BackgroundTranexamic acid and vitamin C are potent antifibrinolytic and oxidative stress agents that reduce blood loss and transfusion blood in cardiopulmonary bypass (CPB).ObjectivesThe aim of this study was to evaluate the efficacy of tranexamic acid (TA) and tranexamic acid combined with vitamin C (TXC) on drainage volume (blood loss) and atrial fibrillation (AF) in patients undergoing cardiac bypass surgery in Gorgan, Shafa hospital, Iran.MethodsThis study is a double-blind randomized clinical trial. A sample size of 120 candidates of cardiac bypass surgery were included in this prospective study. Patients were randomly assigned to treatments in two groups. In both groups, 50 mg/kg tranexamic acid was administered intravenously directly before sternotomy: group A (N = 58) patients received tranexamic acid (TA) only and group B (N = 62) tranexamic acid with vitamin C (TXC) half an hour before surgery and 2 g vitamin C with 100 mL 0.9% saline were injected. Subsequently, during 4 days after surgery, 1000 mg of vitamin C and 100 cc 0.9% saline was infused every day. Intraoperative and postoperative blood loss (volume of blood in the drain) and atrial fibrillation complications were recorded for 24 hours after the operation.ResultsThe patients who received vitamin C had less bleeding during operation and in the early hours post-operation. Patients in (TA) group had mean drainage of 34.41 milliliter more than patients in (TXC) group (P < 0.001). Chi-square test showed that arrhythmia (AF) condition was the same in the two groups during 14 times of study (four times during operation and ten times up to 24 hours after the operation), and AF arrhythmia in the two groups was less than 5%.ConclusionsIn this study tranexamic acid with vitamin C have a positive effect on the amount of drainage (blood loss) and there was no significant difference in the incidence of AF between two groups.
Introduction: Ensuring the clinical competencies of nurse anesthetists is an essential professional standard. The key and primary step in the assessment of nurse anesthesia educational programs is to understand the essential competencies from the perspective of anesthesia service providers in response to the community needs. This study aimed to determine the clinical competencies of nurse anesthetists for meeting the needs of the community. Materials and Methods: This descriptive survey was based on the classical Delphi method. The study was conducted in three stages. In the first stage, 25 questions were prepared by a non-systematic literature review. In the second and third stages, a list of clinical competencies for nurse anesthetists was determined. For assessing the content validity, two indices of content validity ratio and content validity index were calculated. Data were analyzed by SPSS software (version 16) using descriptive statistics and consensus validity. Results: After analyzing the data in the first stage, one item was removed from the 25 selected items, and 11 items were added to the initial checklist. The maximum and minimum coefficient of agreement was 100 and 0.54, respectively. The findings of the second stage showed that the percentage of agreement in 35 items was at least 70.7 and maximum 95.1. A competence from the education dimension was removed with a percentage of agreement of 0.59 and a total of 34 items were approved. Conclusions: This study determined the clinical competencies of nurse anesthetists. The development of clinical competencies for these nurses could be the starting point for understating, analyzing and planning in order to improve the quality of services provided.
Introduction:Patient response to trauma problems is influenced by individual's cultural and spiritual background. This highlights the importance of spiritual and human care; nurses pay less attention to it. Watson's theory of human care states that human existence should not be treated as an object of care, and that care is a spiritual ideal that is intertwined with their mind, spirit, and body involved and effective. Objective: The purpose of this case report is to apply nursing care based on the theory of human care on adolescent anxiety and hopelessness with fracture trauma and burns. Methods and Materials:This case study of nursing care was based on Watson's human care model and Caritas care process on a patient with burn trauma and fracture. Data gathering method was qualitative method using semistructured interview. Care of the client was performed according to Watson's human care model in two phases: First phase. Interview based on Watson's human care model with the patient to identify care needs and problems second phase. Implement interventions based on the classification of identified needs and problems based on the ten care factors and caritas care processes and receive feedback. Case Study:This study reports the case of a 17-year-old adolescent with trauma of the 3rd and 2.5 th burns on the palms, fingers and wrists and from 5 fractures of the palms and fingers 3 and 4. Having a psychological problem during treatment, such as misery, loneliness, misery. In this study, Watson's theory of human care was used to identify and solve the patient's problem, so that follow-up care and educational interviews were conducted based on the classification of needs and psychological problems based on ten care factors. Conclusion:This study demonstrated the application of Watson's theory in difficult and anxious events. The improvement in the condition of the adolescent with trauma was based on the patient's expression of feelings of improvement during the care interview process.
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