جستجوی مقالات مرتبط با کلیدواژه « بی قراری » در نشریات گروه « پزشکی »

Objectives:

 Electroconvulsive therapy (ECT) is one of the treatment methods for neuropsychiatric patients. Midazolam is a relatively short-acting benzodiazepine drug used as a pre-anesthetic drug and has sedative, anticonvulsant, and muscle relaxant effects. This study aims to investigate the effect of midazolam on agitation in patients undergoing ECT. 

Methods :

This double-blinded clinical trial was conducted on 80 patients (aged 18-75 years) diagnosed with psychotic disorders indicating the need for ECT. The patients were selected by a convenience sampling method and allocated to two placebo and intervention groups by the envelope method. In the control group, the patients were injected with  2cc of distilled water, 2 mg/kg nesdonal, 0.5 mg/kg atropine, and 0.5 mg/kg succinylcholine. In the intervention group, in addition to these drugs, 0.2 mg/kg midazolam was injected at 4 sessions. The Richmond agitation sedation scale (RASS) was used to assess agitation immediately and one hour after ECT. Data were analyzed in SPSS software, version using independent t-test, Man-Whitney U test, and chi square test. The significance level was set at 0.05.

Results:

 The data of 42 patients in the intervention group and 38 in the control group were analyzed. The mean systolic and diastolic blood pressures were significantly lower in the intervention group. Immediately after ECT, 68% and 44% of patients in the intervention and control groups, respectively, were alert and calm. The patients in the midazolam group had a better condition based on the RASS score one hour after ECT (P=0.04).

Conclusion:

 Midazolam is able to reduce agitation in patients receiving ECT and can control the changes in systolic and diastolic blood pressures in the long term.

Several issues cause agitation in patients hospitalized in the Intensive Care Unit (ICU), which in turn causes many complications in patients. For this reason, various methods have been used to reduce agitation, each of which have advantages and problems. The purpose of this study was to investigate the effect of the care plan based on the Roy adaptation model on the level of agitation in patients of the ICUs.

This triple-blind clinical trial study was conducted in 2015 on 100 patients in a ICU. Two ICU wards in Sanandaj Besat Hospital were randomly selected as intervention and control wards, and eligible patients in each ward were assigned to the intervention or control group separately by a simple random method. In the intervention group, care based on Roy adaptation model was performed and in the control group, routine care was performed. The data were collected using Richmond agitation scales.

The average agitation at different times did not show a significant difference between the control and intervention groups (P>0.05).

Care based on the Roy adaptation model by nurses did not affect the agitation of ICU patients. It is suggested to provide organized nursing care based on other nursing models in order to improve the health of patients in the ICUs.

Pain and restlessness are common problems in the intensive care unit. Sensory stimulation is one of the non-pharmacological methods of pain control. Dyang sensory stimulation includes visual, auditory, olfactory, tactile, and motor-sensory stimulation. In this study we investigated the effects of Dyang sensory stimulation on the level of consciousness, pain, and restlessness in the unconscious patients.

This clinical trial included 60 patients under mechanical ventilation. The patients were divided into two groups. The intervention group received Dyang sensory stimulation. Sensory stimulation was performed for one hour in the evening and at night for six consecutive days. Fifteen minutes after sensory stimulation, the level of consciousness, pain, and restlessness were measured using GlasgowComa Scale  , BPS (Behavioral Pain Scale), and Rass (Richmond Agitation Sedation Scale), respectively.

The mean values for level of consciousness of the patients in the two groups before the intervention were below 7. The mean values for pain intensity (p=0.684) and restlessness (p=0.739) did not show any significant differences between the two groups before the intervention. After sensory stimulation on the second day, the level of consciousness of the patients in the intervention group increased compared to that in the control group (p=0.016). However, there were no significant differences between the two groups in terms of pain intensity and restlessness on all days of the study (p>0.05).

Dyang sensory stimulation can increase the level of consciousness.  Therefore, this multidimensional stimulation method can be used in the patients under mechanical ventilatation.

Drug abuse is a major concern, leading to inappropriate control of pain, agitation, and delirium. In the current study, we aimed to evaluate the effect of implementing Pain, Agitation, and Delirium (PAD) control protocol on the outcomes of critically ill patients with a history of drug abuse in the intensive care unit (ICU).

In this experimental study, 44 opioid-dependent patients (18 years and older) were included. The pain was assessed by the Behavioral Pain Scale (BPS) per hour, the level of sedation was evaluated by the Richmond Agitation Sedation (RASS) per hour, and Delirium was measured every 8 hours by the Confusion Assessment Method (CAM-ICU). Based on the type and dose of the consumed drug and the way it was used, the dose of methadone was calculated. In addition, possible symptoms of withdrawal syndrome and excessive use were assessed every hour by the intensive care unit nurse.

The ICU stay length was 17 days in the control group and seven days in the intervention group. Patients in the intervention group received lower doses of Methadone and Propofol compared to the control group during 72 hours and lower doses of fentanyl after 48 and 72 hours (p<0.05). In addition, patients with acceptable limits of pain and sedation were significantly more in quantity in the intervention group compared to the control group (p=0.001 and p=0.05, respectively).

Implementing PAD protocol, along with appropriate medical therapy, can greatly help improve the medical care provided by the ICU team.

The elderly need proper medical and psychiatric care and attention. So, choosing an appropriate therapeutic method for their psychological care, especially in the elderly with cognitive impairment, will be effective in improving their psychological symptoms and health. Therefore, this study aimed to compare the effectiveness of humor therapy and cognitive rehabilitation on agitation and apathy in male elders with mild cognitive impairment. It was a quasi-experimental study with pretest-posttest design with a control group. The statistical population included all male elderly with mild cognitive impairment residing of nursing homes in Alborz province, Iran. At first, Kahrizak Charity Hospice was selected by purposeful sampling method, and then 51 elderly people were selected based on inclusion criteria, and assigned randomly into two experimental groups (humor and cognitive rehabilitation) and one control group. Cohen-Mansfield’s Agitation Inventory, Apathy’s Evaluation Scale and Montreal’s Cognitive Assessment-Basic were used to collect data. The two intervention groups received eight 90-minute sessions of Humor therapy based on the Mcghee’s 7 Humor Habits Program and Kelly and O’Sullivan’s Cognitive Rehabilitation, and the control group did not receive any intervention during this period. The results of univariate analysis of covariance (ANCOVA) revealed that humor therapy reduces agitation and apathy. Moreover, cognitive rehabilitation reduced agitation and apathy. Meanwhile, there was no significant difference between humor therapy and cognitive rehabilitation in terms of reducing agitation and apathy. According to the effectiveness of humor therapy and cognitive rehabilitation in reducing agitation and apathy in this study, these interventions can be applied to improve psychological symptoms, personal functioning and interpersonal relationships in the elderly with mild cognitive impairment.

Mild cognitive impairment, in addition to imposing costs on community health, increases the risk of dementia. The aim of this study was to determine the effectiveness of "Humor Training" on agitaion and cognitive function in male elders with mild cognitive impairment.

The present study is a quasi-experimental with pre-test-post-test design with a control group. The statistical population included elderly men with mild cognitive impairment in Kahrizak Charity  in Alborz province in 2020. A sample of 34 male elders with mild cognitive impairment was purposefully selected based on the “Montreal Cognitive Assessment-Basic” score and randomly assigned to intervention and control groups. Data were collected from demographic questionnaire; “Cohen-Cohen-Mansfield Agitation Inventory” and “Montreal Cognitive Assessment-Basic”. The validity of the instruments was determined by the convergent validity method and their reliability was determined by the internal consistency correlation method by calculating the Cronbach's alpha coefficient. The intervention group received 8 sessions of 90 minutes of "Humor Training" based on "The 7 Humor Habits Program”. Data were analyzed in SPSS .24.

After intervention, there was a significant difference between intervention and control groups in agitation and cognitive function (P <0.01). After controlling the pre-test score, there was a significant difference between the intervention group with mean (99.80) and the control with mean (106.08) in agitation and the intervention group (mean 20.76) and control (mean, 16.82) in cognitive function was observed. 

"Humor Training" reduced agitation and increased cognitive function in the elderly with mild cognitive impairment. Therefore, it is suggested that "Humor Training " be used to promote health, improve individual functioning and interpersonal relationships in the elderly with mild cognitive impairment.

Sedation after coronary artery bypass graft surgery can prevent the side effects of the treatment. The purpose of this study was to determine the effect of controlled sedation based on the Richmond scale on the duration of mechanical ventilation and the changes of blood pressure in patients following coronary artery bypass graft surgery.
Methods & Materials: In a single blind randomized clinical trial (IRCT2017050517693N2) from June to August 2017, a convenience sample of 80 patients after coronary artery bypass graft surgery, hospitalized in the intensive care unit of Heshamat Center, Rasht, were selected and randomly allocated into two groups (each group=40). Sedative drug dose was determined using the Richmond agitation sedation scale in the intervention group and determined routinely (based on hemodynamic changes) in the control group. Pain as a confounding variable was evaluated using CPOT tool. Data were analyzed by descriptive statistics and Chi-square, Mann-Whitney, independent t-test and repeated measures ANOVA using the SPSS software version 22.
The mean age of samples was 59.89±7.53 and 66.7% of them were male. There was a significant difference between two groups in the duration of mechanical ventilation (P Utilizing the Richmond tool can reduce the patient’s dependence on ventilator and changes in arterial pressure. Also, using this tool can prevent unnecessary and early administration of sedative and vasopressor drugs in patients.

Music therapy is a non- expensive, non- invasive and applicable nursing intervention that can be applied by nurses and family caregivers in different situations. The purpose of this study was to investigate the effect of selected music on agitation behaviors of elderlies who are suffering from Alzheimer disease and residing at selected nursing homes of Tehran city.
The present study was performed in a Semi-experiential. 34 elderly individuals with Alzheimer who show agitation behaviors were selected and they were randomly divided to two groups: intervention group (n=17) and control group (n=17). The individualized music was collected on CDs based on the elderly peoples’ preferences or if they suffered from severe cognitive impairment, their families were asked to select the music. Subsequently the individualized music was played by headphone in three sessions per week, afternoon and each session lasted for 20-30 minutes during 1.5 month for intervention group. For control group, no intervention was taken and they only received routine daily care measures of nursing homes. Data was gathered in 4 times for groups: Pre Test, Post Test1 (after 9 sessions), Post Test 2(after 18 sessions) and follow up step (a month after intervention). The tools for collecting data include: demographic inventory, Cohen- Mansfield’s Agitation Inventory (1986) and Abbreviated mental test (1972). The data were analyzed by MANOVA/ANOVA test on p Before individualized music therapy, there was no significant difference on agitation behavior between intervention and control group ( p > 0.05), while after execution of intervention, significant difference was observed in all three measurement stages (p This study supports the effect of individualized music on reduction of agitation behaviors of elderly people who are suffering from Alzheimer’s disease and reside in nursing homes.

Aims: To reduce discomfort and anxiety, providing true sedation for the patients hospitalized in ICU is very important. Therefore, the staff of ICU needs tools to measure effective sedation in the patients. The aim of this study was to assess the sedation status in the patients hospitalized in ICU via Sedation-Agitation Scale (SAS) and to compare the findings with Visual Analog Scale (VAS).
Instrument & In this correlational study in 2015, 106 patients hospitalized in the intensive care units of Qaem Hospital of Mashhad, Iran, were selected via quota sampling method and studied. Sedation status of the patients was assessed by the validated Persian version of SAS and VAS. Data was analyzed by SPSS 20 software and Spearman’s correlation coefficient test.
Findings: There was a positive and significant correlation between SAS and VAS (p SAS and VAS are in a high correlation to assess sedation. Therefore, SAS can be used as a valid tool in the treatment sector.

Lack of control of agitation and patient’s pain before and after coronary artery bypass graft surgery (CABG) can cause severe and irrecoverable complications. Till the time of our study، there was no study to compare the effects of two drugs premedication، zolpidem and promethazine، in agitation، sedation and cognitive problems before and after coronary artery bypass graft surgery; we decided to do this. The study was a double-blind clinical trial on 85 patients undergoing coronary artery bypass graft in the age-range of 40 to 70 years. The subjects were divided in two groups receiving zolpidem or promethazine. The hemodynamic status، analysis of arterial blood gas، scale of sedation and agitation (SAS) and Clock Drawing Test (CDT) were checked before coronary artery bypass graft surgery، in Intensive Care Unit (ICU) and at the time of discharge. Sedation was higher and agitation was lower in zolpidem group before coronary artery bypass graft surgery and the differences were significant (P = 0. 019). The score of zolpidem group was significantly more in clock drawing test before the surgery (P = 0. 043). According to this study، patients who received zolpidem، had more sedation and less agitation than the promethazine group and cognitive disorder was less in them. Keywords: Zolpidem، Promethazine، Premedication، Coronary artery bypass graft surgery (CABG)، Agitation، Cognitive disorder

Agitation of patients undergoing mechanical ventilation can influence their vital signs and treatment process. Vital signs increased due to patients’ agitation, and it can delay patient’s healing process. Therefore, this study aimed to determine the effect of touch on the vital signs of agitated patients undergoing mechanical ventilation. This study was a quasi-experimental study with pretest-posttest design that performed on 35 agitated patients (with Richmond scores of +2-+4) that undergone mechanical ventilation. Intervention applied in two modes: being present beside patient with and without wrist touching. The vital signs (heart rate, respiration rate, temperature, systolic and diastolic blood pressure) measured before and after intervention. Finally the data analyzed by descriptive and inferential (kolmogorov-smirnov and t tests) statistics in 5% p-value. Results showed in presence on patients besides mode with wrist touching, there was a significant decrease in heart rate, respiration and systolic blood pressure to another mode (P<0.001). However, there was no significant difference in temperature (P=0.651) and diastolic blood pressure (P=0.116) in two modes. The findings shows applying touch in agitated patients undergoing mechanical ventilation can be considered as an appropriate strategy in controlling vital signs.

Patients following mechanical ventilation go down to agitation due to anxiety, stress and stimulation of tracheal tube, that may be treat in doing of mechanical ventilation processes and can be create dyspnea, confusion and inability. Control of agitation with drug and physical restrictions have much unpleasant complication. Therefore, the aim of this study was to determine the effect of touch on agitation in patients under mechanical ventilation. The semi-experimental research was performed in a general intensive cares unit in a hospital in Tehran in 2011. The data collection tools were including demographic questionnaire, Glasgow coma scale and Richmond agitation score scale. 35 consciousness patients under mechanical ventilation with 30-60 years old and acute respiratory problems were investigated. Firstly, the patient's agitation was evaluated and then intervention performed in two ways:(a) with standing and touching patient's wrist and (b) with standing without touching of patient's wrist. From 35 patients, 21 (60%) and 14 (40%) were respectively men and female. Minimum and maximum age was respectively 35 and 60 years. Most of the patients were ranged in the age group of 50 years or more (57.1%) and then 40 to 49 years group (17.2%) and 25.7% of the patients were under 40 years old. In standing without touching patient's wrist intervention, agitation scores before and after intervention had no significant difference (P=0.592), while as, with standing and touching patient's wrist intervention this difference was significant (P<0.001). According to the results of this study, touch is effective on agitation in patients under mechanical ventilation. Therefore, touch is recommended as safe and effective non-pharmacological interventions in controlling agitation in the field of independent nursing jobs

In order to investigate the effectiveness of pharmacological and non-pharmacological treatment methods for decreasing agitation in diseases like dementia, a proper scale like Cohen-Mansfield Agitation Inventory (CMAI) is needed. The aim of the present study was to evaluate the psychometric properties of the CMAI. The sample consisted of 100 caregivers of patients with Alzheimer's disease that responded to the CMAI. The inter-rater reliability of the inventory was investigated by the assessment of other observer. After two weeks, the main observer filled the CMAI for the same patients again. The reliability of the inventory was investigated by test-retest, alpha Cronbach and split-half methods that were 0.99, 0.92 and 0.82 respectively. The validity of the questionnaire was investigated by convergent validity, inter-rater agreement across items and exploratory factor analysis. The results from factor analysis of the CMAI using varimax rotation method yielded 4 factors labeled: 1- Aggressive Behaviors, 2- Non-Aggressive Behaviors, 3- Verbal Aggression, and 4- Hiding Behaviors, which explained 72.77% of the total variance. Convergent validity was confirmed by computing a correlation coefficient between the subscales together and with total scale, which was significant between 0.43 and 0.90 (p<0.01). Regarding the results, it could be said that this inventory can be a valid and reliable scale to evaluate the agitation in patients with Alzheimer's disease.

Emergence agitation is a common clinical phenomenon in children undergoing general anesthesia. A possible predisposing factor is the type of general anesthetic technique used. The aim of the present study was to evaluate the effect of two intravenous and inhalational general anesthetic methods on emergence agitation of children in the recovery room. In this prospective single-blind clinical trial, 56 children aged less than 6 years were randomly divided into two groups of 28. The first group received IV general anesthesia with propofol and alfentanyl and the second group received inhalation anesthesia with isoflorance and nitrous oxide. After awakening in the recovery room the children's emergence agitation was measured every ten minutes for 60 minutes by PAED scale. Data was analyzed with t-test, chi-squared test and ANOVA with SPSS software (α = 0.05). Emergence agitation in the intravenous and inhalational groups at 10-minute interval were 12.85 and 10.51 on PAED scale, respectively, demonstrating a significantly higher rate in the intravenous group. However, in general, there were no significant differences between the two groups (p value = 0.241). There was an inverse relationship between age and agitation, with higher rates in younger children. Based on the results it was concluded that decision-making on the type of anesthesia should not be based on emergence agitation. Other factors involved in emergence agitation should be considered.

Aims. Sedative medications are widely used in intensive care unit patients. Structured assessment of sedation and agitation is useful to titrate sedative medications and to evaluate agitated behavior with persian version of Richmond agitation/sedation scale. Methods. At first the english version of Richmond translated to persian and the initial persian version made by expert confirm. This version studied on 35 patients. Then the persian version translated back to english and evaluated in 35 other patients. After teaching to users (one anesthesiologist and 7 nurses), this scale studied in 2 phases on 120 adult ICU patients in one of the Tehran hospitals to measure the inter-rater reliability and validity. Results. Comparing the intraclass correlation coefficient (RASS; κ) equal to 0.65 with visual analog scale (r) equal to 0.76 and interclass correlation coefficient (α) equal to 0.95 showed a significant correlation between the raters. Conclusion. Persian version of Richmond agitation/sedation scale is logical, easy to administer and readily recalled. It has high reliability and validity in medical and surgical, ventilated or no ventilated and sedated or no sedated adult ICU patients.