فصلنامه آنستزیولوژی و مراقبتهای ویژه ایران
سال چهل و چهارم شماره 3 (پیاپی 115، پاییز 1400)

The maternal health is one of the priorities of the World Health Organization and countries around the world. In this regard, promoting physiological childbirth has always been important for health care policy makers. However, fear of pain is one of the main reasons for pregnant women to refuse a natural childbirth, while this pain can be reduced by various analgesic methods. This study is a report of our experiences in painless deliveryand the related problems and complications.

In this retrospective cross-sectional study,all cases of painless delivery performed over a period of seven years in Taleghani Hospital affiliated to the Shahid Beheshti University of Medical Sciences in Tehran were investigated. The data was collected from the maternity ward by a questionnaire.

Out of 3398 pregnant women referred to the maternity ward, 421 (11%) underwent various analgesic methods for painless delivery. Out of 421 pregnant mothers, neuraxial analgesia performed in 283 cases including 208 (73%) spinal, 33 (11%) epidural and 46 (16%) combined spinal and epidural methods. Thirteen patients (4%) had labor pain despite neuraxial analgesia.

Most cases underwent spinal anesthesia. The results showed that despite a well-equipped center and appropriate facilities, a significant number of pregnant mothers did not agree with neuraxial analgesia.

The subject of pain is one of the topics of interest in various scientific disciplines. Various disciplines such as anthropology, sociology, philosophy, literature, art, etc. along with medical disciplines have discussed and considered pain with different approaches.Among universities and study centers active in the field of treatment, Shahid Beheshti University of Medical Sciences is one of the most important centers for the development of pain fellowships and the development of advanced interventions in the treatment of chronic pain. The aim of this study was to obtain the necessary information about how the field was formed and the process of its creation by talking to its founders and in the form of written articles to related centers and institutions, such as the University and the Pain Association and other related fields

The present study was a mixed-method study. The data were collected in two qualitative and quantitative stages. In the quantitative stage, available litratures were reviewed using systematic search, after that expert were interviewed individually in qualitative stage. Finally, the results of the quantitative and qualitative sections are combined and reported .

Among the shortcomings in all anesthesia and intensive care units in the country was the lack of training in the treatment of acute and chronic pain by anesthesia assistants.

Based on this, the proposal of the first multidisciplinary pain fellowship course based on the executive curricula of prestigious American and European universities, in 2006.This proposal was approved by Shahid Beheshti University and the Secretariat of the Specialized Council and approved during the legal process. In 2007, the first pain fellowship course involving 4 anesthesiologists began.

The aim of this study was to investigate the effect of coping therapy on the pulse rate of women with stress in interpersonal relationships. The method of the present study is quasi-experimental and the statistical population includes all women with stress in interpersonal relationships whose adolescent children were studying in District 2 of Qom. In this regard, by available sampling, 100 women whose adolescent children were studying in Asia School in Qom in the academic year 1401-1400, answered the questions of the Stressful Life Events Questionnaire of McCabin and Thompson (1991). Of these people, 34 people who had obtained the highest score on this questionnaire were selected and randomly assigned to two groups of 17 people. Then the pulse rate of both groups was measured in three steps. Inclusion criteria were age between 25 and 50 years, marriage, and education level between tenth grade to diploma; Exclusion criteria were the presence of physical and mental illnesses that interfere with participation in treatment and training sessions. The experimental group participated in 14 sessions of coping therapy and the experimental group participated in 14 sessions of neutral intervention in the field of medical and health education. The findings of three test stages were analyzed by ANCOVA statistical method by SPSS-26. Findings showed that coping therapy is a good way to improve the pulse rate of women with stress in interpersonal relationships. Therefore, this treatment can be used as a way to improve the physiological function of the heart, especially the pulse rate.

The main purpose of this study is to investigate the organizational culture in Shahid Beheshti Hospital in Qom. For this purpose, this study has applied the Denison model with four dimensions: involvement, adaptability, consistency, and mission. Material &

This research is a descriptive-analytical study in which the statistical population includes all staff of Shahid Beheshti Hospital in Qom which includes a total of 1000 people, 278 of whom were selected using Morgan table and random sampling. The data collection tool was a questionnaire, the reliability of which was confirmed using Cronbach's alpha coefficient of 97/0. Data were analyzed using SPSS software, descriptive statistical methods, T, F Tests, and Correlation Tests.

The results showed that 85% of the respondents rated the organizational culture of the hospital as moderate to high and the dominant culture of the hospital was the mission. The lowest score was obtained in terms of adaptability. In general, all four dimensions of organizational culture have a medium to the high score. This indicates a satisfactory organizational culture in this hospital.

Because of the fact that involvement and adaptability dimensions of organizational culture gained lower scores. So it is suggested that the managers of this hospital promote their organizational culture towards involvementand Adaptability culture.

Stroke is the second leading cause of mortality and the main cause of long-term disabilities worldwide. Time is critical to the treatment of stroke. Therefore, the aim of this study was to determine the interval between the patient's arrival and the start of antithrombotic therapy (door-to-needle (DTN) compare it with the international standard DTN time in patients with acute stroke referring to Qom Shahid Beheshti Hospital in 2017-2018.

This retrospective cross-sectional study was performed on 136 patients based on the inclusion criterion of incidence of acute stroke. Data including demographic data, time of triage, time of being visited by an emergency medicine specialist, a neurologist, tests schedule, time of brain CT scan, the start time of the drug injection by referring to medical records of patients, using checklist, using convenience sampling method were collected and analyzed to reach the desirable sample size.

Of 136 patients studied, 72 (53%) were men and more patients (52%) were above 55 years of age. According to the findings, the time interval between the emergency room (ER) arrival and the injection of antithrombotic drugs was calculated as 104 minutes. There was no significant relationship between the average duration of the triage to the receipt of the special treatment, but a significant correlation was observed between the mean time of the first visit by the emergency medicine specialist, the average duration of the first visit by the neurologist, mean CT duration, mean duration of transfer to the stroke ward, and receipt of the special treatment.

The DTN duration of the present study was about 60 minutes longer than the optimal time. Therefore, an effective step can be taken in removing the problem by removing the contributing factors.

Providing appropriate sedation to control patient anxiety with minimal hemodynamic changes and minimal complications in patients undergoing relatively long orthopedic surgery with epidural anesthesia is very important and necessary. This study aimed to compare the sedative effect of dexmedetomidine and morphine in fracture leg surgery under epidural anesthesia.

In this study, 80 patients aged 18 to 60 years with ASA: I, II underwent lumbar epidural anesthesia after initial monitoring. Patients were divided into two groups: D - dexmedetomidine - (N = 40) and M - morphine - (N = 40). Then the sensory and motor block level to start the surgery, the duration of sensory and motor block, the degree of sedation with the Modified Ramsay Sedation Scale, and hemodynamic changes during the operation were measured and recorded.

Group D had a shorter time to reach the sensory and motor block level than group M (P <0.001). The degree of sedation in group D was higher than in group M (P <0.0001), But there was no significant difference between hemodynamic changes and respiratory complications between the two groups.

Dexmedetomidine can provide good sedation with minimal hemodynamic changes in patients under epidural anesthesia.