حسین شیری

Preventing ventilator-associated pneumonia (VAP) as one of the most common and also the most fatal complications caused by intubation and mechanical ventilation in intensive care units (ICU) has always been emphasized in countless studies. Chlorhexidine mouthwash is commonly used as a gold standard in the control of dental plaques and prevention of VAP. Given the increasing prevalence of gram-negative infections due to resistance to commonly used antibiotics and the associated complications, this study aimed to investigate and compare the impact of tea tree oil/aloe vera herbal mouthwash, known for its antibacterial and anti-inflammatory properties, on the occurrence of ventilator-associated pneumonia.

This study is a double-blind randomized clinical trial. 62 intubated patients, aged from 16 to 65 and hospitalized in the intensive care units of Hazrat Waliasr Hospital in Arak City in 2023, were assigned using a simple randomization method in two interventions (tea tree oil/aloe vera mouthwash) and control groups (chlorhexidine mouthwash). Mouthwash bottles were covered before distribution. None of the patients, colleagues (nurses), and the specialist determining the final result of the study were aware of the allocation of patients in the intervention or control group. Oral care in both groups was performed by washing hands, wearing gloves, evaluating the mouth condition, adjusting the pressure of the endotracheal tube cuff (20-30 Cm.H2O), brushing with a soft toothbrush, mouthwash twice daily and open suctioning of oral and subglottic secretions. Lastly, at intervals of 3 days (to assess the incidence of early VAP) and 7 days (to assess the incidence of late VAP) after the intervention, the modified clinical pulmonary infection score (MCPIS) was calculated and a score greater than or equal to 6 was considered as a diagnosis of pneumonia. This tool has been utilized in similar studies and its validity and reliability have been confirmed. Eventually, the data was statistically analyzed using the chi-square test, independent t-test, and repeated measures test to investigate the effect of the intervention over time with SPSS version 20 software.

According to the results, 64.5% of the participants were male and 35.5% of them were female. There was no statistically significant difference between the two groups in terms of average age, gender, reason for admission, history of underlying diseases, invasive interventions, average number of drugs and antibiotics, type and amount of nutrition, and duration of mechanical ventilation. The incidence of early-onset pneumonia was 9.7% in the intervention group and 12.9% in the control group. Although the incidence was lower in the intervention group, there was no statistically significant difference between the two groups (P-value=0.99). The incidence of late-onset pneumonia in the intervention group was 12.9% and 16.1% in the control group. Despite of lower incidence of late-onset pneumonia in the intervention group, there was no statistically significant difference (P-value=1.00). Moreover, according to the results of Bonferroni's paired comparisons test, the difference in the average MCPIS score between 3 days and 7 days later in the intervention group was not significant and did not increase significantly (P-value=0.06), which means that in this group, the effect of the intervention can be seen at this time.

Oral care using tea tree oil/aloe vera mouthwash or 0.2% chlorhexidine has no preference or significant advantage over each other, and both can be effective in reducing ventilator-associated pneumonia. Considering the lower incidence of early and late pneumonia in the intervention group, it is recommended to conduct studies with a larger sample size and also use accurate oral assessment tools to confirm the removal of dental plaque (plaque score) in this population of patients.

The main purpose of the current research was to determine the relationship between profit management, transactions with related parties and company performance with the moderating role of internal control in companies listed on the Tehran Stock Exchange during the years 2013 to 2021. This research is from the perspective of the implementation process of a quantitative research, from the perspective of the result of its implementation, an applied research, from the perspective of the goal of conducting an analytical research, from the perspective of the logic of conducting a deductive-inductive research, and from the perspective of the time dimension of a longitudinal research. So it is an event. The information used in this research was collected using the library method and the software of Rehvard-Noin and Tadbir Pardaz and the database of the Statistics Department of the Stock Exchange Company. The studied population was all the companies accepted in the Tehran Stock Exchange, 121 companies were selected as a statistical sample by systematic elimination method. In this research, Excel software was used for data processing and Eviews software was used for data analysis. The results of the panel data model showed that there is a positive and significant relationship between real profit management and accrual-based profit management with the financial performance of companies. The results showed that the quality of internal control can play a moderating role on the relationship between real profit management and financial performance of companies. In other words, the results showed that the quality of internal control can increase the effect of real profit management on the financial performance of companies from 0.2267 to 0.2837 units.

Chronic kidney failure is one of the diseases that affect the quality of life of people today. Peritoneal dialysis is one of the treatments for chronic kidney failure. Education is an important part of the care program that helps the patient to play an important role in the treatment process. The aim of this study was to evaluate the needs of patients undergoing peritoneal dialysis, which is based on nursing diagnoses, nursing interventions and the results obtained during the nursing process. Then, according to the needs of patients, a self-care educational program was developed.

The present study is a descriptive study that was performed on 74 patients referred to peritoneal dialysis wards of 5 medical centers. Demographic-clinical information was collected through patients' medical records and educational needs through face-to-face and telephone interviews with patients undergoing peritoneal dialysis. The training needs were determined based on the nursing diagnoses of the International Association of North America, and finally the self-care program was developed through nursing interventions related to common diagnoses and their expected outcomes. Data were analyzed by SPSS software version 26.

Among the 20 nursing diagnoses presented in NANDA in patients undergoing peritoneal dialysis, 5 diagnoses including: water and electrolyte disorders, infection, constipation, sleep disorders, and skin integrity disorders are the most common. Self-care was developed to meet these needs.

The way that the nurses working in Emergency Departments (ED) encounter the patients under mechanical ventilator is different and their knowledge is limited in this field. Therefore the present study aims to determine the training needs of nurses related to the utilization of mechanical ventilators.

In this descriptive study, 98 nurses working at emergency departments of top rated hospitals of Iran University of Medical Sciences filled the questionaire. This researcher designed questionaire included demographic data, evaluation of knowledge in the format of scenario, evaluation of attitude and a paper of skill checklist , were used after validity and reliability confirmation. Analysis of data were done by SPSS version 22 and parameteric and non-parameteric tests.

Most of the nurses participanting in this study were female (86.7%) and in the age group of 25 to 35 years. Among them, 74.5% of ED nurses had work experience less than 1 year in the Intencive Care Unit (ICU), and 51% hadn’t passed ED nusing course. The most training need in the area of knowledge included patients intubation; in the area of skill included setting the ventilator’s parameters and in the area of attitude included fear of taking care of patients under ventilator.

According to the results of need assessment, it is mandetory to pay attention to the problems and demands of nursing in their educational programming. In order to meet profesional needs, short daily educational courses should be held and practical and skill aspects should be considered in training nurses.

Chest pain is one of the common causes of emergency department visit, but only 25-15% of them are diagnosed with acute coronary syndrome (ACS). However, unexplained cases of ACS have led to high mortality rates. The aim of this study was to compare the effectiveness of ESI triage (Emergency Severity Index) and HEART scale (Chest Pain Diagnostic Scale) in detecting the outcome of patients with complaints of chest pain.

This descriptive study was performed on 200 patients with chest pain in emergency department of selected hospitals of Shahid Beheshti University of Medical Sciences in 2017. The ESI triage form, HEART and demographic information were completed for all patients. Six weeks later patients were re-evaluated in terms of heart problems.

The compliance of the ESI triage and HEART scale in the high-risk group was 27.9% (24 people), the middle-risk group was 79% (62 people) and the low-risk group (30.6%) (11 people). In general, comparing the total scores, these two scales were consistent with 48%. Also, after considering the cut-off point 4.5, the sensitivity 85% and the specificity 89% with a 95% confidence interval for the HEART scale and sensitivity 95%, and the specificity 25% with a 95% confidence interval was found for the ESI triage.

According to the results of this study, despite its wide range, the ESI triage has shown a poor performance over the HEART scale. Therefore, the use of the combined HEART triage ESI scale can be very helpful.

Mechanical ventilation is one of the most common treatments in neonatal intensive care unit and is however associated with many complications. One of the ways to reduce complications is providing nursing care according to standards. This study was conducted with the aim of determining the conformity of nursing care related to weaning neonates from mechanical ventilation to the standards in neonatal intensive care units.
Methods & Materials: In this descriptive study (the audit), 105 nursing cares related to weaning neonates from mechanical ventilation in neonatal intensive care units at the selected hospitals affiliated to Shahid Beheshti University of Medical Sciences were selected and observed by the event sampling method in 2015. Data were gathered through a demographic questionnaire for nurses and hospitalized newborns, a checklist of nursing care related to weaning from mechanical ventilation. The data were analyzed using descriptive statistics and Chi-square test at the significance level less than 0.05.
Conformity rate of nursing care related to weaning neonates from mechanical ventilation to standards, was 68.3 percent, and compliance with the standards of care was 71.4 percent before weaning, 65.7 percent during weaning and 66.4 percent after weaning.
Nursing cares related to weaning neonates from mechanical ventilation are far from standards, and for its improvement, applying clinical guideline for neonatal nursing care and clinical supervision by managers for optimizing its implementation are suggested.

Nurses are in a unique position to have a positive effect on an infant''s ventilation therapy and complications protection because they maintain a continuous presence at the infants’ bedside and perform related tasks. Thus this study was done aimed to determine the conformity rate of nursing cares regarding to respiratory system in neonates under mechanical ventilation in neonatal intensive units(NICU) with the standards.
In this cross-sectional descriptive study¡ 100 nursing care regarding to respiratory system were observed by time sampling and event sampling. Data collected using a checklist included standard cares regarding to respiratory care¡ which was developed according to existing standards. Content Validity Index (0.95) and inter rater coefficient reliability (ICC=0.98)¡ were calculated for checklist. Data collection method was observation and docomentation of checklist’s items which carried out in NICU of Mahdiyeh¡ Mofid and Emam Hosein hospitals affiliated to Shahid Beheshti University of Medical Science. Data were analyzed through descriptive statistics using SPSS software version 21.
Conformity rate of nursing cares regarding to respiratory system in neonates under mechanical ventilation in NICU with developed standards¡ was evaluated 59.27 percents and quality of nursing cares was moderate. The most of the conformity rate with standars (94%) conformiting of ventilator setting with doctors’ orders and documenting its’ amounts and the lowest (1%) correct adjusting of SPO2 alarm limit was evaluated.
According to Nursing cares regarding to repiratory system are the most common cares and results indicated moderate level in compare with standars thus Authorities should pay attention to causes of noncomformity with standard cares and eliminate them for increasing health of hospitalized neonates¡ decrease complications and followed it¡ decrease length of stay as well as costs.

Warfarin is one of the most prescribed medications in the United States for prevention both stroke and venous thromboembolism. There are numerous demographic and medical factors that can potentially complicate successful warfarin management. Patient adherence to warfarin regimens is largest determining factor of anticoagulation therapeutic effectiveness. This study aimed to determine the Relationship of demographic factors with medication adherence among Patients attending in Warfarin Clinics in Tehran was designed and conducted. This cross-sectional descriptive study was conducted on 400 eligible patients. Subjects were selected based on target. Demographic questionnaire, Modified Morisky medication adherence questionnaire, INR test and visit to the clinic were used for data collection. Of 400 patients studied, 61% were woman with mean age (± standard deviation) 52.97 ± 13.32, 57.8% had adherence with Modified Morisky medication adherence questionnaire, 73.5% had INR in therapeutic range, 38% had regular visit and 27.8% of participants had adherence with per three instruments. Adherence was related education (p=0.000), life status (p=0.041), employment status (p=0.000), home area (p=0.012) and income (p=0.002). Adherence is a behavioral multifactorial process and the role education, employment status, socioeconomic status and life status of patients in that is important. Therefore, to improve adherence, nurses should consider this factors in educational programs for these patients.

Kidney transplantation is the best treatment for patients with end stage renal disease. Living donor kidney transplantation is increasingly performed in Iran. Since the quality of life of live kidney donors has been subjected to little investigation, the present study was conducted to investigate the quality of life of live kidney donors in Tehran in 2012-2013.

This is a descriptive study conducted on 45 donors living in Tehran in 2012- 2013. Sample selection was started by recruiting convenient samples following by snow ball sampling. Data were collected by a questionnaire consisting of as a three sections: demographic information, SF-36 quality of life questionnaire and researcher made questionnaire. The data were analyzed by SPSS 19.

Mean age of the donors was 34/4 year. 62/2 % of the donors were men. The quality of life of 66/7 % of donors in physical, 60 % in mental and 48/9 % in social domain were classified as moderate (score:34-66). The mean score of quality of life of donors was 59. 59.58 % of the participants donated their kidney for financial reasons and there was no significant correlation between the quality of life scores and reason for donation. 31 % of the donors regretted the donation.68/8% of donors do not encourage donation and recommend it to others and the average score of these donors is less than the donors who recommend donation(p <0/001)

The quality of life of kidney donors in this study was moderate. It is worthwhile to follow up the donors and to assess physical and mental problem of donors after donation in order to reduce subjective outcomes and regret in donors. There is a need for financial support of kidney donors.

One of the commonest complications of hemodialysis is infection secondary to central venous catheterization. The aim of this study was to compare the effects of chlorhexidine and povidone-iodine (Betadine) on bacterial colonization and local infection at Shaldon catheter insertion site among patients receiving hemodialysis. This study was conducted by using a quasi-experimental design in 2013. In total, 56 patients who had undergone central venous catheterization for receiving hemodialysis at Golestan hospital, Ahvaz, Iran, were recruited and randomly allocated to either the chlorhexidine or the Betadine groups. The catheter insertion site in the chlorhexidine and the Betadine groups was cleaned and disinfected by using chlorhexidine 4% and Betadine 10%, respectively. Groups were then compared with each other in terms of bacterial colonization and local infection at catheter insertion site. The SPSS16 was used for performing the Fisher’s exact, the Chi-square, and the independent-samples t-tests. The incidence of bacterial colonization and local infection at catheter insertion site in the chlorhexidine and the Betadine groups was 3.6% and 21.5%, respectively. The Fisher’s exact test showed a significant difference between the two groups regarding bacterial colonization (P value<0.001). Chlorhexidine is more effective than Betadine in minimizing bacterial colonization and local infection at the insertion site of Shaldon catheter among patients receiving hemodialysis.

Glasgow coma scale is considered as the common measuring tool of consciousness level. However, its utilization has been criticized in some cases and the use of alternative tools for determining consciousness level is recommended. So, this study was conducted to analyze correlation between the instruments with physiological indicators for determining the altered level of consciousness in adult patients with brain damage. This study was descriptive-correlation and it was performed in the Intensive Care Units (ICU). The population was adult patients with brain damage who were hospitalized in ICUs. They were studied with simple method while selected by inclusion criteria. Data were analyzed by SPSS 16. In the second hour after investigation, there was a significant correlation between systolic blood pressure and the two measures of Glasgow Coma Scale (P=0.002) and Full Outline of Unresponsiveness (P=0.001). In addition, for 10th and 12th time points both measures had significant correlation (P<0.001) with diastolic blood pressure. Furthermore, at other time points the two measures significantly correlated with physiological indicators (Systolic pressure, Diastolic pressure, Mean arterial pressure and Respiratory rate) (P<0.001). Heart rate had no significant relationship with the two instruments (P>0.05). There was a significant and positive relationship between Glasgow Coma Scale and Full Outline of Unresponsiveness at all-time points (r>0.947, P<0.001). The Full Outline of Unresponsiveness was considered as preferred instrument for determining altered level of consciousness of patients with brain damage as a result of its higher correlation with Physiological indicators for determining the altered level of consciousness during the time.

Ventilator-associated pneumonia (VAP) is the second most common cause of nosocomial infection in the intensive care units. The aim of this study was to determine the frequency and risk factors for early-onset VAP in Kashan Shahid-Beheshti hospital during 2009-2010. This cross-sectional study was carried out on 100 mechanically ventilated patients hospitalized for more than 48 hours in three intensive care units of Kashan Shahid-Beheshti hospital. After a 96-hour follow up period، VAP was diagnosed using the «Modified Clinical Pulmonary Infection Score». Invasive ventilation was prescribed for all patients. Main reasons for indication of mechanical ventilation were the respiratory disorders and decreased level of consciousness. The VAP incidence rate was 19% (4 women and 15 men). There were 3 groups of risk factors (patient-related، procedure-related and personnel-related). Among the patient-related risk factors، there was a significant difference between the age (P=0. 036)، GCS (P=0. 001) and the onset of VAP; in the procedure-related group، there was a significant difference between the therapist who inserts a catheter (P=0. 01) and the positioning of the patient''s head in≥30 (P=0. 02) and also the onset of VAP; in the personnel-related group، there was a significant difference between the oral care (P=0. 02) and personnel education on infection control (P=0. 002) and VAP. According to the results of this study، providing training for staff and comprehensive oral care are recommended in the mechanically ventilated patients.

Many patients referring to health centers because of chest pain do not require hospitalization at CCUs (Coronary Care Units). The aim of this study was to assess the rate of resource utilization and cardiovascular outcomes in patients with low risk chest pain admitted to CCUs of hospitals affiliated with Shahid Beheshti University of Medical Sciences and Health Services. In this descriptive study, all patients with chest pain admitted to CCUs of 6 hospitals were selected with purposive sampling method. Of 550 patients, 95 were considered low-risk using "Thrombolysis in Myocardial Infarction (TIMI)" scale and assessed in terms of hospital stay, costs and cardiovascular outcomes over 30 days after discharge. A questionnaire validated with content and face methods was used for data collection. The scale was made reliable with inter-rater method (r=0.8). Data were analyzed with SPSS 16. Mean age of the subjects was 46.95 year and 66.3% of them were male. The lowest stay and bed occupancy rates were related to hospital 3 and the highest rates to hospital 1 and 2. Mean length of stay was 3.04 days. ANOVA showed no significant difference between length of stay and expenses in 6 hospitals. No cardiovascular complication was seen 1 month after discharge in 89.5% of patients with any report of death. With respect to the high rate of bed occupancy by the subjects and wastage of material and human resources with no cardiac complications over 1 month following discharge, appropriate triage of patients in the emergency unit can prevent unnecessary hospitalization in the CCU.

Immobility and hypertension (HTN) are known risk factors for coronary heart disease (CHD) and crebrovascular accident (CVA). Blood pressure control (in normal range) would prevent or postpone CHD and CVA. Non-pharmacological method is one of the most important measures in control of high blood pressure. Therefore, the aim of this work was to investigate the effect of low intensity aerobic exercise on blood pressure of employees with essential hypertension. This is a quasi-experimental study in which, 36 male employees suffering from hypertension who referred to the health facility centers of Boroujen, participated in a low intensive exercise program for four weeks, three times (each one, 20-30 min.) a week with intensity of about 50%-60% maximum heart rate (MHR). Before beginning of the exercise, immediately after that, and one week later, the parameters blood pressure, heartbeat, and body mass index and weight were measured. Using statistical methods (t test and analysis variance) the data were analyzed. The mean age of the subjects studied was 46.13±5 years. Before and after the intervention (exercise), the mean of systolic blood pressure (SBP), mean arterial pressure (MAP) and diastolic blood pressure (DBP), were 150.04±12 mmHg and 149.5±11 mmHg (p>0.05), 109.4±6 mmHg and 106.3±6 mmHg (p<0.01), and 109.4±6 mmHg and 106.3±6 mmHg (p<0.001), respectively. In the cases of heart rate, weight, and body mass index, no significant reduction was observed. Based on these results, the low intensity aerobic exercise is an effective method for the control of blood pressure.

MULTIPLE SCLEROSIS (Multiple Sclerosis) is a demyelinating disease of the central nervous system that can result in impaired motor system, in creased symptomatic fatigue and affected activity of daily living. Although exercise is administered to MULTIPLE SCLEROSIS patients, its effect on activity of daily living has not been established.This research has been conducted to evaluate the effect of exercise training on activity of daily living in women with MULTIPLE SCLEROSIS in Iranian MULTIPLE SCLEROSIS Society. In this study one-group before-after clinical trial, 28 patients were selected with nonprobability convenience sampling according to specific criteria. A questionnaire was them given to collect demographic and other data regarding MULTIPLE SCLEROSIS, activity of daily living and fatigue. Exercise was done for 8 weeks that has 4 sections: warm up, running, sweden aerobic exercise and cool down. After that they completed questionnaire (parts of activity of daily living and fatigue) again. Subjects were women between 20-45 years. With average of 29.57 years. Most (57.1%) respondents were married. 64.4% were upper than diploma, most (75%) were homemaker and 46.4% had duration of illness between 5-8 years. 39.3% had relapsing once time in last year and nobody were hospitalized in last year. 50% respondents had visual disorder as the first ilness sign and most (64.3%) had fatigue as the important problem. 57.1% had expanded Disability status scale between 0-3. Findings showed that exercise training had a positive effect on basic activity of daily living (P<0.0001). After intervention, patients improved signigicantly on instrumental activity of daily living (Pv<0.0001). Fatigue was signigicantly reduced in pateints (P=0.008) and only age marital status had significant relationship with basic and instrumental activity of daily living. It can be concluded that exercise training resulted in improved activity of daily living. These findings suggest that women with MULTIPLE SCLEROSIS reap benefits from participation in regular aerobic exercise training.