Educational Hospitals In Tehran Research Articles

Staff perspectives on the relationship between knowledge management and social capital with organizational health in selected educational hospitals in Tehran.

INTRODUCTION:Knowledge management enhances efficiency, empowers employees, and enhances organizational health. Social capital provides a good basis for more productive human resources, and training hospitals also play a key role in the health-care system. The purpose of this study was to determine the relationship between knowledge management and social capital with organizational health in selected educational hospitals of Tehran in 2018.METHODS:This analytical cross-sectional study was performed on 310 medical staff of hospitals using proportional sampling method. The data gathering tools consisted of three standard questionnaires of knowledge management, social capital, and organizational health. Data were analyzed using descriptive and inferential statistics using SPSS version 22 software.RESULTS:Most participants in this study were male (8/66%) and in the age group 31–36 years. The mean of knowledge management and organizational health were 3.43 and 3.49, respectively. There is a significant direct relationship between knowledge management components and organizational health. Moreover, there is a significant but weak direct relationship between knowledge management and social capital with organizational health dimensions (P ≤ 0.05).CONCLUSION:Considering the relationship between knowledge management and social capital with organizational health, enhancing the level of organizational health can help to improve the dimensions of knowledge management and social capital. It is suggested that hospital managers, using knowledge management and social capital components, enhance organizational health so that the hospital is more prepared to adapt to the complexities and changes in the market providing services.

Does the Trace Element Deficiency (Vit A, D & Zinc) Have Any Role in Vulnerability to Urinary Tract Infection in Children: A Case-Control Study: Tehran, Iran

Background and Objective: Urinary Tract Infection (UTI) is one of the most common causes of hospital admission in our young population. This prospective cohort study was carried out to assess the relation of serum levels of zinc, vitamins A and D with UTI in children with proven UTI. Methods: The serum levels of Zinc, vitamins A and D were compared between 25 proven UTI cases (admitted in 2 educational hospitals in Tehran) and 40 controls without infection (children who had undergone for elective surgery). The average age of children was 2.17 years. Atomic absorption Spectrophotometry, Radioimmunoassay, and HPLC methods were used for measuring the Zinc, Vit D and A, respectively. Results: Although the serum levels of zinc were significantly lower in UTI cases (P=0.05), no significant differences had observed between cases and controls for vitamins A and D in sera (P=0.4 and P=0.9). Conclusion: Due to established lower zinc level in UTI cases (p-value = 0.05), zinc deficiency might have a role in susceptibility to UTI in studied children. Administration of zinc could be helpful in preventing UTI. To establish the role of Vitamins A and D in vulnerability to UTI, further extensive research with larger samples is needed. Conclusion: Due to established lower zinc level in UTI cases (p-value = 0.05), zinc deficiency might have a role in susceptibility to UTI in studied children. Administration of zinc could be helpful in preventing UTI. To establish the role of Vitamins A and D in vulnerability to UTI, further extensive research with larger samples is needed.

Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case Control Study.

Background: Patient falls are considered a challenge to the patient’s safety in hospitals, which, in addition to increasing the length of stay and costs, may also result in severe injuries or even the death of the patient. This study aims to investigate the associations between risk factors among fallers in comparison with the control group. Methods: A prospective nested case control study was performed on 185 patients who fell and 1141 controls were matched with the patients at risk of fall in the same ward and during the same time. This study was conducted in a university educational hospital in Tehran with 800 beds during a 9-month period. The data included demographics, comorbidities, admission details, types of medication, clinical conditions, and activities before or during the fall. The data was collected from clinical records, hospital information system, error reporting system and observations, and the interviews with the fallers, their families and care givers (physicians, nurses, etc). Data analysis was conducted through time-based matching using a multi-level analysis. Results: In a multilevel model including patient-related, medication, and care-related variables, the factors that were significantly associated with an increased risk of patient falls included: longer length of stay (odds ratio [OR] = 1.01; CI=0.32 to 0.73), using chemotherapy drugs, sedatives, anticonvulsants, benzodiazepines, and angiotensin-converting enzyme (ACE) inhibitors, visual acuity (OR=6.93; CI=4.22 to 11.38), balance condition (OR= 6.41; CI=4.51 to 9.11), manual transfer aid (OR=8.47; CI=5.65 to 12.69), urinary incontinence (OR= 8.47, CI= 5.65 to 12.69), and cancer (OR=2.86, CI=1.84-4.44). These factors were found to be associating with more odds for a falling accident among patients. Several characteristics such as fall history (OR=0.48; CI= 1.003 to 1.02), poly-pharmacy (OR=1.37, CI=00.85 to 2.2), stroke (OR=0.94, CI= 0.44 to 2.02), and nurse to patient ratio (incidence rate ratio=1.01, CI=0.01 to 0.03) were not significantly associated with falling in hospitals. Conclusion: It seems that a combination of both patient-related factors and history of medication should be considered. Moreover, modifiable clinical characteristics of patients such as vision improvement, provision of manual transfer aid, diabetes control, regular toilet program, and drug modification should be considered during the formulation of interventions.

Frequency of Uncommon Clinical Yeast Species Confirmed by ITS-Sequencing

Background: Accurate speciation of the clinical yeast isolates is essential to a targeted treatment. Objectives: The aim of this study was to identify and determine the frequency of uncommon and rare yeast species causing fungal infections that may be misidentified. Methods: During a 10-month period, yeast isolates collected from patients referring to or hospitalized in some educational hospitals in Tehran, Iran, were included in this study. In addition to conventional methods such as direct microscopy and culture on CHROMagar Candida, molecular methods including PCR-RFLP and ITS-sequencing were used for the accurate identification of the yeast strains. Results: Among 930 yeast isolates recovered from normally sterile and other clinical specimens, a total number of 27 strains were identified as uncommon Candida species and three were identified as rare non-Candida species yeasts. They included C. kefyr (n = 12), C. lusitaniae (n = 8), C. intermedia (n = 3), C. orthopsilosis, C. guilliermondii, and Trichosporon asahii (each n = 2), and Magnusiomyces capitatus (n = 1). Conclusions: The isolation of less common or rare yeast species, which can cause a variety of infections from superficial to systemic infections, is increasingly reported. Since this uncommon yeast species may exhibit low susceptibility to some antifungal agents, the use of reliable methods for accurate screening of these yeasts is necessary.

Influence of Preoperative Magnetic Resonance Imaging in Surgical Planning for Breast Cancer

Background: Assessment of efficacy of preoperative magnetic resonance imaging (pMRI) is important to improve the diagnosis and treatment results in patients with breast cancer (BC). Objectives: We designed this study to determine the role of pMRI in surgical planning for patients suffering from BC. Methods: We, cross sectionally, observed 98 women with BC referring to an educational hospital in Tehran from January 2014 to December 2015. Data pertaining age, pathological type of BC, preoperative imaging findings, and surgical planning were gathered. The frequency of plan alteration was determined according to pMRI findings and analyzed, using appropriate statistical analyses (descriptive statistics, independent t-test, Chi-square, and Fisher’s exact tests). Results: Initial surgical plan of 23 patients (23.47%) was changed. Pathological diagnosis of BC (P = 0.460), size of lesion (P = 0.696), laterality (P = 0.139), and lymph node involvement (P = 0.094) did not seem to alter the surgical plan. On the contrary, younger age (P = 0.049), more lesions (P = 0.002), pMRI enhancement curve washout pattern (P = 0.020), and multifocality (P 0.050). Conclusions: pMRI findings, including multiple lesions and multifocal involvement showing enhancement pattern suggestive for malignancy, may change surgical planning in about a quarter of women suffering from BC, particularly the younger ones, but MRI is not mere criterion for determining and usage of it should be limited to necessary subjects because when it is done without strict parameters, it will cause over diagnosis and over treatment.

The consequences of nurses' endeavors to overcome inter-professional discrimination.

Discrimination in nursing has led to the formation of some taboos that often impact the individual's professional development. Nurses use strategies to overcome discrimination that can lead to consequences. This study assessed nurses' experiences to explore the consequences of Iranian nurses' strategies to overcome intra-professional discrimination. This qualitative content analysis study employed purposive sampling to reach 25 nurses working at educational hospitals in Tehran, Tabriz, and Ilam, Iran. The data were collected using deep and unstructured interviews along with notes in a period of time between April 2016 and May 2017. Interviews were simultaneously analyzed using inductive and conventional content analysis method after being transcribed. This study was approved by the Regional Committee of Medical Research Ethics. Also, voluntary participation, anonymity, and confidentiality were considered. Two themes emerged from our analysis due to consequences of nurses' efforts to overcome intra-professional discrimination: "seeking justice" and "passivity." Nurses' efforts to overcome professional discrimination have led to outcomes. These outcomes can be affect on their individual effort to achieve organizational goals, provide better care or feel disabling or nurses turnover. Strategies adopted by nurses to overcome intra-professional discrimination have led to consequences which vary from negative to positive and impact their performance.

Audit of Intrapartum Care Based on the National Guideline for Midwifery and Birth Services.

Providing high-quality maternity care is a worldwide health concern that necessitates regular assessment of intrapartum practice. In an observational study, we aimed to audit intrapartum care based on the National Guideline for Midwifery and Birth Services. Using quota sampling, a total of 200 pregnant women, admitted for normal vaginal delivery, were recruited from four educational hospitals in Tehran, Iran. An observational checklist was developed based on the national guideline to assess the quality of provided care. Content and face validity of the tool were checked and confirmed. Reliability of the observational checklist and questionnaire was confirmed using concurrent observation (intrarater reliability; r = .93) and test-retest ( r = .9) methods, respectively. We found that the compatibility of intrapartum care and the national guideline in different domains were as follows: history taking 88.3%, vital sign measurement 64.6%, performing Leopold's maneuver 38.5%, initial assessment 83.4%, labor care 22.5%, using pain relief methods 63.5%, labor progress assessment 71.5%, process of delivery 89.5%, and postpartum management 89.5%. The findings indicate that additional attention and monitoring are required to align current intrapartum care practices with the national guidelines.

Emergence and characterization of nosocomial multidrug-resistant and extensively drug-resistant Acinetobacter baumannii isolates in Tehran, Iran.

Acinetobacter baumannii is one of the antibiotic-resistant superbugs that threatens hospitalized patients. Emergence and spread of the multidrug-resistant (MDR) and extensively drug-resistant (XDR) clones cause erratic outbreaks following environmental contamination of hospital settings. The present study intended to characterize the antimicrobial resistant profiles and the genotypes of clinical and environmental isolates of A.baumannii as a result of dissemination of resistant strains. Clinical and environmental isolates of A.baumannii were obtained from patients, staff, and environment of an educational hospital in Tehran. Antimicrobial susceptibility testing was carried out using the disk diffusion and E-test methods. Multiplex PCR was performed for detection of OXA-type genes (blaOXA-23-like, blaOXA-24-like, blaOXA-58-like, and blaOXA-51-like). Genotypic relatedness of the isolates was achieved using repetitive extragenic palindromic element PCR (Rep-PCR) technique. All the isolates were found to be susceptible to colistin and most of them (77%) were non-susceptible to tigecycline. A majority of the clinical and environmental isolates (97%) were considered as MDR strains and 41% as XDR. In multiplex detection, blaOXA-23-like was found in 54% of the isolates, which was the most frequent OXA-type gene. In addition, the frequency of the carbapenem-resistant A.baumannii (CRAB) was observed to be high (96%). In addition, molecular typing showed different Rep patterns of clinical isolates and clonal spread of environmental isolates. The present study highlights the circulation of drug-resistant A.baumannii strains in different wards of hospitals principally in intensive care unit (ICU) as a nosocomial pathogen due to unwise managements.

Specialist Physicians' Attitude towards Emergency Medicine; a Semi-Structured Qualitative Study.

The present study is a survey to assess the pros and cons of emergency medicine (EM) from the viewpoint of the scholars from other medicine disciplines to improve the efficiency of EM in the healthcare system. This is a semi-structured qualitative study. Face-to-face interviews with various physicians with different specialties were performed to gather information on their viewpoints. Study population was selected mainly based on their history of collaboration with emergency medicine specialists in several educational hospitals in Tehran, Iran. All interviews were recorded and then transcribed to paper. Data were mainly categorized and reported into four themes: 1) general aspects of emergency medicine, goals and policies 2) Management of emergency department 3) Educational aspects 4) therapeutic aspects. 22 specialist physicians with the mean age of 47.3±7.6 years were studied (77.3% male). The average of their work experience as a specialist was 13.6±7.5 years. From the viewpoint of other experts, the establishment of EM and training of EM specialists is accompanied with relative disadvantages and advantages regarding goals and policies, patient management, therapeutic interventions and student education in the emergency department. Initiating resuscitation and maintaining hemodynamic stability and appropriate triage of the patients can add to the benefits of EM by preventing unreasonable hospitalization, and reducing the workload and difficulty of the work of other professionals working in the hospital. Based on the results of the current study, it seems that most Iranian specialist physicians have a positive attitude towards emergency medicine and think that emergency medicine could have beneficial effects for the health system and hospital management system.

The Relationship Between Work Commitment, Dynamic, and Medication Error.

Incidence of medication errors in intensive care unit (ICU) can cause irreparable damage for ICU patients. Therefore, it seems necessary to find the causes of medication errors in this section. Work commitment and dynamic might affect the incidence of medication errors in ICU. To assess the mentioned hypothesis, we performed a descriptive-analytical study which was carried out on 117 nurses working in ICU of educational hospitals in Tehran. Minick et al., Salyer et al., and Wakefield et al. scales were used for data gathering on work commitment, dynamic, and medication errors, respectively. Findings of the current study revealed that high work commitment in ICU nurses caused low number of medication errors, including intravenous and nonintravenous. We controlled the effects of confounding variables in detection of this relationship. In contrast, no significant association was found between work dynamic and different types of medication errors. Although the study did not observe any relationship between the dynamics and rate of medication errors, the training of nurses or nursing students to create a dynamic environment in hospitals can increase their interest in the profession and increase job satisfaction in them. Also they must have enough ability in work dynamic so that they don't confused and distracted result in frequent changes of orders, care plans, and procedures.

Evaluation of Appropriateness Admission and Hospital Stay at Educational Hospital.

Appropriate admissions and patients' length of stay are two of the most important indicators of efficient health care delivery in hospitals. Paying due attention to these indicators may lead to optimal use of hospital resources as well as provision of ambulatory services to a larger population of patients. The purpose of the current study is to quantify the rate of inappropriate hospital admissions and days of hospital stay to identify factors affecting them. Data were collected regarding admissions and length of stay of 1815 patients admitted to an educational hospital in Tehran, Iran, with a total 12,629 days of hospitalization using the Appropriateness Evaluation Protocol. A qualitative study was conducted using content analysis method by analyzing data from interviews with the hospital personnel about the factors affecting patients' length of stay. The results indicated that the average length of stay in medical and surgical wards was 9.4 to 6.3 days, and 8.5% of admissions and 3.4% of stays were inappropriate. The necessity to receive nursing care and/or to receive medical services and/or the patients' conditions accounted for 57.6% of total hospitalization days, followed by the need to receive nursing care alone (36.6%). Planning/Procedures/ Personnel factors were responsible for 77.3% of inappropriate stays. The qualitative study revealed that in addition to sound in house policy setting, abundance of suitable equipment and facilities at the hospital site had positively affected the appropriateness of hospital stay while incoordination of health care delivery groups, rotation of residents and other wards personnel and lack of a proper complementary patient follow-up system, had a negative impact on the same indicator. Inappropriate admissions and inappropriate stays are influenced by numerous factors, both inside and outside of the hospitals; the results of the current study indicate that structural factors such as techniques adopted in the studied hospital, contributed significantly to decreasing inappropriate stays. Improving and upgrading these techniques will make optimal use of hospital beds possible.

Knowledge, Attitudes and Practices of Internal Medicine Residents Towards Deep Vein Thrombosis Prophylaxis in a University Hospital in Tehran

Background: Deep Vein Thrombosis (DVT) is a major problem in hospitalized patients. There is discrepancy between healthcare providers’ knowledge and their clinical practice regarding DVT prophylaxis. In this study we aimed to evaluate knowledge, attitude and practices of internal medicine residents at an educational hospital in Tehran. Methods: This cross-sectional study was conducted during December 2015 at Shariati hospital of Tehran, IRAN. A questionnaire covering five domains of clinical scenarios, adherence to guidelines, personal beliefs, practice, preferences and personal beliefs, was distributed between internal medicine residents. Medical records of patients at the internal ward were reviewed to assess the status of DVT prophylaxis in patients, who needed DVT prophylaxis based on American college of chest physicians’ (ACCP) guidelines. Results: Overall, 71 residents out of 88 residents returned the questionnaire, and 43.7% were aware of the guidelines. Furthermore, 97.2% thought DVT prophylaxis is clinically important but only 66.90% of the patients, who needed DVT prophylaxis, were receiving DVT prophylaxis. More than 50% of the residents underestimated the incidence of DVT and mortality rate due to pulmonary embolism. The most common reason for not prescribing DVT prophylaxis was concern about bleeding in 53.5% of the participants. Further analysis of different components of the questionnaire showed that there is a significant association between “awareness” and “adherence” scores (P = 0.041) and correct answers to “clinical scenarios” and “practice” (P = 0.012). Conclusions: Although the level of knowledge on these clinical situations is good, underestimation of the risk of DVT development in hospitalized patients needs more attention. This might be due to low levels of awareness of presence and content of DVT prophylaxis guidelines. Programs should be designed to uphold the levels of information of DVT prophylaxis guidelines among internal medicine residents.

Frequency of Preseptal Cellulitis and Its Risk Factors in Patients Admitted to Two Educational Hospitals in Tehran, Iran, During 2014 - 2015

Background: The orbital septum is a membranous sheet acting as the anterior boundary of the orbit. Preseptal cellulitis is a kind of an infection of the eyelid and portions of skin around the eye, anterior to the orbital septum. Preseptal cellulitis is different from orbital cellulitis in epidemiology, etiology and treatment of choice. The current study aimed to evaluate the frequency of major risk factors of preseptal cellulitis. Methods: This descriptive prospective study was conducted on 40 patients with preseptal cellulitis admitted to two educational hospitals in Tehran, Iran, during 2014 - 2015. Epidemiologic and clinical findings of the patients with CT scan documented preseptal cellulitis were recorded as risk factors and complete history of trauma. All the patients were scanned for sinus involvement (axial and coronal paranasal sinus CT scan). Complete physical exam for cutaneouse lesions predisposing to preseptal cellulitis as varicella was performed. Blood samples were cultured. Data were analyzed using the SPSS Software version 20. Results: During the study period, 40 patients including 21 females and 19 males with preseptal cellulitis were studied. The mean age of the patients was 38.95 ± 16.20 years. The most common underlying factors was trauma (57.5% of the patients) following sinusitis (25%) with the ethmoid sinus being the most common involved sinus. Ophtalmic Zoster, dacryocystitis and hordeolum were predisposing factors in 17.5% of the cases. Most cases occurred in spring (47.5%) and the least in summer (5%). Conclusions: Sinusitis was the most common predisposing factor of preseptal cellulitis in previous studies, but in this study trauma was the most common one. Recognition of major risk factors of preseptal cellulitis can be effective in planning the treatment of choice in preseptal cellulitis in different communities.

Frequency of Preseptal Cellulitis and Its Risk Factors in Patients Admitted to Two Educational Hospitals in Tehran, Iran, During 2014 - 2015

Frequency of Preseptal Cellulitis and Its Risk Factors in Patients Admitted to Two Educational Hospitals in Tehran, Iran, During 2014 - 2015

Prevalence of Pathological Entities in Neck Masses: A Study of 1208 Consecutive Cases

Background: Many head and neck diseases manifest as neck masses with a wide range of pathologies from developmental lesions to malignancies. However, there is a lack of large-scale studies about the relative prevalence of these lesions in the neck region. Objectives: This retrospective study was conducted to assess the distribution of neck masses related to gender, age, pathology, and anatomical location. Patients and Methods: During a 13-year period (1996–2009), the medical records of 1,208 patients with neck masses were collected from the department of pathology at Loghman educational hospital in Tehran, Iran. The cases were reviewed for data on gender, age, the type of origin tissue, the type of lesion, and the anatomical location. Comparisons between genders, age groups, and tissue origins were performed using the Chi-square test. The significance level was set at P < 0.05. All statistical tests were performed with SPSS 20 software. Results: Over a period of 13 years, a total of 1,208 patients (617 men and 591 women) had neck masses resected for pathological assessments. The median age of presentation was 42.1 (ranging from 6 to 83 years). Among the 1,208 cases, 33 cases (2.7%) developed in the pediatric group (≤ 15 years old), 466 cases (38.6 %) developed in the young adult group (16 to 40 years of age), and 709 cases (58.7%) developed in the adult group (≥ 40 years old). Both the inflammatory/infectious and neoplastic lesions were more common in the older adult group with 129 and 433 cases, respectively. The Chi-square test showed significant differences between the genders and the different types of lesions (P = 0.000) and between the different age groups and the different types of lesions (P = 0.000). The anterior triangle (n = 654; 54.1%) was the most common anatomical site for the neck masses, followed by the midline and anterior neck (n = 548; 45.4%), and the posterior triangle (n = 6; 0.5%). Conclusions: The age and location of neck masses are the most important variables. The data in this study showed that the neoplastic lesions (including metastatic lesions) were the most common neck masses and the anterior triangle was the most common anatomical location. In addition, age can play an important role in differential diagnosis. Therefore, any mass in the neck, especially in older patients, located in the anterior triangle must be considered neoplastic until proven otherwise.

Evaluation of Vancomycin Administration After Pharmacist Intervention in the Intensive Care Unit of an Educational Hospital

Background: Vancomycin is a glycopeptide antibiotic used to treat infections caused by Gram-positive bacteria. Irrational administration of this antibiotic may result in increased morbidity or mortality due to toxicity and the emergence of resistant organisms and also impose additional costs. Objectives: The current study aimed at evaluating the effect of pharmacist intervention on vancomycin administration, and discussing appropriate and inappropriate applications of this drug. Methods: The current study was performed on all patients receiving vancomycin intravenously in the intensive care unit (ICU) of Loghman educational Hospital in Tehran, Iran, from May to September 2015. Relevant data were collected by a pharmacist from each patient and their datasheets such as medical records, patient’s history, medical orders, nursing reports, and the experimental results available in the patient’s records, duration of vancomycin use, history of drug allergy, first diagnoses, type of administration, monitoring necessity, dosing regimen, and occurrence of adverse drug reaction. Patients then were followed until discharge from ICU. Results: About 82% of patients had received vancomycin without noticing their body mass index (BMI) or calcium-induced calcium release (CICR). In addition, 2.63% had inappropriate indication, and in general, the duration of therapy was somehow correct in 44.73% of patients, and 55.26% received vancomycin for more than the appropriate period. Most of the wrong administration was for postoperative prophylaxis. The appropriate duration is maximum 48 hours. But in 63.33% of the patients, it continued for more than 2 - 3 days. And this inappropriate usage could increase vancomycin resistance. Conclusions: Due to the increasing resistance rate to antibiotics, indication and duration of administration and dosing should be more accurate, and for each patient must be according to his/her ideal body weight (IBW).

Psychometric Properties of the Family Inventory of Resources for Management in a Sample of Iranian Family Caregivers of Cancer Patients.

Objective. The aim of this study was to investigate the psychometric properties of the Family Inventory of Resources for Management (FIRM) in a sample of family caregivers of cancer patients. Methods. In this methodological study, construct validity of the FIRM was evaluated by known groups and convergent validity in a convenience sample of family caregivers of cancer patients (n = 104) referred to the outpatient oncology wards of five educational hospitals in Tehran from January to April 2016. Reliability was determined by assessing the internal consistency and stability of the instrument. Results. The known-groups findings showed that there is a significant difference between the scores of the FIRM in family caregivers with different levels of caregiver burden (p < 0.001). Also, the results of convergent validity showed that there is a moderate negative correlation (r = −0.50; p < 0.001) between the total scores of the FIRM and the scores of the caregiver burden inventory (CBI). The FIRM showed a good internal consistency (α = 0.85) and a good stability of the test-retest reliability result. Conclusions. There is a sound psychometric basis for the use of the Persian translation of the FIRM for family studies in the Iranian population.

Comparison of direct and indirect nursing care time in 8-hour and 12-hour shifts

AbstractIntroduction: Nurses are the largest and one of the most important groups of health care providers. The quality of health care mostly depends on the quality of direct and indirect nursing care. Measuring the average nursing care time is an objective measure for assessing the quality of patient care.The goal of the present study was to compare the time being devoted to professional – nonprofessional activities by nurses in 8 hours and 12 hours working shift in Shahid Modarres teaching hospital in Tehran.Methods: A descriptive- comparative study was conducted on 30 nurses (27 female, and 3 male) working in medical and surgical wards of Shahid Modarres teaching hospital in Tehran. The nurses were working 8 and 12 hours shifts and in rotating schedule. Data were collected by direct observation of nurses’ activities,using a checklist with list of direct, indirect and nonprofessional nursing activities. The reliability of the checklist was assured by calculating inter observers’ agreement (The duration of time which nurses spent for each activity was recorded. Data were analyzed using SPSS and Wilcoxon test.Results: The findings of the present study revealed that, nurses working 8 hour shift duration, spent 64.99% of their time on professional and 35.3% on nonprofessional activities (41.21% on direct nursing care, 23.78% on indirect nursing care, 22.53% on personnel affairs and 12.5% on administrative activities). Nurses with 12 hour shift duration, spent 65.59% of their times on professional activities and 33.92% on nonprofessional activities (41.57% on direct healthcare, 24.02% on indirect healthcare, 20.94% on personnel affairs and 12.98% administrative activities).Conclusion: Nurses working in both 8 and 12 hours shift spend most of their times for professional activities (direct and indirect healthcare) and devote less time to nonprofessional activities (administrative and personal affairs), and these activities are independent of their shift durationKeywords: Working shift, Nurse, Direct nursing care, Indirect nursing care, Teaching hospital REFERENCES Admi H Tzischinslcy O Epstein R et al (2008). Shift work in nursing: Is it really a risk factor for Nurses health and patients safety?. Nursing Economics. 26 (4)250-256 Farquharson B (2013). How much time do nurses actually spend on patient care? An analysis of real-time data across medical and surgical wards. Avaible at: https://www.rcn.org.uk/__data/assets/pdf_ file/0019/512146/2013_RCN_research_3.1.3.pdf French L (1977). The Personal Management Process.6rd ed. Boston: Houghton Mifflin Co. Hagerty B, Spengler C.(1985). Work sampling analyzing nursing staff productivity. The Journal of Nursing Administration. 5(9) 13-20. Heslop L Power R Cranwell K (2014) Building workforce capacity for complex care coordination: A function analysis of workflow activity. Heslopet al. Human Resources for Health2014,12:52. Avaiable at:http://www. human-resources-health.com/content/12/1/52 Josten DC (2003).The effects of extended work days on fatigue, health, performance and satisfaction in Nursing. Journal of Advanced Nursing.44(6) 643-652. Kabiri F (1992) [ How nurses relate themselves to patients in the internal and cardiology wards of Tehran university]. M.S Thesis. Faculty of Nursing and Midwifery Shahid Beheshti University of Medical Sciences. (Persian). Liang Y, Chen W, Lee J & Huang L (2012). Nurse staffing, direct nursing care hours and patient mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study BMC Health Services Research 2012, 12:44 Medical Dictionnary (2014). Avaible At: http://medical-dictionary.thefreedictionary.com/indirect+care. Accessed time: 9/24/2014. Puente LM, Rabbino H (2003). Creating value with strategic resources. Avaiable At:http://www.iseesystems. com/community/connector/Zine/SeptOct03/luz.html. Accessed time: 9/24/2014. Rogers AE, Hwang WY, Scott LS, Aiken LH, Dinges DF(2004). The Working Hours of Hospital Staff Nurses And Patient Safety. Avaiable at:http://content.healthaffairs.org/content/23/4/202.full. Accessed time 9/24/2014. Rostamipoor A(1986).[ Assessment of nurses non professional activities in Tehran hospitals ] M.S Thesis. Tarbiat Modarress university.(Persian). Shams Azad M (1995).[ Comparison of nurses’ productive hours in various wards of educational hospital in Tehran. M.S thesis. Shahid Beheshti University of Medical Sciences. (Persian). Safari M (2002).[ Impact of touching group discussion technique to nurses on the quality of care for myocardial patients]. M.S thesis. Tarbiat Modarress University. [Persian]. 1393 راهب ،84 هرامش ،24 هرود / 50 ناراکمه و یسیئر ناروپ Telles SCR, & Castilho V.(2007). Staff cost in indirect nursing care at an intensive care unit. Rev Latino-am Enfermagem. 15(5) 1005-9 Thompson P (2009). Health care financial management. Health Management Journal.63(1) 76-82. Westbrook JI Duffield C Li L & Creswick NJ (2011) How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals, BMC Health Services Research 11:319. Avaible at: http://www.biomedcentral.com/1472-6963/11/319 Williams M (1977).Quanification of direct nursing care activities. Journal of Nursing Adminstration. 7(8)15-8, 49-51.

Effects of Pharmacist Intervention on the Utilization of Vancomycin in a Teaching Hospital.

In order to investigate the effect of pharmacist intervention on vancomycin use, this study was performed on all patients receiving vancomycin in the intensive care unit (ICU) and hematology-oncology ward of Taleghani Educational Hospital in Tehran, Iran. Vancomycin use was assessed during a pre- and post-intervention period in accordance with the Center of Disease Control and prevention (CDC) and Infectious Diseases Society of America (IDSA) guidelines. Following the intervention, there was a significant change in appropriate initiation of vancomycin (P = 0.009) and no significant improvement was observed in adequate dosage and the duration of therapy (P = 0.15 and P = 0.54 respectively); however, informing the physician resulted in discontinuation of the drug in 50% of inappropriate cases and vancomycin dosage was adjustedin 31% of cases. Temperature charts, culture results and pre-treatment CBC tests changed significantly (P = 0.02, P = 0.009 and P = 0.04 respectively). The rate of infusion related adverse drug reactions did not decrease significantly (P = 0.06); yet in 100% of patients, these reactions were resolved after notifying the nursing team. After pharmacist intervention,vancomycin use improved in some aspects. A significant improvement in appropriate initiation of therapy was observed; however, treatments continued despite negative cultures. It is necessary to optimize the use of vancomycin by performing more educational interventions.

Identification and assessment of medical errors in the triage area of an educational hospital using the SHERPA technique in Iran

Accidents caused by human error are prominent in the medical field. The present study identified medical errors in the emergency triage area by assessing the tasks of all healthcare workers employed in the triage area of an educational hospital in Tehran, Iran in 2014. Data were collected using the systematic human error reduction and prediction approach (SHERPA). The tasks and sub-tasks were determined and analyzed using hierarchical analysis and the errors were extracted. A total of 199 human errors were identified in the different tasks. The rate of error for action was 46.8%, checking was 25.6%, retrieval was 8.5%, communication was 12.1% and selection was 7%. Rate of unacceptable and unfavorable risks were 21.1% and 38.6%, respectively. SHERPA was shown to be an appropriate technique for detecting medical errors. The establishment of control programs should be a high priority in the management and implementation of health facilities in triage areas.