Effect of protocol-based family visitation on physiological indicators in ICU patients: a randomized controlled trial.

BACKGROUND: Intensive care unit (ICU) patients often experience significant physiological stress. This study evaluated the effect of a defined family visitation protocol on physiological responses in the ICU. METHODS: A randomized, block-randomized clinical trial was conducted on 78 ICU patients at Imam Reza Hospital between February 8, 2017, and August 8, 2017. The intervention group received protocol-based visits, and the control group continued with standard visitation. Block randomization was utilized for group assignments. The primary outcome was the measurement of physiological signs using designated monitoring devices. Data were analyzed using SPSS version 22, employing independent t-tests, Mann-Whitney U test, repeated measures analysis, and Friedman's test. RESULTS: The results showed no significant differences in systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, and arterial blood oxygen levels between the two groups. However, heart rate in the intervention group was significantly lower in three stages before, during, and after the meaningful visiting (P = 0.008). CONCLUSION: Protocol-based scheduled family visits in the ICU may reduce physiological stress, as evidenced by a decrease in patients' heart rate. Implementing tailored visitation protocols sensitive to patient preferences and clinical contexts is advisable, suggesting the integration of family visits into standard care practices for enhanced patient outcomes. TRIAL REGISTRATION: IRCT20161229031654N2; 25/01/2018; Iranian Registry of Clinical Trials ( https://en.irct.ir ).

The impact of cardiopulmonary rehabilitation in phase II cardiac rehabilitation program on the health-related quality of life of patients undergoing coronary artery bypass graft surgery.

BACKGROUND: Coronary artery bypass surgery is the leading cause of change in the quality of life and pulmonary function of patients. One strategy to enhance lung muscle strength and improve overall quality of life is pulmonary rehabilitation. This study aimed to investigate the impact of incorporating a pulmonary rehabilitation program into phase II cardiac rehabilitation program on the quality of life of patients undergoing coronary artery bypass graft surgery. METHODS: This randomized clinical trial study included 53 patients who underwent coronary artery bypass graft surgery at Imam Reza Hospital in Mashhad between September 2019 and March 2020. The research participants were selected based on specific inclusion criteria and divided into two groups. The control group followed the routine rehabilitation program, whereas the intervention group underwent a pulmonary rehabilitation program for 20-30 min after each session of the cardiac rehabilitation program. Data collection tools included a demographic information questionnaire and the Ferrans and Powers' quality of life index. The data were analyzed using the independent t-test, Mann-Whitney test, paired t-test, Spearman correlation, Wilcoxon test, and SPSS25. RESULTS: The mean quality of life score in the intervention group(20.7±1.8) was significantly higher than that of the control group (18.8±2.3)(P < 0.05). Furthermore, the intervention group exhibited significantly higher mean scores in the physical, psychological-spiritual, and family dimensions than the control group(P < 0.05). CONCLUSION: The study results demonstrate the positive impact of incorporating a pulmonary rehabilitation program into cardiac rehabilitation on the health-related quality of life of patients undergoing coronary artery bypass graft surgery. TRIAL REGISTRATION: IRCT20190707044132N1.

The relationship between anthropometric indices and the presence of hypertension in an Iranian population sample using data mining algorithms.

Hypertension (HTN) is a common chronic condition associated with increased morbidity and mortality. Anthropometric indices of adiposity are known to be associated with a risk of HTN. The aim of this study was to identify the anthropometric indices that best associate with HTN in an Iranian population. 9704 individuals aged 35-65 years were recruited as part of the Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study. Demographic and anthropometric data of all participants were recorded. HTN was defined as a systolic blood pressure (SBP) ≥ 140 mmHg, and/ or a diastolic blood pressure (DBP) ≥ 90 mmHg on two subsequent measurements, or being treated with oral drug therapy for BP. Data mining methods including Logistic Regression (LR), Decision Tree (DT), and Bootstrap Forest (BF) were applied. Of 9704 participants, 3070 had HTN, and 6634 were normotensive. LR showed that body roundness index (BRI), body mass index (BMI) and visceral adiposity index (VAI) were significantly associated with HTN in both genders (P < 0.0001). BRI showed the greatest association with HTN (OR = 1.276, 95%CI = (1.224, 1.330)). For BMI we had OR = 1.063, 95%CI = (1.047, 1.080), for VAI we had OR = 1.029, 95%CI = (1.020, 1.038). An age < 47 years and BRI < 4.04 was associated with a 90% probability of being normotensive. The BF indicated that age, sex and BRI had the most important role in HTN. In summary, among anthropometric indices the most powerful indicator for discriminating hypertensive from normotensive patients was BRI.

Introduction of Various Models of Palliative Oncology Care: A Systematic Review.

BACKGROUND: The aim of this study is to synthesize the existing evidence on various palliative care models for cancer patients. This effort seeks to discern which facets of PC models are suitable for various patient cohorts, elucidate their mechanisms, and clarify the circumstances in which these models operate. METHODS: A comprehensive search was performed using MeSH terms related to PC and cancer across various databases. The Preferred Reporting Items for Systematic Reviews and a comprehensive evidence map were also applied. RESULTS: Thirty-three reviews were published between 2009 and 2023. The conceptual PC models can be classified broadly into time-based, provider-based, disease-based, nurse-based, issue-based, system-based, team-based, non-hospice-based, hospital-based, community-based, telehealth-based, and setting-based models. The study argues that the outcomes of PC encompass timely symptom management, longitudinal psychosocial support, enhanced communication, and decision-making. Referral methods to specialized PC services include oncologist-initiated referral based on clinical judgment alone, via referral criteria, automatic referral at the diagnosis of advanced cancer, or referral based on symptoms or other triggers. CONCLUSION: The gold standard for selecting a PC model in the context of oncology is a model that ensures broad availability of early PC for all patients and provides well-timed, scheduled, and specialized care for patients with the greatest requirement.

The efficacy of phase I cardiac rehabilitation training based on augmented reality on the self-efficacy of patients undergoing coronary artery bypass graft surgery: A randomized clinical trial.

BACKGROUND: Open-heart surgery is considered one of the primary treatments for severe coronary artery stenosis, but it comes with its own set of complications. However, these complications can be reduced through the implementation of proper cardiac rehabilitation during phase I. This study aimed to examine the impact of phase I cardiac rehabilitation training, using augmented reality, on the self-efficacy of cardiac management in patients undergoing coronary artery bypass grafting. METHODOLOGY: This randomized clinical trial study involved 60 patients who were admitted to the Cardiac Surgery Intensive Care Unit at Ghaem Hospital in Mashhad. The software used in this study consisted of various videos and educational images demonstrating physical exercises for cardiac rehabilitation. The software was developed to train the patients in the intervention group on the rehabilitation program, starting from their admission to the Intensive Care Unit until their discharge from the hospital. The collected data were analyzed using statistical tests such as independent t-test, Mann-Whitney test, paired t-test, chi-square test, as well as descriptive indicators. Cohen's d was also used to evaluate the magnitude of the effect size. RESULTS: The findings of this study revealed that the total mean score for cardiovascular management self-efficacy significantly increased during the transfer to the Intensive Care Unit and at the time of discharge. Notably, the increase observed in the intervention group was significantly greater than that of the control group (P < 0.001). CONCLUSION: The results of this study indicated that implementing early rehabilitation programs, using innovative educational technology like augmented reality, enhanced the self-efficacy of patients undergoing coronary artery bypass grafting. These findings suggest that such programs can be effectively employed as educational tools throughout different stages of cardiac rehabilitation. TRIAL REGISTRATION: This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20200203046361N1) on 16/02/2020.

Prevalence and the affecting factors on depression, anxiety and stress (DASS) among elders in Qazvin City, in the Northwest of Iran.

BACKGROUND: Depression, anxiety, and stress are among the most common mental health disorders of the elderly that affect the health of individuals and society. Considering the growing trend of the elderly population in Iran, this study aimed to determine the prevalence of these disorders and to identify the factors affecting them in the elderly. METHODS: We conducted this cross-sectional study using cluster random sampling on 301 elderly people referred to Qazvin health centers. Data was collected using the Depression, Anxiety, Stress Scale 21 (DASS-21) questionnaire and analyzed through univariate and multivariate linear regression tests with the interaction between variables in STATA Version 14 software. A P-value of less than 0.05 was significant. RESULTS: The prevalence of depression was 45.5%, anxiety 35.5%, and stress 40.2%. Our findings showed that 22.9%, 7.9%, and 14.3% of people had severe and very severe levels of depression, anxiety, and stress. The variables of age, comorbidity, living status and job status had a significant relationship with the DASS score (p < 0.05). There was an interaction between the variables of comorbidity and income status influencing the DASS score (ß = 0.68, 95% CI 0.15, 1.22). CONCLUSION: The prevalence of depression, anxiety and stress in the elderly was high, indicating the inappropriate status of their mental health. Therefore, it is necessary to take operational steps to reduce some problems in the elderly, prioritize the elderly suffering from concurrent diseases, the unemployed elderly, those who do not have a certain income, and the elderly who live alone.

Comparing the Effects of Pulsatile and Continuous Flushing on Time and Type of Peripheral Intravenous Catheters Patency: A Randomized Clinical Trial.

Introduction: Peripheral intravenous catheters (PICs) patency techniques such as flushing are being developed. According to some studies, flushing can be used continuously or in pulsatile forms. This study aimed to compare the effects of pulsatile flushing (PF) and continuous flushing (CF) on time and type of PICs patency. Methods: In this double-blind randomized clinical trial, 71 patients were randomly assigned into two groups of PF (n=35) and CF (n=36). The PF protocol was performed as successive injections of 1 mL normal saline (N/S) per second (sec) with a delay of less than 1 sec until the completion of 5 mL of solution. However, CF protocol was performed by injecting 5 mL N/S within 5 sec without any delay before and after each medicine administration. Data related to the time and type of PICs patency were collected using a patency checklist every 12 hours (h) up to 96 h. The statistical analysis was done by R statistical software (Version 3.5.1). Results: The results showed that the number of PICs remaining open was not significantly different between PF and CF groups during 96 h. The highest number of PICs excluded from the study was related to the time of 96 h as a result of partial patency in the two groups. Conclusion: There was no difference between CF and PF regarding the time and type of PICs patency. Thus, both techniques can be used to maintain the catheter patency.

Isolation Compliance and Associated Factors Among COVID-19 Patients in North-West Iran: A Cross-Sectional Study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has now turned into a public health emergency. Isolation of patients is a possible solution for controlling epidemic infectious diseases. We assessed the compliance of isolation and associated factors among patients with COVID-19. METHODS: This cross-sectional study was conducted on 320 COVID-19 patients discharged from hospitals of Qazvin province. Patients' isolation, self-care health behaviors, reference to public health services and possible related factors were assessed. Data were analyzed using multiple logistic regression. RESULTS: In this study, 320 patients were enrolled, including 175 men (54.7%). Two hundred and eighty-six patients (89.4%) had complete isolation. Factors such as phone tracking by health center (OR = 1.30; 95% CI: 1.01 to 1.75) and dry cough (OR = 2.36; 95% CI: 1.09 to 5.09) increased odds of complete isolation in COVID-19 patients, but having a COVID-19 patient in the family (OR = 0.32; 95% CI: 0.15 to 0.71) and symptoms of disease like shortness of breath (OR = 0.39; 95% CI: 0.18 to 0.85) and muscle pain (OR = 0.43; 95% CI: 0.20 to 0.95) decreased odds ratio for these patients. CONCLUSION: Phone tracking by the health center was the most important factor to increase the odds of patient isolation. Thus, the health system should consider improving health workers' knowledge and skills through education.

Enclosed in the synergistic rings of suffering: The experience of conscious patients under mechanical ventilation in the intensive care unit of the causes of suffering.

BACKGROUND: Patients undergoing mechanical ventilation in intensive care units are in a special position of suffering, and discovering their experiences in the painful situations of the intensive care unit can contribute greatly to improve the quality of nursing care for them. OBJECTIVE: The present study was performed aiming to explain the experience of conscious patients receiving mechanical ventilation in the intensive care units of the causes of suffering. METHODS: This is a qualitative content analysis study conducted in Iran in 2017. Participants of this study included 15 conscious mechanically ventilated patients in the intensive care unit. Semi-structured interviews and observations were used to collect data. For sampling, first, the purposeful and then theoretical methods (guided by the created categories) were used and the procedure continued until saturation of the data. The text of the handwritten notes of recorded interviews were analyzed using conventional qualitative content analysis. RESULTS: Four subclasses of "unpleasant consequences of disease", "bitter elixir of therapy", "an inconvenient environment" and "understanding the threat to family safety and comfort" all under the general category "enclosed in the synergistic rings of suffering" were extracted from the profound descriptions of contributors. CONCLUSION: Mechanically ventilated patients in the intensive care unit are enclosed in the rings of suffering, so that each of these rings imposes a great deal of pain and suffering on the patient and have a synergic and intensifying effect on each other. Therefore, design and application of strategies and nursing care is essential to reduce the severity of the suffering and discomfort of these patients.