Effect of needles distance of arteriovenous fistula cannulation on hemodialysis adequacy based on KT/V: a randomized controlled trial.

Background: This study aims to assess the effect of needle distance of arteriovenous fistula (AVF) cannulation on haemodialysis adequacy based on KT/V. Materials and methods: This study was a parallel-group, randomized controlled trial. Patients who met the inclusion criteria were divided into two groups with 3 and 6 cm needle distances using block randomization. Data acquisition transpired through a comprehensive checklist encompassing demographic variables such as age and sex, alongside clinical metrics comprising actual weight, dry weight, average dialysis duration, fistula longevity, and KT/V rate. Results: A total of 42 haemodialysis patients were enroled in this investigation, with 21 allocated to the 3 cm needle distance group and another 21 to the 6 cm needle distance group. The mean post-haemodialysis KT/V values for the 3 cm and 6 cm needle distance groups were 1.25 (SD=0.25) and 1.42 (SD=0.24), respectively, demonstrating a statistically significant difference (P<0.001). While there was no significant difference in the average pre-haemodialysis and post-haemodialysis KT/V values within the 3 cm needle distance group (t=1.93, P=0.068), the corresponding values for the 6 cm needle distance group exhibited a notable discrepancy (t=9.66, P<0.001). Conclusion: In general, a needle distance of 6 cm between arteriovenous points yielded superior enhancements in dialysis adequacy compared to a 3 cm needle distance following haemodialysis. Consequently, health administrators and policymakers may consider instituting efficacious interventions to scrutinize the care and therapeutic protocols for haemodialysis patients, involving the development of policies and applications.

Effects of aromatherapy with Matricaria chamomile essential oil on anxiety and hemodynamic indices in patients with acute coronary syndrome, 2021: a randomized controlled trial.

BACKGROUND: Patients with Acute Coronary Syndrome (ACS) experience high levels of anxiety that may cause instability of hemodynamic indices, increased risk of ischemia, myocardial infarction and poor quality of life. Aromatherapy can affect patients' anxiety levels and improve hemodynamic indices. This study aimed to evaluate the efficacy of aromatherapy on anxiety and hemodynamic indices in ACS patients. METHODS: This study was a double-blind, randomized clinical trial conducted on 154 ACS patients. The participants were classified into two equal groups of intervention and placebo through the block randomization method. The data collection tools consisted of demographic information, a shortened 6-item version of the Spielberger questionnaire and a form of hemodynamic indices. For two consecutive nights, the intervention group inhaled 7 drops of the chamomile essential oil (%10) and the placebo group inhaled 7 drops of the sesame oil poured on a sterile cotton ball. The hemodynamic indices were collected half an hour before, one and four hours after the intervention until the next morning. The Spielberger questionnaire was completed once before the intervention and once after the end of the intervention, by the researcher through an interview. The number of heart rate (HR) was counted for a full minute. Also, the blood pressure (BP) of all the samples was measured by the researcher. Data analysis was done using Chi-square, paired t-test, and analysis of variance (ANOVA) in SPSS22. RESULTS: The mean and standard deviation of the age of patients were 58/2 ± 11.6 and 59.7% of them were female. The results of ANOVA showed a significantly lower anxiety score as well as systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR in the intervention group compared to those of the placebo group (P < 0.001). The decrease in anxiety score after the intervention, in the intervention and placebo groups was (5.2 ± 1.9) and (1 ± 1. 18) respectively. In the intervention group, the SBP and DBP after the intervention, was significant (P < 0.05). Also, the HR was significant (P < 0.001) after the intervention. CONCLUSIONS: Aromatherapy could reduce anxiety and improve hemodynamic indices in ACS patients. TRIAL REGISTRATION: IRCT20080825001083N11.

Needle Direction and Distance of Arteriovenous Fistula Cannulation in Hemodialysis Adequacy; a Systematic Review and Meta-Analysis.

Introduction: This systematic review and meta-analysis aimed to summarize the evidence regarding the impact of needle direction and distance of arteriovenous fistula (AVF) cannulation on KT/V (where k is the dialyzer urea clearance, t, the duration of dialysis, and V, the volume of distribution of urea) and access recirculation (AR) as hemodialysis (HD) adequacy criteria. Methods: A comprehensive systematic search was performed on international and domestic electronic databases from the earliest to June 4, 2022 using keywords. Analysis was performed in STATA software v.14. Results: Three randomized control trials (RCTs) and four non-RCT articles were included in the final review. Six studies reported the effects of direction, while four mentioned the effects of distances of AVF cannulation on outcomes of HD adequacy based on KT/V or AR. Results of three non-RCT studies showed that retrograde direction decreased KT/V more than antegrade direction (ES: 0.44, 95% CI: -0.38 to 1.27). Two non-RCT studies showed that antegrade decreased AR compared to the retrograde direction (ES: -0.64, 95%CI: -1.94 to 0.67). However, the results of two RCTs indicated uncertainty about this issue. Two of the four studies suggested that a distance of 5 cm or more in arterial and venous needles had greater adequacy than a distance of less than 5 cm. However, other studies did not confirm this finding. Conclusion: Overall comparison of the results qualitatively and quantitatively indicated uncertainty about the effects of direction and distance of AVF cannulation on HD adequacy outcomes. More studies with high-quality designs, such as RCTs, are required to better understand and adjudicate the effects of needle direction and distance of AVF cannulation on HD adequacy outcomes.

Prevalence of Anxiety and Depression in the Iranian General Population during the COVID-19 Pandemic: A Web-Based Cross-Sectional Study.

Objective: This study aimed to determine prevalence of anxiety and depression and associated factors in the general population of Iran during the COVID-19 pandemic. Method : We conducted this web-based cross-sectional study on 5328 individuals in Iran between 17th and 29th of April 2020. Data were collected using the convenience sampling method through an anonymous online questionnaire via social media like WhatsApp and Telegram. The online survey collected data on demographic variables, COVID-19-related variables, and symptoms of anxiety and depression. Anxiety and depression were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), respectively. Simple and multiple logistic regression analyses were performed to determine independent predictors of anxiety and depression. Results: The mean GAD-7 and PHQ-9 total scores were 7.17 (SD = 5.42) and 7.80 (SD = 6.68), respectively. Prevalence of anxiety, depression, and comorbid anxiety-depression were 30.1%, 33.4%, and 22.1%, respectively. According to the adjusted analysis, anxiety was significantly associated with female gender, being young and middle-aged, being unemployed or a housewife, having chronic diseases, spending considerable time thinking about COVID-19, having family members, friends, and/or relatives infected with COVID-19, and death of family members, relatives or friends due to COVID-19. Same results were also found for depression. Furthermore, depression was associated with being single, being resident in urban area, and having high risk individual in family. Conclusion: Prevalence of anxiety and depression were considerably higher in the general population of Iran during the COVID-19 pandemic. In addition, the findings suggest that more attention needs to be paid to vulnerable groups such as women, young/middle-aged adults, the unemployed, and people with chronic disease.

The effects of meteorological variables on ambulance attendance for cardiovascular diseases in Rasht, Iran.

Climate change has a devastating effect on human societies, including their economic, cultural and health conditions. Our objective was to investigate the association between meteorological variables and ambulance attendance in the event of cardiovascular diseases using time-series analyses. We used a time series analysis to investigate the relationship between meteorological variables and ambulance attendance in the event of cardiovascular diseases from 2010 to 2015. To examine the effect of high temperatures on ambulance attendance, we investigated the relative risk of the daily volume of high temperature attendance, the 99th temperature percentile compared to the 75th temperature percentile. Upon examining the effect of cold temperatures on ambulance attendance, or the relative risk of the daily volume of attendance with low temperatures, the 1st temperature percentile compared to the 25th temperature percentile. In 1826 days, from March 21, 2010 to March 19, 2015, there were 7051 emergency calls for cardiovascular diseases. Significant variations were identified in the monthly (P < 0.001) and seasonal (P < 0.001) distributions. The highest seasonal incidence occurred in the winter and lowest was observed in the summer. With regard to association between cold temperature and calls for ambulance attendance in the event of cardiovascular diseases according to lag days, our findings showed a significant increase in lag 7 ((RR, 1.026; 95% CI, 1.003 to 1.050), lag 8 (RR, 1.023; 95% CI, 1.005to 1.041) and lag 9 (RR, 1.019; 95% CI, 1.002 to 1.036) respectively. These results suggest that the demand for an ambulance for cardiovascular diseases was higher in the cold weather and that humidity can increase this demand in the warm seasons.

Acute triggers of myocardial infarction: A case-crossover study.

BACKGROUND: Acute myocardial infarction (AMI) is one of the most preventable non-communicable diseases in human. Identifying triggers of myocardial infarction (MI) and prevention ways of exposure-induced complications can reduce morbidity and mortality in people at risk. AIM: The aim of this study was to identify the emotional, environmental, physical and chemical dimensions of acute triggers in patients with AMI. METHODS: This case-crossover study was conducted on 269 patients with AMI, hospitalized at two remedial centers in Rasht in 2015. The study samples were selected by convenient sampling method. Data were collected using researcher-made questionnaire through interviews. Hazard and control periods for each trigger and its effects on the development of MI were studied. The collected data were analyzed using descriptive and analytical statistical methods, Cochran test, and generalized estimating equation (GEE) model with logistics function default in SPSS version 21, and p < 0.05 was considered statistically significant. RESULTS: The results showed that quarrel (P = 0.008, OR = 2.01) and hearing the sudden news (P = 0.001, OR = 2.19) were the most common emotional triggers. Respiratory infections (P = 0.0001, OR = 6.78) and exposure to hot or cold weather (P = 0.005, OR = 2.19) were the most frequent environmental triggers. Doing heavy activities (P = 0.005, OR = 1.66) and sexual activities (P = 0.003, OR = 2.36) were among the most common physical triggers. High-fat foods consumption and overeating (P = 0.0001, OR = 3.79) were the most frequent chemical triggers of AMI. CONCLUSION: It seems that given the importance of the triggers in the incidence of AMI, planning is necessary to train vulnerable individuals to reduce exposure to triggers.

A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel.

CONTEXT: In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence. OBJECTIVES: The research question addressed by this paper is, "What are the characteristics and findings of studies on workplace violence against emergency medical services personnel"? DATA SOURCES: A systematic literature review was conducted using online databases (PubMed, Scopus, Google Scholar, and Magiran) with the help of experienced librarians. STUDY SELECTION: Inclusion criteria comprised studies in the English or Persian language and researcher's access to the full text. There was no limit to the entry of the study design. Exclusion criteria included lack of access to the full text of the article, studies published in unreliable journals or conferences, and studies in which the results were shared with other medical or relief groups and there was no possibility of breaking down the results. DATA EXTRACTION: A "Data extraction form" was designed by the researchers based on the goals of the study that included the title and author(s), study method (type, place of study, sample size, sampling method, and data collection/analysis tool), printing location, information related to the frequency of types of violence, characteristics of victims /perpetrators, and related factors. RESULTS: The papers reviewed utilized a variety of locations and environments, methods, and instrument samplings. The majority of the studies were performed using the quantitative method. No intervention study was found. Most studies focused on the prevalence of violence, and their results indicated that exposure to violence was high. The results are presented in six major themes. CONCLUSIONS: Workplace violence and injuries incurred from it are extensive throughout the world. The important causes of violence include the shortage of training programs dealing with violence, lack of violence management protocols, and delays in response times. Therefore, afterthought and resolve are more crucial than ever. Workplace violence reduction strategies and suggestions for future studies are also discussed.

Calculation of the probability of survival for trauma patients based on trauma score and the injury severity score model in fatemi hospital in ardabil.

BACKGROUND: Trauma, in addition to economic and social costs, is the fourth cause of death in the world and in the year 2000 alone, it led to the death of more than 6000000 people. In Iran, Trauma has the first burden of disease and also needs a long medical surveillance. OBJECTIVES: The aim of this study was to evaluate the outcome of trauma cases using the trauma score and the injury severity score (TRISS) model and then comparing this with the results of a major trauma outcome study (MTOS) carried out in the US. PATIENTS AND METHODS: This study is a retrospective, descriptive and analytical study on 1000 patients aged 2 - 82 years old with closed or penetrating traumas staying at Ardebil Fatemi hospital. In this study, injury severity score (ISS), revised trauma score (RTS), and TRISS were calculated and patients' viability ratios were obtained. RESULTS: The results showed that 714 patients (71.4%) were male and 286 patients (28.6%) female with the mean age of 35.68 years. In this study 45 (4.5%) and 955 patients (95.5%) had penetrating and blunt traumas, respectively, whereby the head and neck were the most prevalent (74%) areas of injury. The most common reason for these traumas was, accident with vehicles with 670 cases (67%), which resulted in hospitalization. From this group, ninety-seven cases (9.7%) died in the hospital. From these results, calculations of ISS and RTS were 15.50 ± 11.31 and 7.49 ± 0.79, respectively. According to the calculation of the TRISS model, 91.5% of trauma victims should be survived, while only 90.3% survived practically. CONCLUSIONS: We can conclude that the surveillance presented to our injured group probably had some defects that need to be revised in therapeutic services to enhance survival requirements.