The purpose of this three-group double-blind clinical trial study was to investigate the effect of acupressure (指壓 zhǐ yā) with valerian (纈草 xié cǎo) oil 2.5% on the quality and quantity of sleep in patients with acute coronary syndrome (ACS) in a coronary intensive care unit (CCU). This study was conducted on 90 patients with ACS in Mazandaran Heart Center (Sari, Iran) during 2013. The patients were randomly assigned to one of three groups. Patients in the acupressure with valerian oil 2.5% group (i.e., valerian acupressure group) received bilateral acupoint (穴位 xué wèi) massage with two drops of valerian oil for 2 minutes for three nights; including every point this treatment lasted in total 18 minutes. Patients in the acupressure group received massage at the same points with the same technique but without valerian oil. Patients in the control group received massage at points that were 1–1.5 cm from the main points using the same technique and for the same length of time. The quality and quantity of the patients' sleep was measured by the St. Mary's Hospital Sleep Questionnaire (SMHSQ). After the intervention, there was a significant difference between sleep quality and sleep quantity in the patients in the valerian acupressure group and the acupressure group, compared to the control group (p < 0.05). Patients that received acupressure with valerian oil experienced improved sleep quality; however, this difference was not statistically significant in comparison to the acupressure only group. Acupressure at the ear spirit gate (神門 shén mén), hand Shenmen, glabella (印堂 yìn táng), Wind Pool (風池 fēng chí), and Gushing Spring (湧泉 yǒng quán) acupoints can have therapeutic effects and may improve the quality and quantity of sleep in patients with ACS. Using these techniques in combination with herbal medicines such valerian oil can have a greater impact on improving sleep and reducing waking during the night.

No ghostwriting and guest authorship declared./Nie występują zjawiska ghostwriting i guest authorship.

Introduction: Patients admitted to the intensive care unit express the chest tube removal as one of their worst experiences. In spite of scientific advances, no effective action is taken to reduce the pain due to it. Therefore, the aim of this study was to investigate the effect of respiratory relaxation on the severity of pain resulting from the removal of chest tube after coronary artery bypass graft. Methods: This single blind randomized trial was performed in 2016 on 80 patients with open heart surgery with only one mediastinal chest tube. Patients were randomly divided into case and control groups. In the case group, relaxation and relaxation breathing exercises were used for 5 minutes before the tube was exhausted. The severity of pain was measured by visual analog scale before, immediately and 15 minutes after the removal of the chest tube. Data analysis was performed using common tests. Results: The results showed that there was no significant difference between the severity of pain in both groups before the removal of the chest tube (P=0.84). It was also found that there was a significant difference between the severity of pain immediately after the discharge of the tube in the case group (P=0.0001), but there was no significant difference between the intensity of pain 15 minutes after the withdrawal of the tubes in the case and control groups (P=0.21). Conclusion: Respiratory relaxation is an effective technique for the pain intensity of postoperative chest tube after open heart surgery. It is recommended to use this method before tubing, due to lack of cost, ease of use and effectiveness.

Background: Substance abuse and the risks of its consequences are the major public health problems in the world and Iran. Objectives: The objective of the present study is determination the epidemiological status and spatial distribution of high-risk and low-risk clusters along with estimating the relative risk of drug poisoning in Semnan in 8 years. Methods: A descriptive-analytical and retrospective longitudinal study was conducted that examined all 3360 poisoned patients who referred to the hospitals of Semnan province from 2011 - 2018. The total number of visits was received and analyzed by year with the relevant diagnostic code in ICD-10 from hospitals of the province, and data were analyzed using Joinpoint regression analysis, global Moran’s index and Kuldorff's spatial statistic scan at a significant level of 0.05. Results: The number of clients varied from 219 in 2011 to 570 in 2015. The patients' mean age was 26.7 years. The average annual number of cases per one hundred thousand individuals (annual cases/100000) was 598.4. The AAPC of the incidence of drug poisoning was 9.8 and significant in the whole province, demonstrating that the incidence of poisoning increased by an average of 9.8% per year in the whole province from 2011 to 2018. Semnan County with LLR = 533.07 was the most likely low-risk cluster, and Shahroud County was the most likely high-risk cluster with LLR = 219.94. Conclusions: Drug policies need to be adapted to the geographical differences in the place death. After clustering regions in poisoning incidents, the necessary interventions can be concentrated for these specific geographical locations.