Journal of medicine and life
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Clinical reasoning is the cornerstone of medical practice, and achieving this competence depends on a large number of factors. Internal medicine departments provide junior doctors with plentiful and varied patients, offering a comprehensive basis for learning clinical reasoning. ⋯ Twenty-two residents were tested after six months of their internal medicine rotation and compared to twenty-five residents that had the first rotation in another specialty (control). We showed a significant difference in the improvement of the script concordance tests scores (p=0.015) between the beginning and the end of their first rotation between the internal medicine and the control groups, and this implies the lower improvement of clinical reasoning skills and spontaneous learning slope of the junior doctors in other departments.
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Randomized Controlled Trial
The Effect of Music Therapy and Aromatherapy with Chamomile-Lavender Essential Oil on the Anxiety of Clinical Nurses: A Randomized and Double-Blind Clinical Trial.
Nurses may be anxious due to critical and emergencies, and anxiety can affect their professional performance. Non-pharmacological interventions, as a safe method, can reduce anxiety. This study aimed to determine the effect of music therapy and aromatherapy with chamomile - lavender essential oil on the anxiety of clinical nurses. ⋯ Therefore, the obtained mean score of each group was significantly lower than that of the control group (56.08) (p < 0.0001). The results showed that the interventions of music therapy and aromatherapy with chamomile-lavender essential oil could reduce the anxiety of nurses. Therefore, it is recommended to use music therapy and aromatherapy with chamomile-lavender essential oil to reduce the anxiety of nurses in the clinical setting.
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Whether syncope as a presenting symptom independently classifies acute pulmonary embolism (APE) into a high mortality risk group remains a matter of controversy. We retrospectively included all consecutive patients admitted to our clinic with APE from January 2014 to December 2016. Our sample consisted of 76 patients with a mean age of 69 ±13.6 years, 64.5% female. 14.3% presented with syncope at admission. ⋯ Patients with syncope had a higher PESI score (150.9 ± 51.1 vs 99.9 ± 30.1, p < 0.001) and a greater in-hospital mortality (OR= 4.5, 95% CI 1.14-17.62, p=0.03). However, multivariate logistic regression equations did not identify syncope as an independent predictor of mortality. In our sample, syncope did not independently reclassify the patient in a higher mortality group, but due to the association with hemodynamic instability, which remains the primary tool in therapeutic decision-making.
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Introduction and Objective: Medical errors and adverse events are among the major causes of avoidable deaths and costs incurred on health systems all over the world. Medical errors are among the main challenges threatening the safety of patients in all countries and one of the most common types of medical errors is medication errors. This study aimed to determine the frequency, type, and causes of medication errors in the emergency and pediatric wards of hospitals affiliated to Tehran University of Medical Sciences in 2017. ⋯ On the other hand, the most common causes of medication errors in clinical wards were the following: illegible physician orders, shortage of manpower and high workload, incomplete physician orders, the use of lookalike and sound-alike drugs, absence of pharmacist/pharmaceutical expert in the ward, lack of dosage forms appropriate for children, and lack of adequate training regarding drug therapy. Discussion and Conclusion: Considering the results of this study, it is necessary to reduce the workload and working hours of nurses, increase medical staff's awareness of the significance of medication errors, revise the existing techniques of drug prescription, and update the indices of human resource in hospitals. It is also necessary to correct the process of naming and selecting the dosage forms of drugs by the industry.
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Introduction: Patients under mechanical ventilation are usually in the supine position due to various arterial/venous tubes attached to them. Although many studies emphasize the advantages of prone position for oxygenation, some studies enumerate its disadvantages. Objective: The aim of the present research was to determine the effect of prone position on oxygenation of patients with Acute Respiratory Failure (ARF) under mechanical ventilation in the Intensive Care Unit (ICU). ⋯ Findings: The prone position had a significant relation to Oxygen Arterial Blood (Sao2) and Pressure of Arterial Oxygen (pao2), (p-value<0.05). Also, on days one and two, there was no significant relationship between the prone position and physiological signs; however, this relation was significant on day three (p-value<0.05). Conclusions: Results showed that the prone position improves sao2 and pao2 without adverse effect on physiological signs.