Journal of Isfahan Medical School
Year:2021 | Volume:39 | Issue:613|Papers Count:3

Background: Acute kidney injury is a major problem in hospitalized patients, especially patients in the intensive care unit (ICU), which plays an important role in the outcome, hospitalization length, and treatment costs. The present study aimed to assess the incidence of acute kidney injury (AKI) and its risk factors in a sample of ICU patients. Methods: This was a cohort case series study that evaluated 500 patients from ICU in of Alzahra hospital, Isfahan, Iran, during the year 2016-2017. In total, 2700 patients were admitted to 4 ICUs of this hospital, of which, 500 were randomly entered to the study. Demographic and lab data were gathered using a checklist, and patients were followed up by checking twice in a week. Finally, the incidence of AKI and its risk factors were determinate based on different variables. Findings: The overall prevalence of AKI was 40. 8%. The AKI group was classified according to Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) criteria, which showed 44. 6% at risk, 29. 4% at injury, 18. 1% at failure, and 7. 8% at loss stages, respectively. The mean age (56. 5 vs. 51. 4 years), hospitalization time (29. 38 vs. 12. 92 days), and mortality (40% vs. 55) in patients with AKI were higher. Of 204 patients with AKI, 39% had complete recovery, 8% relative recovery, and 40% died. Moreover, 30 patients needed dialysis during the hospitalization, 13% of them became dialysis-dependent. Conclusion: According to the data of this article on the high incidence of AKI in ICU, this complication is also one of the important problems of ICUs in our country, Iran. However, despite other similar articles, the mortality rate from AKI in this study is lower, which can indicate an improvement in preventive, diagnostic, and therapeutic measures for this complication.

Background: Hematoma block (HB) is a technique for local anesthesia injection between fractured bone fragments. The aim of the present study was to compare the effect of HB with injection of lidocaine with and without ketamine on reduction of pain, blood pressure, and heart rate in patients with distal radius fracture. Methods: In this randomized double-blind clinical trial study, a total of 60 patients with distal radius fracture were randomly selected and divided in two equal groups. Patients in the first group underwent HB with injection of 8 ml lidocaine 2%, and patients in group B underwent HB with injection of 8 ml lidocaine 2% plus ketamine (0. 5 mg/kg). The intensity of pain, blood pressure, and heart rate were measured before, during, and after 1 and 6 hours of bone placement. Findings: There was no significant difference in the mean pain between the two groups before bone reduction (P = 0. 87). But, the mean pain significantly was lower in group B during (P = 0. 004) and 1 (P < 0. 001) and 6 (P < 0. 001) hours after bone reduction. Conclusion: According to our data, it can be concluded that combination of ketamine and lidocaine has better analgesic effect in HB technique in patients with distal radius fracture. However, further studies should be conducted to confirm our data.

Background: Given that clinical education is at the heart of medical education, it is also very important to pay attention to the efficiency of clinical teaching and a good clinical teacher. Clinical instructors often play both educational and therapeutic roles at the same time, and they must be empowered enough to not only do the right thing, but also to show and explain to students how to do it. The aim of this study was to explain the characteristics of a good clinical teacher based on the experiences of medical residents. Methods: In this study, 14 medical assistants were selected through purposive sampling. Data were collected using a semi-structured interview. Coding and data analysis were performed using MAXQDA 2012. Content analysis method was used to analyze the data. Findings: In continuous and rotational analysis of the data, 60 codes were finally obtained, which were divided into 10 subcategories and 3 main categories. Based on the experiences of assistants participating in the study, help and support, nurturing, counseling and guidance, role model, morality, patient care, scientific expertise, clinical skills, educational management, and teaching experience were expressed as the main characteristics of a good clinical teacher that were classified in three categories of supporter and mentor, ethics model, and wise instructor. Conclusion: In this study, the characteristics of a good clinical teacher were identified with more depth. By paying attention to the results of the study, clinical professors can have a comprehensive plan to acquire these characteristics, and while empowering themselves, help to promote clinical education and community health.