Bedsore Healing Using Selenium-Enriched Lactobacillus brevis LSe: A Randomized, Double-Blind, Controlled Clinical Trial.

Bedsores impose an important challenge to the healthcare system. Se-baring probiotics are considered effective agents in wound healing and inflammation reduction via several pathways. The present study focused on the administration of a Se-enriched probiotic, originally obtained from a traditional dairy product for bedsore healing. Daily doses of the probiotic were administered to 20 ICU patients for 14 days and the wound healing criteria were compared with those of the same group of ICU patients as control, both groups suffering from stages I and II bedsore (a randomized, double-blind, controlled clinical trial). The administered Se-enriched probiotic decreased the bedsore healing period significantly (on average by 2.4 days, P-value: 0.039), as well as bedsore size (on average by 7 mm2, nonsignificant) and bedsore grade (10%, nonsignificant) in the treatment group more efficiently than the control group. Some key laboratory parameters associated with inflammation were also improved in patients receiving the Se-supplemented probiotic. The limitations of this study include the low number of patients meeting inclusion criteria within the timeframe of the study, and the impossibility of following up patients after discharge from the ICU. In summary, this study revealed the effectiveness of the Se-enriched probiotic in bedsore improvement, suggesting consideration of the enriched probiotic as an auxiliary agent in bedsore management.

The relationship between depressive symptoms and sleep quality in medical staff after their infection with COVID-19.

Background: Healthcare workers (HCWs) play a crucial role in managing infectious diseases like COVID-19. However, the demanding working conditions during the pandemic have led to an increased risk of depression and sleep disorders among these dedicated professionals. Therefore, this study aimed to examine the relationship between depressive symptoms and sleep quality in medical staff who had contracted COVID-19. Methods: This descriptive study involved a sample of 203 HCWs who had contracted COVID-19. These HCWs were employed at a hospital affiliated with Kerman University of Medical Sciences in 2020. The data for this study were collected using a demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Beck Depression Inventory (BDI). Statistical analysis was conducted using SPSS22, with a significance level set at less than 0.05. Results: The study found that the mean score for depressive symptoms among the participants was 11.67 ± 2.68, while the mean score for sleep quality was 5.47 ± 3.02. It was observed that 18.2% of the participants experienced moderate depression, 10.3% had severe depression, and 59.6% had poor sleep quality. Furthermore, a significant and positive correlation was identified between sleep quality and depression (r = 0.54; p = 0.001). Multiple regression models indicated that the harmful pattern and sleep quality together could predict 34% of the variance in depression. Additionally, the use of sedatives and depression were found to predict 33% of the variance in sleep quality. Conclusion: The findings of our study indicated a high prevalence of depressive symptoms and insomnia among medical staff who had contracted COVID-19. These results provide valuable insights for health managers, highlighting the need for implementing interventions in epidemic environments to reduce the vulnerability of HCWs.

Comparison of Morbidity, Mortality, and Costs of VAP Patients with Non-VAP Patients in the Tertiary Referral Hospital of Kerman, Iran.

Background: Ventilator-associated pneumonia is the most common type of nosocomial infection in ICUs. Hence, this study shall focus on the morbidity, mortality, and costs associated with this infection among ICU patients. Materials and Methods: The current research is a prospective descriptive-analytical study. The study population included patients admitted to the Tertiary Referral Hospital of Kerman University of Medical Sciences who were enrolled in the study according to inclusion criteria and demographic characteristics data, length of stay in ICU and general wards, and direct and indirect medical expenses such as unemployment and rehabilitation cost, etc. Results: Nine of the 144 patients studied died. (4 in the Ventilator-Associated Pneumonia (VAP) group and 5 in the non-VAP group). Among them, the prevalence of Acinetobacter Baumannii was significantly higher than other bacteria (P-Value=0.001). The duration of hospitalization in the ICU (18±9 vs. 9.5±6 days) and recovery time (21.6±9 9.6 vs. 13.2±7 days) were higher in the VAP group (P-Value<0.05). Moreover, the duration of hospitalization in the general ward was 15.4±8 days in the VAP group and 10.6±6 days in the non-VAP group (P-Value<0.05). The cost of treatment in the VAP group ($7952.28) was significantly higher than in the non-infected group ($4400.98). The average rehabilitation cost in the VAP group was $2571.42 and in the non-affected group was $1530.88. The financial loss due to the delay in work starting was $482 in the non-VAP group which was significantly less than the VAP group ($792). Conclusion: Having VAP can significantly increase mortality, length of stay in the ICU as well as increase direct and indirect costs for patients.

Hospital challenges and managerial approaches to combat COVID-19 outbreak: a qualitative study in southeastern Iran.

BACKGROUND: During the covid-19 pandemic, hospitals have faced several challenges, so they need to identify and address effective management strategies to cope with these challenges that enhance their current knowledge to deal with similar challenges in the future. This study aimed to identify managerial strategies for dealing with Covid-19 pandemic challenges at a hospital in southeastern Iran. METHODS: This qualitative content analysis study used purposive sampling to select eight managers, three nurses, and one worker from Shahid Bahonar Hospital. In this study, semi-structured interviews were used to collect data and Lundman and Graneheim's approach was used to analyze them. RESULTS: Three hundred fifty codes remained after constant comparison, compression, and merging. The results demonstrated one theme "Managerial reengineering in the healthcare system during the Covid-19 crisis", two main categories, seven subcategories and, 19 sub- subcategories. The first main category was "The difficulty of managing challenges," including "Insufficient resources and physical space", "Socio-organizational challenges" and, "Incompetence and unpreparedness of managers." The second main category was "Reforming the management duties." This category included "Planning and decision-making," "Organization," "Leadership and motivation," and "Monitoring and control." CONCLUSIONS: Hospitals and managers were less prepared to cope with the Covid-19 crisis challenges due to health system organizations' less attention to biological crises. Healthcare organizations can carefully evaluate these challenges, and the strategies managers adopt to deal with these problems. They also can identify the strategies' strengths and weaknesses and propose more effective strategies. As a result, healthcare organizations will be better prepared for similar crises.

A Rule Based Intelligent Software to Predict Length of Stay and the Mortality Rate in Trauma Patients in the Intensive Care Unit.

Background: Intensive Care Unit (ICU) has the highest mortality rate in the world. ICU has special equipment that leads to the hospital's most costly parts. The length of stay in the ICU is a special issue, and reducing this time is a practical approach. We aimed to use artificial intelligence to help early and timely diagnosis of the disease to help with health. Methods: We designed a rule-based intelligent system to predict the length of stay and the mortality rate of trauma patients in ICU. A neuro-Fuzzy and eight machine learning models were used to predict the mortality rate in trauma patients in ICU. The performances of these techniques were evaluated with accuracy, sensitivity, specificity, and area under the ROC curve. Decision-Table was used to predict the length of stay in trauma patients in ICU. For comparison, eight machine learning models were used. The method is compared based on Mean absolute error and relative absolute error (%). Results: Neuro-Fuzzy expert system and Decision-Table showed better results than other techniques. Accuracy, sensitivity, specificity, and ROC Area of Nero-Fuzzy are 83.6735, 0.9744, 0.3000, 0.8379, and 1, respectively. The mean absolute error and Relative absolute error (%) of the Decision-Table model are 4.5426 and 65.4391, respectively. Conclusion: Neuro-Fuzzy expert system with the highest level of accuracy and a Decision-Table with the lowest Mean absolute error, which are rule-based models, are the best models. Therefore, these models are recommended as a valuable tool for prediction parameters of ICU as well as medical decision-making.

Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study.

Background: The practice of hand washing is an effective way to prevent contamination and disease transmission. Following the COVID-19 pandemic, hand washing has become increasingly important. Therefore, this qualitative study aimed to understand barriers to hand hygiene compliance among healthcare workers during the COVID-19 pandemic. Materials and methods: Twenty-five healthcare workers from intensive care units were sampled using purposive sampling in a qualitative content analysis study. Data were collected through a semi-structured interview and field notes. Based on the Lundman and Graneheim approach, the data were analyzed. COREQ checklist was used to report the research. Results: According to the findings, there are three main categories of barriers to hand hygiene practice: barriers related to individuals (including two subcategories of lack of knowledge of healthcare workers and healthcare workers' improper attitude), barriers related to management (including two subcategories of wrong behavioral patterns and unsuitable training and planning), and barriers related to organizations (including four subcategories of heavy workloads, improperly designed wards, a lack of equipment, and lack of quality equipment). Conclusions: This research indicates that hand washing practice increased during the COVID-19 pandemic. Nevertheless, some barriers persist, resulting in a decline in hand washing compliance among health care workers. This finding can help managers and policymakers remove barriers to hand washing compliance and improve healthcare workers' adherence to hand washing.

The effect of learning management system on ICU nurses' sustained learning about safe blood transfusion: A quasi-experimental study.

Background and Aims: Transfusion of blood products is an important part of the health care system. Since one of the significant challenges in nursing education is using an effective method that provides depth and stability of learning, this study aimed to assess using a learning management system (LMS) for intensive care unit (ICU) nurses' sustained learning about safe blood transfusion in southeast Iran. Methods: This was a quasi-experimental study in southeast of Iran in 2021 in two groups, control and intervention. Two ICUs received lecture training and two ICUs received LMS. The samples 80 nurses were selected by random convenience sampling. In the LMS group, the educational content was presented using Edmodo software. The control group received no intervention except for traditional education (lecture). The questionnaires were completed immediately, 1 month, and 3 months after the intervention. Results: The mean score of knowledge immediately, 1 month and 3 months after the intervention were 9.53 ± 1.82, 9.46 ± 1.85, and 8 ± 2.94, in the lecture group and 8.91 ± 1.59, 9.47 ± 2.46, and 8.09 ± 1.94 in the LMS group, respectively. The mean score of practice immediately, 1 and 3 months after the intervention were 59.69 ± 39.6, 70.63 ± 7.4, and 83.70 ± 43.6 in the lecture group and 45.68 ± 55.5, 67.69 ± 4.56, and 35.70 ± 46.4 in the LMS group, respectively. The mean score of knowledge and practice in the two groups significantly increased immediately and 1 month and 3 months after intervention (p < 0.001). No significant difference was observed between the two groups (p > 0.05). Conclusions: LMS method has a significant effect on improving the sustained learning of ICU nurses, and no significant difference was observed between the two educational methods. Hence, considering the busy work schedule of nurses, lack of staff, and the impossibility of physical attendance in lecture classes, it seems that LMS-based methods are appropriate alternatives to traditional learning methods.

A randomized controlled clinical trial of the effects of range of motion exercises and massage on muscle strength in critically ill patients.

BACKGROUND: Atrophy and muscle weakness is a common problem in critically ill patients admitted to the intensive care unit (ICU). Muscle weakness in severe cases can lead to tetraplegia, reduced or lost tendon reflexes, delayed weaning from mechanical ventilation, physical disability, and increased mortality. The aim of this study was to compare the effects of range of motion exercises (ROM) and massage on muscle strength of the patients admitted to ICUs. METHODS: This study was a single-blinded randomized controlled trial conducted in ICUs of Afzalipour hospital in Kerman, southeastern Iran. Ninety conscious ICU patients were randomly divided into three groups (massage, ROM exercises and control). The researcher/co-researcher massaged or did ROM exercises on the patients' extremities once a day for seven consecutive days. Using a hand-held dynamometer, the co-researcher, rated the muscle strength before, on the fourth and seventh days of intervention at 8 p.m. RESULTS: The mean muscles strength of the right arm in the ROM exercise and massage groups increased by 0.63 kg, and 0.29 kg, respectively after the intervention compared with before the intervention. The muscle strength of the right arm in the control group reduced by 0.55 kg. The mean muscles strength of the left arm in the ROM exercise and massage groups increased by 0.61 kg and 0.28 kg after the intervention, respectively while it reduced by 0.56 kg in the control group. The mean muscles strength of the right leg in the ROM exercise and massage groups increased by 0.53 kg and 0.27 kg after the intervention compared with before the intervention while it reduced by 0.70 kg in the control group. The mean muscles strength of the left leg in the ROM exercise and massage groups increased by 0.54 kg and 0.26 kg after the intervention compared with before the intervention while it reduced by 0.71 kg in the control group. CONCLUSION: The results of the present study showed that ROM exercises and massage were effective interventions in increasing muscle strength of the critically ill patients admitted to intensive care units.

Limb edema in critically ill patients: Comparing intermittent compression and elevation.

Intensive care unit (ICU) patients are at high risk for limb edema, which caused complications such as pain, joint contracture, limited range of motion and atrophy of the limbs. Thus, this study was conducted to compare ICU patients' upper limb edema between two groups with the intervention of limb elevation and intermittent pneumatic compression (IPC). In this quasi-experimental before and after study, 40 patients were recruited. One upper limb was randomly assigned to the upper limb elevation (ULE) group and the other one was assigned to the IPC group. The circumference of the wrist and the middle of the arm were compared between and within groups. Results showed that in both groups of IPC and ULE and all five sessions (unless the second session of ULE), participants' arm and wrist edema were reduced significantly after the interventions (arm: P < .01; wrist: P < .0001). The differences between the two groups of ULE and IPC in regards to limb edema reduction were not significant. Although there was no significant difference between IPC and ULE intervention in the removal of edema, ULE seems to be more feasible and practical, which should be assessed in future studies.

The effect of foot massage on the level of consciousness and delirium of intensive care patients: A randomized single-blind controlled trial.

INTRODUCTION: Depressed level of consciousness and delirium are associated with multiple complications in cognitive, perceptual and sensory functions in the patients of the intensive care units. The present study aimed to determine the effect of foot massage by a nurse and patient's family on the level of consciousness and delirium in patients admitted to the intensive care units (ICU). METHODS: This was a randomized parallel single-blind controlled trial. Seventy-five ICU were assigned in three groups (massage by a nurse, massage by patient's family and control group) by stratified block randomization method. Both feet were massaged with Swedish massage (10 min) once a day for six days by a nurse or patient's family. Delirium and level of consciousness was measured before, and post-intervention. RESULTS: The mean level of consciousness in all the three groups increased significantly one-week post-intervention. However, there was no significant difference in the level of consciousness among the three groups during the study. The frequency of delirium in the massage group by the family was 20% before the intervention, which decreased to 12% after intervention. In the massage group by a nurse and control group, 16% of the samples had delirium before the intervention. After the intervention, the prevalence of delirium was 8% in the massage group by a nurse, and it decreased to 12% in the control group, none of which was statistically significant. CONCLUSION: The use of Swedish foot massage did not change the level of consciousness and delirium of patients admitted to the ICU.

The Effects of Lavender and Citrus aurantium on Anxiety and Agitation of the Conscious Patients in Intensive Care Units: A Parallel Randomized Placebo-Controlled Trial.

BACKGROUND: Conscious patients admitted to intensive care units (ICU) suffer from anxiety and agitation for various reasons, which can affect their recovery processes. AIMS: To compare the effects of lavender and Citrus aurantium essential oils on anxiety and agitation of conscious patients admitted to ICUs. DESIGN: A randomized parallel placebo-controlled trial. METHODS: One hundred and fifty conscious patients admitted to ICUs were selected by convenience sampling and were randomly divided into three groups, groups of lavender aromatherapy and Citrus aurantium aromatherapy, in addition to the routine care and inhalation of five drops of lavender or Citrus aurantium essential oils for 30 minutes. The placebo group, in addition to routine care, was provided with 5 drops of normal saline for 30 minutes. Anxiety was assessed with the state subscale of State-Trait Anxiety Inventory, and agitation was examined with Richmond Agitation-Sedation Scale before, immediately, one hour, and three hours after the intervention. RESULTS: All three groups suffered from relatively severe state anxiety before the intervention. The level of anxiety in the lavender and Citrus aurantium groups was significantly lower than that of the placebo group immediately and three hours after the intervention (P < 0.05). No significant difference was observed between the two groups of lavender and Citrus aurantium. The majority of the samples in all three groups were agitated before the intervention, but agitation of all three groups decreased after the intervention. Restless/agitation reduced significantly in all three groups. Although restless/agitation of the lavender and Citrus aurantium groups reduced more than that of the placebo, no significant difference was found between the three groups. CONCLUSION: The results of the present study showed the positive effects of lavender aromatherapy and Citrus aurantium aromatherapy on reducing the anxiety of patients admitted to ICUs. Relevance to Clinical Practice. Aromatherapy can be used as an effective and safe intervention to reduce anxiety in ICUs.

Higher Morbidity and Mortality in Trauma Intensive Care Unit Patients with Opium Addiction.

BACKGROUND: Opium addiction is associated with multiple physical, psychological, and social problems. The aim of this study was to compare the risk of morbidity and mortality in opium-addicted and non-addicted trauma patients admitted to the intensive care units (ICUs) of trauma center of Kerman Province, Iran. METHODS: In this cohort study, a total of 200 addict and non-addicted patients who were admitted due to trauma in ICUs of Shahid Bahonar Hospital in Kerman during 9 months of 2018 were included. Patients were compared in terms of mortality, incidence of pressure ulcers, incidence of organ failure, duration of mechanical ventilation, and duration of hospitalization. Data were analysed using Fisher's exact test and independent t-test at P < 0.05. FINDINGS: Out of 197 examined patients, 161 (81.7%) individuals were men and 36 (18.3%) were women. Moreover, 98 (49.7%) patients had a history of opium abuse, while 99 (50.2%) patients had no history of opium addiction. The addicted and non-addicted groups had no significant differences in terms of age (P = 0.650) and gender (P = 0.580). In addicted patients, mortality, duration of mechanical ventilation (P = 0.027), the incidence of pressure ulcer, and organ failure were significantly higher (P < 0.001), but mean ICU stay and hospitalization time was the same in both groups. CONCLUSION: The results of this study indicated higher mortality and morbidity in opium-addicted patients admitted to ICU than non-addicted ones. This suggests that various systems of the body are affected by opium and, in certain circumstances such as severe diseases, this will cause problems for patients. Therefore, experts should pay attention to complications and side effects of addiction in the management of critical patients with a history of opium abuse.

The Educational Needs of Family of Patients Discharged from the Intensive Care Units: The Viewpoints of Nurses and the Patients' Families.

INTRODUCTION: Thousands of patients are admitted to the intensive care units annually, which are stressful for patients and their families. The discharged patients and their families face different challenges in the caring process of the patients. OBJECTIVES: This study aimed to determine the educational needs of the families of patients discharged directly home from the postintensive care units and to compare the views of families and nurses about these needs. METHOD: This was a cross-sectional study. One hundred forty nurses and 140 family members of the patients discharged from intensive care units participated in the survey by convenience sampling method. A questionnaire of sociodemographic information and a researcher-made questionnaire on the educational needs of the family of patients discharged from the postintensive care units were used for data collection. RESULTS: The mean total score of the educational needs of the patients' families was 31.81 and 35.33 from views of families and nurses, respectively. Nurses significantly estimated the educational needs of families more than what they did (P < 0.001). The families and nurses reported the educational needs of self-care as well as nutrition and medicine at the highest level, respectively. Both groups reported the educational needs of defecation at the lowest level. Nurses estimated higher educational needs in all dimensions, except for the patient's mental health and family self-care than families (P < 0.001). CONCLUSION: According to the present study, the educational needs were high from the views of nurses and families. Family need assessment is essential in designing and applying instructional interventions. Given the high level of family needs, implementing educational and practical interventions is necessary to enhance their skills.

The Impact of COVID-19 Outbreak on Nosocomial Infection Rate: A Case of Iran.

BACKGROUND: Coronavirus disease-19 (COVID-19) is a new type of coronavirus that has caused a global pandemic. The disease is highly contagious, and all people are susceptible to the disease. Therefore, extensive measures were taken to prevent the spread of the disease at the community and hospitals. This study aimed to investigate the impact of COVID-19 outbreak on nosocomial infection rate. METHODS: This cross-sectional study was conducted in an educational hospital, southeast Iran. The nosocomial infection rates of critical/intensive care units (CCU/ICUs) and medical-surgical units were assessed during and before the COVID-19 outbreak. RESULTS: There was a 19.75-point decrease in the total rate of nosocomial infection during the COVID-19 outbreak (P = 0.02). In addition, there was a 39.12-point decrease in the total rate of CCU/ICUs' nosocomial infection during the COVID-19 outbreak (P < 0.001). A 19.23-point decrease was also observed in the total rate of medical-surgical units' nosocomial infection during the COVID-19 outbreak (P = 0.13). All kinds of CCU/ICUs' nosocomial infections had between 31.22- and 100-point decreases during the COVID-19 outbreak. Among medical-surgical units, 33.33- and 30.70-point decreases were observed only in UTI and SSI, respectively, during the COVID-19 outbreak, while BSI had a 40-point increase during the COVID-19 outbreak. CONCLUSIONS: Proper implementation of infection control protocols during the COVID-19 pandemic seems to reduce nosocomial infections.

Effects of lavender and Citrus aurantium on pain of conscious intensive care unit patients: A parallel randomized placebo-controlled trial.

BACKGROUND: Conscious patients admitted to intensive care units (ICUs) suffer from pain for various reasons, which can affect their recovery process. OBJECTIVE: The present study compared the effects of aromatherapy with Citrus aurantium and lavender essential oils against placebo for reducing pain in conscious intensive care patients. DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS: This study was a parallel randomized placebo-controlled trial. The ICUs of two educational hospitals in Kerman in Southeastern Iran were the study setting. One hundred and fifty conscious intensive care patients were randomly divided into three groups using a stratified block randomization method. Two groups received aromatherapy with essential oils: one with lavender and the other with C. aurantium; these patients received a 30-minute therapy session using their assigned essential oil on the second day of their intensive care stay. The placebo group used 5 drops of normal saline instead of essential oil during their session. MAIN OUTCOME MEASURES: Patient's pain was assessed using a visual analog scale before the aromatherapy intervention, as well as immediately after and one and three hours after intervention. RESULTS: The mean pain score of the lavender group was 40.01 before the aromatherapy intervention and fell to 39.40, 30.60 and 23.68 immediately after the intervention, and at hour one and three post-intervention, respectively. The mean pain score of the C. aurantium group was 45.48 before the intervention and was reduced to 32.34 at three hours after the intervention. The mean pain of the placebo group decreased from 42.80 before the intervention to 35.20 at three hours after the intervention. Pain scores of all groups decreased during the study (P < 0.001). The mean pain of the lavender group was significantly lower than that of the placebo group at three hours after the intervention. CONCLUSION: The results of this study showed that aromatherapy with lavender essential oil reduced pain in conscious ICU patients. Our data could not justify the use of C. aurantium for reducing pain in this population. TRIAL REGISTRATION: No. IRCT20170116031972N9 (https://en.irct.ir/trial/40827).

Informational Needs of the Families of Patients Discharged From Intensive Care Units: A Case of Iran.

BACKGROUND: thousands of patients are admitted to intensive care units annually, which is a stressful event. Many of these patients still require particular care after discharge. In many countries, families play an essential role in taking care of these patients after discharge. This study aimed to determine the informational needs of families of patients discharged from Intensive Care Units (ICU), Kerman, southeast Iran. METHODS: this study had a cross-sectional design. Families were selected using the information extracted from patients' medical records. One hundred forty family members of the ICU discharged patients participated in the survey using convenience sampling. Data collection tools were a validated researcher-made questionnaire about informational needs and a demographic characteristics form. RESULTS: the mean score of family informational needs was 31.18 ± 3.97 out of 40. Most families required a high level of information in all dimensions. However, the maximum need was associated with self-care subscale (4.89 out of 5), and the minimum need was associated with defecation (3.13 out of 5). CONCLUSION: the families of patients discharged from intensive care units required much information about different areas of care particularly self-care. Health care providers, especially nurses, should be aware of the informational needs of the ICU patients' families post-discharge to provide better care.

Assessment of Leg Massage on Hemodynamic Parameters of Intensive Care Patients: A Parallel Single-Blinded Randomized Controlled Trial.

OBJECTIVE: We aimed to determine the effectiveness of leg massage by a nurse and patients' families on hemodynamic parameters in patients admitted to intensive care units. METHODS: This parallel single-blinded randomized clinical trial involved 75 patients admitted to the intensive care units at Shahid Bahonar Hospital in Kerman, Iran. Patients were assigned to 3 groups by the minimization method (massage by a nurse, massage by the patient's family, and the control group). Swedish massage was used on both legs (each leg for 5 minutes) once a day for 6 days, and the hemodynamic parameters of patients were measured before intervention, at the end of intervention, and 1 week later. RESULTS: The results showed that mean arterial pressure decreased in all 3 groups 1 week after intervention, which was not statistically significant. Mean heart rate also decreased in all 3 groups 1 week after intervention, which was statistically significant except for massage by family. Mean arterial oxygen saturation significantly decreased in all 3 groups 1 week after intervention but remained normal. The 3 hemodynamic parameters did not differ significantly among the 3 groups. CONCLUSION: According to the results of this study, the use of massage has no effect on hemodynamic parameters.

Comparing the Efficacy of Methadone and Tincture of Opium in Controlling Agitation Caused by Withdrawal Syndrome in Opium-Addicted Patients in the Intensive Care Unit: A Randomized Trial Study.

BACKGROUND: Few studies have been conducted regarding the comparison of the efficacy of methadone and tincture of opium (TOP) in controlling agitation induced by withdrawal syndrome. Therefore, the current randomized trial study is carried out with the aim to evaluate comparisons on the efficacy of methadone and TOP in controlling agitation caused by withdrawal syndrome in opium addicted patients in the intensive care units (ICUs). METHODS: This clinical trial study was conducted on 60 patients admitted to ICU of Shahid Bahonar Hospital, Kerman, Iran. After classification of the patients into two groups, the first and second groups consumed methadone syrup (5 mg/ml) and TOP (10 mg/ml), respectively. Agitation in these patients was assessed through the Richmond Agitation-Sedation Scale (RASS). Vital signs were also assessed. Paired sample t-test and independent t-test were used for data analysis. FINDINGS: In the current study, the administered dose of methadone and TOP was 36.17 ± 26.99 and 112.67 ± 102.74 mg, respectively (P < 0.010). Methadone administration led to a significant decrease of the patients' vital signs, including systolic blood pressure, heart rate, respiratory rate, and Glasgow Coma Scale (GCS) (P < 0.05). Though TOP administration decreased systolic blood pressure and GCS significantly (P < 0.05), it had no effect on patients' diastolic blood pressure, body temperature, heart rate, and respiratory rate (P > 0.05). In total, no significant difference was detected between two groups regarding vital signs (P > 0.05). However, a significant difference was seen between methadone and TOP groups in terms of RASS score (P < 0.01). CONCLUSION: According to the results of the current study, lower dose of methadone, compared to TOP, could control agitation caused by opium withdrawal symptoms.

The Effect of Foot Massage on Pain of the Intensive Care Patients: A Parallel Randomized Single-Blind Controlled Trial.

MATERIALS AND METHODS: This randomized, parallel, single-blind controlled trial study was performed on 75 ICU patients. Patients were allocated into three groups (massage by a nurse, massage by the patient's family, and control group) by the minimization method. Swedish massage was provided for the patients in experimental groups (each foot for 5 minutes) once a day for six days. The pain was examined in all three groups before, immediately, and one week after the intervention. RESULTS: The mean scores of pain in the groups of foot massage by the patient's family and by a nurse showed a significant reduction at the end of the study (from 4.48 to 3.36 and 4.76 to 2.96, respectively). The control group had significantly more pain after the intervention than the family-based massage group and the nurse-based massage group (P < 0.05). Although significant difference was found in the mean scores of pain between the massage provided by a nurse and that provided by the patient's family immediately after the intervention (P < 0.05), it was not significant one week after the intervention (P > 0.05). CONCLUSION: Using foot massage, by both nurses and family members can reduce the pain of ICU patients. This intervention may improve the nursing care quality with the least cost and complications.

Efficacy of Simple Eye Ointment, Polyethylene Cover, and Eyelid Taping in Prevention of Ocular Surface Disorders in Critically Ill Patients: A Randomized Clinical Trial.

BACKGROUND: Under normal conditions, the cornea of the eye is protected from bacterial invasion, physical injury, and drying by the presence of tears, eyelids, and blinking reflex. However, patients admitted to the intensive care unit (ICU) for several reasons including loss of consciousness, receiving sedative and neuromuscular blocking agents, and mechanical ventilation may lose eye-protective mechanisms causing exposure keratopathy. Therefore, this study intended to compare three eye care methods to prevent ocular surface disorders (OSDs) in ICU patients. METHODS: This study was a double-blind clinical trial (IRCT: 201109225426N3, https://www.irct.ir/trial/5825), in which 152 patients were randomized into three groups and each group underwent a different eye care procedure. The eye care methods included simple eye ointment, polyethylene cover, and eyelid taping. The eligible patients received the care procedure for seven days, and their corneas were examined daily for OSD by a portable slit lamp with fluorescein staining. Descriptive and analytical tests (ANOVA, chi-square, logistic regression, and zero-inflated Poisson regression) were used for statistical analysis by STATA14. RESULTS: The odds of OSD (chances of getting an OSD grade between I and VI) in the ointment group were 0.19 (95% CI: 0.09, 0.41), and the odds of OSD in the polyethylene cover group were 0.06 (95% CI: 0.01, 0.20), showing a significant difference with the tape group (p=0.0001). Despite the lower odds of OSD in the cover group than in the ointment group, there was no significant between-group difference (p=0.08). However, the mean OSD scores in both the ointment and polyethylene cover groups were significantly lower than that in the tape group. CONCLUSION: The results of this study showed that polyethylene cover followed by simple eye ointment and eyelid taping were the most effective methods in preventing OSD. Therefore, polyethylene cover and simple eye ointment are recommended as effective eye care methods in ICU.