seyed jalal madani

Despite advances in the treatment of abdominal injuries in patients with trauma, it remains a major public health problem worldwide. Evaluation of hazard ratio (HR) of 90-day mortality in intensive care unit (ICU) patients with abdominal injuries compare with head injuries in trauma patients and non-trauma surgical ICU patients.

This single-center, prospective cohort study was conducted on 400 patients admitted to the ICU between 2018 and 2019 due to trauma or surgery in Hamadan, Iran. The main outcome was mortality at 90-day after ICU admission. Cox proportional hazards models were used to determine the HR and 95% confidence interval (CI) for 90-day mortality.

The 90-day mortality was 21.9% in abdominal injuries patients. According to multivariate Cox regression, the expected hazard mortality was 2.758 times higher in patients with abdominal injuries compared to non-trauma patients (HR: 2.758, 95% CI: 1.077–7.063, P = 0.034). About more than 50% of all deaths in the abdominal and head trauma groups occurred within 20 days after admission. Mean time to death was 27.85± 20.1, 30.27 ± 18.22 and 31.43± 26.24 days for abdominal-trauma, surgical-ICU, and head-trauma groups, respectively.

Difficulty in accurate diagnosis due to the complex physiological variability of abdominal trauma, less obvious clinical symptoms in blunt abdominal injuries, multi-organ dysfunction in abdominal injuries, failure to provide timely acute care, as well as different treatment methods all account for the high 90-day mortality rate in abdominal-trauma patients. Therefore, these patients need a multidisciplinary team to care for them both in the ICU and afterwards in the general ward.

Hospitalization in intensive care units results tactile deprivation, which may cause level of consciousness and physiologic imbalance. Foot tactile stimulation can influence the level of consciousness in comatose patients. The aim of this study was to examine the effects of foot tactile stimulation on level of consciousness and physiological parameters in comatose patients admitted to the intensive care unit. 

This randomized clinical trial was conducted on 60 patients with coma who were hospitalized in the intensive care units of Shohadaye Tajrish Hospital in Tehran in 2019. The subjects were assigned in two groups of experimental and control, by using randomize blocked allocation. In experimental group, feet, ankles and soles of patients were touched for 10 minutes twice a day for three days (morning and evening). The level of consciousness was recorded using Glasgow Coma Scale. The level of consciousness and physiological parameters (blood pressure, respiratory rate, and pulse rate) were recorded from the 1st to 3th day of admission (before, immediately, 30 min after intervention). Data were analyzed using descriptive and inferential statistics and analyzed using SPSS- v 20.

According to the results, foot tactile stimulation significantly decreased physiological parameters in the experimental group each therapeutic session (P < 0.05). Moreover, Multivariate analysis revealed a significant difference between experimental and control groups in level of consciousness at all-time points (P<0.05).

The foot tactile stimulation could increase the level of consciousness and stability of physiological parameters in comatose patients. it should be recommended for increasing level of consciousness in comatose patients., if it is administered frequently for long term

Pneumomediastinum and pneumothorax are usually rare conditions after pneumonia. This study examines the progress of pneumonia of the coronavirus disease 2019 (COVID-19) to spontaneous pneumothorax and pneumomediastinum in a patient.

The patient was a 40-year-old man who complained of nonproductive cough and dyspnea. He also complained of fever, sore throat, back, and chest pain. The patient used to smoke but now he quit .His O2 saturation was 89% at the time of admission. He was assessed with suspicion of COVID-19. CT scans of the chest showed brief changes of emphysema and a ground glass view was also seen in the lungs. In the patient’s tests, RT-PCR testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was performed and it was positive. Treatment was initiated and because of the progression of symptoms, the serial CT scanning of the patient’s lungs was performed daily; and cavitary changes, air-fluid appearance, and destructive changes of lungs were reported. After eight days, the patient’s cough worsened. CT scans of the patient’s lungs showed some bullaes, pneumothorax, and pneumomediastinum, thus a chest tube was inserted and oxygen therapy was begun on the patient with 3-6 L/min. After 5 days in CT, the patient was relieved of pneumothorax and pneumomediastinum and after a week, the chest tube came out.

Pulmonary lesions of COVID 19 can progress to bullae, pneumomediastinum, and pneumothorax. Deterioration of dyspnea and respiratory symptoms can be a warning of pneumomediastinum and pneumothorax that can be confirmed by graphics and timely treatment of the patient can be life-saving.

Gastrointestinal surgery is one of the procedures that result to produce inflammatory reactions and pain to patients. Administrate of high-safe analgesia in surgery is very essential, to reduce pain and improve inflammatory reactions.

The present study compared inflammatory markers and pain relief with the epidural infusion of bupivacaine-fentanyl and intravenous morphine bolus in gastrointestinal cancer surgeries.

This randomized control clinical trial study was carried out from December 2018 to October 2020, on ASA I and II patients aged between 30-80 years who referred for gastrointestinal cancer surgery. Cases were randomly distributed into two groups. Group I received epidural catheter with bupivacaine (18 cases), and group II received fentanyl and morphine bolus injection (18 cases). On the first and second days post-operation, data on pain scores based on visual analogue scale (VAS) score, inflammatory markers (procalcitonin [PCT] and C-reactive protein [CRP]), platelet (PLT), white blood cells (WBCs), and erythrocyte sedimentation rate (ESR) was recorded.

The mean age was 52.21±16.13 years (41.6% male, 58.4 female). The mean of ESR, CRP and PCT postoperative were significantly higher than preoperative (P < 0.05). There were no differences between the two groups regarding PLT, ESR, CRP, and PCT preoperative postoperative (P > 0.05). The mean of pain was less in the epidural group than in the morphine group postoperative (P = 0.02).

The results showed that epidural fentanyl-bupivacaine infusion was more effective in pain reduction than the intravenous infusion of morphine in cases undergoing gastrointestinal cancer operation. However, both analgesic approaches were similar in inflammatory functions.

The weaning process from mechanical ventilation in chronic obstructive pulmonary diseases (COPD) is a time-consuming process required for the care of these patients. This study aimed to: 1. decide cut-off points of combined and common indices RSBI, P0.1, NIF, CROP, and IWI in the population of COPD patients; and 2. compare different weaning factors from the mechanical ventilator of combined, RSBI, P0.1, NIF, CROP, and IWI indices in the population of COPD patients.
This observational, prospective multi-center triple-blinded study was conducted from January 2013 to March 2014 in the population of hospitalized COPD patients in the critical care units of selected Military hospitals in Tehran, Iran. Patients were divided into two groups with cut-off points determining the first group (n = 90) and different predictive weaning factors from the mechanical ventilator determining the second group (n = 90). The process of weaning from the mechanical ventilator was performed in the same way in both groups and was based on the defined protocol. ROC analysis was used to determine cut off points in the first group and predictive factors in the second group.
Six indices combined, RSBI, IWI, P0.1, NIF, and CROP were compared from different predicting weaning factor's view. Generally, RSBI, combined, IWI, P0.1, NIF, and CROP indices were devoted the most favorably factors to itself, respectively. The highest area under the curves were devoted to RSBI (0.927) and combined (0.891) indices.
Although the proposed index has more components than other common indices in weaning process from mechanical ventilator, the RSBI index in addition to simplicity, provided the most desirable characteristics of predictive weaning from mechanical ventilator. It is also suggested that corrected RSBI index (RSBI application alongside tight subjective and objective signs and symptoms of respiratory distress) be used in the population of chronic obstructive pulmonary patients.

Medical science education has special characteristics due to the need for diverse learning areas in the wide range of health and disease. This study was conducted with the aim of Environmental analysis and providing effective strategies for the development of medical education at a military medical faculty.
This cross-sectional study was conducted in 2016 which the SWOT model and review of internal factors (strengths and weaknesses) and external factors (opportunities and threats) was used. Participants included 42 members of the scientific board, experts and stakeholders of a military medical faculty in Iran with purposive sampling. Data collection was performed by reviewing documents, focus group discussions and standard strategic planning questionnaires. Data was analyzed using content analysis and descriptive statistics in TOWS model.
The score of internal and external factors of the faculty was determined by 12 effective strategies for the development of medical education. Strategies included: quantitative and qualitative transformation of educational programs and promotion of the top scientific and educational status in the country and the region; becoming a scientific and educational center in the fields of basic sciences, clinical medicine and military medicine; and development of disciplines and educational levels with new trends and interdisciplinary sciences.
Based on the results of the evaluation and environmental analysis of the medical faculty in the field of medical education, the strategic position of the faculty is competitive. Therefore, this faculty needs to make more efforts to achieve a desirable situation through development-driven strategies.

Researches’ needs assessment has a great contribution in the research planning process. This research has been carried out for the needs assessment and prioritization of strategic researches in the field of scientific development of a medical faculty in Iran.
This research is a mixed study that was conducted in two qualitative and quantitative phases, and was completed in 2016. The research sample consisted of strategic documents, 9 policy makers, 31 managers of educational groups and 12 stakeholders from a medical faculty in Iran who were selected by a purposeful sampling method.The data of the qualitative section were gathered through reviews, analysis and documentation analysis and group interviews were done and analyzed by content analysis method. The Analytic Hierarchy Process (AHP) was used to rank the criteria and the TOPSIS technique was used to rank the titles.
By analyzing the qualitative phase data, 48 research topics were identified in four strategic axes. . In the quantitative phase, the first priorities of the research were based on the evaluation of experts and policy makers of the faculty determined and included: providing solutions for maintaining human capital (with a score of 0.713) in the human capital axis, the need for the assessment of the fields and sections required based on the organizational needs and stakeholders (with a score of: 0.769) in the education and training of students, evaluating and assessing the required scientific-educational poles (with a score of 0.761) in the knowledge generation axis and the identification of priority areas was obtained based on the mission of the faculty (with Score: 0.746) governance of the faculty.
The research topics prioritized in this study (within the framework of the strategic goals of the faculty) can realize the perspective of its scientific development and make the dynamism necessary for its mission.

Most patients hospitalized at intensive care units have a continuous infusion catheter in place for receiving drugs and solutions; nonetheless, blood sampling in these units is still performed through an invasive and painful venipuncture. However, it is possible to take blood from a peripheral venous catheter to obtain accurate laboratory test results and alleviate the suffering of patients.
The aim of this study was to compare hematology, chemistry, and blood gas values sampled from venipuncture and continuous infusion intravenous catheter.
In this cross-sectional comparative study, a convenient sample of 61 adult patients was drawn according to the inclusion and exclusion criteria, from the intensive care unit. Two blood samples, one from a continuous infusion catheter, which was already in place and one from venipuncture at the other extremity, were obtained from each patient. The two sets of samples were compared in terms of hematology, biochemistry and blood gas values by using the paired-samples t-test.
The two sets of samples differed significantly in terms of blood sugar values. Other differences between the two sets were not statistically significant.
Except for blood sugar, blood sampling from a continuous 24-hour infusion catheter produces reliable hematology, biochemistry and blood gas results as that of venipuncture blood sampling method. Moreover, compared with the routine venipuncture method, sampling from a continuous infusion catheter is simpler, easier and safer.

Nowadays, Non-communicable diseases are widespread due to modernization of societies, technology development, population density in urban areas, and changes in life style. Variety of cardiovascular diseases are the most common causes of death and important factors of failure in most countries including Iran.This study was conducted to determine the effect of progressive muscle relaxation on the lifestyle of patients with myocardial infarction. In this randomized double-blind clinical trial, after sampling, 66 patients were randomly selected and assigned to either the control or test group. An orientation session was held to explain the research goals and intervention. The test group did the progressive muscle relaxation techniques, two 20-30 minute sessions daily for two months (120 sessions). Data collection tools were demographic information questionnaire, lifestyle questionnaire, and self report check list. Independent t- test and mann-whitney U showed there are no significant differences in four aspects of life before the intervention, but these differences were significant after the intervention(P<0.05). ANOVA with repeated measures in three different times (before, 1 and 2 months after intervention) showed significant difference between the two groups (P<0.05). Applying progressive muscle relaxation technique on various aspects of life of patients suffering myocardial infarction would modify, adjust and improve their lifestyles.

Determining the patient's readiness for weaning from mechanical ventilation and predicting the weaning outcomes are important issues that should be carefully evaluated and the risks of delay in weaning and increased mortality rates should be avoided. The aim of this study was to compare the outcomes of weaning with current and IWIbased methods in patients admitted to the intensive care units. This was a prospective clinical trial - one blind - multicenter study where 124 adult patients, who were mechanically ventilated for more than 24 hours, were evaluated in 2 groups of current and IWI-based methods (62 in each group). Initially, in current method, the rates of successful and unsuccessful weaning were evaluated in 62 patients and the threshold value of IWI was determined. In this group, the readiness for weaning and the decision to return to mechanical ventilation was made by physician in charge (who was completely blind to the result of the indexes evaluated). Then, after training the IWI to the medical team responsible for weaning, in 62 patients of the second group, weaning was made based on this index and the rates of successful and unsuccessful weaning were assessed. Ultimately, the rate of successful and failure weaning of the two groups was compared. In Current method among 62 patients studied, 35 were successful and 27 unsuccessful. APACHE II in successful group was 15.09±5.68, in unsuccessful group 18.70±5.39, Carrico index (PaO2 / FiO2) in successful group was 214.102±40.35, in unsuccessful group 182.87±76.22, DO index (dissolved oxygen (SaO2)) in successful group was 96.74±2.46, in unsuccessful group 95.37±3.28, GCS Score in successful group was 9.57± 1.22, in unsuccessful group 9.30±1.54, duration of mechanical ventilation (hour) in successful group was 82.54±72.31, in unsuccessful group 89.74±82.30, IWI in successful group was 42.30±12.16, in unsuccessful group 28.24±10.70. In IWI method among 62 patients studied, 58 were successful and 4 unsuccessful. APACHE II in successful group was 13.47±4.97, in unsuccessful group 13.25±4.57, Carrico index (PaO2/FiO2) in successful group was 212.80±42.15, in unsuccessful group 176.87±14.04, DO index(dissolved oxygen(SaO2)) in successful group was 95.30±3.12, in unsuccessful group 94.25±3.86, GCS Score in successful group was 9.03±1.75, in unsuccessful group 9.25±1.50, duration of mechanical ventilation (hr) in successful group was 141.43± 63.48, in unsuccessful group 51±15.10, IWI in successful group was 65.77±26.28, in unsuccessful group 40.15± 8.13. According to the research findings and studies that examined the predictive indexes of weaning from mechanical ventilation, it is indicated that in addition to objective and subjective criteria to determine the optimal time for successful weaning, predictive indexes should be used. The use of IWI index that integrates important weaning parameters can evaluate the weaning outcome with better accuracy.

Today, usage of weaning index is a controversial issue. Proper use of these indexes is beneficial for prevention of the losses caused by weaning failure, rapid and reliable identification of patients who are potentially ready for spontaneous breathing and accelerating the weaning of mechanical ventilation.. This study is to determine the validity of integrative weaning index as a mechanical ventilation discontinuation predictor in patients hospitalized in the Iranian intensive care units..Patients and This scale was evaluated on 124 adult patients who were on mechanical ventilation for more than 24 hours, in two 24-hour phases, in six ICUs (Surgery-Trauma-Medical-Poisoning) of selected hospitals in Tehran, totaling 60 beds, by the researcher as a single blind test. Inclusion criteria were: Patient 18 to 80 years old, none of them suffering from neurological and neuromuscular diseases, none or a minimal dose of sedative drugs being used (15 - 18 points based on Palma and Cook criteria), non-addict or heavy smokers, not admitted in ICU-OH. The study was conducted from November 2011 to December 2012. The ventilators used were from Rafael brand.. There were 80 successful and 44 unsuccessful as well as 72 successful and 8 unsuccessful weaning cases in the first and second phase of the study, respectively. The area under the ROC curves for IWI was 0.967, with standard error of 0.020, 95% Confidence interval of 0.899 to 0.993 and Significance level of P = 0.001, SE = 94.59, SP = 66.67, PPV = 97.22, NPV = 50, DA = 92.5 and likelihood ratio of positive test being 2.84 besides the lowest likelihood ratio of negative test equal to 0.08), with Diagnostic odds ratio being 97% and Confidence interval of 0.82 to 0.97.. Integrative weaning index has appropriate predictive validity for weaning patients from mechanical ventilation in Iranian intensive care units..

According to this approach that: “standardization of nursing care according to the last evidences has the best results in increasing care quality”، the aim of this study has been determined: “Designing evidence based nursing care instructions for mechanically ventilated patients”. The study had been done with “developmental research” method with the approach based on evidences in Intensive Care Units of Baqiyatallah hospital in 1392. At first quality of 15 present instructions in Intensive Care Units had been evaluated in three levels of weak، moderate and good. Then 22 new instructions had been designed according to Stetler model and with the approach based on evidences. For assessing content validity of the instructions، opinions of ten faculty members of Baqiyatallah، Tehran and Shahid Beheshti Universities had been considered in three refers by Delfi method. Applicability of the instructions had been assessed by focused group discussion method with experienced experts of Intensive Care Units. Evaluation of the 15 present instructions showed that their quality is in the medium. In addition to reviewing nursing books، 655 articles had been studied، and with considering criteria of choosing evidences، 121 articles had been chosen as credible evidences. At the end 22 care instructions with good quality had been designed. Lack of specification of the present instructions and their low quality showed necessity of designing instructions based on evidences with high quality and specifically for different units. Designing such instructions prepares background of using nursing studies at bedside and it is going to be an effective step for based on evidence nursing. So it is recommend that designing such application instructions should be in the priority of the next studies.