afshin gholipour baradari

Sequential organ failure assessment (SOFA) is used to assess the severity of the disease and mortality rate in patients admitted to ICU. SOFA requires experiments that are impractical in centers with limited resources. The aim of this study was to compare the diagnostic value of bedside SOFA (b SOFA) and SOFA scores in mortality of ICU patients.

This cohort study was performed in 60 patients with Systemic Inflammatory Response Syndrome (SIRS) older than 18 years of age. SOFA and b SOFA scores were recorded at admission, then daily until admission at ICU.

According to the Lin and Bland-Altman agreement coefficient, there was a very good agreement between SOFA and b SOFA scores at days 1, 15, 16, 17, 18, and 20. At days 3, 5, 7, 14, and 19 we observed a good agreement and significant correlation between SOFA and b SOFA scores. Findings showed a moderate agreement between SOFA and b SOFA scores at days 2, 4, 6, 8, 9, 10, 11, 12, and 13, but at days 13 and 15 there was a direct relationship between the two scores (P>0.05). Area Under Curve (AUC) method in ROC Curve showed no significant difference in diagnostic value between SOFA and b SOFA scores except at day 17 (P>0.05), indicating acceptable diagnostic value of b SOFA score compared to SOFA score. The sensitivity and specificity of the tools in terms of prognosis were found to be very close at different times showing similar diagnostic values.

The study showed diagnostic accuracy, and high sensitivity and specificity for predicting mortality and strong positive correlation between the two tools, so b SOFA is a suitable alternative due to lower cost with greater ease.

Type of anesthesia during elective cesarean is very important and is chosen according to the decision of the specialist as well as the mother’s desire. This study aimed to determine the rate and associated factors of choosing general or regional (spinal and epidural) anesthesia among pregnant women who underwent elective cesarean in hospitals of Northern Iran in 2017.

This descriptive-analytic study included the pregnant women referred to the hospitals in Sari with indications for both kinds of anesthesia. The reasons for choosing the type of anesthesia were asked and collected in a researcher-made checklist. The collected data were described and analyzed using SPSS software (version 24) through the Chi-square or Fisherchr('39')s exact tests and Logistic regression. A p-value less than 0.05 was considered statistically significant.

Out of 384 pregnant women who participated in the study, 60% and 40% of the cases chose general and regional anesthesia, respectively. Fear of spinal cord damage (64.3%) and fear of observing and hearing in the operation room (53.3%) were the most reasons for the rejection of the regional methods of anesthesia. However, the fear of not waking up (54.3%) and being interested in seeing the baby during childbirth (40.7%) were the main reasons for choosing spinal anesthesia. Most of the women who had experienced regional anesthesia selected this procedure in the current operation (53%), while general anesthesia was chosen by women without previous history of regional anesthesia (62%).

Although most of the pregnant women selected general anesthesia, the reasons for rejecting the spinal method were mainly non-scientific and could be managed with maternal education.

Context: Supraglottic Airway Devices (SADs) are applied in airway management of pediatric emergency conditions. This review study aimed to examine the literature regarding pediatric supraglottic airway devices, to introduce the optimal devices in terms of Oropharyngeal Leak Pressure (OLP), risk of insertion failure on the first attempt and risk for blood staining of the device. Data Sources: An electronic search was conducted on MEDLINE, EMBASE, CINAHL and PubMed databases. We also searched the Cochrane database (CENTRAL) and Web of Science up to July 1, 2017. Study Selection: Of 112 potential studies, the full texts of 53 articles were available, in which 15 were duplicated and omitted, accordingly. Papers which did not directly discuss SADs were also excluded. In total, 30 papers were identified related to the children supraglottic devices. Data Extraction: The current review was conducted and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The LMA ProSeal may be the best supraglottic airway device for children due to its high oropharyngeal leakage pressure and low risk of insertion failure. It seems that i-gel is a very functional tool as well. Further research is recommended to investigate the most appropriate supraglottic airway in diverse clinical situations and various conditions among children.

The use of positive end-expiratory pressure (PEEP) can have an important role as one of the ways to prevent and treat atelectasis, but it seems that there is still no consensus about its beneficial level. The aim of this study was to determine the effect of different levels of PEEP on the incidence of atelectasis after heart surgery.

This is a double-blind randomized controlled trial that was adopted from a research project recorded in the Iranian Registry of Clinical Trials. This paper is the result of a research project undertaken at Fatemeh Zahra Hospital (Mazandaran Heart Center) in 2015. 180 patients underwent open heart surgery were selected and were divided randomly into three groups: control, PEEP=8, and PEEP=10 (60 in each group). The patients in the two PEEP8 and PEEP10 intervention groups separately received 8 cm H2O and 10 cm H2O PEEP, respectively, 30 minutes after admission to the ICU for 4 hours and then received 5 cm H2O PEEP until extubation. Atelectasis was examined two hours after the extubation and on the third day after surgery.

The incidence rates of atelectasis two hours after extubation on the first day of surgery were 22 (36.7%), 20 (33.3%) and 10 (16.7%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were statistically significant among the three groups (p=0.035). The incidence rates of atelectasis on the third day after surgery were 39 (65%), 36 (60%) and 21 (35%) patients in the control, PEEP8 and PEEP10 groups, respectively. The differences were also statistically significant among the three groups (p=0.003).

The use of 10 cm H2O PEEP can lead to a reduction in the incidence of atelectasis, intubation time at the ICU and length of ICU and hospital stay. Given that this level of PEEP is effective, this method is recommended to be used in postoperative care of patients.

Background and Critical care nurses could actively participate in the decision made by the healthcare team especially if they have the knowledge on the factors that affect extubation time following coronary artery bypass surgery. This study aimed to evaluate the duration of intubation after coronary artery bypass surgery and related factors in Mazandaran Heart Center, Sari, Iran.
A descriptive analytical study was carried out in 200 patients with a diagnosis of coronary artery disease undergoing coronary artery bypass surgery. Relevant information was obtained via observation, patients medical records, and nursing notes. Data analysis was performed using frequency and central tendency, dispersion indices, Spearman correlation, Mann-Whitney, Kruskal-Wallis, chi-square, and regression tests.
The duration of intubation was 9.39±2.27 hours. Meanwhile, the relationship between demographic variables and preoperative clinical factors was examined using regression models. In this study, respiratory disease, history of MI, age, and weight were found to be significantly associated with duration of intubation.
Considering demographic and clinical factors on admission and preparation of patients undergoing coronary artery bypass surgery results in earlier detection of patients at risk of prolonged intubation, and makes it possible to schedule and perform care plans accurately to prevent physical and psychological complications of prolonged mechanical ventilation and increased healthcare costs.

Background and Intensive care unit (ICU) nurses play an important role in non-pharmacological prevention of ventilator-associated pneumonia (VAP). The aim of this study was to assess the knowledge of nurses in ICU about non-pharmacological prevention of ventilator-associated pneumonia.
In a descriptive cross-sectional study, 120 ICU nurses were studied in teaching hospitals of Mazandaran University of Medical Sciences, 2015. Demographic information of nurses were recorded including age, sex, duration of being in ICU and their educational level. An authentic multiple-choice questionnaire was administered to assess the nurse's knowledge about the prevention of VAP.
120 nurses including 96 females and 24 males (mean age: 32.39±5.57, mean work experience: 5.94±4.5 years) were studied. The average number of beds in the studied ICUs was 9.53±1.97 beds (Median=9). Percentage of correct answers of nurses on the oral route for intubation, frequency of ventilator circuit changes, type of airway humidifier, frequency of humidifier changes, type of suction system, frequency of change in suction systems, drainage of subglottic secretions, kinetic vs. standard beds, and patients positioning were 81.7%, 53.3%, 42.5%, 6.7%, 62.5%, 38.3%, 30%, 46.7%, and 85.8%, respectively. The average score of the participants was 4.48±1.69 out of 9.
ICU nurse's knowledge about the type of humidifier, switching frequency of humidifier, switching frequency of suction system, subglottic secretion drainage, and the type of bed was found to be very low. These findings call for continuous training and assessment to promote the knowledge of nurses in ICUs for non-pharmaceutical prevention of VAP

Background and Some patients need to repeat certain tests. However, despite a peripheral vein catheter in the patients usually phlebotomy is done. This study examined the biochemical and hematological test results of the two methods of usual blood sampling and blood sampling through peripheral vein catheter.
A case-control study was carried out in 96 patients admitted to the intensive care unit in Sari Imam Khomeini Hospital, 2014. Each patient was considered as a control group. Blood samples were taken in the usual way (control) and peripheral venous catheter (case). To obtain a blood sample, peripheral venous catheters were washed by 2cc of normal saline. After 5 minutes, 0.5 CC blood was discarded and sampling was performed again. In all samples the levels of hemoglobin, hematocrit, sodium, potassium, BUN, Cr and FBS were investigated. Results were analyzed using Chi-square test, t-test, Wilcoxon, and Fisher’s exact test in SPSS V.18.
The patients were 56.2% male (n= 54). Mean age of the participants was 47.58±17.83 years. The results showed no significant difference in the values of hemoglobin (P=0.452), hematocrit (P=0.718), potassium (P=0.282), BUN (P=0.239), Cr (P=0.247) and FBS (P=0.074) between the two methods. But a significant difference was found between the values determined for sodium levels (P= 0.034).
Blood sampling through peripheral venous catheter while the patient is receiving liquid, is a reliable method for the analysis of hematocrit, hemoglobin, BUN and Cr.

Background and Despite the proven effectiveness of propofol on reducing smooth muscle tone, the effect of this drug on ureteral spasm has not been investigated yet. This study was designed to investigate the effect of propofol on transurethral lithotripsy (TUL) and its influence on reducing acute ureteral spasm.
A double-blind clinical trial was conducted in 122 patients. Initially, all patients were given 0.02mg/kg midazolam and 2μg/kg fentanyl. The subjects were then randomly divided into two groups. The first group (n=65) received 2.5mg/kg propofol and for the second group (n= 57) 5mg/kg thiopental was injected. TUL was performed using pneumatic method. Duration of TUL, hemodynamic condition, and success rate of lithotripsy, using ESWL, ureteral stent, Double J and any complications were recorded.
There were no significant differences in terms of gender, age, weight and stone size between the two groups (P> 0.05). Duration of TUL (P=0.004) and the mean of SBP, DBP and HR in one and five minutes were significantly lower in the propofol group (P Propofol was associated with higher reduction in systolic and diastolic blood pressure, less changes in heart rate, reducing the duration of TUL, increasing the success rate of TUL, and less need to Double J and ESWL.

Background and Gastrointestinal complications frequently occur in patients admitted to intensive care units (ICUs). Of these, ulceration and bleeding due to stress-related mucosal disease (SRMD) can lengthen hospitalization and increase mortality. The purpose of this study was to evaluate the risk factors of SRMD in patients and review the rational use of SUP drugs in ICU.
The study was conducted in Sari Imam Khomeini Hospital, 2013-2014. We investigated 100 patients in ICU. Demographic and clinical data was recorded and the appropriateness of SUP administration was determined according to American Society of Health-System Pharmacists (ASHP) protocol.
The patients were 51% male and 43% female. Overall 92% of the patients received prophylaxis. 34% of the patients who were administered parenteral drugs tolerated oral medications too. Among the patients, 31% who received prophylaxis did not have any indication for SUP. We found that 64% of the patients received SUP according to ASHP guidelines.
Unnecessary prophylaxis could cause adverse drug reactions, increase the risk of hospital-acquired pneumonia, and increase the burden of treatment. The prophylactic regimen to prevent stress ulcer bleeding should be chosen based on risk factors and underlying diseases of patients in order to provide the best therapy. Health care professionals should evaluate the risks and assess the need for stress ulcer prophylaxis.

Background and Severity of illness scoring systems is used for the classification of patients to receive medical services, predict the risk of mortality, determine hospital bed occupancy, and assess treatment progress. In Iran, these scoring systems are not frequently used due to the lack of knowledge of medical staff. This study aimed to evaluate the effect of education on the knowledge and attitude of intensive care unit (ICU) staff towards the use of predictive illness severity scoring systems in Imam Khomeini Hospital of Sari, Iran.
This pre-experimental study was conducted using a researcher-made questionnaire to assess the knowledge and attitude of ICU staff towards the use of illness severity scoring systems. Study population consisted of all the ICU nurses and physicians engaged in Imam Khomeini Hospital of Sari, Iran. In total, 60 participants were selected via census sampling. All the participants received training on the application of disease severity scoring systems. Knowledge level and attitude of the participants were assessed 10 days after the intervention. Data analysis was performed in SPSS V.18 using descriptive and inferential statistics, Mann-Whitney U test, and repeated measures one-way analysis of variance (ANOVA).
In this study, 43 participants (72%) were female, and the mean age of thesubjects was 32.5±7.3 years. Mean score of knowledge increased from 3±5.25 before the intervention to 18.4±0.96 after the intervention. With regard to attitude, mean scores reached from 100.42±11.34 before the intervention to 122.30±9.81 after the intervention (P=0.001).
After receiving education on the function of disease severity scoring systems, level of knowledge in the ICU nurses improved from low to high, while their attitude improved from moderate to excellent. Therefore, it is recommended that predictive patient scoring systems be included in medical and nursing curricula. Furthermore, new strategies must be considered to apply these tools in all the critical care units of the country.

Laryngoscopy and intubation frequently used for airway management during general anesthesia, is frequently associated with undesirable hemodynamic disturbances.. The aim of this study was to compare the effects of etomidate, combination of propofol-ketamine and thiopental-ketamine as induction agents on hemodynamic response to laryngoscopy and intubation..Patients and In a double blind, randomized clinical trial a total of 120 adult patients of both sexes, aged 18 - 45 years, scheduled for elective surgery under general anesthesia were randomly assigned into three equally sized groups. Patients in group A received etomidate (0.3 mg/kg) plus normal saline as placebo. Patients in group B and C received propofol (1.5 mg/kg) plus ketamine (0.5 mg/kg) and thiopental sodium (3 mg/kg) plus ketamine (0.5 mg/kg), respectively for anesthesia induction. Before laryngoscopy and tracheal intubation, immediately after, and also one and three minutes after the procedures, hemodynamic values (SBP, DBP, MAP and HR) were measured.. A repeated measurement ANOVA showed significant changes in mean SBP and DBP between the time points (P < 0.05). In addition, the main effect of MAP and HR were statistically significant during the course of study (P < 0.05). Furthermore, after induction of anesthesia, the three study groups had significantly different SBP, DBP and MAP changes overtime (P < 0.05). However, HR changes over time were not statistically significant (P > 0.05). Combination of propofol-ketamine had superior hemodynamic stability compared to other induction agents.. Combination of propofol-ketamine may be recommended as an effective and safe induction agent for attenuating hemodynamic responses to laryngoscopy and intubation with better hemodynamic stability. Although, further well-designed randomized clinical trials to confirm the safety and efficacy of this combination, especially in critically ill patients or patients with cardiovascular disease, are warranted..

Emergence Agitation that has been first described by Eckenhoff et al. in 1960’s is a dissociated state of consciousness in which the child is inconsolable, irritable, uncooperative, typically thrashing, crying, moaning or incoherent. It is also a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This literature review focused on presence of Emergence Agitation and contributing factors in children under general anaesthesia. It was conducted on Medline in PubMed area, Alta Vista Data bases, CINHAL and Google scholar in January 2013 for publications written in English with the following keywords: “Emergence Agitation, Etiology, Treatment, Pediatric Anaesthesia, Postanesthetic Care Unit, Children, inhaled anesthetics, intravenous anesthetics and Post Anesthetic Emergence Delirium”. In this paper, we intend to review the factors contributing postanesthetic emergence agitation in children to improve our vision in this area.

Background and Nursing is a stressful job and nurses are always susceptible to health threats in various aspects due to long shifts. Zinc is a trace element that is essential for human health. This study was performed to assess the effect of zinc supplement on general health of nurses working in intensive care units (ICU). This double blind randomized clinical trial was performed in 46 ICU accessible nurses from Imam Khomeini and Fatima Zahra hospitals (Sari-2011) with general health disorder (n = 23 intervention and 23 control). In intervention group zinc sulfate 220 mg capsules were administered twice daily every 78 hours for a month while for the control group placebo were administered in the same way. General health and serum zinc level were measured pre and post-intervention. Data was obtained using demographic and standard general health questionnaires. For data analysis we applied SPSS ver. 18, chi square, t-independent, paired t-test and kolmogorov-smirnov tests. In the intervention group the mean of general health score was 23.04±9.54 after a month and in the control group it was 27.96±13.82, (P=0.298). Among the four aspects of public health, significant improvement was observed only in physical symptoms in the intervention group (P=0.044). After a month the mean levels of zinc were 73.57±13.4 and 59.67±14.3 in the intervention group and in control group, respectively. The study showed significant increase in level of zinc in the intervention group (P=0.034). This study indicated a low level of zinc serum in nurses working in ICU. The zinc supplements showed positive effects on some aspects of general health, hence, administrating zinc supplements could be of great benefit in enhancing the general health among nurses. (Clinical Trials Registry Number: IRCT20120625436513)

Background and Pain and fatigue are complications after coronary artery bypass graft surgery. Because of non- pharmacological methods are the preferred pharmacological agent therefore; the purpose of this study was assessment of effect of foot reflexology on pain and fatigue in patients undergoing coronary artery bypass surgery (CABG). This study was a randomized controlled clinical trial، conducted on 80 patients hospitalized in the Heart Center of Mazandaran in 2011. Sampling was in manner of Non-random and accessible. Patients were age and sex matched and divided randomly in two equal groups of case and control. The reflexology group received 20- minutes left foot massage، from the second day after surgery for 4 consecutive days. In the control group، patient''s left foot without applying any pressure and only for 1 minute was fat. Variables pain and fatigue before and after the intervention was recorded by the use of visual analogue scale at the time mentioned. The findings were analyzed by using the software SPSS version 17، descriptive and inferential statistics and tests of x2 and Repeated measurments. Results showed that there is a significant differences in pain levels before and after the intervention between experimental and control groups (P= 0. 0001). Also، a significant difference confirmed in before and after fatigue levels between experimental and control groups (P= 0. 0001). According to the study results، Foot reflexology massage، as one of the branches of complementary alternative method can reduce fatigue and pain in CABG patients. Because of its the low cost، the lack of side effects and ease of the procedure to reduce pain and fatigue reflexology massage can be recommended in patients with CABG.

Background and

Surgical Site Infection (SSI) is the third leading cause of hospital infections and lead to increased morbidity, mortality and costs after cardiac surgery. The importance of prophylactic antibiotics in cardiac surgery has been proved. The aim of this randomized clinical trial was to compare of two prophylactic antibiotic regimens (cefazolin and cefazolin + Gentamicin) on surgical site infection of CABG patients in Mazandaran Heart Center.

A total of 400 patients, meeting eligibility criteria, were randomly allocated into two equal groups. In the control group the prophylactic regimen consists of Cefazolin 2 g IV before sternal incision followed by 1 g IV every 6 hours for 72 hours. In the intervention group the prophylactic regimen consists of Cefazolin 2 g IV plus Gentamicin 1.5mg/kg IV before sternal incision followed by Cefazolin 1 g IV every 6 hours plus Gentamicin 1.5mg/kg IV every 8 hours for 72 hours. Patients were observed by cardiac surgeon for signs of surgical wound infection at 3, 7, 21 and 30 days after cardiac surgery. Also Creatinine and BUN was measured before, 2th and 4th days after surgery. Data were analyzed by Independent t test, Paired t test, Chi-Square, Fisher and Repeated Measures tests.

392 of 400 patients were examined, 198 patients in control group and 194 patients in intervention group. There was no significant difference between the two groups regarding demographic and clinical variables (P>0.05). After intervention there was no significant difference between the two groups regarding the incidence of infection (P>0.05) but serum level of Creatinine and BUN was significantly higher in intervention group (P<0.05).

With considering to the lack of significant difference in infection rates between two groups and significant increase in serum level of Creatinine and BUN in intervention group, Cefazolin alone is sufficient as a prophylactic antibiotic to prevent surgical site infection of CABG patients.

Background and There has been no objective evaluation of the amount medical errors in Ïran; it seems a disproportionate attitude with this approach is the main hindrance to reporting of such errors. Çonsidering the role of the chief manager in executive functioning of every institution, this study has been carried out with the aim of surveying the attitude of chief managers of Mazandaran Üniversity of Medical Sciences towards voluntary report of medical errors. This is a descriptive cross-section study. Çhiefs, managers, chief nurses, supervisors and head-nurses from 32 hospitals under supervision of MÂZÜMS were questioned. Â self-sufficing questionnaire in two sections containing closed questions, in order to determine experience of medical error and also to study their attitude towards voluntary report system of medical errors in hospital was implemented. The questionnaire was based on a review of studies and the aims of research and had face validity and in the primary studies a reliability of 79%. Ïn this study, out of 278 (54 %) of questionnaires collected, 110 (39.6%) managers had experienced medical error, 190 (%68.4) stated that in the hospital they work, errors are reported. Most chief managers (%95.7) thought that reporting the medical errors would improve patient safety. Regarding ‘need for a different approach in executive policies’ 89.6 % of managers agreed. Â large majority of responders (%85) disagreed with an ‘absolute punishment policy’ in case of encounter with medical error.Çonclusion: Most hospital managers are in favor of a system for reporting and analyzing of medical errors. Ït seems reinforcing the foundation of systematic and non-individual reporting and assessing of the errors is a crucial step towards realization of this end.

Background and The monitoring of the patients’ hemodynamic status and vital signs is a routine practice in ÏÇÜ and the use of a low-cost and soothing method to maintain stable physiological parameters is necessary. This study aimed at investigating the effect of music on the vital signs and SpÔ2 of patients after open heart surgery. This study was a randomized clinical trial (RÇT) conducted on 60 patients hospitalized in the open heart surgery ÏÇÜ of Mazandaran Heart Çenter. Patients were randomly assigned into case and control groups. Ïn the case group, the patients listened to the music, which they selected before, through headphones for 30 minutes, while headphones without playing any music were used for patients in the control group. Vital signs and SpÔ2 of the patients were assessed before the intervention, immediately, 30 and 60 minutes after the intervention. The data were analyzed using Çhi-square; T-test and repeated measure statistical tests. Findings showed that music led to a significant decrease in the rate of heartbeat, systolic blood pressure, and mean arterial pressure and a significant increase in SpÔ2 rate (P<0.05) was also observed. But music had no significant effect on the respiratory rate and diastolic blood pressure (P>0.05).Çonclusion: Âs a non-pharmacologic, inexpensive, non-invasive method and without any side effects, music can improve the vital signs of the patients after open heart surgery.

Primary heart tumors are not common. Âlthough myxoma is the most common tumor of the heart، mitral valve myxoma is extremely rare. The patient is a 55 years old woman who had atypical retrosternal pain، retinal artery emboli and visual deficit. Ïn transesophageal echocardiography a (4x3x3) cm mass was detected in posterior leaflet of mitral valve. The posterior leaflet of mitral valve was totally resected and the mitral valve was successfully replaced with prosthetic mechanical valve. Histopathology result confirmed myxoma.