Over 60 years of age as an independent prognostic factor of in-hospital mortality among COVID-19 patients: a cohort study in an Iranian high-incidence area.

OBJECTIVES: COVID-19 continues to cause devastation throughout the world. Various factors influence the perioperative course and prognosis of COVID-19. This study aims to collate the independent prognostic factors among hospitalised COVID-19 patients in east Iran. STUDY DESIGN: In this cohort study, all patients with a confirmed diagnosis of COVID-19 between 19 February 2020 and 1 August 2020 who were admitted to nine public hospitals of South Khorasan province, Iran, were enrolled. METHODS: Univariate analysis (chi-square [χ2], and Mann-Whitney U test) and multiple logistic regression were performed. RESULTS: This study included 1290 participants; 676 patients (52.4%) were male. A total of 1189 (92.2%) recovered, and 101 (7.8%) died. The results show that in-hospital mortality increases with advanced age (the optimal cut-off point = 62 years). The following three variables were shown to have the most significant role in in-hospital mortality: age >60 years (odds ratio [OR] = 8.01, 95% confidence interval [CI] 4.8-13.35), shortness of breath (OR = 2.65, 95% CI: 1.4-69.17) and atypical radiological manifestations in a chest X-ray on admission (OR = 2.16, 95% CI: 1.3-28.64). In the univariate analysis, associated comorbidities, such as cardiovascular diseases, influenced the in-hospital mortality rate, while the same could not be replicated in the multiple variable analysis. CONCLUSIONS: This study revealed the potential predictors of COVID-19 and highlighted the need to be cautious with advanced age and heightened clinical symptoms at the time of admission.

The effects of family-centered affective stimulation on brain-injured comatose patients' level of consciousness: A randomized controlled trial.

BACKGROUND: Despite the well-defined effects of sensory stimulation, the knowledge of the pure effects of affective stimulation is scarce. OBJECTIVE: To evaluate the effects of family-centered affective stimulation on the level of consciousness among comatose patients with brain injuries. DESIGN: This study was designed as a three-group double-blinded Randomized Controlled Trial. METHODS: Ninety consecutive patients with traumatic brain injuries and a Glasgow Coma Scale score of 5-8 were selected. Patients were randomly allocated to an experimental, a placebo, and a control group using permuted block randomization. Affective stimulation intervention was provided to patients in the experimental group by their family members twice a day during the first seven days of their hospitalization. In the placebo group, a sensory stimulation program was implemented by a fixed trained person who was not familiar with the patients. Patients in the control group solely received sensory stimulation which was routinely provided to all patients. The level of consciousness among the patients using the Glasgow Coma Scale and Coma Recovery Scale-Revised were measured both before and after a family visit. The SPSS software (version 17.0) was used to analyze the data through running the one-way and the repeated measure analyses of variance. RESULTS: Despite an insignificant difference among the groups regarding baseline level of consciousness, the results of the one-way analysis of variance revealed at the seventh day of this study, however, the level of consciousness in the experimental group was significantly higher (9.1±2.1) than the placebo (7.2±1.1), the control groups (6.6±1.7) (P<0.001), subsequently. Moreover, at the seventh day of the study, the Coma Recovery Scale score in the experimental group (11.9±3.7) was significantly greater than the placebo (9.0±2.0) and the control (6.6±1.6) groups (P<0.001). Recovery rate and effect size values also confirmed the greater effectiveness of affective stimulation compared with pure sensory stimulation. CONCLUSION: Our findings in this study indicate that early family-centered affective stimulation is more effective than sensory stimulation in improving the level of consciousness among comatose patients with brain injuries. Family-centered affective stimulation is recommended to be integrated into the nursing curricula and routine care plans for comatose trauma patients in intensive care units.