ABSTRACT
Objective: To compare the postoperative complications between Laryngeal Mask Airway [LMA] and endotracheal tube [ETT] during low-flow anesthesia with controlled ventilation
Methodology: Eighty adult Patients with ASA class I or II were randomly allocated into two forty-patient groups [ETT or LMA]. Cuff pressure was monitored during anesthesia. After high uptake period, fresh gas flow [FGF] was decreased to 1 lit/min and isoflurane set to 1%. Monitoring during anesthesia included non-invasive blood pressure, ECG, ETCO2 and pulse oximetry. System leakage [>100 ml/min], rebreathing and any attempt to increase FGF to overcome the leak were monitored during anesthesia. Later, patients were extubated and transferred to Post Anesthesia Care Unit [PACU]. In PACU, the incidence of sore throat, cough, difficulty in swallowing and shivering was monitored for all patients
Results: Leakage was observed in two and three cases in ETT and LMA groups respectively [P>0.05]. Postoperative cough, sore throat and difficulty in swallowing were significantly less in LMA than ETT group. No significant difference was observed regarding ETCo2 values between 2 groups
Conclusion: If careful measures regarding insertion techniques, correct LMA position and routine monitoring of LMA cuff pressure are taken, LMA can be used as a safe alternative with lower incidence of post operation complication compared with ETT during low-flow controlled anesthesia with modern anesthetic machines
ABSTRACT
Implementation of the motivational program by nurse managers can improve nurses' performance and behaviour, provide better care for patients, and promote patients' satisfaction. This study aimed to determine the effect of implementation of the motivational program designed using "Expectancy Theory" by head nurses on patients' satisfaction. This was a quasi-experimental study conducted in medical and surgical units of two hospitals in Zanajn in 2011. Data were gathered using a patient satisfaction questionnaire. The reliability of the questionnaire was confirmed [alpha=0.72]. Forty participants were selected and allocated in two study groups. The groups were matched for some variables before the intervention. The motivational program was implemented in the intervention group for five months. The program had two designing and implementation phases including: 1] determining nurse managers' expectancies from nurses, assessing nurses' attitudes about valuable rewards, founding reward management committee and management improvement committee, and providing evaluation checklists for nurses' performance; 2] implementing standards of nursing care and patient education by nurses, monthly evaluation of nurses by head nurses and collaborative members of the reward management committee, determining level of rewards based on the results of nurses' performance evaluation, and giving reward to nurses at the end of each month in a reward ceremony. Data were analyzed using the Paired t-test, Independent t-test, Mann-Whitney, and Chi-squared in the SPSS v.16. There were no significant differences between the two groups at baseline dealing with the demographic variables. The results showed that patients satisfaction was significantly higher in the intervention group after the intervention [P<0.05]. This motivational program designed based on the "expectancy theory" has clear steps to be implemented among nurses and can be used as a practical guide by nurse managers to improve patients' satisfaction
ABSTRACT
Electrocardiography [ECG] is a valuable device in the assessment of cardiovascular diseases. Recent medical software developments such as the invention of modern automated ECG interpreters have greatly facilitated the work of electrocardiographers and cardiologists. We present our experience in the use of one such device in the routine reporting of 200 successive ECGs recorded in our Cardiac Care Unit and Cardiac Emergency Ward. The interpretations of 200 ECGs provided by the GE-digital ECG device were chosen and compared with those supplied by four cardiologists in a single blind manner. All statistical analyses were performed by using SPSS version 11.5 for windows. A p value of less than 0.05 was considered statistically significant. There was a diagnostic match between the interpretations by the device and those by the cardiologists in 107 [53.5%] cases as opposed to a diagnostic mismatch in 93 cases [46.5%]. The matching rate in the interpretations of myocardial ischemic disorders was high, which means practically all the ischemic cases diagnosed by the device were confirmed by the cardiologists. Only in 12 cases myocardial infarction or ischemic changes were reported by the cardiologists, while they were missed by the device. As regards rhythm disorders, the sensitivity and specificity of the device were 67.7% and 75.7%, respectively. With respect to conductive disorders, the respective sensitivity and specificity of the device were 70% and 96.6%, respectively. Finally, in the case of structural disorders, the interpretations of the device were 92.8% sensitive and 83.3% specific. According to the results of our study and similar researches, it seems that the interpretations of an automated ECG device in diagnosing the ischemic and structural disorders of the heart are reliable. The device, however, should not be relied upon when assessing conduction disorders and dysrhythmias. We, therefore, recommend that the users of digital ECG devices recheck the digital interpretations in those cases