---

Background&Objective: Research utilization provides quality and cost- effective care, optimizing patient outcomes and enhancing the credibility of nursing. Despite of increase in the amount and quality of nursing research, the conduct of research and use of its results remains poor. In Iran one of the most important barriers of research is related to research utilization. The aim of this study is to identify the barriers and facilitators of research utilization in nursing practice. Materials&Methods: The study used a descriptive- analytic design. The questionnaire was divided into two sections: The former asked for information on the academic and professional profiles of respondents, the latter was based on the BARRIERS Scale. In addition there was one open –ended question to measure the facilitators of research utilization. Content and face validity was further enhanced by submitting it to nursing researchers. Results: In factor analysis procedure four factors were extracted. The factors were labeled as: organization barriers and limitations, Quality of research, Nurses' values, awareness and skills, Communication of research. Factor loading for barrier item ''the nurse is unaware of the research'' was not included under factor headings. The top three barriers were The nurses do not have time to read research, the facilities are inadequate for implementation and the nurses do not feel they have enough authority to change patient care procedures. All the participants suggested facilitators to increase research use The most frequently mentioned facilitators were related to human resources, individual and organizational factors. Conclusion: The most dominant findings were related to organizational support. The top three barriers mentioned by the participants reflect a traditional organizational culture which hinders professional autonomy. Organizations need to ensure that facilities are provided and give the authority to the nurses to change the practice based on research.

---

Background & Objective: Propofol is one of the latest anesthetic agent which has many advantages with few side effects in patients. One of the application problems of this drug is pain at the time of injection. Several methods are investigated to reduce the pain, and one of them is the application of Lidocaine together with Propofol.

Materials & Methods: This randomized clinical trial study was done in 5th Azar teaching during 2007. 272 patients were selected randomly between age of 15-55 years with ASA Class I,II who were the candidates of elective surgery. We injected  Fresenius %1 to the first group with 91 patients, Lipuro %1 to the second group with 90 patients and Propofol drug Lipuro %1 mixed with 20 mg Lidocaine (2 ml of Lidocaine %1) to the third group with 91 patients. Injections was carid out on the supenlial vein of dorsal hand. Patients were asked about the severity of pain at the time of injection, 5-10 seconds after %25 of anesthetic induction doze. Data analyzed with using SPSS software and Chi-Squre test.

Results: The rate (incidence) of pain (Score 1-3) has been 63.91 (%69.2) in the first group, 50.90 (%55.6), and 22.9 (24.2%) in the third group in which there is a significant difference (P<0.001). Moderate and sever intensity of pain (Score 2.3) was 42.91 (46%) For the first group, 18.90 (20%) for the second group and 2.91 (2.2%) for the third group (P<0.001).

Conclusion: On the basis of this study, it is recommended to use lidocaine, at the time of injection, to reduce pain.

---

Endoscopic sinus surgery can cause orbital and intracraniol complications. Anisocoria is one of sings of orbital complication. We report a case with anisocoria during endoscopic sinus surgery. Patient was a 42 years old female that was operated because extensive polyposis in right nose and sinuses and retention in otherwise under general ansthesia. A half on hour after the surgery was started, we found dilatation of pupil in left eye which unresponsed to light. Also, as far as the eye symptoms returned to normal after 8-10h after and there was not any veridence of orbital trauma. It seems difiusion of local injection of adrenalin in surgery nasal cavity can probably case of pupil dilatation.

---

Background and Objective: Mortality rate and causes of death is one of the main components in health planning at each society. This study was done to show the pattern of mortality trends in Iran during 1970-2009. Materials and Methods: In this cross-sectional descriptive study related data to 9740656 deaths registered in National Organization Civil Registration were surveyed and analyzed during 1970-2009. SPSS software and statistical descriptive methods were applied to evaluate the data. Results: 60.4% of all registered death was in rural areas. 61.1% were male. Crude death rate according the current statistics decreased from 13 per 1000 in 1970-75 to 5 per 1000 in 2005-09. Life expectancy with 28.6% increased from 55.2 years in 1970-75 to 71 years in 2005-09. Conclusion: This study showed that all mortality indicators in Iran were lower than other part of the world. There was a general decreasing in infant mortality rate in last three decade. Also the death registry system has been improved during study years.

---

Background and Objective: The characterization of any disease have important role for the evaluation and control strategy and programming of diseases. This study was done to determine the epidemiology of Tuberculosis in Iran during 2001-08. Materials and Methods: In this descriptive cross sectional study, Annual percentage change (APC), average annual percentage change (AAPC) of Tuberculosis incidence rate, mortality of Tuberculosis, case detection rate, success percentage in Tuberculosis treatment and relapses cases during 2001-08 have been studied in Iran. Linear segmented regression model was used for analysis trend of Tuberculosis and estimate parameters. Results: The trend of Tuberculosis smear positive (SP) incidence rate was reduced in Iran during 2001-08. Anually, 4.1% and 3.6% reduction took place in incidence rate and relapses cases, respectively. Tuberculosis mortality decreased annually by 6.8% and success in case detection increased by 2.5%. The Tuberculosis treatment though AAPC is decreasing by 0.5%. The trend of Tuberculosis are higher among women and in both sexes over 65 years of age. Conclusion: This study showed that trend of SP pulmonary tuberculosis and treatment success rate is decreased, but case detection was increased.

---

Background and Objective: Multiple sclerosis is one of demyelinating disorder of CNS that is an uncommon cause of the sensorineural hearing loss. This study was done to determine the hearing loss in multiple sclerosis patients.

Materials and Methods: This case-control study was performed on 60 (44 women, 16 men) multiple sclerosis patients and 38 (27 women, 11 men) normal subjects by pure tone audiometery, otoacustic emissions and auditory brainstem responses in Gilan provine, Iran during 2010-11. Data was analyzed by using SPSS-17, Chi-Square and Fischer tests.

Results: 12.5% of case and 3.9% of the control ears had abnormal pure tone audiometery (P<0.05). The frequencies of abnormal HF-pure tone audiometery and two modalities of otoacustic emission did not show any significant differences in two groups. Abnormal autidory brainstem response of ears were observed in 20% and 9.2% of cases and controls, respectively (P<0.05). 20% of case and 9.2% of the control ears had abnormal auditory brainstem response (P<0.05). The absolute latencies of waves I, II and V had not significant differences between two groups. Inter peak latencies of I-III and III-V waves were observed in 10% and 11.7% in cases ears and 1.3% and zero percent in controls, respecticely. 6.7% of cases and 2.6% of control ears had retrocochlear abnormality.

Conclusion: Hearing loss detected by pure tone audiometery and auditory brainstem response is more common in multiple sclerosis compared to normal population.

---

Background and Objective: Electro convulsion therapy (ECT) is one of the most common ways for treatment of psychiatric disorders. The aim of this study was to compare the effect of Propofol, Etomidate, and Thiopental on seizure and recovery duration following ECT.
Methods: In this clinical trial study, 90 patients diagnosed with a psychiatric disorder by a psychiatrist, who need to be treated by ECT in 5 Azar hospital, Gorgan, north Iran. The patients were randomly divided into the three groups by simple random allocation method. Interventions included standard monitoring and pre-oxygenation with 100% FiO2 for 3 minutes for all patients in three groups. Anesthesia of the patients in the first, second, and third group was done with Thiopental (1.5 mg/kg), Propofol (0.6 mg/kg), and Etomidate (0.1 mg/kg), respectively. Administration of Succinyl Colin (0.5 mg/kg) as muscle relaxant and Atropine for prevention of bradycardia was uesd in all patients. Duration of seizure and recovery; changes in hemodynamic status including heart rate (HR) and mean arterial pressure (MAP); and amount of charge for ECT were recorded for each subject.
Results: Mean of seizure duration in Thiopental, Propofol, and Etomidate groups were 43.72±11.81, 35.74±10.58 and 45.81±17.26 seconds, respectively (P<0.05). Amount of charge for ECT in 3 sessions of treatment and changes of HR were not different between the 3 groups. Changes of MAP in the Propofol group was significantly less than other two groups (P<0.05). Recovery time following ECT was the least in Etomidate group in comparison with Thiopental and Propofol (P<0.05).
Conclusion: Ethomidate and Thiopental had the same effect on increasing seizure duration. However, due to the significant reduction in recovery time compared with Thiopental, Ethomidate may be considered as the best choice.

---

Background and Objective: Chronic itching reduces the quality of life of patients undergoing hemodialysis. This study was done to determine the effect of chronic itching on the quality of life of patients under hemodialysis in north of Iran.

Methods: In this descriptive-analytical study, 111 patients with mean age of 58.36±12.7 years were randomly selected from hemodialysis centers of Golestan province from May to December 2017. Demographic data, quality of life (Itchy QOL questionnaire), Xerosis, pruritus intensity (Balaskas 1998), and laboratory tests including calcium, phosphorus, alkaline phosphatase, parathyroid hormone, blood urea nitrogen, creatinine, hemoglobin and hematocrit were evaluated.

Results: The mean score of itching severity and overall quality of life was 29.27±7.46 and 41.4±10.44, respectively. There was a significant correlation between the severity of itching and the overall score of patients' quality of life (P<0.05). Correlation between severity of pruritus with symptom dimension, functional dimension and emotional dimension was significant (P<0.05). There was a significant correlation between severity of itching and Xerosis and serum calcium level (P<0.05). There was a significant correlation between Xerosis and calcium level with increased itching (P<0.05).

Conclusion: Itching reduced the quality of life in hemodialysis patients in north of Iran.

---

Background and Objective: Appropriate analgesia after surgery helps patients feel more comfortable and increase the mobility of them. The purpose of this study was to compare the effect of subcutaneous injection of Ketamine and Lidocaine in reducing postoperative pain in patients undergoing elective inguinal hernia surgery under general anesthesia.
Methods: This double blinded, randomized clinical trial study was done on 60 patients undergoing elective inguinal hernia under general anesthesia. Subjects were randomly assigned into three groups including control, Ketamine and Lidocaine groups. Subjects in Ketamine group were received infiltration of subcutaneous Ketamine 0.5 mg/kg/bw after closure of surgical incision. Subjects in Lidocaine group were received infiltration of subcutaneous Lidocaine 1 mg/kg/bw at the time of wound suturing. Subjects in control group did not receive Ketamine and Lidocaine. The visual analogue scale (VAS) of pain and vital signs were continuously assessed. If VAS≥3, 100 mg diclofenac suppository was administered and if there were no response, 30 mg intravenous pethidine was also administered. The complications, including hallucination, nystagmus, nausea, vomiting and drowsiness in patients were also recorded.
Results: The mean VAS at 1, 2 hours after surgery were significantly lower in the Ketamine and Lidocaine group in compared to control group (P<0.05). No significant adverse effect was observed in the Ketamine group.
Conclusion: For reduction of pain, administration of subcutaneous Ketamine is recommended due to no adverse effect and anti analgesic effect of Ketamine is similar to Lidocaine.

---

Background and Objective: Ventilator-associated pneumonia (VAP) is an important complication in intensive care unit (ICU) patients with endotracheal intubation. Finding potential early indicators of this condition can aid in reducing the disease burden. We aimed to investigate the relationship between VAP occurrence and serum levels of C-reactive protein (CRP), procalcitonin (PCT), and hemoglobin (Hgb) during ICU hospitalization of brain trauma patients.
Method: This descriptive-analytical study was carried out on brain trauma patients (99 male, 39 female), referring to the 5th Azar hospital in Gorgan, Iran, in the course of 2017. The patients were hospitalized in ICU with endotracheal intubation and mechanical ventilation. The diagnosis of VAP was confirmed by a 12-score rating based on chest radiographs, body temperature, white blood cell count, and sputum culture. After admission, serum CRP, PCT, and Hgb were documented daily for 6 days.
Results: According to the diagnostic criteria, VAP was confirmed in 41 patients (30%). Serum CRP and PCT levels on the 6th-day post-admission were significantly associated with VAP diagnosis, while Hgb levels did not differ significantly between VAP and non-VAP patients. Serum levels of CRP, PCT, and Hgb on the 6th day were not associated with age or sex.
Conclusion: Our results indicate that serum CRP and PCT levels are associated with the occurrence of VAP in ICU patients receiving mechanical ventilation. Therefore, these biomarkers could be utilized to warn physicians about the possibility of VAP, thereby reducing mortality rate and hospitalization length.