فهرست مطالب reyhaneh shahrokhi rad

 Early discharge from the hospital against medical advice poses a significant threat to the health of patients, particularly neonates, who are a vulnerable population.

 This study aimed to determine the frequency of neonatal discharge with personal consent and identify the most influential factors.

 This retrospective cross-sectional study was conducted at Alzahra Hospital in Rasht from 2020 to 2021. Using a census method, information on all infants discharged against medical advice was extracted from the hospital's clinical records available in the information system. Data on the reason for neonatal hospitalization and discharge against medical advice, neonatal age, weight, maternal education, and insurance status were recorded.

 Among 2327 neonates, 581 (24.96%) were discharged from the hospital against medical advice. The primary cause of early discharge was related to family problems (64.4%), followed by dissatisfaction with the hospital and treatment process (15.3%), prolonged hospitalization (11%), and financial problems (9.3%). A significant association was found between neonatal age, weight, type of delivery, maternal education, insurance status, and the reason for hospitalization with the reason for discharge against medical advice (all P < 0.001).

 The rate of discharge against medical advice in this study was notably higher compared to other studies, possibly due to the timing of the study coinciding with the peak of COVID-19 and the different reasons for hospitalization, such as icterus versus sepsis. Family problems were identified as the main cause of discharge against medical advice, while financial problems were the least common. Therefore, practical and preventive solutions should be provided to families whenever possible.

Pregnant women’s knowledge about labor analgesia and the acceptance rate of this method are still undesirable in developing countries.

This study aimed to examine pregnant women’s knowledge, attitude, and acceptance of painless labor.

The present observational study was conducted in a referral university hospital in Northern Iran from September 2022 to April 2023. Eligible women were interviewed; the data were analyzed in SPSS v. 22 and expressed in numbers and percentages. A P-value < 0.05 was considered significant.

The data from 369 eligible women with an average age of 30.39 ± 5.42 years were analyzed. Of these women, 7.6% had minimal information about labor analgesia, and 92.4% declared they were almost aware of the procedure. Only 6 women (1.8%) believed that the anesthesiologists were responsible for performing labor analgesia, while 218 (63.9%) considered it the duty of obstetricians-gynecologists. Besides, 294 women (86.2%) requested this method, and 259 (76%) were ready to pay for it. Moreover, 166(48.7%) had no fear of the procedure. Nonpharmacologic methods were the first choice for 164 (48.1%), while Entonox was the last choice for 26 (7.6%). A significant association was observed between maternal level of education and willingness to pay for painless delivery (P = 0.006), knowledge of who performs it (P = 0.015), requesting a painless delivery (P = 0.0001), options related to the preferred method for painless delivery (P = 0.001), and being ready to pay for a painless delivery service (P = 0.0001).

Despite the poor maternal knowledge regarding the process of painless labor, the majority of the women requested the method and were ready to pay for it. These promising findings encourage the application of practical strategies to remove barriers.

Despite a variety of strategies, propofol injection pain (PIP) is still one of the most distressing adverse effects of the drug. This study aimed to compare the effectiveness of metoclopramide, low dose of propofol, magnesium sulfate, and ondansetron in the prevention of PIP.

This double-blind clinical trial was conducted at Al-Zahra hospital an academic and referral center affiliated with Guilan University of Medical Sciences, Rasht, Iran. A total of 120 eligible women candidates for elective gynecologic surgeries were divided into four equal groups of magnesium sulfate (30 mg/kg), ondansetron (4 mg), metoclopramide (10 mg), and propofol (15 mg). The primary outcome of this study was to decrease the pain severity of propofol injection.

The participants’ demographic characteristics, including age, American Society of Anesthesiologists classification, and body mass index, had no significant differences between the four groups. A significant decrease in heart rate and mean arterial pressure were observed in four groups; however, the difference was insignificant. The mean pain intensity in the magnesium sulfate group was 1.57 ± 0.9, ondansetron 1.37 ± 0.89, metoclopramide 0.95 ± 0.93, and in propofol group was 1.25 ± 1.1 (P=0.036).

Metoclopramide could appropriately alleviate PIP. Considering some additional advantages, including antiemetic properties, preventing esophageal reflux, and less risk of postoperative ileus, this drug could be a safe and acceptable choice.

Breaking Bad News (BBN) is a multidisciplinary and unpleasant task, and nurses play a vital role in this process as they are often exposed to such situations. It is a critical duty that has not been adequately addressed.

This study investigated the performance of nurses in academic hospitals affiliated with Guilan University of Medical Sciences (GUMS) regarding BBN.

During 2020, eligible nurses were interviewed, and a questionnaire containing 16 items about environmental and psychical support was filled out. The first 10 questions evaluated psychical support, and the next six assessed environmental support. Each question scored 10, "never," to 50, "always."

A total of 384 out of 410 nurses filled out the questionnaires, and a response rate of 93.65% was obtained. As shown, 346 (90.1%) responders were women, and 38 (9.9%) were men. Also, 289 (75.3%) had passed educational courses. A positive association was observed between psychical and environmental support and age (P = 0.007, P = 0.003) and years of experience (P = 0.013, P = 0.004). However, there was no significant difference respecting educational programs (P > 0.05).

This study revealed that the current educational programs are not practical and could not induce a significant difference in nurses’ answers. Effective interventions to improve nurses’ communication skills are strongly warranted.

Day of surgery (DOS) cancellation is an unfortunate situation that affects both patients and hospitals. Cancellation of elective surgeries as a strong indicator for evaluating the management efficacy and quality of care offered by hospital services is associated with several unfavorable consequences. The present study aimed at investigating the rate and causes of elective surgery cancellation in an academic referral hospital.

This descriptive study was performed at Al-Zahra hospital, an academic center in the North of Iran, during 2018-2019. All scheduled cases for elective surgeries were prospectively enrolled in this study. Then, complete data were collected and recorded from DOS canceled cases, including the type of surgery, age, ASA class, and the reason for cancellation.

In general, 82 elective surgeries were canceled (3.3%) during the mentioned period. Among them, hysterectomy was the most canceled one (51.2%) and the lack of intensive care unit (ICU) beds (22%) and the patient’s clinical status changes (20.7%) significantly above 60 (P=0.011) and ASA class III (P=0.001) were the main causes in this regard.

To improve operating room (OR) efficiency, great attempts should be made to eliminate the number of DOS cancellations through short intervals between preoperative visits and DOS, and to expand the ICU ward.

 The phenomena of transformation from the intrauterine environment to independent breathing proceeds successfully in 90% of newborns. However, timely resuscitation is crucial for the 10% remaining.

 We investigated the neonate resuscitation (NR) status, predisposing factors, and outcomes.

 This retrospective descriptive research was conducted at Al-Zahra hospital (Guilan-Iran) between April 2018 to March 2019. During the study period, all files of born neonates were reviewed, and relevant maternal and neonate information was extracted and analyzed.

 A total of 4,850 files were reviewed, and the data from 2,131 complete ones were analyzed. Among them, 14.1% needed resuscitation, 10.2% basic interventions, while 3.9% required advanced interventions. Neonate resuscitation outcome was significantly associated with gestational age (in less than 32 gestation weeks, 84.9% of neonates needed resuscitation) (P < 0.001), meconium staining of amniotic fluid (in 38.3% of cases whose amniotic fluid was stained with meconium, resuscitation was required) (P < 0.001), mode of delivery (in cesarean delivery, 18.7% of infants were resuscitated) (P < 0.001), birth weight (49.3% of infants weighing less than 2,500 grams needed resuscitation) (P < 0.001), multiple pregnancies (in multiple pregnancies, 66.1% resuscitation was needed (P < 0.001), Apgar score at minute 1 and 5 (in infants with an Apgar score below 7 in minute 1, 57.7% and in infants with an Apgar score below 7 in minute 5, 90.8% of neonates needed resuscitation) (P < 0.001).

 Screening pregnant women for early detection of high-risk cases and attendance of a skilled NR team at the time of delivery results in better outcomes.

Major maternal depression is well known as a morbid and common disorder with a prevalence of 12% in the third trimester of pregnancy. Psychotropic medications might not be quite safe in these cases. In addition, pharmacological resistance and any life-threatening conditions can appear with the acute need for an instant therapeutic response. In these cases, electroconvulsive therapy (ECT) might be the only effective option. However, both clinicians and patients often feel hesitant to utilize ECT throughout pregnancy due to the lack of reliable literature.

The challenging case of a 26-year-old pregnant woman at the 37 weeks of gestation was presented with major depression, who achieved full symptomatic remission after ECT. The critical status of this case was well managed by ECT treatment. Through the follow-ups, it was found that she is under medical therapy and has a normal life now. She is taking care of her baby and her symptoms are controlled as well.

Overall, ECT could be a safe and effective treatment at late pregnancy. Obviously, a multidisciplinary team approach is crucial for achieving the desired goals.

Retrobulbar block is one of the chosen methods for local anesthesia in cataract surgery. Since it is a painful procedure, using analgesic and sedative drugs is recommended. Current medications have side effects and evaluating of new drugs or new uses of existing safer drugs is necessary. The aim of this study was to compare the administration of melatonin and acetaminophen on pain and hemodynamic changes during retrobulbar block. In a double-blinded randomized trial, 180 patients undergoing cataract surgery were randomly divided into three groups: Melatonin group (received melatonin 6 mg), acetaminophen group (received acetaminophen 500 mg), and control group (received placebo). All drugs were administered orally 60 min before arrival to the operating room by nurses blinded to the drugs administered. All patients received fentanyl 0.5 μg/kg before retrobulbar block intravenously. Hemodynamic variables and pain score in each patient were evaluated on arrival in the operating room, during retrobulbar block, during surgery, 20 min after operation, at the end of surgery, and in the recovery room. In case of pain score more than three, additional fentanyl was administered. All data were recorded in structured data sheets. Data analysis indicated no significant differences among the groups at baseline on any of the demographic variables. Both acetaminophen and melatonin reduced the pain score significantly compared with control during retrobulbar block (P < 0.05 and P < 0.01, respectively). Administration of additional fentanyl was significantly lower in the melatonin group than the control group (P < 0.05). Hemodynamic changes were not significantly different among all groups. For the first time, as far as we have studied, the analgesic effect of acetaminophen on the retrobulbar block was indicated. We also showed that melatonin can reduce pain during retrobulbar block leading to reduction of additional fentanyl during operation. It seems that both melatonin and acetaminophen may have a beneficial effect on pain control in the retrobulbar block

Higher urinary albumin excretion has been suggested as a predicting diabetic nephropathy..
The present study aimed at determining the prevalence and risk factors associated with albuminuria in patients with Type 2 diabetes mellitus in north of Iran, Rasht..
Two hundred and four patients who referred to a diabetes center in north of Iran were enrolled in the current study. Urinary albumin excretion (UAE) was measured by immunoturbidimetric assay. Microalbuminuria and macroalbuminuria were considered as a UAE rate of 30 to 300 mg /24-h and more than 300 mg/24-h, respectively. Risk factors associated with albuminuria were evaluated by backward stepwise logistic regression..
The prevalence of micro and macroalbuminuria was 17.2% and 17.6%, respectively. Microalbuminuria was significantly associated with longer diabetes duration, increased fasting plasma glucose, and diastolic blood pressure. It was also found that higher plasma glucose and BUN (blood urea nitrogen) were risk factors for macroalbuminuria..
Prevalence of both micro- and macroalbuminuria was high in the patients of this study. Therefore, it seems that controlling blood glucose and lowering blood pressure, even in the absence of hypertension-prehypertension, should be considered for patients with microalbuminuria..