Effects of active and passive implementation of ventilator associated pneumonia guideline on nurses' performance in critical care units: a controlled clinical trial

Ventilator associated pneumonia [VAP] is the most common infections in critical care units, which leads to more length of hospital stay, costs, and high mortality. Therefore, prevention is a priority according to clinical guidelines. The aim of this study is determine the effects of passive versus active implementation of VAP guidelines on nurses' performance in critical care units. In this controlled clinical trial, 110 nurses who working in critical care units in selected hospitals affiliated to Tehran University of Medical Sciences were enrolled to study by convenience sampling at three groups, including active intervention group [n = 40], passive intervention [n = 36], and control [n = 34]. First, nurses' performance in prevention of VAP was evaluated by an observational checklist. In passive intervention group, posters containing recommendations of prevention of VAP was installed over the wall for each bed. In active intervention group, in addition to poster installation, there were training sessions with feedback on nurses' performance. In control group without any intervention, just nurses' preventative performance was evaluated before and 1 month later. A month later the nurses' performance were observed. Data were analyzed by descriptive and inferential tests [Fisher's exact test, chi-square, ANOVA, and paired t-test] in SPSS version 16. Results showed that the nurses' mean percentage score in three groups was 46.80 +/- 5.79 and after intervention it changed from 47.76 +/- 4.61 to 63.32 +/- 6.97 [P < 0.001] in active group, from 45.24 +/- 5.72 to 55.03 +/- 10.20 [P < 0.001] in passive group and 47.33 +/- 6.86 to 47.90 +/- 6.06 in control group [P = 0.263]. Nurses' performance in active group improved significantly in comparison to passive group and in passive group, it improved significantly in comparison to control group [P < 0.001]. The results of this study showed that both active and passive methods are effective on nurses' performance in prevention of VAP. Therefore, considering the existing situation in the country and the high workload of nurses, we can offer VAP guideline as a protocol in critical care units

effect of anthocyanin supplementation on body composition, exercise performance and muscle damage indices in athletes

Flavonoids consider as a large group of plant metabolites that 6,000 types of them have been identified till now. In some studies, it has been shown that they can increase aerobic performance and maximal oxygen consumption [VO[2] max].The aim of this study was to evaluate the effect of anthocyanin [as one of the most important kind of flavonoids] supplementation on body composition, exercise performance and muscle damage indices in athletes. This double-blinded clinical trial involved 54 female and male athletes at Isfahan University of Medical Sciences with athletic history of at least 3 years. Body composition, exercise performance, creatine kinase, and lactate dehydrogenase were assessed. Individuals were selected by simple sampling method, they divided into two groups using permuted block randomization method. First group received 100 mg anthocyanin pills, and the second group received 100 mg placebo pills, daily for 6 weeks. Participants asked to continue their routine diet and physical activity during the study period, and they were followed through phone calls or text messages. Soft lean mass, total body water and percent body fat were not changed significantly in the anthocyanin group after intervention but VO[2] max increased significantly in the anthocyanin group [48.65 +/- 4.73 vs. 52.62 +/- 5.04] [P

Measuring self-rated social health of iranians: a population based survey in three cities

Social health as third dimension of health, along with physical and mental health, has drawn more attention in recent years among policy makers and health system managers. No other study, according to our review, has documented measuring individual-level social health in Iran. In response to this need, our study tends to assess Iranians self-rated social health through conducting a survey in 3 cities of Iran. We conducted a survey using cross sectional method in three cities of Iran [Tehran, Isfahan, Urmia] included people more than 18 years old. We use a random sample size of 800 people. The scale provides a total score of social health and three sub-scores. Total score was calculated by summing all 33 items, so the range was between 33 to 165, considering that higher score indicating better social health. Psychometric parameters of scale were acceptable. To interpret scores, respondents were categorized into five ordered groups as quintiles for amount of social health. To compare social health scores in different demographic groups multiple linear regression was employed to interpret association between demographic variables and social health score. From a pool of 800 persons, 794 [99%] agreed to participate and filled out the questionnaire completely. The mean of self-rated social health score was 105.0 [95% confidence interval, 103.8 to 106.2]. 50% of participants had medium level of social health. Social health score was higher for those who live in Uremia as a small city in comparison with big cities-Tehran and Isfahan [p<0.001] and was lower for unemployed people [p=0.029]. There was no association between social health score and other factors such as sex, age and educational level [p>0.05]. This study may be considered as the first step in evidence-based policy-making in the field of social health in Iran. Certainly, it is necessary to conduct more studies to measure social health and its determinants in a nation-wide approach

[Nurses performance in prevention of ventilator associated pneumonia]

The ventilator associated pneumonia is a common problem in critical care units. It is associated with increased mortality, cost and length of stay. Nurses have great role in preventing the ventilator associated pneumonia. The aim of this study was to assess nurses' performance in prevention of ventilator associated pneumonia. In this descriptive study, 110 nurses working in selected hospitals affiliated to Tehran University of Medical Sciences were selected using convenience sampling method. A 32-item observational checklist was provided based on the ventilator associated pneumonia prevention guideline. The nurses' performance was observed three times. Data were analyzed using descriptive statistics in the SPSS-16. This study showed that the mean score of the nurses' prevention was 46.8 +/- 5.79. Most of the nurses [66.4%] had poor performance; and 36.6% had relatively good performance. There were no nurses with favorable performance in the prevention of ventilator associated pneumonia. The highest score was in contact precaution [72 +/- 9.67] and the lowest score was in mouth hygiene [18.78 +/- 17.4]. The majority of nurses had poor performance in prevention of ventilator associated pneumonia. More attention should be paid for planning appropriate training programs for nurses and giving adequate facilities to improve health care quality

[Effect of application of critical-care pain observation tool in patients with decreased level of consciousness on performance of nurses in documentation and reassessment of pain]

The presence of pain is a common phenomenon among patients in critical care units. Critically ill patients are often unable to communicate because of illness or sedation; so, recognition and assessment of their pain is difficult. In these patients, observational behavioral indices can be used to evaluate pain. The aim of this study was to investigate the effect of application of critical-care pain observation tool in patients with decreased level of consciousness on performance of nurses in documentation and reassessment of pain after palliative intervention. In this before and after quasi-experimental study, 106 nurses working in general intensive care units in selected hospitals affiliated to Tehran University of Medical Sciences were selected. First, we examined the nurses' performance three times in relation to documentation and reassessment of pain after palliative intervention, position change and suction procedure in patients with decreased level of consciousness using a researcher-made check list. Then, we taught nurses individually, how to use this tool to investigate the pain of patient in a session lasting an hour. A week after the training, the researcher reevaluated performance of trained nurses in relation to documentation and reassessment of pain after palliative intervention in patients with decreased level of consciousness. Finally, those data collected before and after the training of the CPOT to nurses were compared using the Wilcoxon test. Findings showed that the CPOT could not lead to improved nurses' function in relation to documentation of pain in the patients records [P=0.209] and recording palliative measures related to pain [P=0.117]. However, there were significant statistical differences between nurses' function in relation to reassessment of pain after palliative intervention, before and after the training and application of the CPOT. Comparing the mean function scores before and after the intervention, demonstrated that the performance of nurses in this area has been improved after the intervention. The critical-care pain observation tool can increase nurses' sensitivity to pain in patients with decreased level of consciousness. It forces the nurses to reassess the pain after palliative intervention. This tool does not motivate in nurses to document pain palliative process. So it is recommended that future studies investigate the impact of this tool on other aspects of pain management, such as diagnosis of pain and using of drugs and non-drug measures

[Modification of environmental factors on quality of sleep among patients admitted to CCU]

Poor sleep quality is a common problem among patients hospitalized in the CCUs. This study aimed to determine the effect of environmental factors modification strategies on quality of sleep among patients admitted to CCU. This was a quasi-experimental study with a single-blinded design. Sixty patients admitted to the CCU of Shariati hospital were divided into two experiment and control groups. Sleep quality was measured in the first day of admission and three days later using the Pittsburgh sleep quality index in both groups. In the intervention group, we implemented a modified work environment between the two measurements. Data were analyzed using the Chi squared and t-test in the SPSS v.18. Findings showed a significant decrease in sleep quality in the control group after hospitalization, compared with the intervention group [P<0.001]. There were no statistically significant changes in the sleep quality before and after hospitalization in the intervention group [P=0.053]. Using environmental factors mitigation strategies can improve sleep quality of patients admitted to CCUs

[Investigation of substance use prevalence and the interrelated factors involved through third-year high school students in Nazarabad city from January 2008 to June 2008]

Opioids are one of the most prevalent hygienic difficulties of the country and are causes of prevalence of some dangerous diseases such as AIDS and Hepatitis. Studies show relatively more prevalence of substance use in 15-35 years old students in the country. The purpose of the present study is investigation prevalence of substance use and the interrelated factors involved with third-year high school students in Nazarabad city. This is a cross sectional study done on 400 students including 204 female and 196 male of third-year of high school in Nazarabad city by random sampling. Research instruments were questionnaire Investigating substance use in young students and MMPI test. The methods of data analysis, were descriptive statistics methods, Pearson and Chi-Square tests, in the format of software program of SPSS 11/5. The findings of the study reveal that 24/5% students were users of substances such as: cigarette, alcohol, opium, psychoactive substances, heroin, heroin crack, LSD, cannabis and cocaine. Prevalence of substance use was expressively more in males [%69/7] than females [%26/2] and the most important cause of use was amusement [%42/5] and curiosity [%29/9]. Prevalence of substance use in suburban boys' high schools is more than urban boys' high schools. Prevalence of psychological disease was similar to usual individuals but some disease such as psychotic disorders, hysteric, adjustment disorders and OCD in substance users was more than usual students. The prevalence of substance use in teenagers is high and the most cause of use is entertainment and curiosity, Therefore some steps should be taken to resolve this problem

Relationship between nurses' knowledge about pain and satisfaction of pain relieving procedures among postoperative CABG patients

The aim of this study was to investigate the relationship between nurses' knowledge about pain and satisfaction from pain relieving procedures among postoperative CABG patients in selected Tehran medical university hospitals. In this cross-sectional study, 100 nurses were recruited from the ICU Open heart. Also, 200 patients were selected from whom underwent CABG in 24 hours after surgery and were extubated using a simple random sampling method. Data were gathered using two questionnaires including 17 question about demographic characteristics of patients and their satisfaction, and 36 questions about demographic characteristics and nurses' knowledge about pain and pain control after the CABG. Data were analyzed using descriptive and inferential methods using SPSS-11.5. There was not significant relationship between the nurses' pain knowledge and the patients' satisfaction. However, there were a -significant relationship between the knowledge of the nurses about pain control after the CABG and the patients satisfactions [F=0.209, P-0.037]. According to the findings of the study, there were some significant relationships between the nurses demographic and pain knowledge with the pain control after the CABG. There was also significant relationship between patients' satisfaction and some of them demographic characteristics

[Factors influencing quality of life in patients with myocardial infraction]

Myocardial infarction is a common and dangerous life threatening disease with an impact on quality of life. The present descriptive-analytical study aims to determine quality of life in patients with myocardial infarction referring to Hadjar hospital affiliated to the Shahre-kord University of Medical Sciences. This was as descriptive- analytical study in which 150 patients admitted to cardiac care unit of Hadja hospital within 8 weeks post infarction were selected by non random sampling method. Data were collected through interview, patients' medical records and patients self report. The tool for collecting data regarding quality of life was SF36 questionnaire. Data were analyzed by descriptive and inferential statistics. Findings showed that the mean value of age was 55.7 +/- 10.5 and that quality of life in majority of subjects [%53] was fairly favorable. Regarding aspects of quality of life, most patients had fairly favorable general status [physical and psychological health] [%62] and social function [%65]. Also, sleep pattern of majority of subjects [%61] was favorable and most of them [62%] had unfavorable physical activity. There was statistically significant correlation between quality of life and variables such as duration of disease [P<0.05], intensity of pain [P<0.05], decline or loss of job function, and the degree of fatigue [P<0.05], but there was no statistically significant relationship between quality of life and other demographics as age, gender, marital status, economic status and occupational status. Because fatigue and pain have some relationship with quality of life in patient with myocardial infarction, health care personnel, spatially nurses should pay attention to dimensions of quality of life when planning care for these patients. Failure to do so may leads to quality of life of patients to be neglected