فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال چهل و پنجم شماره 3 (پیاپی 119، پاییز 1401)

Considering that in recent years the clinical competency test is performed to measure the performance of medical students before graduation, it is necessary to study its psychometric properties in order to make managerial decisions to hold a valid and reliable test.

In this retrospective study, all medical students of Tehran University of Medical Sciences who participated in the clinical competency test during the academic year 2017-2018 were included in the study. Participants' scores and the total score of the OSCE test were collected and analyzed separately for each station. In order to evaluate the quality of OSCE, Difficulty Index, Discrimination Index, R2 and differentiation of degrees were calculated using SPSS software. The reliability of the test was determined using Cronbach's alpha. The correlation between the total grade point average of the students was calculated by the final OSCE score.

772 interns were included in the study in the form of 4 courses of competency test. The value of R2 for each test is 0.33 to 0.78%, 0.75 to 0.91%, 0.63 to 0.90%, 0.53 to 0.89%, respectively. The Cronbach's alpha test was obtained from 0.52 to 0.76. The range of Discrimination Index for each test was equal to -0.02 to 0.52, -0.09 to 0.64, -0.05 to 0.64, and 0.94 to 1 respectively. The range of Difficulty Index for each test was 0.68 to 0.93 and 0.21 to 0.88, 0.62 to 0.91, and 0.72 to 0.96, respectively. The correlation coefficient between the total grade point average and the final OSCE score was calculated to be 0.56 (P<0.001).

The internal consistency of the tests was acceptable. The R-index varied at different test times at different stations. The range of Difficulty Index and Discrimination Index in different test times have changes that can be resulting from the educational effects of test implementation for students and improving the design quality of stations. There was a direct and positive relationship between students' GPA and OSCE final score based on Pearson correlation coefficient.

Ketamine is one of the most common drugs that weaken the central nervous system and alertness, and it is essential to know its side effects.

The purpose of this study is to investigate the effects of short-term and long-term anesthesia of ketamine on the histopathological changes of the cerebral cortex in rat infants.

This study was conducted on 15 female rats (3 groups of 5 including the control group, the long-term anesthesia group with ketamine, and the short-term and repeated anesthesia group (with ketamine). Then the histopathological changes of the cerebral cortex were analyzed by IHC immunohistochemistry method. SPSS software was used to compare the data.

The findings of our study showed that no changes were observed in the brain tissue and different layers in the samples of the control group, and the order and coherence of the brain tissue was reported to be completely clear and normal. There is no significant change in the short-term and long-term dose groups of ketamine, compared to the control group, and only the number of microglia cells was lower than the control group.

Ketamine reduces the number of microglia cells both in the short term and in the long term, and investigating the cause requires biochemical studies, free radicals and other effective factors that play a role in cell apoptosis. Although memory and learning were not examined in our study, the findings of our study did not show drastic changes in the tissue. However, a more detailed examination of the changes in the biochemical and behavioral changes of the mice needs a more detailed examination in subsequent studies to address all aspects of the effect of ketamine on the brain.

Spinal anesthesia is one of the regional anesthesia techniques and the base is the insertions of a special needle at the sterile condition to intrathecal space at a level lower the end of the medulla and injection of local anesthetic alone or in combination with other additives such as opioids, vasoconstrictors to improve quality and duration of the block. One of the most common side effects of intratechal opioids is pruritus. Many drugs are recommended for the prevention of this side effect Gabapentin; an anticonvulsant drug is one of them. The aim of the present study was the evaluation of the prophylactic effect of Gabapentin on intratechal fentanyl-induced pruritus in orthopedic surgeries of lower limbs under spinal anesthesia

80 ASA I-II patients aged between 20 and 50 scheduled for elective lower limb orthopedic surgery were allocated in a double-blind placebo-controlled clinical trial. Patients were randomized to two Gabapentin and placebo groups with equal numbers of patients. Randomization was done using random allocation software. After obtaining written consent, the patients were allocated to Gabapentin (G group) and placebo (P groups). The G group patients received 600 mg of Gabapentin orally two hours before induction of spinal anesthesia and the P group patients received placebo. After IV line, placement and standard monitoring attachment including noninvasive blood pressure, EKG and pulse oximetry, and five cc/Kg Ringer solution were infused into each of the patients. Spinal anesthesia was done Using a 25-gauge Quincke spinal needle, and insertion at L4-L5 or L3-L4 intervertebral space. 12 mg of hyperbaric 0.5% bupivacaine and 30-microgram fentanyl in a sterile condition were injected intrathecally. The patients were positioned supine and the anesthesia level was adjusted to T10 dermatome. 0.015 mg/kg midazolam was used intravenously for sedation. The patients were evaluated at 1,6,12 and 24 hours after spinal anesthesia for pruritus.

Patients of both groups did not differ preoperatively significantly in their basic characteristics and predisposing factors associated pruritus. There was no statistical difference regarding severity, onset time and incidence between two groups.

The use of single 600 milligram Gabapentin 2 hours before spinal anesthesia has no prophylactic effect on intrathecal fentanyl-induced pruritus. The severity, locations, and duration of pruritus between intervention and placebo groups were comparable and there were no statistically significant differences between the two groups.

The World Health Organization (WHO) set six goals to maximize patient safety, with patient identification as the first goal. Today, at least two identifiers written on a paper wristband identify patients. If paper wristbands are used, the patient's identification information may not be available due to tearing or moisture, etc. Due to the fact that modern technology has not been used to solve the above problems, therefore, the intelligent wristband was designed in the educational and treatment center of Imam Reza Hospital in Tabriz in 2023

Smart wristband with QR code is specially designed for each patient. Doctors and nurses can scan the QR code from the patient's wristband and by entering their medical and nursing system number, they can access the demographic and clinical information of patients for safe identification.

The design of smart wristbands makes it possible to use waterproof electronic wristbands instead of using paper wristbands. Also, by scanning the assigned code for each patient, the treatment and care staff are connected to health information software that provides quick access to a summary of demographic information and the treatment history of the patient.

The use of Smart wristband through the provision of high-quality healthcare can have great potential to ensure patient safety, minimize medical errors, and improve the performance of healthcare professionals.

In healthcare environments, increasing patient safety and reducing safety errors is of great importance. These errors can have irreparable consequences for patients and negatively affect the quality and trust in healthcare. Therefore, patient safety training programs have become important in order to prepare medical staff to diagnose and prevent safety errors. In this study, we investigate the effect of patient safety training programs on the reduction of safety errors of employees of a private hospital in Tehran .

two different training methods, i.e. face-to-face training (class and face-to-face training) and virtual training (use of training videos) were used to transfer safety knowledge to employees. And the amount of safety errors in spring and summer seasons was collected through the documents related to error reports .

The results show that both training methods have been able to increase the knowledge of employees. However, face-to-face training has created a significant improvement in the knowledge of employees and reduction of safety errors compared to virtual training, and finally, the comparison of the amount of safety errors in the two seasons showed a significant decrease.

The combined use of non-steroidal anti-inflammatory drugs (NSAID) can lead to more improvement of postoperative pain instead of the exclusive use of these drugs. The purpose of the present study was to compare two drug protocols based on the use of NSAID drugs, including injectable ketorolac with diclofenac suppositories or injectable ketorolac alone in pain relief after abdominal surgery under general anesthesia .

This study was a double-blind randomized clinical trial. Patients undergoing abdominal surgery under general anesthesia were randomly treated with diclofenac suppositories (100 mg each) and ketorolac ampoules (15 mg) or ketorolac alone. Pain intensity was measured during the first 6 hours of recovery and the first 12 hours after the operation. The prescribed dose of pethidine after the operation was also compared between the two groups.

The intensity of postoperative pain during the recovery time in the group receiving the combined drug protocol was significantly lower than the exclusive treatment with injectable ketorolac, although this intensity of postoperative pain during the sixth and twelfth hours after the operation showed a significant difference in the two groups. did not give the prescribed dose of pethidine in the first group was also significantly lower .

Adding diclofenac suppositories to injectable ketorolac in abdominal surgeries leads to a reduction of postoperative pain during the recovery period, as well as a reduction of the opioid injection dose after surgery.