[Nurses' knowledge regarding evidence-based guidelines for preventing ventilator-associated pneumonia]

Introduction: Ventilator-associated pneumonia [VAP] is a subset of hospital infections occurring 24 hours after intubation or mechanical ventilation. Considering the outcome of VAP, prevention is of a high importance in the care of patients who are being treated by mechanical ventilation. Thus, evidence-based guidelines have been published by researchers to prevent ventilator-associated pneumonia and can effectively reduce its incidence

Objective: The purpose of this study was to review the knowledge on these evidence-based guidelines in prevention of ventilator-associated pneumonia

Method: This is a descriptive -analytical, cross-sectional study which used census sampling method. 171 nurses with bachelor and master degree participated in the study. To determine their knowledge of evidence-based guidelines for prevention of ventilator-associated pneumonia, a two-part questionnaire was used. The first part included demographic information including age, sex, nursing position title, university degree, working experience and years in the intensive care unit as well as ICU specifications such as type and number of beds and internet access. The second part had Labeau et al. questionnaire that consisted of 9 multiple-choice questions. Questionnaires were given to the participants during morning, afternoon and night shifts by a researcher in each ward. The response time was 15 minutes. After collecting the questionnaires, correct responses were calculated in percentage and the mean of total score was determined. In this study, evaluations and judgments were based on the mean of score. In order to analyze the data, descriptive statistics were used to estimate the frequency. Chi-square, t-test and ANOVA were used to examine the relationship between level of knowledge, demographic variables and characteristics of intensive care unit

Results: 171 of 219 ICU nurses participated in this study and 48 patients were excluded due to vaccation at the time of sampling or unwillingness. Most of the study population was women [93.6%] with a Bachelor's Degree [94.7%] and nurse position title [89.5%].In this study, 59.9% of the nurses had not passed any ICU-specific training course. 42.7% of them were in ICU with more than 8 beds. The majority of them [40.4%] had between 1-5 years of working experience. Furthermore, the mean score of nine one-score questions equaled 4.63 +/- 1.708. The most wrong answers belonged to the questions about "ventilator set's replacement frequency" and "the moisturizer's replacement period". The most correct answers were about "choosing a semi-sitting position for reducing VAP". Mean of scores obtained by women was higher than men. The independent t-test showed no significant difference between the two groups [P=0.721]. The mean score was higher in nurses with master degree and the ones who had passed specific ICU nursing courses than the ones who did not. Independent t-test manifested no significant difference [P=0.189, P=0.204] in this regard. Among the participants who had replacement nurse position, nurses working in ICUs with more than 8 beds and nurses with more than 10 years of experience had a higher mean score. Yet, ANOVA showed no significant difference among these groups [P =0.168, P=0.882, P=0.327]

Conclusion: This results in more attention to training purposes in some parts of the guidelines. Lack of nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia is one of the potential barriers and increasing the awareness level will be the first step in a successful training program. The findings seem to highlight the importance of specific parts of the guidelines that should be considered in trainings. Lack of nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia is one of the potential barriers. Increasing their awareness will be the first step for a successful training program on VAP prevention

Gastrointestinal stromal tumors: epidemiology and treatment outcomes

Numerous studies have investigated the prevalence, incidence and clinical manifestations of gastrointestinal stromal tumors [GISTs]. However, little is known about GISTs in Iran. This pioneer study focuses on description of 36 patients with GISTs in Iran. A database was created for 36 patients suffering from GIST who were treated in Loghman Medical Center and Tehran Cancer Institute in Tehran, Iran. Information on age, sex, clinical manifestations, treatment and outcomes were recorded and analyzed using SPSS version 13. Patients had an average age of 60 years; and 16 of them were males. The disease was most commonly manifested by abdominal mass, weight loss, and anemia. Twenty one patients had a mass smaller than 10cm; and in 33 patients KIT test was positive. In the follow-up, 5 patients experienced relapse and 3 succumbed due to advanced cancer. Primary results showed that GISTs might have different manifestations and incidence in Iran compared to other parts of the world. We hope that this study could serve as a starting point for the better understanding and classification of this disease in Iran and for development of improved management strategies

[Aquracy of modified alvardo score in diagnosis of pediatric acute appendicitis in loqman Hospital]

Abdominal pain is one of the most Important and considerable issues in children. One of the most common causes of abdominal pain in children is acute appendicitis. The course of acute appendicitis in children is very faster than adults. Clinical manifestations in Pediatric patients are less typical and are not able to tell the exact history. In addition, no other signs or diagnostic tests can exactly detect the acute appendicitis in Pediatrics. Purpose of this study was the assessment of MAS in diagnosis is of acute appendicitis in Iranian Pediatrics patients. This prospective study was conducted in Loqman Hakim hospital in 1384-5 .Three hundred children aged from 4 to 12 years old with acute abdominal pain were assessed. All of information were taken from their data sheets and pathologic reports and scored in the form of 24 variables [age, sex ...] The results were analyzed via statistic soft ware spss 12 and absolutes score of MAS was counted on the basis of clinical variables. Based on the MAS the patients were divided to 2 groups: the first group were the patients with score of <7 including 147 cases [49 percent]. The second group were the patients the score of 37 Including 153 cases, [51 percent]. In overall, from 300 cases that operated with the suspicious of appendicitis, 269 cases [89.6%] in the pathologic assessment had acute appendicitis. from the patients with score of <7 [147 cases], 124 cases had diagnosis of acute appendicitis [84/35%] from the patients with score of 37 [153 cases], 145 cases had diagnosis of acute appendicitis [94.77%] this outcomes showed no significant difference between these groups in the diagnosis of appendicitis based of this score. According to this analysis, sensitivity of this scoring system in the diagnosis of acute appendicitis was 53.9% and the specificity was 74.19% showing the MAS in diagnosis of acute appendicitis in Iranian pediatric patients is not soley effective and can't be an absolute clue and should be progressed in sensitivity and specificity

[Surgical approach in soft tissue injection of hydrocarbons]

Hydrocarbon injection is a strange method of suicidal attempt; however, it can be also seen in domestic and industrial accidents. Management of chemical cellulites and other complications are matters of controversy among surgeons. T present study aimed at determining the surgical approach in soft tissue injection of hydrocarbons. For this descriptive study, 21 patients referred to Loghman hospital in Tehran with hydrocarbon injection in a 4-year period [2001-2005] were included. Most of the patients were male, single and aged between 20-29 years. Approximately, half of the cases were opium addicted. Only 6 patients had a documented psychological problem and 5 patients had a previous suicidal attempt. Choline-estrase inhibitors with hydrocarbon carrier and base were the most common injected substances [in 10 patients]. Anterior of forearm was the most frequent site of injection [in 15 patients]. Pain and swelling in injection site [21 patients] were the most prevalent symptoms while localized tenderness [21 patients] and erythema [17 patients] were the most common signs. Most of patients had leukocytosis [18 patients] and normal chest x-ray. All of the patients have been operated during the first 24-hour following the admission. The most common early-operations were fasciotomy and debridement [13 patients] and the most common late-operation was skin graft [10 patients]. The most frequent complication was skin irritation and then compartment syndrome. Close monitoring of injection site for local complications and monitoring for systemic complications seem to be necessary in these patients. The majority of patients will need at least one operation despite conservative management

Prevalence of groin hernia and penoscrotal disorders in elementary-school boys in Khoramabad, 2001-2

Inguinal hernia and symptomatic genital diseases are common surgical problem. Late diagnosis and treatment of these abnormalities can lead to irreversible complications such as intestinal strangulation, infertility and psychosomatic problems. Most of these disorders can be diagnosed during childhood period.As a cross-sectional study, 3205 elementary school boy students have been examined.Abnormalities were detected in 213 children [6.6%]. 78[2.4%] had inguinal hernia, 28[0.9%] had hydrocele, 75[2%] had undescended testis and 25[0.8%] had hypospadiasis. Meanwhile, two cases of epispadiasis, one case of varicocele and three cases of micropenis were also reported. Ambiguous genitalia and apenia were not seen in our subjects. Most of the parents were not alert about their children's anomalies.According to the high incidence of penoscrotal anomalies and low public knowledge, educational and screening programs are recommended