1. استاد راهنما : دکتر نوروزی ارائه دهنده : الهام حیدری

2. Relationship of Vitamin D Deficiency to Clinical Outcomes in Critically Ill Patients Title

3. Topic Study identification (Include author, title, year of publication, journal title, pages ) Author: David M.; Paul E; Kelly M; Stefan H; Alexandra J; and Daren K. Title: Relationship of Vitamin D Deficiency to Clinical Outcomes in Critically Ill Patients. year of publication: November 2012. journal title: American Society for Parenteral and Enteral Nutrition (aspen). Pages: 713-720.

4. Background Objective Method and material Result Discussion Critical appraisal 4

5. ویتامین D ساختمان کلسترولی

7. ویتامین D تفاوت های منطقه ای در وضعیت سرمی ویتامین D نقش دارد. تفاوت در مواجهه با نور خورشید, شرایط جغرافیایی, سطوح تابش فرابنفش, پیگمانتاسیون پوستی, از جمله موارد مهم تاثیر گذار بر وضعیت ویتامین D می باشند. Lucas et al 2005 شیوع کمبود ویتامین D در مشهد 61/3% بیان شده است. Heshmat et al 2008

8. Background Objective Method and material Result Discussion Critical appraisal 8

9. Objective The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes. We confirm in this study that vitamin D deficiency is common population and is associated with a longer ICU length of stay, may increase the risk of ICU-acquired infections and pneumonia, and may be associated with elevated organ failure scores. 1 2 34

10. Background Objective Method and material Result Discussion Critical appraisal 10

11. Method and material The authors conducted an analysis of samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital. Sample size

12. Method and material blood sample collection daily for a maximum of 10 days 1 Serum samples were also collected and stored at −80°C prior to analysis 2 They measured serum 25-hydroxyvitamin D at admission and up to 10 days following admission and followed patients prospectively for 28-day outcomes 3

13. Inclusion criteria What criteria are used to decide who should be INCLUDED in the study? The inclusion criteria of the patients included all consecutive patients 18 years and older who were expected to stay more than 24 hours in the ICU and were enrolled within the first 24 hours of ICU admission.

14. Exclusion criteria What criteria are used to decide who should be EXCLUDED from the study? Only patients admitted for overdoses were excluded from the study.

15. Background Objective Method and material Result Discussion Critical appraisal 15

16. Result Of analyzable patients: 50 (26%) were deficient (≤30 nmol/L). 109 (56%) were insufficient (>30 and ≤60 nmol/L). 1) Baseline 25(OH)D levels decreased significantly in all patients after 3 days in the ICU and remained significantly lower through 10 days (P <.001). 2)25(OH)D status was not significantly associated with 28-day all-cause mortality.

17. Result 3)Higher levels of 25(OH)D were associated with a shorter time-to-alive ICU discharge. 4)25(OH)D-deficient patients showed a non statistically significant trend toward a higher infection rate compared with patients with sufficient levels of 25(OH)D.

18. Background Objective Method and material Result Discussion Critical appraisal 18

19. Discussion vitamin D deficiency effect on longer ICU length of stay, ICU-acquired infections, pneumonia and organ failure scores

20. The earlier studies Lee P, (2009)

21. The earlier studies Mata-Granados JM, (2010)

22. Background Objective Method and material Result Discussion Critical appraisal 22

23. Critical appraisal Topic Abstract Introduction Method and material Result Discussion Conclusion References

24. Topic Relationship of Vitamin D Deficiency to Clinical Outcomes in Critically Ill PatientsDirect Use simple language ConciseMemorableInformative

25. Topic Study identification (Include author, title, year of publication, journal title, pages ) Author: David M.; Paul E; Kelly M; Stefan H; Alexandra J; and Daren K. Title: Relationship of Vitamin D Deficiency to Clinical Outcomes in Critically Ill Patients. year of publication: November 2012. journal title: American Society for Parenteral and Enteral Nutrition (aspen). Pages: 713-720.

26. Critical appraisal Topic Abstract Introduction Method and material Result Discussion Conclusion References

27. Abstract Brief Structured: -Back ground -Objective -Method -Result (specific data, statistically significant) -Conclusion -Keywords

28. objective

29. Critical appraisal Topic Abstract Introduction Method and material Result Discussion Conclusion Acknowledgment References

30. Introduction The reasons The earlier studies Objective

31. The reasons

32. The earlier studies Lee P, (2009)

33. The earlier studies Mata-Granados JM, (2010)

34. Objective The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes. We confirm in this study that vitamin D deficiency is common population and is associated with a longer ICU length of stay, may increase the risk of ICU-acquired infections and pneumonia, and may be associated with elevated organ failure scores. 1 2 34

35. Critical appraisal Topic Abstract Introduction Method and material Result Discussion Conclusion References

36. Method and material Sample size Type of study Exclusion criteria Inclusion criteria testimonial Method and material Statistical analysis

37. Sample size samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital. به روش تعیین حجم نمونه اشاره نشده است.

38. Method and material Sample size Type of study Exclusion criteria Inclusion criteria testimonial Method and material Statistical analysis

39. Cohort Type of study prospective study

40. Method and material Sample size Type of study Exclusion criteria Inclusion criteria testimonial Method and material Statistical analysis

41. Exclusion criteria What criteria are used to decide who should be EXCLUDED from the study? Only patients admitted for overdoses vitamin D were excluded from the study.

42. Method and material Sample size Type of study Exclusion criteria Inclusion criteria testimonial Method and material Statistical analysis

43. Inclusion criteria What criteria are used to decide who should be INCLUDED in the study? The inclusion criteria of the patients included all consecutive patients 18 years and older who were expected to stay more than 24 hours in the ICU and were enrolled within the first 24 hours of ICU admission.

44. Method and material Sample size Type of study Exclusion criteria Inclusion criteria testimonial Method and material Statistical analysis

45. Testimonial Research ethics boards from Queen’s University approved the protocol for the original study; informed consent was obtained from next of kin before enrollment.

46. Method and material Sample size Type of study Exclusion criteria Inclusion criteria testimonial Method and material Statistical analysis

47. Method and material blood sample collection daily for a maximum of 10 days 1 Serum samples were also collected and stored at −80°C prior to analysis 2 They measured serum 25-hydroxyvitamin D at admission and up to 10 days following admission and followed patients prospectively for 28-day outcomes 3

48. Method and material Sample size Type of study Exclusion criteria Inclusion criteria testimonial Method and material Statistical analysis

49. STATISTICAL ANALYSIS The Student t test was used to compare the means of baseline 25(OH)D between patients with and without pneumonia.

50. STATISTICAL ANALYSIS

51. Critical appraisal Topic Abstract Introduction Method and material Result Discussion Conclusion References

52. Result Brief and organized Consist of : words table statistics

53. words

54. table

55. statistics

57. words

60. Result

62. Critical appraisal Topic Abstract Introduction Method and material Result Discussion Conclusion References

63. Discussion خلاصه ای از شرایط مطالعه مروری بر یافته های قدیم محدودیتها و نقصهای مطالعه پیشهاد در مورد مطالعات بعدی در این زمینه

64. خلاصه ای از شرایط مطالعه

65. مروری بر یافته های قدیم Lee P, (2009)

66. مروری بر یافته های قدیم Mata-Granados JM, (2010)

67. محدودیتها و نقصهای مطالعه 1 2

68. 3

71. Discussion پیشنهاد در مورد مطالعه های بعدی دراین زمینه داده شود :

72. Critical appraisal Topic Abstract Introduction Method and material Result Discussion Conclusion References

73. Conclusion

74. Thanks for your attention