جستجوی مقالات مرتبط با کلیدواژه "patient positioning" در نشریات گروه "پزشکی"

Epidural analgesia (EA) is an effective and common method of pain relief during labor. However, EA may also have some adverse effects like prolonged labor, increased risk of operative delivery, and some unwanted complications. It's unclear how maternal position affects the outcomes of natural birth with EA. This study aimed to compare mode of delivery and maternal and neonatal outcomes between recumbent and upright positions in nulliparous women with EA. This randomized clinical trial involved 540 women who received EA at cervical dilatation of 4 to 6 cm. During the second stage of labor, they were instructed to adopt upright or recumbent position. The main outcome was the mode of delivery. The secondary outcomes included duration of labor, pain intensity, the Apgar score, and other maternal and neonatal complications. Finally, 528 women were included in the final analysis. The upright group had a higher rate of cesarean section than the recumbent group. The duration of the labor stages did not differ between the groups. The pain intensity in the second stage was higher in the upright position. The Apgar score at 1 and 5 minutes was higher in the recumbent group. There was no difference in terms of other outcomes between the groups. Recumbent positions are beneficial in the case of rate of cesarean, mother’s pain, and Apgar score in women with EA. So, adopting a recumbent position during the second stage of labor may be preferable for women with EA.

Panoramic imaging is a technique to create images of facial structures. Various factors affect the preparation of a high quality and proper panoramic image, such as the patient’s proper position. The aim of this study was to investigate positional errors in panoramic images based on the dentition type of patients referring to oral and maxillofacial radiology department of Tabriz Dental School

This cross-sectional study was conducted in Radiology Department of Tabriz Dental School in 2017-18. Dentition of patients (primary, mixed, permanent, complete edentulous) was determined by radiography. 410 radiography per group (1640 samples) were selected from the archives of Radiology Department by simple random sampling method. one radiologist evaluated all the images in the same condition and in a semi-dark room, in a 21-inch DELL monitor, regarding the presence of each of the positioning errors. Radiographs that were repeated due to positioning errors and poor diagnostic quality were classified as unacceptable radiographic images.

In primary, mixed, permanent and edentulous dentitions, not attaching the tongue to the palate were the most errors in the radiographies, with 50.4%, 65.6%, 64.3% and 64.8%, respectively. The presence of 2 errors (563 radiographies, 34.3%) had the highest frequency. 123 radiographies (7.5%) were free of errors. Primary dentition with 95 radiographies (23.2%) had the highest unacceptable radiographies, and edentulous dentition with 29 radiographies (7.1%) had the lowest unacceptable radiographies. Chi-square test indicated that this finding was statistically significant (P <0.001).

Positioning error has high prevalence in radiographic images, the most common of which is not attaching the tongue to the palate during radiography. In the primary dentition period, the number of acceptable radiographs was lower than the other periods.

At image‑guided radiotherapy, technique, different imaging, and monitoring systems are utilized for (i) organs border detection and tumor delineation during the treatment planning process and (ii) patient setup and tumor localization at pretreatment step and (iii) real‑time tumor motion tracking for dynamic thorax tumors during the treatment. In this study, the effect of fuzzy logic is quantitatively investigated at different steps of image‑guided radiotherapy. Fuzzy logic‑based models and algorithms have been implemented at three steps, and the obtained results are compared with commonly available strategies. Required data are (i) real patients treated with Synchrony Cyberknife system at Georgetown University Hospital for real‑time tumor motion prediction, (ii) computed tomography images taken from real patients for geometrical setup, and also (iii) tomography images of an anthropomorphic phantom for tumor delineation process. In real‑time tumor tracking, the targeting error averages of the fuzzy correlation model in comparison with the Cyberknife modeler are 4.57 mm and 8.97 mm, respectively, for a given patient that shows remarkable error reduction. In the case of patient geometrical setup, the fuzzy logic‑based algorithm has better influence in comparing with the artificial neural network, while the setup error averages is reduced from 1.47 to 0.4432 mm using the fuzzy logic‑based method, for a given patient.Finally, the obtained results show that the fuzzy logic based image processing algorithm exhibits much better performance for edge detection compared to four conventional operators. This study is an effort to show that fuzzy logic based algorithms are also highly applicable at image‑guided radiotherapy as one of the important treatment modalities for tumor delineation, patient setup error reduction, and intrafractional motion error compensation due to their inherent properties.

Maintaining endotracheal tube intracuff pressure (ETTICP) within an optimal range is crucial for effective ventilation and prevention of aspiration. This study aimed to determine the effect of changing body position on ETTICP in patients under mechanical ventilation.

In the current single-group study, each patient was taken as his/her own control. Thirty patients who met the inclusion criteria were selected as the study sample. First, the patients were placed in a supine (flat) position, head of the bed was raised to 30 degrees, and ETTICP was set at 25 cmH2 O as the baseline. Then, the ETTICP changes in the three positions (left lateral, right lateral, and semi-fowler) were compared with the baseline. Interventions were made on a random basis among the patients. Data were analyzed by repeated-measures ANOVA using SPSS version 13.

There was a significant difference among ETTICP means in three different body positions, so that ETTICP was higher in the left lateral position compared to other positions. Moreover, there was a significant difference among ETTICP means 0, 15, 45, and 90 minutes after changing the body position. ETTICP means after 0 and 15 minutes were significantly higher than other times compared to the baseline.

ETTICP changes were affected by different body positions and the passage of time. Thus, regular monitoring and adjusting of ETTICP after any body positioning is essential, especially immediately and 15 minutes after repositioning.

This study aimed to assess the effect of head position on linear cephalometric measurements by cone-beam computed tomography (CBCT).

CBCT scans of four human dry skulls were obtained by NewTom 3G volume scanner with alarge (15 x15 cm)field of view in 1 centric and 18 eccentric positions: 10°, 20°, and 30° tilt (right and left), 10°, 20°, and 30° rotation (right and left), 10°, 20°, and 30° extension and 10°, 20°,and 30° flexion. The distances between the selected landmarks namely the Nasion (N), Sella (Se), anterior nasal spine (AN S), Menton (Me), Gnathion (Gn), Gonion (Go), and Condylion (Co) were measured by two observers on maximum intensity projection reconstructions using the NNT Viewer software, and compared with the actual measurements (gold standard). The inter-class correlation coefficient (ICC) and the student’s t-test were used for statistical analysis.

The mean inter-rater agreement was excellent for all head positions (ICC=96.89%). The maximum error in absolute mean measurements was 2.56 mm (P=0.03) The minimum error was for the N-Me line, which is a vertical line closest to the midline.

The greatest error was observed in 30° left ward rotation for the left CoGn linear measurement. Although this level of error may not be of clinical significance, it is suggested that clinicians acquire the scans in ideal head position to minimize distortion and errors.

The aim of this study was to determine the accuracy of two different immobilization methods in patient positioning in cranial radiotherapy. The six-dimensional (6D) target localization accuracy of using a dedicated stereotactic mask was compared with that of a conventional head mask by the ExacTrac system.

A total of 56 patients with cranial lesions were included in this study (26 patients with a dedicated stereotactic mask and 30 subjects with a conventional head mask). The ExacTrac image-guided positioning system was utilized to obtain daily translational and rotational patient positioning displacement from the intended position. The 6D setup data was analyzed to obtain population mean, systematic and random errors, and three-dimensional (3D) vector shifts in all the patients.

The population mean values of setup errors were comparable with both immobilization systems; however, the spread as indicated by population systematic and population random errors was more in the use of a conventional head mask. The mean values of the 3D vector shifts were 2.09±1.00 and 4.51±3.38 mm with the use of a dedicated stereotactic mask and conventional head mask, respectively. The frequency distribution of maximum rotational deviation and statistical analysis demonstrated a significant difference in immobilization accuracy between stereotactic immobilization and 3-clamp immobilization (P<0.05).

The results revealed that there was a significant reduction in target positioning errors with a dedicated stereotactic mask, compared to that with a conventional cranial mask. Furthermore, a dedicated stereotactic mask is required to keep rotational deviations within system correctable limits.

Control and maintenance of endotracheal tube cuff pressure and prevention of sore throat are major concerns in post-anesthesia care.

This study aimed to evaluate changes in the pressure of the endotracheal tube cuff filled with saline versus air and post-anesthesia sore throat when the position is altered from supine to lateral.

Thisdouble-blind randomized clinical trial was performed on 60 participants under lateral hip replacement surgery in an educational, research, and treatment center in the northeast of Iran in 2018-2019. After intubation, the cuffs of the intervention and control groups were filled with saline and air, respectively. Cuff pressures and Visual Analog Scale of sore throat were measured and analyzed using repeated measures ANOVA and Pearson's correlation coefficient in SPSS software, version 20.

The mean ages of the participants in the intervention and control groups were 45.8±11.6 and 40±13.1 years, respectively. Changes in the cuff pressure of different time points were statistically significant in both intervention (P=0.03) and control (P=0.02) groups. Based on the results of the independent sample t-test, the pain score was significantly different between the intervention (0.1±0.4) and control (1.1±2.1) groups 12 h post-surgery (P=0.01). The results of the Pearson’s correlation coefficient revealed a significant association between the pain score 12 h post-surgery and pressure difference of the fifth and first stages in the control group (r=0.585, P=0.001). In addition, the 12-h pain score and the pressure difference of the fifth and fourth stages were also significantly correlated in the control group )r=0.479, P=0.01).

Based on the findings, in the lateral-position hip surgery, the use of saline to fill the endotracheal tube cuff could lead to better control of cuff pressure and may also reduce the postoperative sore throat.

A new method based on image registration technique and an intelligent correlation model to calculate. The present study aimed to propose inter- and intra-fraction motion errors in order to address the limitations of conventional Patient positioning methods. The configuration of the markerless method was accomplished by using four-dimensional computed tomography (4DCT) datasets. Firstly, the MeVisLab software package was used to extract a three-dimensional (3D) surface model of the patient and determine the tumor location. Then, the patient-specific 3D surface model which also included the breathing phases was imported into the MATLAB software package in order to define several control points on the thorax region as virtual external markers. Finally, based on the correlation of breathing signals/patient position with breathing signals/tumor coordinate, an adaptive neuro fuzzy inference system was proposed to both verify and align the inter- and intra-fraction motion errors in radiotherapy, if needed. In order to validate the proposed method, the 4DCT data acquired from four real patients was considered. Final results revealed that our hybrid configuration method was capable of aligning patient setup with lower uncertainties, compared to other available methods. In addition, the 3D root-mean-square error has been reduced from 5.26 to 1.5 mm for all patients. In this study, a markerless method based on the image registration technique in combination with a correlation model was proposed to address the limitations of the available methods, including dependence on operator’s attention, use of passive markers, and rigid-only constraint for patient setup.

The present study was aimed at evaluating common positioning errors on panoramic radiographs taken in the Radiology Department of Mashhad Dental School.
The study sample included 1,990 digital panoramic radiographs taken in the Radiology Department of Mashhad Dental School by a Planmeca Promax (Planmeca Oy, Helsinki, Finland), during a 2-year period (2010–2012). All radiographs, according to dentition and sex, were evaluated for positioning errors.
There were 1,927 (96.8%) panoramic radiographs with one or more errors. While the number of errors in each image varied between one and five, most images had one error (48.4%). The most common error was that the tongue was not in contact with the hard palate (94.8%). "Open lips" was an error not seen in any patients.
positioning errors are common in panoramic radiographies. The most common error observed in this study was a failure to place the tongue on the palate. This error and the other errors reported in this study can be reduced by training the technicians and spending little more time for patient positioning and more effective communication with the patients.

To avoid microaspiration or tracheal injury, the target endotracheal tube cuff pressure must be maintained 20–30 cmH2O. Changing in patient's positions may effect on endotracheal tube cuff pressure. The aim of this study was to investigate the effect of various patient's positions on endotracheal tube cuff pressure after adult cardiac surgery.
This prospective, interventional study was conducted on 25 adult patients with orotracheal intubation for the cardiac surgery. Patient's endotracheal tube cuff pressure was assessed after surgery in a neutral starting position during an end-expiratory hold, and cuff pressure was regulated at 25 cmH2O. Then, ten changes in head position were performed: anteflexion, hyperextension, left and right lateral flexion, left and right rotation, semi-recumbent position (head elevation in 45°), recumbent position (head elevation in 10°), horizontal supine position, and finally, Trendelenburg position (10°). The observed cuff pressures were compared with the basic cuff pressure at the starting position.
Of total 250 measurements (25 participants in 10 positions), 109 (43/6%) were greater than the upper target limit of 30 cmH2O. In contrast, no measurements were less than the lower target limit of 20 cmH2O. 141 (56/4%) measurements were between the target limit of 20–30 cmH2O. All ten changes of patient's head position lead to statistically significant increase in endotracheal tube cuff pressure (P Simple changes in intubated patient's position could significantly increase in endotracheal tube cuff pressure that may potentially damage tracheal mucosa.

The prevention of ventilator-associated pneumonia (VAP) can decrease the duration of mechanical ventilation, length of hospital stay, mortality, and healthcare costs.
The aim of this study was to compare the effect of the elevation of head of bed (HOB) to 30 and 45 degreess on the incidence of VAP.
This study was a 3 group controlled randomized clinical trial. It consisted of 120 patients who were under mechanical ventilation and hospitalized in the intensive care unit (ICU) from February to July 2016 in the selected governmental hospitals of Iran University of Medical Sciences. The patients were allocated into 3 groups. The patients of intervention groups received interventions consisting of HOB elevation to 30 and 45 degreess for 3 consecutive days. The patients in the control group were in the routine position in the bed for 3 consecutive days. The HOB elevation was measured using the goniometer and recorded by nurses in perticular forms. At the end of the third day, VAP and pressure ulcers were evaluated using the clinical pulmonary infection score (CPIS) as well as Braden scales. The data were analyzed using descriptive and inferential statistics.
Statistically significant differences were reported in terms of VAP between the groups of the HOB evelation to 30 degrees (32.50%) and 45 degrees (20.00%) and control groups (52.50%) (P = 0.01). However, the mean scores of pressure ulcer showed no statistically significant differences between the groups (P = 0.625). The greatest change in position was performed by the staff nurses for nursing care in the group of 45 degrees elevation that reported as 6.125 ± 3.13 hours.
The HOB elevation to 45 degrees helped with the prevention of VAP compared with the HOB elevation to 30 degrees as well as bed routine. Therefore, it is suggested that nurses elevate HOB to 45 degrees (more than 30 degrees) among mechanically-ventilated patients admitted to the ICU.

Hypotension is one of the most common complications of spinal anesthesia in parturients undergoing cesarean section. In this regard, the patient’s position may affect the incidence of hypotension.
In this clinical trial, we evaluated the effects of 1- and 2-minute sitting positions versus immediately lying down after spinal anesthesia on hypotension and vasopressor requirements.
A total of 72 parturients, scheduled for cesarean section under spinal anesthesia, were randomly divided into 3 groups (24 subjects per group). Groups S1 and S2 remained in a sitting position for 1 and 2 minutes after the induction of spinal anesthesia, respectively, while group T was immediately placed in a lying position. Systolic, diastolic, and mean arterial blood pressure, as well as heart rate, was recorded at 1, 2, 3, and 5 minutes after anesthesia induction, every 5 minutes during the first 30 minutes of surgery, and then every 10 minutes until the end of surgery. P-value less than 0.05 was considered statistically significant.
The overall frequency of hypotension was 50 (69%) cases during surgery; the reported frequency was higher in group T in comparison with group S2 (P = 0.003). The frequency of hypotension before delivery (the first 5 minutes after spinal anesthesia) was 40 (55%) cases, with a higher frequency reported in group T (20, 83%), compared to groups S1 (12, 50%) and S2 (8, 33%) (P = 0.03 and P = 0.001, respectively). The ephedrine requirement in group T (11.73 ± 7.16 mg) was higher than the other two groups (8.69 ± 7.57 and 7.82±7.95 mg in groups S1 and S2, respectively); nevertheless, the difference was not statistically significant (P = 0.19). Moreover, the difference in time to achieve T6 sensory level was only significant between group T (3.25 ± 1.1 minutes) and group S2 (4.73 ± 1.73 minutes) (P = 0.03).
The present study showed that 1- or 2-minute sitting position after spinal anesthesia with 2.5 cc of hyperbaric bupivacaine in elective cesarean section results in more hemodynamic stability, compared with immediately lying down.

After coronary angiography to prevent potential complications, patients are restricted to 4-24 hours bed rest in the supine position due to the complications. This study was designed to assess the effect of changing position and early ambulation on low back pain, urinary retention, bleeding and hematoma after cardiac catheterization. In this clinical trial, 140 patients by using a convenience sampling randomly divided into four 35-individual groups. The patients in the control group were in the supine position for 6 hours without a movement. Change position was applied to the second group (based on a specific protocol), early ambulation was applied to the third group and both early ambulation and change position were applied to the fourth group. Then, severity of bleeding, hematoma, back pain and urinary retention were measured at zero, 1, 2, 4, 6, and 24 hours after angiography. The data was collected through an individual data questionnaire, Numerical Rating Scale (NRS) of pain and Kristin Swain’s check list was applied to evaluate the severity of bleeding and hematoma. None of patients developed vascular complications. Incidence of urinary retention was higher in the control group, although this difference was not significant. The mean of pain intensity in the fourth and sixth hours showed a significant difference. Based on the findings of this study, changing patients’ position can be safe and they can be ambulated early after angiography.

Children with Cerebral palsy need to be cared like other children, the same as other children do. Usually the primary caregivers of children are their mothers who experience several problems due to this prolonged care.. This research aimed to investigate the effect of education of the correct ways of carrying and positioning to mothers of children with cerebral palsy on mothers’ quality of life (QOL)..Patients and This randomized clinical trial was conducted on 20 mothers of children with cerebral palsy who were referred to rehabilitation centers of Ahvaz school of rehabilitation sciences. They were randomly assigned to two groups of ten. The correct ways of carrying and positioning were instructed in two sessions to experimental group and then QOL in both groups was assessed at baseline, after second session, and after four weeks. The data were analyzed by the SPSS version 16.. The mean differences in three domains of QOL including the physical health, psychological health, and environmental health, were significant between groups (P < 0.05). The difference in scores of social relationships domain was not significant between groups (P > 0.05).. Since the difference between groups was significant in three domains of QOL, it can be concluded that the training could influence the QOL of mothers of children with cerebral palsy. Training the parents by experts is recommended..