Hospitals In Isfahan Research Articles

The Effectiveness Group Emotion Regulation Training on Promoting the Mental Health of Physicians and Nurses of Public Hospitals in Isfahan

The Effectiveness Group Emotion Regulation Training on Promoting the Mental Health of Physicians and Nurses of Public Hospitals in Isfahan

Prevalence incidence and clinical outcome of Klebsiella and Acinetobacter ventilator-associated pneumonia

Introduction: Antimicrobial resistance identification for each hospital has benefits in management of nosocomial infections. Objectives: The aim of this study was to determine antimicrobial susceptibility of meropenem against Acinetobacter and Klebsiella strains in samples obtained from hospitalized patients with ventilator-associated pneumonia (VAP). Patients and Methods: In this cross-sectional study, 100 patients with VAP were selected from the intensive care unit (ICU) of Amin hospital in Isfahan. Lung secretions were collected and tested for bacterial infections. In samples with the positive bacterial infection, E-test and agar diffusion test were used to determine and compare the susceptibility of Acinetobacter and Klebsiella strains to meropenem. Results: The two susceptibility testing methods – E-test and agar diffusion test – showed similar results in 87 cases (87%) therefore, 84 cases were resistant and three cases were susceptible to meropenem. However, in 13 cases, the result of the agar diffusion test was resistant and the result of E-test was sensitive. According to the Kappa test, the agreement between the two tests was 0.87 and statistically significant (P <0.001). Conclusion: Due to the high resistance of Klebsiella and Acinetobacter strains to meropenem, it should not be used as an experimental treatment in patients diagnosed with VAP caused by these strains. We recommend using meropenem for Acinetobacter and Klebsiella after susceptibility testing by E-test confirmed its efficacy.

Barriers to rational antibiotic prescription in Iran: a descriptive qualitative study

IntroductionRational antibiotic prescription (RAP) refers to the purposeful and appropriate antibiotic prescription with correct dose and course to produce the most possible benefits and less possible side effects. Identification and management of the barriers to RAP can help promote RAP. The aim of the study was to explore the barriers to RAP in Iran.MethodsThis descriptive qualitative study was conducted in 2021 on 46 physicians (including general physicians, specialists, and subspecialists), pharmacologists, microbiologists, and nurses. Participants were purposefully selected from five specialty and subspecialty hospitals in Isfahan, Iran, and the Treatment Administration of Isfahan University of Medical Sciences, Isfahan, Iran. Data were collected via semi-structured interviews and were analyzed via conventional content analysis.ResultsThe barriers to RAP in Iran came into sixteen subcategories and four main categories, namely physicians’ limited professional competence (with six subcategories), poor informational and functional resources (with four subcategories), ineffective supervision of RAP (with three subcategories), and inappropriate context for RAP (with three subcategories). The subcategories of these categories were physicians’ limited professional knowledge, physicians’ poor attitude towards RAP, physicians’ routine-based practice instead of evidence-based practice, physicians’ limited accountability, physicians’ fear over the legal consequences of not prescribing antibiotics, physicians’ financial motives, limited access to quality educational materials, poor in-service training for physicians, lack of culturally appropriate guidelines, inefficiency of the stewardship committee, limited supervision of physicians’ performance, ineffective managerial supervision, limited supervision of sampling for antimicrobial susceptibility testing, sociocultural factors contributing to irrational antibiotic prescription, poor adherence of insurance companies to their financial commitments, and financial incentives of pharmaceutical companies for physicians.ConclusionThe barriers to RAP are different and complex and include physician-related, resource-related, supervision-related, and contextual factors. Physicians with limited professional competence, limited access to resources, and limited supervision will have problems in RAP. Effective management of the barriers to RAP can promote RAP and minimize irrational antibiotic prescription and its consequences, chiefly antimicrobial resistance.

Prevalence of Different Types of Craniosynostosis in Isfahan, Iran

Background: Craniosynostosis is a congenital deformity of the skull that occurs at birth. Objectives: This study aimed to investigate the frequency of different types of craniosynostosis in Isfahan, Iran. Methods: In this retrospective study, the records of all patients referred to the pediatric neurosurgery clinic of Imam Hossein children’s hospital in Isfahan, Iran from 2013 to 2018 were diagnosed with craniosynostosis. Incomplete files were excluded. Demographic information of patients and type of delivery, underlying diseases of their parents, diseases of maternal pregnancy, type of craniosynostosis, syndromic or non-syndromic craniosynostosis were collected. Data were analyzed using SPSS software version 22. Results: The diagnosis of craniosynostosis in 63% of cases (n=121) was a single suture and in 37% of cases (n=72) was a complex suture. There was no significant difference in the frequency distribution of craniosynostosis in males and females (P>0.05). Conclusion: Due to the prevalence of 16 cases per 100,000, we can reduce the complications of this disease by educating doctors and parents.

Effect of Nebulized Eucalyptus on Arterial Blood Gases and Physiologic Indexes of Mechanical Ventilated Patients: A Randomized Clinical Trial.

Introduction: Arterial hypoxia is one of the most common findings in critically ill patients. Inhaled medications in ventilated patients can reduce airway resistance, facilitate dilution, and prevent airway infections. This study aimed to examine the effects of nebulized Eucalyptus (NE) on arterial blood gases (ABG) and physiologic indexes of patients receiving mechanical ventilation (MV). Methods: The current randomized clinical trial was performed in three intensive care units (ICUs) of Al-Zahra Hospital in Isfahan, Iran. Using purposive sampling method, 70 intubated patients were selected and randomly divided into NE (n=35) and control (n=35) groups. NE group received 4 ml (5%) Eucalyptus in 6 mL normal saline (NS) every 8 hours since intubation to 3 days by a nebulizer. Control group received 10 mL NS in the same way. Glasgow Coma Scale (GCS) and ABG parameters (pH, BE, HCO3, PCO2, SaO2, and PaO2), and the peak inspiratory pressure (PIP) and tidal volume (TV) were equally assessed in both intervention and control groups. Data were analyzed using SPSS software version 13. Results: There was no significant difference between the patients of both groups in terms of vital signs (blood pressure, temperature, respiratory rate, and pulse rate), GCS, pH, BE, HCO3, PCO2, SaO2, PaO2, PIP, and TV before the study. Amongst the parameters of ABG, there was a significant difference between PaO2 and SaO2 and PIP in the intervention and control groups 3 days after intervention. Conclusion: Inhaled Eucalyptus can improve oxygenation and reduce airway pressure in patients undergoing MV.

Sleep-Wake Cycle in Newborns with 28 - 32 Weeks of Gestation: A Comparative Study of Nasal Continuous Positive Airway Pressure and Nasal Intermittent Positive Pressure Ventilation

Background: Sleep is a central component of brain development. Preterm neonates follow an exclusive sleep-wake rhythm in a way that they can sleep up to 22 hours per day, 70% of which is spent during active sleep. Sleep can create a period of time for the production of active neurotransmitters, which can enhance brain development flexibility. Objectives: It is a matter of controversy whether the widespread use of nonsynchronized nasal intermittent positive pressure ventilation (NIPPV) in neonatal intensive care units and the concerns over the use of nonrespiratory support can affect the quantity and quality of the sleep-wake cycle (SWC). Therefore, the current study aimed to compare two types of intervention, nasal continuous positive airway pressure (nCPAP) and NIPPV, during the SWC. Methods: The present randomized controlled trial crossover study was conducted on neonates with 28 - 32 weeks of gestation receiving nCPAP who had been administered surfactant after being diagnosed with respiratory distress syndrome in Shahid Beheshti hospital in Isfahan, Iran, within March 2018 to August 2020. The SWC was monitored using cerebral function monitoring for all study participants. Results: The present study showed no significant difference between the number of SWCs during nCPAP and NIPPV. The duration of SWCs when participants received nCPAP was significantly higher than when they received NIPPV intervention. Rapid eye movement (REM) sleep duration was significantly longer during nCPAP respiratory support. Furthermore, NonREM sleep duration was significantly longer in nCPAP respiratory support. Conclusions: Noninvasive respiratory support modes can affect the SWC, with nCPAP being the favored in the present study. Nonetheless, further studies are required to be performed in this regard.

Challenges of Help-Seeking in Iranian Family Caregivers of Patients with Cancer: A Qualitative Study

Background: The nature of cancer is such that it causes several problems for patients and caregivers. As a vital source of support for patients with cancer, family caregivers must seek assistance and make use of available resources to overcome these issues and offer better care for the patient. Objectives: This study aimed at exploring the challenges of seeking help in Iranian family caregivers of patients with cancer from supportive sources. Methods: This qualitative study was conducted from 2019 to 2021 on 15 family caregivers with a wide variety of caring experiences and 13 health professionals (i.e. nurse, physician, social worker, clergyman, and family counselor who were engaged with services for the patient and caregiver) via purposive sampling and semi-structured in-depth interviews in a central cancer care hospital in Isfahan. Graneheim and Lundman's conventional qualitative content analysis approach was used to analyze the data. To assess data trustworthiness, Lincoln and Guba's criteria were used. Data management was performed using MAXQDA (v. 10) software. Results: Four main categories were identified consisted of (1) being strained by social desirability; (2) stigmatizing attitudes toward help-seeking; (3) reactive self-forgetfulness; and (4) resistance to change. Conclusions: The need to develop and implement interventions geared to enhance family caregivers' preferred attitudes and personal skills in order to overcome socio-cultural obstacles to help-seeking behaviors was underlined in this research. Both health care professionals and the community should be prepared to make support services more accessible and usable for family caregivers.

The Study of the Effect of Occupational Stress on Resilience: Mediating Role of Occupational Engagement (A Case Study: Nurses of Al-zahra Hospital in Isfahan)

Introduction: Considering the high mental pressures on nurses at work, identifying the effective resilience factors is deemed necessary. Therefore, this study aims to investigate the mediating role of occupational engagement in the relationship between occupational stress and resilience among the nurses of Al-zahra Hospital of Isfahan.
 Methods: The present study was a descriptive survey-correlational study. The population of this study included 1700 nurses from Al-zahra hospital in Isfahan city. Based on Cochran’s formula and by convenience sampling method, 200 people (60 men and 140 women) were chosen. Occupational stress questionnaires of HSE, resilience, and occupational engagement were performed on the sample. The collected data were analyzed using SPSS and AMOS software using structural equation modeling.
 Results: The results showed that occupational stress had a negative and significant effect (P <0.001) on the vibration with the mediating role of occupational engagement. Also, occupational stress had a negative and significant (P <0.001) negative effect on occupation and there was a significant and positive effect (P <0.001) on resilience.
 Conclusion: The results indicate that occupational stress affects the resilience, but if the nurses are engaged in their jobs, this effect will reduce and the construct of engagement will act as a mediating variable.

Prevalence of antibiotic resistance in Enterobacteriaceae among the patients hospitalized in Al-Zahra hospital, Isfahan, Iran

Introduction: Enterobacteriaceae are a high prevalent gram-negative species worldwide, which play a major role in various infections. Objectives: The present study aims to assess the prevalence of antimicrobial resistance in Enterobacteriaceae at a tertiary hospital in Isfahan, Iran. Materials and Methods: This cross-sectional laboratory-based study was performed during 2020 in Al-Zahra hospital, Isfahan, Iran. The isolates of all of the clinical samples submitted for the bacterial culture containing Enterobacteriaceae strains were checked for antibiotic resistance during March 2018 to March 2019. Results: The results revealed that the specimens obtained from intensive care units (ICUs) exhibited more resistance than the others. Additionally, the highest abundant antibiotic resistance among inpatients was related to ampicillin/sulbactam, and carbapenem resistance was significantly high. Conclusion: The high prevalence of antibiotic resistance indicated the inappropriate antibiotic prescription in this center. The results emphasized the importance of preventive strategies and restrictions in over-the-counter antibiotic consumption.

Comparative study of histopathological diagnostic criteria in cutaneous lesions of lichen planus and discoid lupus erythematosus

Background and aims: Lichen planus (LP) and discoid lupus erythematosus (DLE) are two relatively common mucocutaneous lesions whose clinical and histopathological features overlap in some cases. The present study aimed to distinguish between these two lesions histopathologically in order to treat them more accurately. Methods: In a cross-sectional descriptive-analytical study, 29 and 48 microscopic slides of skin samples of DLE and LP, respectively, were examined in the pathology archive of Al-Zahra hospital of Isfahan from 2008 to 2018. The slides prepared by hematoxylin-eosin staining were examined simultaneously and blindly by three pathologists with a light microscope and compared according to certain histopathological criteria. Then obtained data were analyzed by SPSS version 24 using chi-square, Fisher’s exact, Mann-Whitney, and t tests (P<0.05). Results: Based on the findings, the presence of hyperparakeratosis with superficial hyperorthokeratosis, epithelial atrophy, deep perivascular infiltration, presence of edema in the papillary dermis, presence of plasma cells with lymphohistiocytes in inflammatory infiltration, and presence of mucin in the dermis were significantly higher in DLE than in LP (P<0.05). On the other hand, the intensity of lichenoid infiltration, presence of saw tooth hyperplasia of rete ridges, presence of cleft between the epithelium and connective tissue, spongiosis, hyperorthokeratosis alone, and wedge-shaped hypergranulosis were significantly higher in LP than in DLE (P<0.05). Conclusion: Perieccrine and perifollicular inflammation, presence of Civatte bodies (CBs), abundance of fibrosis, presence of pale keratinocytes, and presence of pseudoepitheliomatous hyperplasia were not the criteria for differential diagnosis of LP and DLE.

Severity of Disease and COVID-19 Complications During Hospital Stay: A Prospective Cohort Study.

COVID-19, with its high transmission and mortality rates and unknown outcomes, has become a major concern in the world. Among people with COVID-19, severe cases can quickly progress to serious complications, and even death. So, the present study aimed to examine the relationship between the severity of the disease and the outcome in patients afflicted by COVID-19 during hospitalization. A total of 653 patients with COVID-19 aged 18 years or older were included from Khorshid hospital in Isfahan, Iran and followed for a mean of 22.72 days (median 23.50; range 1-47). Severe COVID-19 was defined by respiration rate≥30 times/min, oxygen saturation level≤88% in the resting position, and pulse rate≥130/min. The primary outcome was mortality. The secondary outcomes included need for mechanical ventilation and intensive care unit (ICU) admission. During 4233 person-days of follow-up, 49 (7.5%) deaths, 27 (4.1%) invasive ventilation and 89 (13.6%) ICU admissions in hospital were reported. After adjustment for potential confounders, severity of the disease was positively associated with risk of mortality, invasive ventilation and ICU admissions (hazard ratio [HR]: 5.99; 95% CI: 2.85, 12.59; P<0.001, HR: 7.09; 95% CI: 3.24, 15.52; P<0.001 and HR: 4.88; 95% CI: 2.98, 7.98; P<0.001, respectively). In addition, greater age (HR=1.04; 95% CI=1.02-1.07; P=0.002), chronic kidney disease (HR=3.05; 95% CI=1.35, 6.90; P=0.008), blood urea nitrogen (BUN) (HR=1.04; 95% CI=1.03-1.05; P<0.001) and creatinine (HR=1.44; 95% CI=1.26-1.65; P<0.001) were probably significant risk factors for mortality in severe COVID-19 patients. More intensive therapy and special monitoring should be implemented for patients with older age, hypertension and kidney disease who are infected with COVID-19 to prevent rapid worsening.

Evaluation of the Efficacy and Side Effects of Catheter-Specific Intrauterine Insemination in Infertile Couples, a Randomized Clinical Trial

Introduction: Intrauterine insemination (IUI) is one of the assisted reproductive techniques, which increases the likelihood of egg being exposed to sperm in the uterus and thus the chances of pregnancy. The purpose of the present study was to compare the efficiency of the Masstec catheter (the internal product) with imported catheter (PMIU) so that, if similar, use domestic production as an alternative to imported. Methods: This study was a randomized controlled clinical trial continuous sampling method performed in Shahid Beheshti Hospital in Isfahan between 2016-2017. In this study, out of 62 infertile couples, 30 used catheters (Masstec), produced by Salamat Yar Hakim Engineering Company - Iran, and 32 imported catheters (PMIU), produced by Ellios BioTek – France. Primary outcomes included difficulty in catheter placement, the need to use a tenaculum, and the need for cervical dilatation during IUI. Secondary outcomes included chemical pregnancy, clinical pregnancy, and abortion. The data were analyzed using Chi-square, t-test and logistic regression. Results: Fisher exact test results showed no significant difference in primary outcome between the two groups (P&gt;0.05). Secondary outcomes, including chemical, clinical and abortion rates were not significantly different between the two groups (P&gt;0.05). Efficacy and side effects of Masstec IUI catheter were not different from PMIU catheter. Conclusion: Our study showed that the efficacy and side effects of the Masstec IUI catheter were not different from PMIU catheter. Given the similar efficacy and side effects and lower cost of the IUI catheter produced by the local company than the imported catheter, the use of local catheter is recommended for IUI candidate patients.

Effect of using an innovative tool for organizing surgical sutures on the self-efficacy of the scrub nurse during surgery

BackgroundApplying workplace organization methods can improve staff self-efficacy which leads to the desirable outcome and proper performance. The aim of this study was to investigate the effect of using an innovative tool for organizing surgical sutures on the self-efficacy of the surgical technologists during surgery in the operating room of Al-Zahra hospital in Isfahan. MethodsThis single-blind randomized clinical trial was conducted in 2020–2021 on 44 surgical technologists conveniently recruited from Al-Zahra hospital in Isfahan, Iran. Then, by random allocation, they were divided into two intervention (22 people) and control (22 people) groups. In order to organize the surgical sutures during the surgery, the control group used the routine method and the experimental group used the tool of organizing surgical sutures invented by the researcher. The data collection tool was a researcher-made self-efficacy questionnaire that was completed between July 2020 and January 2021. The data were analyzed through the independent t -test, Paired t-test, Chi-square test and Mann-Whitney test. ResultsParticipant's age was in the range of 23–50 years (mean 37.20±6.45), they were mostly female (75%). There was no significant difference in demographic characteristics between the two groups. The results showed that there was a statistically significant difference between the mean score of self-efficacy after the intervention in the experimental group (66.5 ± 3.36) and the control group (48.81± 8.49) (p <0.001). ConclusionThe use of surgical suture management tool during surgery can improve the self-efficacy of the surgical technologists. Hence, its use as an efficient tool is suggested.

Relationship Between Hemoglobin Level and the Expiration Date of Transfused Blood With the Death of Patients Admitted to the Intensive Care Unit

Background and Objectives In this study, we aim to investigate the relationship of the numbers of days until blood expiration and pre-transfusion hemoglobin level with mortality rate in patients admitted to the intensive care unit (ICU) and received packed red blood cell (PRBC) transfusion. Subjects and Methods This is a retrospective cross-sectional study that was performed in 2020 on 205 patients admitted to the ICU of Al-Zahra Hospital in Isfahan, Iran in the past year and received PRBC transfusion. Their demographic information as well as information about related to the blood such as the number of days until PRBC expiration and pre-transfusion hemoglobin level were extracted from the patient’s medical records. Results The mean pre-transfusion hemoglobin level of patients was 10.53±2.8 g/dL. Male patients had significantly higher hemoglobin level than female patients (P&lt;0.05). Of 205 patients, 55(26.8%) had a death outcome. The mortality rate was significantly higher in males than in females (P&lt;0.05). The number of days until PRBC expiration was 11.52±3.71 days. It was not significantly different between the deceased and surviving patients (P&gt;0.05). Also, the hemoglobin level of the deceased patients was significantly lower than that of surviving patients (P&lt;0.05). The patients with underlying diseases had significantly lower pre-transfusion hemoglobin level and higher mortality. Conclusion The mortality rate among ICU patients received PRBC transfusion in the study hospital is 26.8%.

Daytime sleepiness and work ability index in health care workers

Introduction: Hospital personnel are susceptible to sleep disorders due to their occupational nature, which has a negative impact on their behavioral and cognitive function and can decrease their ability to work. The aim of this study was to investigate the relationship between daytime sleepiness and its affecting factors and work ability index.&#x0D; Methods: This cross-sectional study was performed on 384 personnel of different departments of Al-Zahra hospital in Isfahan who were selected by quota sampling based on the ratio of number of staff of each job title to the total number of hospital personnel. For participants a checklist of demographic and occupational variables and two questionnaires: ESS (Epworth sleepiness scale) and WAI (Work Ability Index) were completed. Scores 13 and more for ESS questionnaire were considered as daytime sleepiness, and scores 28 and less for the WAI questionnaire were considered as poor performance.&#x0D; Result: 48% of participants were male and 52% were female. The mean age of the participants was 35.79±7.65 years and their mean working experience was 10.48±7.24 years. The results showed that there is a significant relationship between daytime sleepiness and demographic and occupational variables other than gender and educational level. Regarding the work ability index a significant relationship was seen with the above variables except gender, educational level and job title. A strong reverse and significant relationship was observed between daily drowsiness and the work ability index.&#x0D; Conclusion: The relationship between WAI and ESS in hospital personnel indicates that the ability to work can be increased by improving sleep status and controlling the factors that lead to daytime sleepiness.

Evidence-Based Prediction of COVID-19 Severity in Hospitalized Children.

Objective In this study, by using clinical and paraclinical characteristics, we have aimed to predict the severity of the disease in hospitalized COVID-19 children. Method This cross-sectional study was conducted on medical records about epidemiologic data, underlying diseases, symptoms, and laboratory tests from March to October, 2020, on 238 hospitalized confirmed COVID-19 paediatric cases in several children's hospitals of Tehran, Ahwaz, Isfahan, and Bandar Abbas. Results From 238 patients, 140 (59%) were male and most of them were in the age group of 1 to 5 years (34.6%). Among all hospitalized patients, 38% had an underlying disease and in total, 5% of cases were expired. Conclusion Determining patient severity is essential for appropriate clinical decision making; our results showed that in hospitalized pediatric patients, by using several variables such as SGOT, CRP, ALC, LDH, WBC, O2sat, and ferritin, we can use clinical and paraclinical characteristics for predicting the severity of COVID-19.

COVID-19 Information Needs and Information-Seeking Behavior of Cardiovascular Patients: A Qualitative Study

Background Patients with serious diseases need to have further access to reliable information regarding how to take care of themselves against COVID-19. Objective This study endeavored to elucidate COVID-19 information needs and information-seeking behaviors of cardiovascular patients hospitalized in the hospitals of Isfahan, Iran. Methods This qualitative study was conducted using content analysis in 2020. The population was 17 cardiovascular patients referred to the Shahid Chamran Hospital of Isfahan, who were selected using the purposive sampling method. Data were collected using semi-structured interviews and analyzed through continuous thematic analysis. Results The findings showed four categories and ten sub-categories as follows: information needs (general information regarding COVID-19, prevention methods, and treatment methods), information resources (reliable information resources and unreliable information resources), information validation (using formal and informal resources), and information-seeking barriers (media-related, political, economical, and COVID-19-related barriers). Conclusion Cardiovascular patients are in serious need of awareness-raising concerning COVID-19 to take care of themselves. This study’s results could help health education policy-makers of Iran pinpoint the information needs of high-risk patients and provide these patients access to reliable information while preventing damages due to misinformation regarding the COVID-19 pandemic.

Effects of Lifestyle Education on Depression, Anxiety, Stress, and Perceived Family Support Among Hypertensive Patients

Background: Hypertension is a major global health problem and a risk factor for cardiovascular disease. An unhealthy lifestyle can increase the risk of hypertension and psychological disorders, thereby heightening the risk of cardiovascular disease. Objectives: The study aimed to evaluate the effects of lifestyle education on depression, anxiety, stress, and perceived family support among hypertensive patients undergoing coronary angioplasty. Methods: This randomized clinical trial recruited 60 hypertensive patients undergoing angioplasty at the coronary care units of an educational hospital in Isfahan, Iran, in 2015. Then, 30 subjects were randomly allocated to each intervention and control group. The patients in the intervention group and their family members were provided with group lifestyle education in six sessions held in three successive weeks, accompanied by one-month follow-up telephone contacts. Data were collected before, immediately after, and one month after the intervention using a demographic questionnaire, the 21-item Depression, Anxiety, and Stress Scale with Cronbach’s alpha values of 0.80, 0.83, and 0.87, and a researcher-made family support questionnaire. Data analysis was done using the paired-sample t, independent-sample t, chi-square, Mann-Whitney U, and repeated-measures analysis of variance tests. Results: The study groups did not significantly differ respecting demographic characteristics, and the pretest mean scores of depression, anxiety, stress, and perceived family support (P &gt; 0.05). However, significant between-group differences were observed at both posttests, respecting the mean scores of depression, anxiety, stress, and perceived family support (P &lt; 0.05). Moreover, while these mean scores did not significantly change in the control group (P &gt; 0.05), the mean scores of depression, anxiety, and stress significantly decreased, and the mean score of perceived family support significantly increased in the intervention group across the three measurements (P &lt; 0.05). Conclusions: Lifestyle education effectively reduced depression, anxiety, and stress and improved perceived family support among patients with hypertension and angioplasty. Nurses can use such interventions to improve patient outcomes.

Microbiology and antimicrobial sensitivity of ventriculo-peritoneal shunt infections in a referral paediatric neurosurgery ward during a period of 7 years

This study aims to evaluate the aetiology and antibiotic susceptibility pattern in children with ventriculo-peritoneal (VP) shunt infections. A retrospective investigation was conducted from March 2011 to March 2018 among 163 children, who were admitted because of VP shunt infections in a referral educational hospital in Isfahan, Iran. Coagulase negative staphylococcus (CoNS) was the most common organism (49.0%), followed by Acinetobacter baumannii (10.4%) and Staphylococcus aureus (8.9%). Susceptibility of Gram-positive organisms to a different class of antibiotics was as follows: glycopeptides (82, 96%), carbapenems (78.38%), aminoglycosides (57.81%), fluoroquinolones (50.00%) and trimethoprim-sulfamethoxazole (50%). Gram-negative isolates were more susceptible to aminoglycosides (56.52%) and fluoroquinolones (52.78%), respectively. Sensitivity of Gram-negative bacteria to fluoroquinolones was significantly higher in infections that occurred in the first month of the shunt implantations compared to infections that were detected afterward (78.95% vs. 23.53%, respectively, P=0.001). The highest sensitivity of Gram-positive bacteria was to glycopeptides and carbapenems. In addition, Gram-negative organisms had the best susceptibility to aminoglycosides and fluoroquinolones. A high level of resistance to studied antibiotics among Gram-negative isolates underscores the necessity of including new antibiotics such as colistin, fosfomycin, ceftazidime/avibactam, ceftolozane/tazobactam and tigecycline in susceptibility testing and empiric antibiotic therapy for VP shunt infections.

Epidemiological Status and Health System Screening of COVID 19 Hospitalized Patients in Isfahan, Iran.

Background: The first case of Covid-19 disease was identified in Iran on February 19, 2020, and spread rapidly throughout the country. The aim of this study was to investigate the characteristics of COVID-19 hospitalized patients in Isfahan province of Iran from February 29, 2020, to July 21, 2020, and evaluate the effect of health system screening on the final outcome patients. Methods: In this cross-sectional study, all patients with positive COVID-19 PCR test and patients with negative PCR test but suspected clinical symptoms of COVID 19, admitted to Isfahan hospitals from February 29 to July 21were included in the study and the epidemiological characteristics of patients such as demographic characteristics, underlying disease, early signs and symptoms and the final outcomes of patients were analyzed using SPSS software version 20. Results: Of 11817 inpatients with COVID-19, 6590 (55.9%) were male, 1222 (10.4%) died, 9759 (82.8%) were discharged, and 4324 (36.7%) of hospitalized patients were asymptomatic. Among the hospitalized patients, 4642 (35.8%) had received primary screening services, and the mean age of the screened patients was statistically significantly higher than the group without primary screening (58.9±20.61, 55.08±21.57, P=0.068). 6914 (64.6%) of hospitalized patients had a positive initial PCR test, which was statistically significantly higher in patients with diabetes and an early symptom of sore throat. The Odds Ratio (OR) of readmission was most significantly associated with underlying cancer (OR=3.05, CI 95% 1.31-7.1) (P=0.011). The rate of readmission was statistically significantly higher in elderly, rural residents, and patients with underlying disease, diabetic, and hypertensive patients (P<0.05). Conclusion: This study showed that about half of the people who tested positive for COVID- 19 needed to be hospitalized, and about 9 percent mostly diabetic and hypertensive patients, needed readmission. More than half of the hospitalized people were not screened by the health system. However, screening by the health system had no effect on the length of hospital stay and disease outcome.