Sir: We read with interest Bousarri et al.’s article which has been recently published in your journal under the title “The effect of expiratory rib cage compression before endotracheal suctioning on the VITAL SIGNS in patients under mechanical ventilation.” While the article is potentially of interest to readers, there are several aspects that need attention.

Background: Cooling the dialysate is an important factor that contributes to the hemodynamic stability in patients during hemodialysis. The aim of this study was to determine the effect of cool dialysate on VITAL SIGNS, and the adequacy and common complications of hemodialysis. Materials and Methods: The present crossover, triple-blind, clinical trial was performed on 62 dialysis patients, who were selected through stratified block randomization. First, one group underwent hemodialysis using a cool dialysate (35° C), and the other received routine hemodialysis (36. 5° C). Each patient received a total of eight hemodialysis sessions. Then, treatment methods were swapped, and each group received the other group's method. The patients' blood pressure, pulse rate, and temperature were measured before dialysis, and in the first, second, third, and fourth hours of dialysis. The frequency of common complications of hemodialysis and dialysis efficacy were measured. The marginal model and Generalized Estimating Equations (GEE) were used to analyze the data. Results: The participants' systolic (p = 0. 01) and diastolic blood pressures significantly increased with a decrease in temperature (p = 0. 005). The patients' pulse rate (p = 0. 143), adequacy of dialysis (p = 0. 922), and common complications of hemodialysis did not significantly differ between the two temperatures (p > 0. 05). Conclusions: Reducing dialysate temperature from 36. 5 to 35° C led to hemodynamic stability; the blood pressure of the patients undergoing hemodialysis was more stable with the cool dialysate method and the number of drops in the blood pressure during the hemodialysis was reduced.

Introduction: Big volume of patient’ s medical data is one of the medical error reasons in coronary care unit (CCU). The purpose of this study was the designing a system that can monitored the patient’ s VITAL sign continuously and when there are abnormal, producing alarms and proposed appropriate medical interventions according to the patient’ s conditions in CCU. Methods: This was application-development study that done in cross-sectional method in Shahid Rajai hospital at Tehran in 2015. 15 physicians and 15 nurses of CCU were considered as nonrandom purposively sampling. MEAN. js technology and MIMIC II Physionet’ s database were used for system designing. Results: Normal and abnormal ranges of VITAL SIGNS were assessed according to the environmental and population conditions in this study. Variety of therapeutic interventions due to the patients’ VITAL SIGNS changing was identified with their priorities. The results showed that the clinical decision support system (CDSS) had accuracy (94/68 %), sensitivity (82/60 %) and specificity (100 %) in proposing of proper interventions and had (92/92 %) accuracy, (80 %) sensitivity and (100 %) specificity in producing of timely alarms. Conclusion: There are several factors that impact on determining of normal and abnormal ranges of VITAL SIGNS and interventions priorities. The results showed that CDSS can help professionals in appropriate medical interventions selecting in unanticipated conditions at clinical care processes. At clinical point, this system can improve the understanding of VITAL SIGNS, patient health conditions and decision-making process that can help in reducing of medical errors.

Aims: Pain is the main complain of hospitalized patients suffering from burns. Anxiety, troubled interaction with others, disturbed sleep, movement defect, loss of appetite, low quality of life, and increase in healthcare and hospitalization costs are the consequences of non-alleviated pain and pruritus. Regarding this the present study aimed to investigate the effectiveness of muscle relaxation on severity of pain, pruritus and VITAL SIGNS among patients suffering from burns.Methods: In a semi-experiment study and by using a simple convenient sampling method, 110 hospitalized patients of Burn Ward were randomly chosen in two separated stages and allocated to case and control groups. It took two consecutive months to choose the controls and cases respectively. Tools for data gathering were as follows; demographic information, a pain visual analogue scale, and pruritus assessment scale and documentation form (VITAL SIGNS, pruritus, and pain). As the desired intervention, cases were delivered a twenty-minute Benson muscle relaxation and then their pain, pruritus and VITAL SIGNS were measured and compared to these in controls. Achieved data were analyzed by SPSS software16.Results: There were no significant differences between severity of pain (mean of pain in controls and cases were 5.8 and 6.3 respectively), itching (mean of pruritus in controls and cases were 3.5 and 2.6 respectively), and VITAL SIGNS (respiration, pulse rate, blood pressure, perspiration and dilated pupils) in two groups (p>0.05). But, conversely, a post-intervention independent t-test revealed that there were significant differences between severity of pain (mean of pain in controls and cases were 5.5 and 2.2 respectively), itching (mean of pruritus in controls and cases were 3.6 and 2.1 respectively) and VITAL SIGNS (respiration, pulse, perspiration and dilated pupils) in two compared groups (p<0.05).Conclusions: Muscle relaxation technique can be effective in relieving the pain, pruritus and VITAL SIGNS of patients suffering from burns. Therefore, its use as a therapeutic and alleviative method could be suggested for patients suffering from burns.