Predictors of length of stay in intensive care unit after coronary artery bypass grafting: development a risk scoring system

Abstract Introduction: To determine predictors of length of stay (LOS) in the intensive care unit (ICU) after coronary artery bypass grafting (CABG) and to develop a risk scoring system were the objectives of this study. Methods: In this retrospective study, 1202 patients' medical records after CABG were evaluated by a research-made checklist. Tarone-Ware test was used to determine the predictors of patients' LOS in the ICU. Cox regression model was used to determine the risk factors and risk ratios associated with ICU LOS. Results: The mean ICU LOS after CABG was 55.27±17.33 hours. Cox regression model showed that having more than two chest tubes (95% confidence interval [CI] 1.005-1.287, Relative Risk [RR]=1.138), occurrence of atelectasis (95% CI 1.000-3.007, RR=1.734), and occurrence of atrial fibrillation after CABG (95% CI 1.428-2.424, RR=1.861) were risk factors associated with longer ICU LOS. The discrimination power of this set of predictors was demonstrated with an area under the receiver operating characteristic curve and it was 0.69. A simple risk scoring system was developed based on three identified predictors that can raise ICU LOS. Conclusion: The simple risk scoring system developed based on three identified predictors can help to plan more accurately a patient's LOS in hospital for CABG and can be useful in managing human and financial resources.

The Impact of Depression, Personality, and Mental Health on Outcomes of Total Knee Arthroplasty

Background@#Precise assessment of preoperative mental health and psychological determinants may be useful in identifying patients at risk for poor postoperative outcomes of total knee arthroplasty (TKA). The aim of this study was to investigate the influence of psychological status and physical and mental health on the outcome of patients undergoing TKA. @*Methods@#Fifty-two patients undergoing unilateral TKA were assessed preoperatively with Oxford Happiness Inventory, Eysenck Personality Inventory, 12-item short form health survey (SF-12), and Knee Injury and Osteoarthritis Outcome Score (KOOS) for evaluating depression, personality traits, physical and mental health, and function, respectively. At 1 year after surgery, health-related quality of life (HRQL) and function were assessed using the SF-12 and KOOS. @*Results@#HRQL and function of all personality traits increased significantly after TKA, without significant difference among them. Extroversion and neuroticism did not have significant correlation with subjective well-being, HRQL, and function before and after surgery. Subjective well-being and the baseline physical and mental health scores were correlated strongly and directly with postoperative physical component summary, mental component summary, and KOOS scores and their improvement. Among many factors that significantly affected the outcomes of TKA, the only independent predictor of physical, mental, and functional outcome was depression. @*Conclusions@#Outcomes of surgery were not significantly different among diverse personality traits. Patients with less depressive symptoms and higher baseline mental and physical scores had significantly greater improvement in HRQL after surgery. The only independent factor affecting the physical, mental, and functional outcome was depression.

Predicting factors of medical treatment success with single dose methotrexate in tubal ectopic pregnancy: a retrospective study

Nowadays, The first step in treatment of ectopic pregnancy [EP] is medical treatment. Medical treatment with methotrexate [MTX] for EP is safe and effective method without the risks associated with the surgical procedure. But there are controversies between studies for which patients will respond better to medical treatment. The aim of the present study was to investigate the predictive factors of success or failure of treatment of EP with single dose MTX. In this retrospective study, records of 370 patients who were treated for tubal EP with single dose of MTX were reviewed during four years. Patients were divided into two groups; the first group or "success group" are the patients who were successfully treated with MTX. The second group or "failure group" consist the patients who did not respond to the MTX therapy. The week of gestation, size and location of EP and beta-hCG level were compared between groups. Of 370 patients, 285 [77.1%] were successfully treated with MTX. 85 patients [22,9%] required surgery after a mean of 5.4 [range 2-15] days. Day-1 beta-human chorionic gonadotropin [p-hCG] and fall in beta-hCG between day 1 and day 4 were the best predictors for single dose MTX treatment success. The cutoff value of initial beta-hCG with the success treatment results was found to be 1375 lU/mL there was no statistical difference between groups about week of gestation, size and location of EP. The results showed that patients who have beta-hCG levels below 1375 and the number of cases with decreasing beta-hCG level on day 4 are the good candidates for medical treatment

Comparison of nucleated red blood cells in the umbilical cord of term neonates in healthy women and women with preeclampsia

Background: asphyxia is a common cause of perinatal mortality in 5-10% of all births worldwide. The present parameters for determining perinatal asphyxia, e.g. preeclampsia, cannot be considered as markers per se, and require auxiliary markers, e.g. increased number of nucleated red blood [NRBC] cells, for early diagnosis of perinatal asphyxia

Objective: in this study, we evaluated the mean NRBC count in preeclampsia and to determine the usefulness of the NRBC as independent prognostic factors of perinatal complications

Materials and Methods: this was a cross-sectional study in order to compare the NRBC in the umbilical cord of term neonates born to 50 mothers with preeclampsia and 150 normal mothers. The exclusion criteria were mother's affliction with complications of pregnancy and inexact last menstrual period. The variables under study were maternal and neonatal data. The count of NRBC was determined with standard laboratory procedures in the blood samples from umbilical cord of the neonates. The acquired data were fed into SPSS 16 software and analyzed using statistical tests

Results: the mean value of NRBC count was significantly higher in preeclamptic women [p<0.0001]. The average 1[st] and 5[th] minute Apgar scores were significantly higher in normal mothers [p<0.001]

Conclusion: increase of NRBC in neonates born to mothers with preeclampsia may be due to chronic hypoxia; this group of neonates has increased risk and requires more precise and extensive care during delivery and after birth in order to have reduced mortality and complications during the neonatal period

Evaluation of Persian academy approved genetics terms acceptance in upper graduate user population

Finding Persian equivalents for scientific terms is one of the aims of Academy of Persian language and literature, and more than 50 scientific committees are now working on this scope in terminology department of the academy. Genetics and biotechnology terminology committee is one of these teams that started his activity from 2009 and since then approved more than 500 of these terms for use in academic fields. In this research 101 questionnaires including 20 questioned term were given to more than 101 upper graduate users including MSc and PhD students and academic staff of randomly selected universities in Tehran and Semnan provinces. And then the evaluation of their acceptance was carried out by a model given by Cooper for the Study of Language Spread. All 20 studied terms were randomly selected from genetic approved terms and divided in to two groups: newly coined equivalents [those equivalents that was newly coined by the committee] and selected equivalents [those that have the selected equivalent before]. Results gathered and analyzed with statistical tests, and showed that most of accepted terms are among selected equivalents. By another words the newly coined terms has much less acceptability than the others. This research introduces a method for evaluation of approved Persian equivalents of scientific terms and besides show the state of some of these equivalents between user populations. The important point is that term selection for scientific terms including genetic terms; is not an obligatory rule, but is a proposal for meeting the researchers need to strength Persian language as a scientific language. And usage of these equivalents is completely on the part of researchers and students and their point of view to equivalents

[Trends of psychiatric consultation in Rasoul Akram hospital]

The present study aimed to assess the characteristics of psychiatric consultations and their changes over a 3-year period in Rasoul Akram Hospital, [Tehran, Iran]. The consultations' characteristics of various hospital wards were retrospectively evaluated since 2007 to 2010 and some characteristics like gender, the reason of consultation request, the requesting ward for consultation, request and consultation date and psychiatric diagnosis were recorded. The data were analyzed using 2 and matched-paired t-test. During the study period, for 1.09% of the inpatients, a psychiatric consultation was requested. Most of the referrals were from internal medicine department. Current psychiatric symptoms [55%] and unexplained physical symptoms [16%] were the most prevalent reasons for referral; and major depressive disorder [27.7%], delirium [11.8%] and substance dependency [10.2%] were the most common psychiatric diagnoses. There were no significant differences between the two time periods [2007 and 2010] based on the total number of consultations, gender of patients, the requesting ward for consultation and lag time. Although the rate of referrals from some departments such as neurology had significant difference [p<0.05], the reason for consultations were not different between the two periods [p

Factors influencing pre-hospital delay among patients with acute myocardial infarction in Iran / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acute myocardial infarction (AMI) is the leading cause of morbidity and disability among Iranian population. Pre-hospital delay is an important cause of increasing early and also late mortality in AMI. Thus the aim of the present study was to identify the factors influencing pre-hospital delay among patients with AMI in Iran.</p><p><b>METHODS</b>Between August 2010 and May 2011, a cross-sectional and single-center survey was conducted on 162 consecutive patients with ST-elevation myocardial infarction (STEMI) admitted to Cardiac Care Unit (CCU) of Dr. Heshmat Hospital, Rasht. All patients were interviewed by the third author within 7 days after admission by using a four-part questionnaire including socio-demographic, clinical, situational and cognitive factors. Data were analyzed by descriptive and Logistic regression model at P < 0.05 using SPSS 16.</p><p><b>RESULTS</b>Mean age was (60.11 ± 12.29) years in all patients. Majority of patients (65.4%) were male. The median of pre-hospital delay was 2 hours, with a mean delay of 7.4 hours (± 16.25 hours). Regression analysis showed that admission in weekend (P < 0.04, OR = 1.033, 95%CI = 1.187 - 2.006) and misinterpretation of symptoms as cardiac origin (P < 0.002, OR = 1.986, 95%CI = 1.254 - 3.155) and perceiving symptoms to not be so serious (P < 0.003, OR = 3.264, 95%CI = 1.492 - 7.142) were factors influencing pre-hospital delay > 2 hours.</p><p><b>CONCLUSIONS</b>Our findings highlight the importance of cognitive factors on decision-making process and pre-hospital delays. Health care providers can educate the public on AMI to enable them recognize the signs and symptoms of AMI correctly and realize the benefits of early treatment.</p>

Trends in Persian medicinal terminology a progressing field of interdisciplinary research

Conceptualization for new findings is the main aim of science and technology development. Sometimes new concepts are pathfinders for science and starting fundamental revolutions in science. An important area in scientology or scientific studies is the concept and term field, so terminology and its effect on science and technology is one of the most important subjects in the last decade. Standardization in scientific terms [scientific term selection] is one of the strongest terminology methods. These methods break down the terms to their meaningful parts or use prevalent terms, which are common among people or use eponyms and abbreviation processes, and finds the appropriate equivalent for them. The word parts are prefixes, suffixes and stems. In medical sciences, terms are mostly originated from Latin stems, so this method could be extremely efficient in these fields. The terminology committee of Persian Academy studied the highly frequent prefixes, suffixes and stems to help the standardization of terminology in medical sciences. This research introduces methods of term selection, some approved terms and their Persian equivalents. Term selection for medical terms is not an obligatory rule, but is a proposal for meeting the researchers need to strength Persian language as a scientific language

[View points of faculty members of guilan university of medical sciences in regard to electronic learning]

Background and Objectives: In the world of information technology, tendency toward using electronic learning as a novel learning style is increasing. The contribution to electronic learning is dependent on the knowledge and attitude of faculty members toward this issue. The aim of this study was to find the knowledge and attitude of faculty members in Guilan University of Medical Sciences toward electronic learning

Methods: In this descriptive cross-sectional study by using census sampling all faculty members in Guilan University of Medical Sciences were studied of whom 220 ones eventually responded to the questionnaire. Data collection instrument was a questionnaire consisted of 4 sections of demographic features [5 questions], computer knowledge [6 questions], attitude-testing items [10 questions based on Likert scale] and questions related to the facilities [8 yes/no questions]. Competency [9 questions]. Content validity and reliability were determined by a-cronbach. Data analysis was performed by SPSS 16 software package

Results: The majority of respondents had sufficient knowledge [68.3%] and positive attitude [89.4%]. From all, 69.5% asserted that they have the required computer skills, but 95% said that they do not have enough lacilities in home and university for using electronic sources

Conclusion: Positive attitude of faculty members toward electronic learning requires implementation of continuous education programs for faculty members in order to improve their knowledge about information technology and up-to-date electronic learning skills

[Nurses' perspectives of nursing research priorities about cancer patients]

Cancer patients are in need of specialized and low-cost care therefore has brought about many challenges for health care team and necessitates conducting research. This study aimed to determine nursing research priorities for cancer from the viewpoint of the nurses attending nursing research priorities for cancer from the viewpoint of the nurses attending at the conference of Asian Pacific Organization for Cancer Prevention [APOCP]. In this study, Delphi method was used. A two-part questionnaire consisting of demographic characteristics and phrases related to the research items was given to the participants. Delphi method was organized in two phases. The responses from the first stage [30 samples of scientific member in APOCP], were divided into 4 theme groups including 35 statements. Then, in the second stage, questionnaire was distributed among participants in APOCP conference. Finally, 54 nurses returned them. Data were analyzed by SPSS [ver. 10]. The findings showed that the majority of samples were female [92.6%], clinical nurse [59.3%], above 40 years old [40.7%]; and had working experience less than 10 years [economic-psycho-social effects of cancer diagnosis on family], [chemotherapy-related mouth care], [nutritional needs], [continuity of care], and [communication with patients]. The topics with the lowest priority were [nurses' fear of caring cancer patients], [evaluation of instruments measuring fatigue and spirit], and [palliative care from patients' point of view]. The study findings showed that areas such as psychological, socio-economic and special care as well as the method of care delivery were still as the main concerns of the researchers. These results can help the clinical investigators in choosing interesting and challenging topics in the field of cancer