant difference between them.

Esophageal pressure measurement in patients with COVID-19 receiving NIPPV can reduce barotrauma in the patients.

Clinical competency is one of the performance indicators of nurses requiring the use of technical and communication skills, knowledge, clinical reasoning, emotions, and professional values at the bedside. The present study’s aim was to assess the clinical competency of nurses working at intensive care units (ICUs) and explore some of its associated factors in hospitals affiliated with the Golestan University of Medical Sciences.

This descriptive-analytical study was conducted on ICU nurses working at the hospitals affiliated with the Golestan University of Medical Sciences in the northeast of Iran. A total of 160 eligible nurses were recruited using the simple random sampling method. The data were collected through the Intensive and Critical Care Nursing Competence Scale (ICCN-CS), which evaluates the 4 areas of knowledge, skill, attitudes and values, and work experience via 80 statements. The data were analyzed by SPSS 16 software using the Kruskal-Wallis and Mann-Whitney tests at a significance level of 5%.

Most of the participants (69.2%) attained an excellent clinical competency score, and the overall level of clinical competency was excellent. Also, the highest level of competency belonged to the knowledge area (85.11 ± 82.63), and the lowest level was related to the field of skills (80.40± 17.19). Clinical competency showed a significant association with demographic features, including age (P<0.001), type of contract (P<0.001), work experience (P<0.001), marital status (P<0.001), and average overtime hours (P<0.003).

Evaluation of nurses’ clinical competency can help improve the quality of care. It is suggested that health policymakers focus on upgrading the clinical competency of ICU nurses by improving their clinical skills.

Pressure ulcer is a common problem in ICUs and its prevention is one of nurses’ duties.

The present study was performed with aim to evaluate the effectiveness of preventive nursing care based on Braden’s scale on the incidence of pressure ulcer in ICU patients.

This clinical trial study was performed on 72 patients admitted to the ICUs of Golestan and Imam Khomeini hospitals of Ahvaz in 2020. The preventive care based on Braden scale was performed for 6 days in the intervention group. Routine care was provided for the control group. The rate and duration of pressure sores were measured based on Braden scale at the beginning of the study, every 48 for 3 times for the intervention group. The data was collected by demographic information questionnaire, Braden scale, and Pressure Ulcer Scale for Healing (PUSH).

The pressure ulcers occurred less in the intervention group (2.8%) than in the control group (8.3%), but this difference was significant (p=0.614). There was a significant difference between the two groups in terms of Braden's subscales during the intervention period (first, second and third 48 hours) (p<0.05). Preventive care increased the length of time required for the occurrence of pressure ulcers in the test group.

Implications for Practice:

 The results showed that the intervention based on the Braden scale reduces pressure ulcers, therefore it is recommended that nurses carry out care interventions based on the Braden scale to improve the quality of care and prevent pressure ulcers among ICU patients.

The premature infant imposes significant tension and stress on mothers and may affect quality of mothers' sleep. Therefore, this study was performed to assess the effect of kangaroo mother care using the role-playing method on the mother-infant attachment and sleep quality of mothers of premature infants.

 This randomized clinical trial was conducted on 78 mothers of premature infants in the neonatal intensive care unit (NICU) of the hospital affiliated to the Hamadan University of Medical Sciences from July 2010 to September 2011. The samples were selected by convenience method, then divided into two experimental and control groups by simple random allocation method. Mothers in the experimental group learned kangaroo mother care in two 30-minute sessions using modeling and unique clothing (role-playing). Then,  mothers performed 20-minute kangaroo mother care three times a day. Mothers in the control group performed kangaroo mother care through pamphlets and educational videos. Subjects completed mother-infant attachment and and sleep quality questionnaires before, after, and one week after the intervention. Data analysed by SPSS (version 22).

There was statistically significant difference between the two groups in the mother-infant attachment one day (P<0.011) and one week (P<0.012) after the intervention. Also, a statistically significant difference was ssen between the two groups in the mothers' sleep quality one day (P<0.001) and one week (P<0.002) after the intervention.

Training of kangaroo mother care by role-playing method could be used as a therapeutic technique in the NICU to improve mother-infant attachment and mamtenal sleep quality.

Malnutrition, as defined by the World Health Organization (WHO), occurs when the body does not receive sufficient nutrients or energy to meet growth, maintenance, and functional needs. Severe malnutrition in children increases the risk of death, disease episodes, complications, and prolonged illnesses. Therefore, early nutritional support is crucial in pediatric critical care settings. In cases where oral feeding is not feasible, enteral feeding (EN) becomes necessary to provide adequate energy. However, despite its advantages, feeding intolerance remains a significant challenge. This study aims to determine the prevalence of feeding intolerance among critically ill children in the Pediatric Intensive Care Unit (PICU).  This cross-sectional study was conducted at the Akbar Pediatric Subspecialty Center's PICU in Mashhad, Iran between March and April 2022. The evaluation focused on nutritional adequacy and feeding intolerance.  A total of 72 patients were included in this study with a majority being girls. Approximately 30 percent of patients exhibited severe malnutrition based on their BMI Z-score (<-3). Boys were more affected than girls in this regard. Most patients received a combination of EN and parenteral nutrition (PN) to fulfill their energy and protein requirements successfully. In most cases, children consumed over 66% of their energy needs through these methods. Feeding intolerance primarily manifested as vomiting and regurgitation (47%), followed by high gastric residual volume (GRV) (36.1%) and abdominal distention (34.7%).  The findings from our study highlight the prevalence of malnutrition within PICU settings along with common complications associated with feeding intolerance such as vomiting and regurgitation. Standardizing a definition for feeding intolerance could prove beneficial for improving research protocols aimed at effectively managing this condition.

Carspecken’s critical ethnography method has gained prominence in nursing research, necessitating a fresh perspective on its practicality and advantages. This study aims to provide a unique viewpoint on using critical ethnography as a foundational methodology to uncover health disparity culture in intensive care units.

Methods & Materials: 

While emphasizing its review design with original examples, this perspective piece provides a practical explanation of Carspecken’s five-stage critical ethnography approach. Grounded in the ontological and epistemological paradigm, this essay examines critical ethnography as a crucial approach to illuminating the discursive culture surrounding health disparities. Also, this study presents original instances of monological and dialogical data, reconstructive analysis, and findings from a study that was carried out to provide more perspective on implementation. It also mentions how it relates the findings to social factors and sociopolitical theories.

The study reveals nuanced insights into the practicality and advantages of Carspecken’s method, shedding light on social processes contributing to health disparities in intensive care units. This method allowed us to identify how external powers extend to the intensive care unit, revealing a concealed culture that disrupts service provision balance. It exposed individual, organizational, and systemic roots contributing to disparities. Additionally, it highlighted how individual diversities can lead to disparity.

This study highlights the significance of Carspecken’s critical ethnography in nursing studies within the critical theory tradition. It is argued that Carspecken’s approach to critical ethnography is particularly instrumental in elucidating the social structures contributing to health disparities.

In the context of the Sustainable Development Goals (SDGs), the emphasis on quality is increasing. This study aims to analyze quality indicators in the main Operation Theatre (OT) complex and the Intensive Care Unit (ICU) of a tertiary care hospital in Chennai, South India.

Data were retrospectively collected from January 2018 to December 2019 at a tertiary care hospital in Chennai, India. Given the limitations of the study area, a census methodology was used for data collection. A total of eight quality indicators for the Operation Theatre and nine for the Intensive Care Unit were analyzed. During the two-year period, the maximum number of defaults (departures from the benchmark set by the hospital) was calculated and analyzed using Wilcoxon’s signed rank test..

Among the parameters associated with the OT, the percentages of rescheduling surgeries and unplanned returns to the OT had the highest number of departures from the benchmark. In the ICU, the rate of return within 48 hours and the re-intubation rate exhibited the highest departures from the benchmark. The subsequent one-sided Wilcoxon’s signed rank test confirmed that the average rate of departures for these parameters was not statistically significant.

Although the one-sided Wilcoxon W test confirmed that the departures of the aforementioned parameters were not statistically significant, factors such as lack of awareness among staff members about policies and procedures, insufficient continuous education in terms of quality, absence of clear communication, and staff shortage might be reasons why certain indicators analyzed in this study exceeded the benchmark set by the hospital. Addressing these issues is crucial, as quality is increasingly important in the healthcare industry.

 Sepsis is a leading cause of morbidity and mortality in neonates.

 This study aimed to investigate the bacterial profile and antibiotic sensitivity in infants with sepsis.

 This cross-sectional study was conducted on 90 neonates with sepsis admitted to the neonatal intensive care unit of Namazi Hospital, a tertiary-level hospital, in Shiraz, Iran, from 2020 to 2021. Demographic and clinical data including gestational age, previous diseases, maternal infectious, underlying diseases, history and duration of premature rupture of the membrane and delivery, clinical symptoms (fever, reduced breastfeeding, and lethargy), laboratory results (complete blood cell and C-reactive protein), and results of blood and urine cultures were recorded and analyzed.

 Among 90 neonates with sepsis, the average age was 6.7 ± 7.6 days; 54 were male (60.0%), and 36 were female (40.0%). Fifty (55.5%) neonates had early sepsis. Gram-negative organisms were grown in 61% of positive blood cultures; the most common was Klebsiella. Among Gram-positive organisms, Staphylococcus epidermidis was the most common. Most organisms were sensitive to colistin, and most were resistant to cefotaxime. There was a significant relationship between the age of onset of sepsis symptoms and birth weight in infants with positive blood cultures (P = 0.004) (r = 0.3).

 Gram-negative bacteria are the most common causes of sepsis, mainly resistant to aminoglycosides and cefotaxime. Therefore, increasing awareness about the optimal use of antibiotics is necessary to curb the increase in resistance levels.

 Open-heart surgery is associated with life-threatening complications, and providing nonstandard nursing care without any plan for patients undergoing this type of surgery in the intensive care unit (ICU) can deteriorate their conditions.

 This study investigated the effect of providing nursing care based on Gordon's functional health patterns model on the clinical outcomes of patients undergoing coronary artery bypass surgery in the cardiac surgery ICU.

 This was a quasi-experimental study involving 58 patients undergoing coronary artery bypass surgery admitted to the cardiac surgery ICU of Ahvaz Golestan Hospital in 2021. The patients were selected using convenience sampling and based on the inclusion criteria, and they were divided into intervention and control groups. First, the information related to the outcomes of the patients in the control group was collected using a checklist. Then, all the ICU nurses working at the study site were trained in Gordon's model and how to perform nursing care based on this model. They provided the necessary nursing care based on this model for the patients in the intervention group under the supervision of the researcher. The data of the patients in the intervention group were collected after completion of the intervention using the same checklist used for the control group. Finally, the data were analyzed using SPSS version 25.

 There was a statistically significant difference between the intervention and control groups in the length of stay at the ICU (P = 0.007), length of ventilation (P = 0.001), and successful weaning from the ventilator (P = 0.026). However, there was no significant difference between the 2 groups in terms of patient mortality (P = 0.16) or re-admission to the ICU (P = 0.16).

 According to the results, Gordon's functional health patterns model of the nursing process can be easily used to improve the care and treatment outcomes of patients admitted to the cardiac surgery ICU.

The objective of the present study was to identify prognostic factors associated with mortality and transfer to intensive care units (ICUs) in hospitalized COVID-19 patients using random forest (RF). Also, its performance was compared with logistic regression (LR).

In this retrospective cohort study, information of 329 COVID-19 patients were analyzed. These patients were hospitalized in Besat hospital in Hamadan province, the west of Iran. The RF and LR models were used for predicting mortality and transfer to ICUs. These models' performance was assessed using area under the receiver operating characteristic curve (AUC) and accuracy.

Of the 329 COVID-19 patients, 57 (15.5%) patients died and 106 (32.2%) patients were transferred to ICUs. Based on multiple LR model, there was a significant association between age (OR=1.02; 95% CI=1.00-1.05), cough (OR=0.24; 95% CI=0.10-0.56), and ICUs (OR=7.20; 95% CI=3.30-15.69) with death. Also, a significant association was found between kidney disease (OR=3.90; 95% CI=1.04-14.63), decreased sense of smell (OR=0.28; 95% CI=0.10-0.73), Kaletra (OR=2.53; 95% CI=1.39-4.59), and intubation (OR=8.32; 95% CI=3.80-18.24) with transfer to ICUs. RF showed that the order of variable importance has belonged to age, ICUs, and cough for predicting mortality; and age, intubation, and Kaletra for predicting transfer to ICUs.

This study showed that the performance of RF provided better results compared to LR for predicting mortality and ICUs transfer in hospitalized COVID-19 patients.

Transferring patients from intensive care units to general units can increase anxiety in patients and their families, which can lead to re-admission of patients in intensive units and increase hospitalization costs.

The present study was performed with aim to determine the effect of the transition nursing program from intensive care units to general units on the anxiety and satisfaction of patients and their families.

This randomized clinical trial study was conducted on 50 patients hospitalized in surgical ICUs and 50 of their relatives. The research units were randomly assigned to the intervention and control groups. Before transfer, patients and their families filled out the Spielberger and satisfaction questionnaire. Then, the transition nursing program was implemented and the patient was examined by the liaison nurse immediately, 8, 16 and 24 hours after transfer. Then, the questionnaires were filled out again. Data were analyzed by SPSS software (version 22). p<0.05 was considered statistically significant.

After the implementation of the nursing transfer program, the anxiety of patients (34.68±8.02) and their families (32.52±7.84) reduced in the intervention group compared with the control group (p<0.0001). Also, the satisfaction of the patients (47.64±5.65) and their families(45.56±6.10) significantly increased in the intervention group (p<0.000).

Implications for Practice: 

The transition nursing program reduces anxiety and increases the level of satisfaction in patients and their families. The findings of the present research can be suggested to the policymakers and nursing managers in order to plan to improve the role of nurses as liaison nurses.

Admitted neonates in neonatal intensive care units undergo painful, invasive procedures that can have serious consequences. Nurses have a crucial role in pain management. However, studies have shown that their knowledge and attitude in pain management are not acceptable. The present study was done to study the impact of virtual education in pain management on the nurses working in neonatal intensive care units affiliated with Shiraz University of Medical Sciences.

In this quasi-experimental study, 60 nurses completed knowledge and attitude questionnaires on the neonates’ pain management. Then, they were educated through two virtual education sessions through Adobe Connect. The questionnaires were completed again 8 and 30 days after the educational session. The data was analyzed using SPPSS 21 software through the Bonferroni Test.

There was a significant difference between the mean score of knowledge before (17.48±3.14), one week after (19.37±3.63), and the educational intervention (p<0.001). However, the difference between the mean score of knowledge one week and one month after (19.42±3.41) the intervention was not significant (p=0.998). There was no significant difference between the mean attitude score before (52.78±4.62) and one week after the intervention (52.93±4.58; p=0.096). However, this significantly differed after one month (53.45±4.48; p=0.043).

Virtual education increases nurses' knowledge about pain management in one week; however, it changes their attitude in one month.

Ignoring outliers in data may lead to misleading results. Length of stay (LOS) is often considered a count variable with a high frequency of outliers. This study exemplifies the potential of robust methodologies in enhancing the accuracy and reliability of analyses conducted on skewed and outlier-prone count data of LOS.

The application of Zero-Inflated Poisson (ZIP) and robust Zero-Inflated Poisson (RZIP) models in solving challenges posed by outlier LOS data were evaluated. The ZIP model incorporates two components, tackling excess zeros with a zeroinflation component and modeling positive counts with a Poisson component. The RZIP model introduces the Robust Expectation-Solution (RES) algorithm to enhance parameter estimation and address the impact of outliers on the model’s performance.

Data from 254 intensive care unit patients were analyzed (62.2% male). Patients aged 65 or older accounted for 58.3% of the sample. Notably, 38.6% of patients exhibited zero LOS. The overall mean LOS was 5.89 (± 9.81) days, and 9.45% of cases displayed outliers. Our analysis using the RZIP model revealed significant predictors of LOS, including age, underlying comorbidities (p<0.001), and insurance status (p=0.013). Model comparison demonstrated the RZIP model’s superiority over ZIP, as evidenced by lower Akaike information criteria (AIC) and Bayesians information criteria (BIC) values.

The application of the RZIP model allowed us to uncover meaningful insights into the factors influencing LOS, paving the way for more informed decision-making in hospital management.