Prognostic effects of cardiopulmonary resuscitation (CPR) start time and the interval between CPR to extracorporeal cardiopulmonary resuscitation (ECPR) on patient outcomes under extracorporeal membrane oxygenation (ECMO): a single-center, retrospective observational study.

BACKGROUND: The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO). METHODS: This single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA. RESULTS: The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218-2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183-0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106-0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332-3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest. CONCLUSIONS: Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly.

Prognostic values of modified NUTRIC score to assess outcomes in critically ill patients admitted to the intensive care units: prospective observational study.

PURPOSE: Modified Nutrition Risk in the Critically Ill (NUTRIC) score (mNUTRIC score) have been validated as screening tool for quantifying risk of adverse outcome critically ill patients admitted to the intensive care units (ICUs). The aim of this study was to evaluate the prognostic value of mNUTRIC score to assess outcomes in this population. MATERIALS AND METHODS: This prospective, observational study was conducted on adult patients admitted to the general ICUs of two university affiliated hospital in northwest of Iran. The association between the mNUTRIC score and outcomes was assessed using the univariate and multivariate binary logistic regression. The performance of mNUTRIC score to predict outcomes was assessed using the receiver operating characteristic (ROC)-curve. RESULTS: In total 445 ICU patients were enrolled. Based on mNUTRIC score, 62 (13.9%) and 383 (86.1%) individuals were identified at high and low nutritional risk, respectively. The area under the curve (AUC) for predicting ICU mortality, using vasopressor, duration of vasopressor, and mechanical ventilation (MV) duration were (AUC: 0.973, 95% CI: 0.954-0.986, P < 0.001), (AUC: 0.807, 95% CI: 0.767-0.843, P < 0.001), (AUC: 0.726, 95% CI: 0.680-0.769, P < 0.001) and (AUC: 0.710, 95% CI: 0.666-0.752, P < 0.001), respectively. CONCLUSIONS: An excellent and good predictive performance of the mNUTRIC score was found regarding ICU mortality and using vasopressor, respectively. However, this predictive was fair for MV and vasopressor duration and poor for ICU and hospital length of stay.

Psychological Distress Impact of Coronavirus Disease (COVID-19) Outbreak on Three Continents: A Systematic Review and Meta-analysis.

BACKGROUND: The dire state of coronavirus disease (COVID-19) outbreak has had a substantial psychological impact on society. METHODS: A systematic search was performed through Medline, PubMed, Embase, Scopus, and Web of Science, to investigate the impact of the COVID-19 pandemic on the psychological health of individuals in various countries. Subgroup analyses considered gender and classification of countries into three continents of America, Europe, and Asia. Only studies that used the COVID-19 Peritraumatic Distress Index (CPDI) questionnaire as a tool to assess mental distress were included in this meta-analysis. Heterogeneity among studies was assessed by I2 statistic, and the random-effects model was utilized to obtain the pooled prevalence. RESULTS: This pooled analysis included a large data sample of 21 studies consisting of 94,414 participants. The pooled prevalence of the psychological distress during the time of COVID-19 pandemic by CPDI for the continent of Asia was 43% (34.6% mild-to-moderate and 8.4% severe) which was greater than that for Europe (35%; 30% mild-to-moderate and 5% severe) but lower than that for America (64.3%; 45.8% mild to moderate and 18.5% severe). In addition, the prevalence of psychological distress according to CPDI was higher in females (48%; 40% mild to moderate, 13% severe) compared with males (59%; 36% mild to moderate and 5% severe). CONCLUSIONS: Our findings suggest that psychological distress in the Americas is a larger problem than in Asia and European continents. Females appear to be more vulnerable and may therefore require further attention in terms of preventive and management strategies. Implementation of both digital and molecular biomarkers is encouraged to increase objectivity and accuracy of assessing the dynamic changes in mental health in the current and future pandemics.

Effect of specific training course for competency in professional oral hygiene care in the intensive care unit: a quasi-experimental study for developing a standardized learning curve.

BACKGROUND: The development of evidence-based training standards can help improve the quality of educational programs for novice intensive care unit (ICU) nurses. This study was conducted to assess the application of a training course on competency development of nurses in relation to oral hygiene care in ICU patients and to develop a checklist for evaluating the competence performance. In addition, to achieve a certain level of oral hygiene competence, as well as to assess the relative importance of predicting factors and learning competency patterns in oral hygiene care, we used standard learning curve. METHODS: This quasi-experimental study with time series design was conducted on newly registered ICU nurses of a teaching hospital affiliated with Tehran University of Medical Sciences, Iran, between 2016 and 2018. In the first phase of this study, we designed a checklist to assess nurses' professional competence in oral hygiene care in three stages: before, during, and after care. Then, in the second phase, the level of competence of nurses in repeated times of oral hygiene care was determined based on checklist items and recorded in the learning curve. RESULTS: The greatest increase of oral hygiene care competency due to repetition was observed in the first and fourth times of repetition in comparison to the subsequent and previous steps. In the linear regression model, demographic variables predicted 12-19% of changes related to skill scores in repetitions. CONCLUSION: According to the learning curve, newly registered ICU nurses can reach an acceptable competency after 6 repetitions of oral hygiene care.

The Experiences of Recovered COVID-19 Patients in Baqiyatallah Hospital: A Qualitative Study.

The emerging COVID-19 disease affects not only the physical health but also the emotional and psychological health of patients. This study aimed to explain the experiences of 22 recovered COVID-19 patients in Baqiyatallah hospital, Tehran, Iran. Data were collected through in-depth semi-structured interviews. All interviews were recorded and transcribed and then analyzed using the conventional content analysis method. This resulted in emergence of 3 themes "emotional-sensational paradox", "spiritual growth", and "experienced mental-psychological effects", with 11 main categories and 33 subcategories. The results of the study can be used to develop instructions and guidelines for the families of patients as well as healthcare teams to provide effective measures and interventions to minimize the suffering of patients and the damage to mental health.

Deep Learning Analysis in Prediction of COVID-19 Infection Status Using Chest CT Scan Features.

Background and aims Non-contrast chest computed tomography (CT) scanning is one of the important tools for evaluating of lung lesions. The aim of this study was to use a deep learning approach for predicting the outcome of patients with COVID-19 into two groups of critical and non-critical according to their CT features. Methods This was carried out as a retrospective study from March to April 2020 in Baqiyatallah Hospital, Tehran, Iran. From total of 1078 patients with COVID-19 pneumonia who underwent chest CT, 169 were critical cases and 909 were non-critical. Deep learning neural networks were used to classify samples into critical or non-critical ones according to the chest CT results. Results The best accuracy of prediction was seen by the presence of diffuse opacities and lesion distribution (both=0.91, 95% CI: 0.83-0.99). The largest sensitivity was achieved using lesion distribution (0.74, 95% CI: 0.55-0.93), and the largest specificity was for presence of diffuse opacities (0.95, 95% CI: 0.9-1). The total model showed an accuracy of 0.89 (95% CI: 0.79-0.99), and the corresponding sensitivity and specificity were 0.71 (95% CI: 0.51-0.91) and 0.93 (95% CI: 0.87-0.96), respectively. Conclusions The results showed that CT scan can accurately classify and predict critical and non-critical COVID-19 cases.

Acute Respiratory Distress Syndrome and COVID-19: A Scoping Review and Meta-analysis.

Acute respiratory distress syndrome (ARDS) is a fatal complication of the new severe acute respiratory syndrome coronavirus (SARS-CoV-2), which causes COVID-19 disease. This scoping review was carried out with international, peer-reviewed research studies and gray literature published up to July 2020 in Persian and English languages. Using keywords derived from MESH, databases including Magiran, IranMedex, SID, Web of Sciences, PubMed, Embase via Ovid, Science Direct, and Google Scholar were searched. After screening titles and abstracts, the full texts of selected articles were evaluated, and those which passed the criteria were analyzed and synthesized with inductive thematic analysis. Study quality was also evaluated using a standard tool. The overall prevalence of ARDS was estimated using a random-effects model. This led to identification of 23 primary studies involving 2880 COVID-19 patients. All articles were observational with a cross-sectional, retrospective, case report, and cohort design with moderate to strong quality. The main findings showed that COVID-19-related ARDS has a high prevalence and is different to ARDS due to other etiologies. Elderly and patients with comorbidities and organ failure should be closely surveyed for respiratory organ indications for several weeks after the onset of respiratory symptoms. There is currently no definitive treatment for ARDS in COVID-19 disease, and supportive therapies and their effects are somewhat controversial.

The Level of Procalcitonin in Severe COVID-19 Patients: A Systematic Review and Meta-Analysis.

There is data from individual clinical trials suggesting that procalcitonin (PCT) may be a prognostic factor in the severity of COVID-19 disease. Therefore, this systematic review and meta-analysis was performed to investigate PCT levels in severe COVID-19 patients. We searched Embase, ProQuest, MEDLINE/PubMed, Scopus, and ISI/Web of Science for studies that reported the level of PCT of patient with severe COVID-19. We included all studies regardless of design that reported the level of PCT in patients with severe COVID-19. We excluded articles not regarding COVID-19 or not reporting PCT level, studies not in severe patients, review articles, editorials or letters, expert opinions, comments, and animal studies. Nine studies were included in the analysis. The odds of having more severe COVID-19 disease was higher in subjects with elevated PCT (≥0.05 ng/mL) compared with those having low procalcitonin (<0.05 ng/mL) [n = 6, OR(95% CI) = 2.91(1.14, 7.42), p = 0.025). After estimating the mean and standard deviation values from the sample size, median, and interquartile range, a pooled effect analysis indicated higher serum PCT concentrations in patients with severe versus less severe disease [n = 6, SMD(95% CI) = 0.64(0.02, 1.26), p = 0.042]. The results of this study showed that PCT is increased in patients with severe COVID-19 infection.

Acute Kidney Injury and Covid-19: A Scoping Review and Meta-Analysis.

Acute kidney injury (AKI) is a fatal complication of the new severe acute respiratory syndrome coronavirus (SARS-CoV-2) which causes COVID-19 disease. Here, we performed a scoping review and meta-analysis including clinical studies on patients with SARS-CoV-2 infection with data on AKI assessment and characteristics, and the overall prevalence of AKI was estimated using a random-effects model. We identified 21 articles which passed the search criteria. All were quantitative observational studies which used a cross-sectional, retrospective, case report, or cohort methodology. This showed that aging, diabetes, cardiovascular disease, previous chronic disease, and other comorbidities were risk factors of AKI. Although the prevalence of proteinuria, hematuria, and increased serum creatinine was reported for up to 60% of the patients with COVID-19, the overall prevalence of AKI was estimated to be 8%. We conclude that although approximately two-thirds of patients with COVID-19 had symptoms of kidney damage, most of these did not meet the diagnostic criteria for AKI. Further studies should be performed to validate biomarkers for improved AKI diagnosis in COVID-19 patients and new treatment options are required to reduce the rate of mortality.

Cardiac Injury in COVID-19: A Systematic Review.

Coronavirus 2019 (COVID-19) is responsible for the current pandemic which has already resulted in considerable mortality worldwide. This systematic review was conducted to summarize the results of the published articles assessing the incidence of heart diseases in patients infected with COVID-19. The electronic databases Scopus, Web of Science, Pubmed, Science Direct, and ProQuest were used to search for potentially relevant articles. Articles published from Dec 2019 to April 2020 were included. All cross-sectional, retrospective or prospective observational cohort and case-control studies were selected which reported the incidence or prevalence of myocardial injury, myocardial infarction, or cardiovascular disease in patients with confirmed COVID-19 infection. Based on the inclusion criteria, 12 articles were selected. The incidence of cardiac injury was reported in 8 articles and 8 articles focused on the cardiovascular outcomes of COVID-19 infection. The incidence of new cardiac injury was reported to be 7.2-77% in live and dead patients, respectively. The results showed that patients with cardiac injury had worse outcomes including higher mortality than those without cardiac injury. The most common cardiac injury outcomes were shock and malignant arrhythmias. The most common radiographic findings in patients with cardiac injury were multiple mottling and ground-glass opacities in the lungs (64.6%). A significant number of patients with cardiac injury required noninvasive mechanical ventilation (46.3%) or invasive mechanical ventilation (22.0%). Acute respiratory distress syndrome was seen in 58.5%, acute kidney injury in 8.5%, electrolyte disturbances in 15.9%, hypoproteinemia in 13.4%, and coagulation disorders in 7.3% of patients with cardiac injuries. In addition, survival days were negatively correlated with cardiac troponin I levels (r = -0.42, 95%, p = 0.005). The results of this review showed that myocardial injury in patients with COVID 19 has a poor prognosis. Hence, cardiac investigation and management in these patients are crucial.

Relationship Between COVID-19 and Angiotensin-Converting Enzyme 2: A Scoping Review.

Following the outbreaks of SARS-CoV in 2002 and MERS-CoV in 2012, the COVID-19 pandemic caused by the SARS-CoV-2 virus has become an increasing threat to human health around the world. Numerous studies have shown that SARS-CoV-2 appears similar to the SARS-CoV as it uses angiotensin converting enzyme 2 (ACE2) as a receptor to gain entry into cells. The main aims of this scoping review were to identify the primary hosts of coronaviruses, the relationship between the receptor binding domain of coronaviruses and ACE2, the organ specificity of ACE2 expression compared with clinical manifestations of the disease, and to determine if this information can be used in the development of novel treatment approaches for the COVID-19 pandemic.

Depression, Anxiety, and Stress Among Patients with COVID-19: A Cross-Sectional Study.

AIM: Patients with confirmed COVID-19 infection can develop several psychological consequences. Epidemiological data on mental health and psychological disorder inpatients infected with COVID-19 pneumonia are not available in Iranian patients. The purpose of this study was to evaluate the anxiety, stress, and depression of patients with COVID-19. MATERIAL AND METHODS: This cross-sectional survey was conducted in 2020. All confirmed patients with COVID-19 were included in the study by census sampling. Assessment of depression, stress, and anxiety was performed using the DASS-21 questionnaire. All statistical analyses were performed using R version 3.5.1. RESULTS: The questionnaires were completed by 221 patients with COVID-19 infection (204 males, 17 females). The mean age was 45.90 ± 7.73 years. Our results indicated that the mean scores of depression and anxiety were at "extremely severe" levels, while stress levels were "severe." The prevalence of "extremely severe" symptoms of depression and anxiety was 54.29% and 97.29%, respectively. The prevalence of severe stress was 46.61%. CONCLUSION: In this study, patients infected with COVID-19 reported severe and extremely severe experience psychological distress. Further studies should focus on the combined use of psychological and molecular biomarker testing to increase accuracy. Overall, the findings demonstrate the necessity of special intervention programs for the confirmed patients with emerging infectious disease COVID-19 to promote mental health needs.

Survey of Immediate Psychological Distress Levels Among Healthcare Workers in the COVID-19 Epidemic: A Cross-Sectional Study.

AIM: The outbreak of COVID-19 has laid unprecedented psychological stress on healthcare workers (HCWs). We aimed to assess the immediate psychological impact of COVID-19 epidemic on the HCWs at Baqiyatallah Hospital in Tehran, Iran. MATERIAL AND METHODS: We conducted a cross-sectional survey of HCWs using questionnaires in February and March 2020 in Baqiyatallah Hospital, Tehran. We evaluated depression, stress, and anxiety levels using the DASS-21 questionnaire. Participants were selected by using census sampling. All statistical analyses were performed using R version 3.5.1. RESULTS: The study population included 217 HCWs (111 male, 116 female) and the mean age of the study group was 39.6 years old. Approximately two-thirds of the HCWs stayed in the hospital for 2-3 weeks. The mean scores of depression and stress were at a "severe" level, while anxiety scores were at an "extremely severe" level. The prevalence of severe scores was 38.71%, 2.30%, and 48.97% for depression, anxiety, and stress, and the prevalence of extremely severe scores was 46.54%, 97.24%, and 4.98% depression, anxiety, and stress, respectively. In stress subscale, moderate stress was 47.46%. Female HCWs reported higher levels of depression compared with males. CONCLUSION: In this study, HCWs reported experiencing severe and extremely severe psychological burdens. Timely interventions to promote mental health in HCWs exposed to patients with COVID-19 need to be immediately implemented, with female nurses requiring particular attention. This process could be facilitated via tests for molecular biomarkers in accessible body fluids, such as saliva, plasma, and serum.

Coronavirus (COVID-19)-Associated Psychological Distress Among Medical Students in Iran.

Aim The COVID-19 was declared a pandemic in early 2020 and is associated with high public anxiety all over the world. The healthcare community is at the highest risk of infection and thereby prone to most distress. The aim of this study was to explore and evaluate the degree of depression, anxiety, and stress levels among medical college students during the COVID-19 epidemic in Iran. Methods A cross-sectional study was conducted in February and March 2020, 3 weeks after the first reported COVID-19 infection was identified in Iran. All medical college students who entered clinical courses were eligible for the study. Depression, stress, and anxiety were evaluated in these students using the DASS-21 questionnaire. Participants were selected by using availability sampling. All statistical analyses were performed using R version 3.5.1. Results The total number of participants was 207, with 143 males and 64 females. More than half of the participants (57.97%) were married. The mean duration of working experience among students with COVID-19 infection and experience in a medical ward was 3.00 ± 1.27 days and 17.40 ± 7.26 months, respectively. The majority of students had 2 or 3 days working experience with COVID-19 infection. The mean anxiety score of participants was 28.56 ± 4.68, the depression score was 29.36 ± 4.42, and the stress score was 28.99 ± 4.53. Our findings indicated that the mean scores of depression were at an "extremely severe" level, while stress and anxiety were at "severe" levels. The prevalence of "severe" symptoms of depression, stress, and anxiety was 69.57%, 60.87%, and 99.04%, respectively. Conclusions There is a high prevalence of anxiety and depression among medical students who were exposed to COVID-19-infected patients. Our results highlight the need to establish psychological support programs, training, and self-care for medical college students in relation to mental health. We recommend incorporation of molecular biomarker tests into an algorithm to aid in assessments and consideration of the appropriate therapeutic responses.

A Survey of Psychological Distress Among the Community in the COVID-19 Epidemic: A Cross-Sectional Study.

Aim The ongoing COVID-19 outbreak has not only had an impact on physical health but also on psychological health. The aim of this study was to measure the prevalence and severity of psychological distress in the community due to the COVID-19 pandemic. Methods This cross-sectional survey was conducted in February and March 2020 in Tehran, Iran. We analyzed demographic characteristics and assessed depression, anxiety, and stress levels in 241 people using convenience sampling and the DASS-21 questionnaire. All statistical analyses were performed using R. Results The study population included 241 community-dwelling participants, of whom 145 were women and 96 were males. The mean age was 49.16 ± 8.01 years. Approximately two-thirds of participants (n = 158) reported no history of comorbid illness. The mean scores of depression and stress were at a "severe" level, while anxiety levels were at an "extremely severe" level. The prevalence of severe and extremely severe depression readings was 51.45 and 38.17%, respectively. In the anxiety subscale, the prevalence of severe and extremely severe depression was 95.90 and 4.1%, and in the stress subscale the prevalence was 48.97 and 4.98%, respectively. Conclusion In this study, people reported experiencing severe and extremely severe psychological distress. Therefore, there is an urgent need to implement mental health intervention policies to cope with this ongoing challenge. We suggest that the incorporation of molecular biomarker tests into the algorithm could aid in assessment of patients and guide the most appropriate therapeutic response.

Identification, Monitoring, and Prediction of Disease Severity in Patients with COVID-19 Pneumonia Based on Chest Computed Tomography Scans: A Retrospective Study.

Background and Aims Non-contrast chest computed tomography (CT) scans can accurately evaluate the type and extent of lung lesions. The aim of this study was to investigate the chest CT features associated with critical and non-critical patients with coronavirus disease 2019 (COVID-19). Methods A total of 1078 patients with COVID-19 pneumonia who underwent chest CT scans, including 169 critical cases and 909 non-critical cases, were enrolled in this retrospective study. The scans of all participants were reviewed and compared in two groups of study. In addition, the risk factors associated with disease in critical and non-critical patients were analyzed. Results Chest CT scans showed bilateral and multifocal involvement in most (86.4%) of the participants, with 97.6 and 84.3% reported in critical and non-critical patients, respectively. The incidences of pure consolidation (p = 0.019), mixed ground-glass opacities (GGOs) and consolidation (p < 0.001), pleural effusion (p < 0.001), and intralesional traction bronchiectasis (p = 0.007) were significantly higher in critical compared to non-critical patients. However, non-critical patients showed higher incidence of pure GGOs than the critical patients (p < 0.001). Finally, the total opacity scores of the critical patients were significantly higher than those of non-critical patients (13.71 ± 6.26 versus 4.86 ± 3.52, p < 0.001), with an area under the curve of 0.91 (0.88-0.94) for COVID-19 detection. Conclusions Our results revealed that the chest CT examination was an effective means of detecting pulmonary parenchymal abnormalities in the natural course of COVID-19. It can distinguish the critical patients from the non-critical patients (AUC = 0.91), which is helpful for the judgment of clinical condition and has important clinical value for the diagnosis and follow-up of COVID-19 pneumonia.

The Primary Outcomes and Epidemiological and Clinical Features of Coronavirus Disease 2019 (COVID-19) in Iran.

AIM: We aimed to describe the epidemiological and clinical characteristics of Iranian patients with COVID-19. METHODS: In this single-center and retrospective study, patients with confirmed COVID-19 infections were enrolled. Univariate and multivariate logistic regression methods were used to explore the risk factors associated with outcomes. RESULTS: Of 179 patients with confirmed COVID-19 infection, 12 remained hospitalized at the end of the study and 167 were included in the final analysis. Of these, 153 (91.6%) were discharged and 14 (8.38%) died in hospital. Approximately half (50.9%) of patients suffered from a comorbidity, with diabetes or coronary heart disease being the most common in 20 patients. The most common symptoms on admission were fever, dyspnea, and cough. The mean durations from first symptoms to hospital admission was 8.64 ± 4.14 days, whereas the mean hospitalization time to discharge or death was 5.19 ± 2.42 and 4.35 ± 2.70 days, respectively. There was a significantly higher age in non-survivor patients compared with survivor patients. Multivariate regression showed increasing odds ratio (OR) of in-hospital death associated with respiratory rates >20 breaths/min (OR: 5.14, 95% CI: 1.19-22.15, p = 0.028) and blood urea nitrogen (BUN) >19 mg/dL (OR: 4.54, 95% CI: 1.30-15.85, p = 0.017) on admission. In addition, higher respiratory rate was associated with continuous fever (OR: 4.08, 95% CI: 1.18-14.08, p = 0.026) and other clinical symptoms (OR: 3.52, 95% CI: 1.05-11.87, p = 0.04). CONCLUSION: The potential risk factors including high respiratory rate and BUN levels could help to identify COVID-19 patients with poor prognosis at an early stage in the Iranian population.

Association between passive smoking and cardiovascular disease: A systematic review and meta-analysis.

BACKGROUND: The association between passive smoking (PS) and cardiovascular disease (CVD) has not yet been fully clarified. OBJECTIVE: This meta-analysis was performed to evaluate the association between PS and the incidence of CVDs and mortality due to CVD. METHODS: PubMed/Medicine, Science Direct, Scopus, Web of Knowledge, and ProQuest were searched to identify observational studies that met the inclusion criteria without time, language, age, gender, ethnicity, and design restrictions until July 30, 2018. In case-control studies, relative risk (RR) with 95% confidence interval (CI) was calculated for the relationship between PS and CVD incidence. Also, in cohort studies, hazard ratio (HR) with 95% CI was calculated for the relationship between PS and CVD mortality. RESULTS: Eighteen studies (10 cohort and 8 case-control studies) were included with 10,672 participants (2,542 cases and 8,130 controls) in case-control studies and 2,313,935 participants in cohort studies. This meta-analysis in case-control studies revealed that the PS could increase the risk of CVD incidence by 28% (adjusted RR = 1.28 [95% CI 1.09, 1.50]), where the highest risk was associated with those who were exposed to second-hand smoke at home and at work (Adjusted RR = 1.41 [95% CI 0.73, 2.70]). Also, the meta-analysis in cohort studies indicated that PS was associated with a 12% higher increase in the risk of CVD mortality (Adjusted HR = 1.12 [95% CI 1.06, 1.20]) with the highest risk of mortality being observed for those who were exposed to second-hand smoking at home, work, and public places (Adjusted HR = 1.26 [95% CI 1.13, 1.40]). CONCLUSIONS: PS is significantly associated with an increased risk of incidence and mortality of CVD.

Topical Almond Oil for Prevention of Pressure Injuries: A Single-Blinded Comparison Study.

PURPOSE: The aim of our study was to determine the effect of topical almond oil for prevention of pressure injuries. DESIGN: Single-blind randomized clinical trial. SAMPLE AND SETTING: Patients admitted to an intensive care unit in Besat Hospital, Hamadan, Iran, were invited to participate in the trial. Data were collected over an 8-month period. METHODS: A convenience sample of 108 patients, using a permuted block randomization method was assigned to 3 equal groups that received the intervention almond oil, placebo (liquid paraffin), or control (standard of care). Data included demographic information, Braden Scale score, and National Pressure Ulcer Advisory Panel-European Pressure Ulcer Advisory Panel (NPUAP-EPUAP) pressure injury staging system classification score. The intervention and placebo groups received daily application of 6.5 cc of topical almond oil or paraffin to the sacrum, heels, and shoulders for 7 consecutive days. The skin was evaluated for pressure injuries by an expert nurse who was blinded to groups. Chi-square test, analysis of variance, and regression analyses were used to evaluate relationships within and between groups for study variables, incidence of pressure injuries, and duration of time of onset of pressure injuries. P values less than .05 were deemed statistically significant. RESULTS: The incidence of pressure injury in the almond oil group (n = 2; 5.6%) was lower than that in the placebo (n = 5; 13.9%, P = .189) or control groups (n = 9; 25.1%, P = .024). The incidence of pressure injuries in the control group was 6.8 and 2.12 (P = .227) times higher than that in the almond and placebo groups, respectively. The onset day of a pressure injury occurred 5.4 days after initiation of the protocol in the almond oil group compared to 4.22 days in the control group (P = .023) and 5 days in the placebo group (P = .196). CONCLUSION: The topical application of almond oil was associated with a lower incidence of pressure injuries and that developed later during the study compared to participants who received paraffin or standard of care only. Further study is recommended to advance this work in populations at risk for pressure injury.

A review of 17 years of application of partnership care model on the consequences of chronic diseases: Describing and assessing the quality of the methodology of papers.

Background : Regarding the widespread prevalence of chronic diseases, nurses need to understand the choices, priorities, and abilities of patients in reality, their communication, and the social context in order to play their professional role and responsibility. This review study was conducted with two purposes: determining the effect of partnership-care-model (PCM) on the outcomes of chronic diseases, and describing and assessing the quality of methodology of published papers in the field. Methods : The systematic review was conducted from inception to the year 2019. A systematic search was conducted using PRISMA guidelines to retrieve all national and international PCM studies. To assess the quality of the methodology of studies, four instruments were used, including JADAD, Consort, New Castle-Ottawa, and Cochrane. Results : In the initial search, 11509 papers were retrieved, which according to the PRISMA guidelines, 23 relevant papers remained. The results of the reviewed papers indicated the effectiveness of the PCM. Describing and assessing the quality of the methodology of published papers of PCM was at an acceptable level. The final papers were classified and reviewed according to the authors, year, sampling characteristics, data collection methods, and final PCM conclusion. Conclusion : According to the review of the studies and their effectiveness in the different outcomes, also, the acceptable quality of the methodology of published papers, it can be concluded that the PCM is an effective, context-based, simple, efficient, and reliable model and has the ability to be used in promoting and improving the various dimensions of chronic diseases.