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  Background & Aim: Premature infants are the most admitted group to NICUs. Stabilization of cardio pulmonary parameters is a main goal in NICUs. Mechanical ventilation and endothracheal suctioning are the most common and effective procedures to stabilize cardio pulmonary parameters. The aim of present study was to compare the effects of two endothracheal suctioning methods (open and closed) on physiological stability in premature infants under mechanical ventilation .

  Methods & Materials: In this clinical trial, 90 preterm infants (GA: 27-34 weeks) hospitalized in the NICUs of Alzahra and Taleghani hospitals were selected and randomly assigned to two groups. In one group, infants were suctioned using open suctioning method and in the other group, infants were suctioned using closed suctioning method. The physiologic parameters (O2 sat, HR, mean BP variation) and stability (recovery time of HR, BP) were compared between the groups. Data were analyzed using descriptive and inferential statistical methods such as x², independent t-test and mixed model in the SPSS-21 . 

  Results: There was significant statistical difference between the two groups on mean BP (P=0.016). Recovery time of the BP and HR was shorter in the closed suctioning group. Physiologic stability was better in the closed suctioning group (P<0.05) .

  Conclusion: Variation of the mean BP and recovery time was more in the open suctioning group compared with the closed suctioning group. Considering better physiologic effects of closed suctioning, it is recommended to assess the combined effect of closed suctioning with weight on physiologic parameters of premature infants .

  

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Background & Aim: Randomized clinical trials (RCTs) are studies which are able to provide the most valid evidence to compare various interventions in health research. Biases can affect the quality of research and ultimately make the results of a study invalid. One of the most important biases is selection bias. The best way to reduce selection bias is the use of random allocation. The aim of this study is to provide comprehensive, practical and simple information regarding proper implementation of the random allocation process in randomized clinical trials.

Methods & Materials: A review study was performed using available resources and comprehensive analysis. For this purpose, we searched the relevant books & articles in databases including Medline, Scopus, Science Direct, Google Scholar and Magiran. Key words were randomization, random sequence, allocation concealment, randomized controlled trial, randomized clinical trial, and bias.

Results: From the literature review, we obtained 39 articles and one relevant book that their findings were presented in a simple language with practical examples in three parts including random sequences generation, random allocation concealment and implementation.

Conclusion: Selection bias in clinical trials has an adverse effect on the accuracy of results. In order to avoid it, researchers should employ proper methods in randomization and random allocation concealment, and report it in their articles properly. Therefore, researchers can obtain valid results through a better understanding of randomization and its proper implementation.

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Background & Aim: Randomized controlled trials often suffer from two major problems, i.e., noncompliance and missing outcomes. One potential solution to this problem is using the intention-to-treat (ITT) analysis approach. Therefore, the aim of this study was to review the concept of ITT and the most important issues related to it in practice since RCT researchers utilize it as a guide in order to improve the quality of RCT studies.

Methods & Materials: A review study was performed using available resources and comprehensive analysis. For this purpose, we searched the relevant articles in databases including Ovid/Medline, SCOPUS, Web of Science, Google scholar and Magiran. The key words that were used included randomized clinical trials, randomized controlled trials, intention-to-treat analysis, per-protocol analysis, ITT, as-treated.

Results: The advantages of ITT, the critique of ITT, the alternatives of ITT and their limitations, missing data and their management in clinical trial studies were discussed in this paper.

Conclusion: ITT approach, due to its adherence to the principles of randomization, protects clinical trials from confounding and bias and therefore leads to the generation of the highest quality scientific evidence in the clinical research field. ITT should be considered a strategy at all stages of research, including the design of study, implementation and data analysis, and it should not be considered only a statistical approach.

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Background & Aim: Nurses play an important role in the health system and their turnover disrupts its performance. The aim of this study was to investigate intention to turnover and its relationship with healthy work environment among nursing staff.
Methods & Materials: This cross-sectional study was conducted on 295 nursing staff from Imam Khomeini hospital complex in Tehran in 2016. Nurses were selected by the stratified random sampling with a proportional allocation, and completed a demographic data form, the Healthy Work Environment questionnaire and the Anticipated Turnover Scale (ATS). Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Pearson/Spearman correlation coefficient and multiple linear regression tests using the SPSS software version 20.
Results: The mean score for the intention to turnover was 36.21 (SD=4.38) ranged from 12 to 60. “Authentic leadership” and “skilled communication” domains obtained the highest (9.60±3) and lowest (8.97±2.74) scores respectively. There was poor correlation between the meaningful recognition domain and the anticipated turnover score (r=-0.135, P=0.024). In addition, the anticipated turnover score was significantly higher in male nurses than in female nurses (P=0.023).
Conclusion: Although there was no relationship between anticipated turnover and healthy work environment in this study, considering the importance of nurses’ recruitment and retention, there is a need to investigate the reasons for turnover, including characteristics of work environment, and take necessary measures.
 
 

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Background & Aim: Intramuscular injections represent a painful procedure for premature infants. This study aimed to compare the effects of pressure massage at Hegu point versus Kunlun–Taixi pressure points on pulse rate, arterial oxygen saturation, and crying duration following intramuscular injection of vitamin K in premature infants.
Methods & Materials: A randomized, single-blind clinical trial was conducted on 100 premature infants admitted to the neonatal intensive care unit between 2020 and 2021. Participants were selected through convenience sampling and then randomly assigned into four groups of 25 individuals each: Hegu point massage, Kunlun–Taixi points simultaneous massage, placebo and control. Prior to the vitamin K injection, the intervention groups received targeted pressure point massage, the placebo group received nasal tip massages, and the control group received standard care. Pulse rate, arterial oxygen saturation, and crying duration were recorded before, during and after the intramuscular injection using a pulse oximeter and chronometer. Data were analyzed using two-way repeated measures analysis of variance in SPSS software version 24.
Results: Significant differences were observed in average pulse rate (P=0.013) and average arterial oxygen saturation (P=0.028). The group receiving simultaneous massage at Kunlun–Taixi points exhibited the lowest mean pulse rates during (149.24±7.78) and after (144.16±8.64) the injection, as well as the highest mean arterial oxygen saturation percentages during (88.36±9.37) and after (88.04±8.33) the injection.
Conclusion: Simultaneous massage of Kunlun–Taixi pressure points reduced changes in pulse rate and arterial oxygen saturation induced by intramuscular injection in premature infants. It is recommended to use this simple and low-priced method to reduce the physiological responses to injection-related pain in premature newborns.
Clinical trial registry: IRCT20210630051743N1