Factors affecting supportive needs in hemodialysis patients: A literature review.

BACKGROUND: Explaining the factors affecting supportive needs of patients under hemodialysis seems to be essential to supply their needs. Also, it can help healthcare providers to make favorite decisions about care planning to improve the patients' quality of life. OBJECTIVE: This study was conducted to determine the factors affecting supportive needs in hemodialysis patients using a literature review. METHODS: This literature review was carried out in PubMed, MEDLINE, SCOPUS, SID, Magiran, and Iranmedex. Data based were searched from 2000 to 2018 using the keywords of "Need", "Supportive Need", and "Hemodialysis". In a total of 239 full texts of published articles, 12 such relevant articles were selected. RESULTS: The finding showed that the factors affecting the supportive need of patients can be categorised into two: internal and external factors. Internal factors consist of patient-related factors, disease-related factors, and treatment-related factors. External factors consist of personal living circumstances, health system-related factors and socioeconomic factors. CONCLUSION: By explaining the factors affecting supportive need in hemodialysis patients, it may help clinicians and researchers to identify the patients' need, developing an appropriate questionnaire, and implementing suitable intervention. As a result, it can improve their quality of life.

Analgesic Effects of Ketamine, Magnesium Sulfate, and Sodium-Thiopental on Propofol Injection Pain: A Single-Blind Randomized Clinical Trial.

BACKGROUND: Propofol is one of the most frequently used medications for inducing and maintaining anesthesia. However, propofol injection causes pain and discomfort in more than 70% of patients. This study was performed to determine the comparative effects of ketamine, sodium-thiopental, and magnesium sulfate on reducing pain at the onset of anesthesia induced by propofol injection. MATERIALS AND METHODS: This single-blind randomized clinical trial was conducted on a population of patients, requiring nonemergency surgeries. The sample size was determined as 25 patients per group. The eligible samples were randomly divided into three groups. An 18-gauge intravenous catheter was inserted in the dorsum of the hand for all patients. Three groups received 0.5 ml/kg of ketamine, 30 mg/kg of magnesium sulfate, and 0.5 ml/kg of sodium-thiopental, respectively. Next, 2.5 mg/kg of propofol 2% was administered at a rate of 1 ml/s. The verbal rating scale (VRS) was applied to assess the severity of pain during injection. RESULTS: According to the results, the prevalence of pain was 36% in the magnesium sulfate group, 16% in the sodium-thiopental group, and 4% in the ketamine group. The ordinal logistic regression test showed that patients from the ketamine group experienced less pain, compared to the magnesium sulfate group (OR, 0.045; P= 0.008). However, no significant difference was observed between the ketamine and sodium-thiopental groups (OR, 0.253; P= 0.283). CONCLUSION: Ketamine and sodium-thiopental can be effective medications in reducing pain caused by propofol injection. According to the results, magnesium sulfate is not recommended for reducing pain due to propofol injection.

Multidrug and co-resistance patterns of non-fermenting Gram-negative bacilli involved in ventilator-associated pneumonia carrying class 1 integron in the North of Iran.

INTRODUCTION: Ventilator-associated pneumonia (VAP) due to non-fermenting Gram-negative bacilli (NFGNB), especially Pseudomonas aeruginosa and Acinetobacter spp., is one of the main hospital-acquired infections leading to mortality and morbidity, especially in intensive care units (ICUs). This study seeks to determine the multidrug and co-resistance (MDR) patterns of NFGNB that are agents of VAP, and assess the presence of class 1 integron in these bacteria. METHODS: This cross-sectional study involved VAP patients admitted in the ICUs of 18 hospitals in the Mazandaran province, located in the North of Iran. The antibiotic susceptibility pattern was determined by the minimum inhibitory concentration (MIC) test by using broth microdilution method. Presence of class 1 integron was evaluated by the polymerase chain reaction (PCR) assay. RESULTS: Out of a total of 83 patients who were microbiologically diagnosed as VAP, 52 non-duplicated NFGNBs (24 P. aeruginosa and 28 A. baumannii) were causative of VAP, out of which MDR NFGNBs were responsible for 48 (57.83%) cases. The frequencies of MDR NFGNBs were as follows: 27 (56.25%) A. baumannii and 21 (43.75%) P. aeruginosa. P. aeruginosa isolates were resistant to all aminoglycoside antibiotics (50%), ciprofloxacin (45.8%), ceftazidime (70.8%), cefepime (87.5%), colistin (62.5%), and imipenem (29.2%). A. baumannii isolates were resistant to aminoglycosides (53.6%), ciprofloxacin (85.7%), ceftazidime (92. 9%), cefepime (92.9%), colistin (35.7%), and imipenem (57.1%). Twelve isolates were resistant to all 10 tested antibiotics. The number of rates of class 1 integron, positive for MDR P. aeruginosa and MDR A. baumannii, were 20 (95.23%) and 21 (77.78%), respectively. CONCLUSION: The high prevalence of multidrug resistance and incidence of class 1 integron is a therapeutic concern. Employing antibiotic stewardship in hospitals could prevent the dissemination of MDR bacteria.

Catheter-related urinary nosocomial infections in intensive care units: An epidemiologic study in North of Iran.

BACKGROUND: Urinary tract infection (UTI) is one of the most common infections in developing countries. The aim of this study was to investigate the incidence of nosocomial catheter- associated UTI and its related factors in hospitalized patients in intensive care units of hospitals affiliated to Mazandaran University of Medical Sciences, in 2014. METHODS: This cross-sectional study was conducted on patients who were admitted in hospitals and urinary catheterization was performed for them. Beds of intensive care units were followed-up for the occurrence of catheter-associated UTI for 14 months. Data were analyzed using SPSS Version 16. RESULTS: Our results showed that of the 1409 patients (11648 catheter - days), the incidence of catheter-related UTI was 18.2% (among 256 individuals) equals to 21.987 per 1,000 catheter - days. E. coli was the most important cause of UTI. The results show that the history of the underlying disease, duration of catheterization and perineal washing were significantly associated with the incidence of UTIs. CONCLUSION: The findings of this study show a high incidence of UTIs caused by catheters in ICU. The incidence of this infection increased hospital length of stay and hospital cost. It seems that the necessary use of urinary catheters and its reduced duration use can be effective in decreasing this incidence.

Assessment of extended-spectrum ß-lactamases and integrons among Enterobacteriaceae in device-associated infections: multicenter study in north of Iran.

BACKGROUND: Device-associated nosocomial infections (DA-NIs), due to MDR Enterobacteriaceae, are a major threat to patient safety in ICUs. We investigated on Extended-spectrum ß-lactamases (ESBL) producing Enterobacteriaceae and incidence of integrons in these bacteria isolated from ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs) in 18 governmental hospitals in the north of Iran. METHODS: In this cross-section study, the antibiotic susceptibility test was performed using the MIC method; also, phenotypically detection of ESBL-producing bacteria was carried out by the double-disk synergy (DDS) test. Presence of ESBL-related genes and integron Classes 1 and 2 was evaluated by the PCR method. RESULTS: Out of a total of 205 patients with DA-NIs, Enterobacteriaceae were responsible for (72.68%) of infections. The most common DA-NIs caused by Enterobacteriaceae were VAP (77.18%), CAUTI (19.46%), and sepsis due to VAP (3.35%). The most frequently Enterobacteriaceae were; Klebsiella pneumoniae 75 (24; 32% ESBL positive), E. coli 69 (6; 8.69% ESBL positive) and Enterobacter spp. 5 (5; 100% ESBL positive). Distribution of ESBL-related genes was as follows: bla-SHV (94.3%), bla-CTX (48.6%), bla-VEB (22.9%) and bla-GES (17.14%). The incidence rate of integron class 1 and class 2 was (82.92%) and (2.9%) respectively. Eight types of ESBL-producing bacteria were observed. CONCLUSIONS: Due to the fact that the emergence rate of ESBL Enterobacteriaceae is increasing in DA-NIs, co-incidence of different types of ESBL genes with integrons in 75-100% of strains in our study is alarming for clinicians and healthcare safety managers. Therefore, regional and local molecular level estimations of ESBLs that are agents of DA-NIs are critical for better management of empiric therapy, especially for patients in ICUs.

The effects of aromatherapy with lavender essential oil on fatigue levels in haemodialysis patients: A randomized clinical trial.

OBJECTIVE: This study was intended to examine the efficacy of lavender essential oil for the alleviation of fatigue in haemodialysis patients. METHODS AND MATERIALS: This randomized clinical trial was conducted on 59 haemodialysis patients in two groups. The routine care group received the routine care, but the experimental group inhaled lavender essence 5% for 10 min, three times a week for 4 consecutive weeks. The Fatigue Severity Scale was used to assess fatigue before the intervention and after the last intervention in the second and fourth weeks. RESULTS: No statistically significant differences were observed between the two groups in terms of the fatigue scores before, and after the last intervention in the second and fourth weeks. CONCLUSION: Our result does not support other studies suggesting that lavender essential oil is effective on fatigue in haemodialysis patients. This conflicting result can mostly be ascribed to a variety of factors such as duration of aromatherapy and differences in concentrations of lavender essential oil.

Assessment of Critical Care Provider's Application of Preventive Measures for Ventilator-Associated Pneumonia in Intensive Care Units.

BACKGROUND: The implementation of guidelines for the prevention of Ventilator-associated pneumonia has been shown to have a significant effect in reducing the incidence of VAP. OBJECTIVE: The aim of the present study was to evaluate the implementation of the preventive strategies for VAP in ICUs of university hospitals of Sari, Iran. MATERIALS AND METHODS: This cross-sectional study was carried out in 600 beds/day in the ICUs of university hospitals of Sari from April to June 2012. Sampling was done by availability technique in patients receiving mechanical ventilation in the ICU. The implementation of the preventive measures was assessed by a standard checklist with previously approved validity and reliability. RESULTS: The percentage of implementing each of the measures was as follows: sterile suction, 88.44%; semi-recumbent position, 76.8%; oral hygiene, 58.45%; using heat and moisture exchanges (HMEs), 58%; controlling cuff pressure, 46.8%; hand hygiene, 32.8%; using anti-coagulants, 26.8% and physiotherapy, 25.5%. Closed suction system, continuous drainage of subglottic secretions and kinetic beds were not used at all. CONCLUSION: The overall mean percentage of implementing preventive measures was low and required designing integrated guidelines by considering the conditions of the ICUs in each country, as well as educating and encouraging the staffs to use the recommended guidelines.

Lifestyle in Iranian Patients with Breast Cancer.

BACKGROUND: One of the most commonly diagnosed cancers is breast cancer that leads to mortality and morbidity among Iranian women. Behavioural risk factors, such as common lifestyle patterns are often associated with risk of breast cancer incidence. AIM: This study aimed to investigate lifestyle of breast cancer patients admitted to Cancer Research Center of Mazandaran University of Medical Sciences. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted using convenient sampling method. Sample size consisted of 150 cancer patients, and data collection tool included a researcher-made questionnaire on dimensions of lifestyle containing four dimensions of self-care, exercise and physical activity, diet and coping with stress. Maximum score in different dimensions, based on 100% of marks earned, was evaluated in three categories of undesirable, relatively desirable and desirable. Data were analysed with SPSS-19 software using descriptive statistics (relative and absolute frequencies, mean and standard deviation). RESULTS: In total of 150 women, the mean age of patients was 51.9 ± 1.04 (27-78). The majority of participants were married, housewives, with high school education. Among the four parts of healthy lifestyle, desirable level of physical activity and exercise had the least participants, and in the dimensions of physical activity and exercise, the lowest level related to walking, followed by daily exercise. Most of the participants had undesirable level of self-care and lowest frequency related to mammography after 40-year-old, followed by annual check-up and Pap-smear. With regard to nutrition, most of them were at desirable level. CONCLUSION: The results indicated undesirable levels in two lifestyle dimensions (self-care and physical activity and exercise) in the majority of participants for a year before contracting breast cancer. Primary prevention programs should be implemented with a comprehensive approach, thus, effective strategies are required to modify lifestyle.

Types, Risk Factors, Clinical symptoms and Diagnostic Tests of Acute Adult Meningitis in Northern Iran During 2006-2012.

BACKGROUND: Acute bacterial meningitis is a medical emergency condition that requires prompt diagnosis and treatment and otherwise associated with serious morbidity and mortality. AIM: The aim of this study was to assess types, risk factors, clinical symptoms and diagnostic tests of meningitis in hospitalized patients of Mazandaran University of medical sciences hospitals during 2006-2012. MATHERIALS AND METHODS: This is a retrospective descriptive study. Following approval of the ethics committee of Mazandaran University of Medical Sciences, records of adult patients diagnosed with acute meningitis from 2006 to 2012 were extracted from Mazandaran Provincial Health Center and patients attending hospitals affiliated to Mazandaran University of Medical Sciences. STATISTICAL ANALYSIS: Data were analyzed with SPSS-16 using descriptive statistics (frequency, mean, standard deviation, and median). RESULTS: In this study, of the 137 patients with meningitis, 73 (53.9%) were viral, 61 (46%) bacterial, 1 (0.7%) fungal, and 2 (1.4%) unknown. The majority of risk factors in patients were head trauma, upper respiratory infection, and drug addiction. The most common clinical signs were headache, fever, nausea and vomiting, and stiff neck. CONCLUSION: In this study, the incidence of meningitis was much lower than any other country. It could be due to geographic variation or incomplete recording of patient's data. It is recommended to perform a longitudinal study during the coming years on patients with meningitis.

The effects of lavender aromatherapy on pain following needle insertion into a fistula in hemodialysis patients.

OBJECTIVE: This study sought to determine the effects of lavender aromatherapy on pain following needle insertion into a fistula in patients undergoing hemodialysis. METHOD: This is a randomized controlled clinical trial in which 92 patients undergoing hemodialysis with arteriovenous fistulas were randomly divided into two groups. The experimental-group patients inhaled lavender essence with a concentration of 10% for 5 min during 3 hemodialysis sessions, while the control-group patients received aromatherapy free of lavender essence. RESULTS: The mean VAS pain intensity score in the experimental and control groups before the intervention was 3.78 ± 0.24 and 4.16 ± 0.32, respectively (p = 0.35). The mean VAS pain intensity score in the experimental and control groups after three aromatherapy sessions was 2.36 ± 0.25 and 3.43 ± 0.31, respectively (p = 0.009). CONCLUSION: Lavender aromatherapy may be an effective technique to reduce pain following needle insertion into a fistula in hemodialysis patients.