Isfahan University Of Medical Sciences Research Articles

The epidemiological situation of brucellosis in Isfahan province (2021)

Brucellosis is one of the most important health and economic challenges of many developing countries, including Iran. The present study was conducted in the cities covered by Isfahan University of Medical Sciences and Health Services with the aim of investigating the epidemiology of brucellosis in Isfahan province. Our research was a cross-sectional study on all people suffering from brucellosis disease who were identified in Isfahan province during 2021. Data was analyzed using appropriate statistical methods and by SPSS. In the present study, most of the brucellosis patients were men. Most of them lived in rural areas. The age groups of 30-40 years and less than 20 years included the most cases of patients. Planning to empower at-risk groups in facing risk factors and strengthening the care system are important in the prevention and control of brucellosis.

Exploring the feasibility of augmented reality game-supported flipped classrooms in reading comprehension of English for Medical Purposes

This quasi-experimental study explored the feasibility of the augmented reality game-supported flipped classrooms for English for Medical Purposes reading among 464 students from the Isfahan University of Medical Sciences in two phases. In the quantitative phase, the participants watched the pre-recorded lectures on English for Medical Purposes reading and took part in the assessment. Then, they gathered in small teams to practice reading through the Commercial-Off-The-Shelf or self-made augmented reality games under the surveillance of the teachers. In the qualitative phase, focus-group interviews were conducted to debrief students’ perceptions of English for Medical Purposes reading in the augmented reality game-supported flipped classrooms. Repeated measures ANCOVA and ANCOVA were used to analyze the quantitative data. The qualitative data were analyzed through thematic analysis. The finding showed that learning English for Medical Purposes in the self-made-augmented reality game-supported flipped classrooms resulted in better reading in academia and the field than learning in the Commercial-Off-The-Shelf augmented reality game-supported flipped classrooms. In these classrooms, students who practiced reading in the heterogeneous small teams made more significant progress; they outperformed those in the small homogeneous teams. The participants highlighted their positive perceptions of hands-on learning for streamlining the self-made augmented reality games in flipped classrooms. The results are discussed in detail.

Association Between Helicobacter Pylori Infection and Seronegative Neuromyelitis Optica Spectrum Disorder

Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease in the central nervous system. Association between NMOSD and Helicobacter pylori (H. pylori) infection has been investigated, but few studies have assessed the relationship between H. pylori and seronegative AQP4-Ab NMOSD. Objectives: This study aimed to survey the association between H. pylori infection and NMOSD patients with seronegative AQP4-Ab status, as well as the possible relationship between the presence of H. pylori and clinical characteristics. Materials & Methods: This cross-sectional study was carried out in Kashani Hospital affiliated with the Isfahan University of Medical Sciences, Isfahan, Iran, from October 2017 to May 2019. A total of 35 consecutive seronegative AQP4-Ab NMOSD patients and 37 sex and age-matched healthy controls participated in the study. Demographic and clinical characteristics were obtained from all participants. We assessed participants’ seroprevalence of IgG and IgM antibodies against H. pylori. The Association of H. pylori with NMOSD was determined. Results: The frequency of IgG and IgM Ab H. pylori seropositivity in NMOSD patients was 22.9% and 40.0%, respectively. Among HC, 11(29.7%) and 20(54.1%) were positive for IgG and IgM Ab H. pylori. Although the rate of H. pylori IgG (OR=0.700, 95%, CI=0.243, 2.017, P=0.420) and IgM Ab (OR=0.567, 95%, CI=0.222, 1.444, P=0.233) seropositivity in NMOSD were lower than NMOSD, these differences were not statistically different. No clinical variables associated with H. pylori IgG and IgM seropositivity infection seropositivity. Conclusion: These findings show that possibly there is no relationship between H. pylori infection and seronegative AQP4-Ab NMOSD.

Improving the ability of nursing students in neonatal resuscitation by using the Helping Babies Breathe Program: A quasi-experimental study

BackgroundNursing graduates must have sufficient skills to perform adequately in newborn resuscitations. New nurses should be provided with appropriate situations in order to practice the necessary skills required during a newborn resuscitation. This study aimed to improve the performance of nursing students during neonatal resuscitations through the use of a Helping Babies Breathe Program. MethodsThis quasi-experimental study with a control group (simulator with low similarity) and an interventional group (Helping Babies Breathe Program) was conducted on 84 eighth-semester nursing students studying at Isfahan University of Medical Sciences, Iran. A resuscitation workshop was held for a single day for 5 h with students performing standard practices for each step of the resuscitation. Knowledge and skills of students were assessed using two scenarios and a standardized checklist. ResultsThe mean score of knowledge and basic neonatal resuscitation skills were significantly different between the two groups before and immediately after training, as well as Post-Internship (p < 0.05). The highest score of knowledge (17.38) belonged to the intervention group. Appropriate skills are critically important when performing bag-valve-mask ventilation. Before the intervention occurred, students in the interventional group obtained the lowest scores in resuscitation skills; however, after the intervention, all interventional group students obtained a full score and demonstrated the necessary skills required for effective newborn resuscitations. ConclusionResuscitation training through the use of a high-similarity simulator was significantly more effective than utilizing a low-similarity simulator when performing basic neonatal resuscitation.

SARS-CoV-2 Seroprevalence among Health-Care Workers in Isfahan, Iran.

Health-care workers (HCWs) are in the frontline for fighting the coronavirus disease 2019 (COVID-19) pandemic and are at higher risk of acquiring the infection. Therefore, the defining immunity status among HCWs helps mitigate the exposure risk. In this study, we investigated the anti-SARS-CoV-2 immunoglobulin G (IgG) and immunoglobulin M (IgM) and also the associated risk factors in the HCWs working in Isfahan University of Medical Sciences COVID-19 referral hospitals. In a cross-sectional study, demographics, COVID-19 symptoms during the past 2 weeks, and health-care details were collected from 200 consenting health workers of COVID-center-hospitals of Isfahan University of Medical Sciences from 23 October to 21 December 2020. The recombinant SARS-CoV2 nucleocapsid protein enzyme-linked immunosorbent assay-based IgM, and IgG antibody tests were evaluated. Data were analyzed using Chi-square and independent-t-student tests, and P < 0.05 was considered significant. One hundred and forty-one women and 59 men with a mean age of 36.4 ± 7.77 years participated in the study. IgG Ab and IgM Ab were positive in 77 (38.5%) and 12 (6%) of samples, respectively, and both antibodies were detected in 9 (4.5%). Higher ages, direct contact with the patients with COVID-19, muscle pain, loss of taste and smell, fever, and cough were the factors associated with antibody seropositivity against SARS-CoV2. This study demonstrated that the prevalence of HCWs with antibodies against SARS-CoV-2 is relatively high in Isfahan University referral hospitals. The development of safety protocols and screening and vaccination strategies in the frontline HCWs must be implemented to reduce the burden of infection.

Identifying and prioritizing the stressors of obstetrics and gynecology residents.

Studies have shown that the obstetrics and gynecology residents face severe burnout and a large number of stressors, and excessive stress could adversely affect performance and quality of patient care. Thus, the current study attempts to identify and prioritize the stressors of obstetrics and gynecology residents at Isfahan University of Medical Sciences. A cross-sectional descriptive-analytical study was conducted on 62 residents and faculty members in the department of obstetrics and gynecology at Isfahan University of Medical Sciences in 2022. Respondents were selected by census method. The stressors of obstetrics and gynecology residents were investigated using a researcher-made, 37-item questionnaire. The questionnaire was prepared based on a literature review and respondents' opinions, then its validity and reliability were confirmed. Collected data were analyzed using the SPSS 20, non-parametric Friedman's test, and descriptive statistics methods. This study included 46 respondents (74%), 16 faculty members, and 30 residents, who were asked to rate each stressor of the given questionnaire. The residents and their teachers believed that the main stressors were heavy workloads, lack of personal time, long shifts, financial problems, sleep deprivation, and compassion fatigue. Insufficient study time, study workload, and inappropriate assessment systems for residents were among the high-priority stressors, according to the residents. However, the faculty members reported medical errors, unreasonable expectations from residents, and residents' multiple responsibilities as high-priority stressors. According to the Friedman's test, there was a significant difference in rates received from both the faculty members and medical residents (P value <0/001). The stressors due to the nature of obstetrics and gynecology, medical care, residency training, and medical resident assessment are the highest priority. The findings of this study could be beneficial to the officials in residency training programs to take the necessary corrective actions.

Effect of Home-Based Cardiac Rehabilitation Program on Self-Efficacy of Patients With Implantable Cardioverter Defibrillator.

For more effective control and treatment of cardiac dysrhythmias caused by diseases, ischemia, or other causes, an implantable cardioverter defibrillator (ICD) is used. One of the effective ways for secondary prevention is the home-based cardiac rehabilitation (HBCR) which nurses have an effective role in its implementation. The study aimed to investigate the effect of implementing HBCR programs on the self-efficacy of patients with ICD. This is a semi-experimental study conducted on 70 patients who received ICD in Shahid Chamran Heart Center of Isfahan University of Medical Sciences (IUMS) in 2021. The patients were randomly assigned to intervention and control groups and were introduced to the practical concepts of HBCR during four training sessions. In the following, 3-month follow-up and trainings were continued by home visits, telephone follow-up, and use of social messaging networks due to the conditions of coronavirus disease 2019 (COVID-19) pandemic. The data were analyzed with SPSS/21. The findings showed that performing HBCR programs was effective in improving the self-efficacy of patients with ICDs. A significant trend in the implementation of the HBCR programs in two groups was shown using chi-square test and independent t-test and variance with repeated measurements (p < .001). There was no significant difference in self-efficacy score in both groups at the beginning of the study (p < .056). Considering the effectiveness of HBCR programs on improving the self-efficacy of patients with ICDs, it can be used in the educational care programs of healthcare workers and in the strategic policies of health care services.

Development and validation of the clinical information literacy questionnaire.

Clinical Information Literacy (CIL) seems to be a prerequisite for physicians to implement Evidence-Based Medicine (EBM) effectively. This study endeavors to develop and validate a CIL questionnaire for medical residents of Isfahan University of Medical Sciences. This study employs sequential-exploratory mixed methods in 2019. The participants were 200 medical residents in different specialties; they are selected through the convenience sampling method. In the first (qualitative) phase, an early CIL questionnaire was designed by reviewing literature and performing complementary interviews with health professionals. In the second (validation) phase, the questionnaire's face validity and content validity were confirmed. In the third (quantitative) phase, the construct validity was examined via Item-Response Theory (IRT) model, and the factor loading was computed. The gathered data were analyzed using descriptive statistics, t-test, two-way ANOVA, as well as two-parameter IRT model in R software. In the qualitative phase, the concept of CIL is initially described in seven main categories and 22 subcategories, and the items were formulated. An initial 125-item questionnaire was analyzed by the research team, leading to a 43-item. Through the content validity and face validity examination, we removed 11 and 4 items in the Content Validity Ratio (CVR) and Content Validity Index (CVI), respectively. Throughout the face validity analysis, none of the items were removed. According to the construct validity results, difficulty coefficient, discriminant coefficient, and factor loading were confirmed, most of the other questions achieved a proper factor loading value that is higher than 0.30, and a value of 0.66 was achieved for the reliability via the Kuder-Richardson method. Ultimately, the real-assessment 28-item CIL questionnaire was developed with four components. The CIL questionnaire could be employed to examine the actual CIL basic knowledge. Because of using the real-assessment approach rather than self-assessment in the design, it can be claimed that this instrument can provide a more accurate assessment of the information literacy status of medical residents. This valid questionnaire is used to measure and train the skills needed by healthcare professionals in the effective implementation of EBM.

A Process Evaluation of the Isfahan Antibiotic Awareness Campaign: Developing Engagement on Antimicrobial Resistance.

One of the most prominent global health threats is antibiotic resistance, leading to infection treatment failure. The first Iranian antibiotic awareness week campaign was initiated to improve the prudent use and wise prescription of antibiotics. The Isfahan antibiotic awareness campaign was held from November 30 to December 6, 2019, among two targeted populations; the general population and health-care workers by Isfahan University of Medical Sciences. In this campaign held in the main squares, streets, and a city's referral hospital, various educational methods were used to aware and sensitize the general population and medical staff about antibiotics and microbial resistance. These methods include face-to-face training, brochures, advertisement posters and billboards around the city, educational videos, social media messages, retraining for medical doctors and medical specialists, and interviewing in the Islamic Republic of Iran Broadcast. Two hundred and twenty general practitioners, medical specialists, and residents participated in two retraining educational conferences in Al-Zahra Hospital, Isfahan, Iran. The mean score satisfaction of the two conferences was three from four. Nearly 2000 of the general population were under face-to-face educational programs whom after that, 83.6% had the correct answer to the questions around antimicrobial awareness. This campaign was an excellent experience as a pilot study with appealing issues. Further, activities are required to improve engagement with the target population and determine the impact of this campaign on antibiotic consumption and prescription behavior among the public and health-care professionals.

Mothers' views on mobile health in self-care for pregnancy: A step towards mobile application development.

Applications for pregnancy self-care (APSC) can improve post-partum by empowering pregnant women's status quo. This study endeavored to identify the operational needs of an application (app) from the perspective of Iranian pregnant women. In a qualitative manner, semi-structured and face-to-face interviews were conducted using an interview guide. Interviewees were pregnant women who encountered to health facilities of Isfahan University of Medical Sciences for prenatal care and were willing to be interviewed. The interviews were conducted from June 2019 to June 2021. All the recorded interviews were transcribed. The obtained data were analyzed through conventional content analysis using MAXQDA 12 (Developer: VERBI GmbH Release: 2015 Version: 12 OS: Microsoft Windows Type: Qualitative Data Analysis - Offline). Data saturation was obtained after 14 interviews. One of the researchers, as a data encoder, became acquainted with them by immersing himself in the data. After the data was first encoded and summarized, the codes were analyzed. In addition, an attempt was made to reduce the impact of researchers' experiences at different stages of the study process. Based on the opinions of pregnant women, 7 main themes (nutrition, training, fatal monitoring, relaxation, health, risk factors, physical activity) and 38 sub-themes were identified for APSC development. The findings revealed that pregnant women tend to use APSC, but because they are not comprehensive, women search the Internet to answer some of their information needs. The findings can be useful in developing a comprehensive pregnancy self-care mobile application that is localized based on the operational needs of pregnant women to make them capable and self-caring in controlling pre-risk situations.

Development of a post discharge telecare program for premature infants in Covid 19 era: Protocol for a mixed methods study.

Post-discharge care of premature infants is an important goal that can provide a safe transition for these infants from the hospital to the home setting, especially who has undergone significant changes during Covid19. Most premature infants experience complications because of routine hospital care termination after discharge because of limitations and barriers that Covid can create for the infant and the parents. It is necessary to develop a program that provides ongoing care for these infants. Telecare is one feasible option that can be used to implement this program. The study aims to develop a post-discharge telecare program for premature infants in the Covid era in Iran. This is an exploratory mixed-methods study that will be conducted by Qualitative-quantitative methods in three consecutive phases at Isfahan University of Medical Sciences in January 2022. In the first phase, a qualitative study will be conducted to identify and determine the needs and strategies in the Covid 19 era to promote premature infant care after discharge. The data will be collected through deep semi-structured interviews. Participants (parents, physicians, and nurses) will be selected by purposive sampling methods, and the conventional content analysis method will be used for data analysis. In the second phase, the identified infants' and parents' needs as an initial draft of the program will be prioritized and confirmed by the modified Delphi method and a panel of experts. The final program will be developed in this phase. In the quantitative third phase, the confirmed program will be implemented as a semi-experimental study that uses a telecare strategy. Finally, we will evaluate the effectiveness of this telecare program. A program that uses qualitative and quantitative methods can provide evidence for promoting premature infant health after hospital discharge in Covid 19 era. We anticipate that this program will promote knowledge and empower health team members, especially nurses, to provide ongoing telecare for premature infants.

Medication Beliefs, Cognitive Defusion, and Valued Living in Hypertensive Patients with Varying Medication Adherence.

One of the most severe problems that patients with Hypertension (HPN) face are lack of medication adherence, which is influenced by psychological factors. Thus, the current survey sought to compare medication beliefs, cognitive defusion and valued living in hypertensive patients with varying medication adherence. A cross-sectional study with 162 HPN patients from three clinics at Isfahan University of Medical Sciences was conducted in 2019. Participants completed the BMQ (Beliefs about Medicines Questionnaire), MMAS (Morisky Medication Adherence Scale), CFQ (Cognitive Fusion Questionnaire), and VLQ (Valued Living Questionnaire). The data were analyzed using descriptive statistics, chi-square, and analysis of variance (ANOVA). Only 22.2% of patients scored high in medication adherence (MA). MA levels increased with age in a significant correlation (P=0.03). ANOVA results revealed that the three MA levels (low, medium, and high) had substantial differences in both VLQ subscales (importance of person-valued living and allotted time for values; P=0.002 and P=0.023). However, no significant differences in MA levels were found in the CFQ (cognitive defusion and cognitive fusion) and BMQ subscales (specific necessity, specific concern, general overuse, and general harm). This study discovered that a higher MA is associated with increasing age. In addition, patients with HPN who value living and devote more time to their values have higher MA.

Exploring internship nursing students' experiences regarding the effect of supervision model implementation on medication safety: A descriptive qualitative study.

Medication safety is one of the main aspects of safe care in the nursing profession, which leads to increasing patient safety and preventing medication errors. Clinical supervision is an integral part of nursing education that leads to the professional and social development of nursing students. This study was designed with the aim of revealing the experiences of nursing internship students from the implementation of the clinical supervision model on medication safety. This descriptive qualitative study was done in 2022. The participants were selected from nursing internship students (Last year undergraduate) of Isfahan University of Medical Sciences, Isfahan, Iran. Participants in this study were 15 nursing internship students selected using a purposeful sampling method. Data were collected using in-depth semi-structured interviews. The qualitative content analysis approach was used for data analysis. After analyzing the data, four categories, "promotion medication safety competence and knowledge," "development trust and respect climate," "outcome of feedback," and "role of clinical supervisor," and 10 subcategories were extracted from the participants' experiences. The implementation of the clinical supervision model led to an increase in the competence of nursing internship students in medication safety. The students believed that this educational method made them follow the principles of medication safety administration. The feedback provided in the clinical supervision sessions made students think about their clinical activities, understand the reason for their mistakes, and use the reliable nursing resources introduced by the supervisor to improve their performance.

Demographic and Clinical Characteristics of Familial and Sporadic Multiple Sclerosis Patients.

Multiple sclerosis (MS) is a chronic, inflammatory, demyelinating, immune-mediated disease of the central nervous system. It is still unestablished whether heredity correlates with the disease's progression and severity. This study includes the patients with MS seen in the MS clinic of Kashani Hospital, affiliated with Isfahan University of Medical Sciences, from January 2019 to January 2020. We gathered data regarding the demographic and clinical characteristics, such as type of disease and family history of MS. Patients were grouped based on having relatives with MS. We compared demographic and clinical characteristics between those with a family history of MS (familial MS: FMS) and those without a family history of MS (sporadic MS: SMS). We included 2,929 MS patients, 523 (17.2%) with FMS and 2,406 (82.8%) with SMS. Patients with FMS were found to have active lesions in the thoracic spine more frequently than those with SMS (P = 0.022). We also found differences in the distribution of gender (P = 0.036) and the frequency of having active brain lesions (P = .024) among patients with FMS and SMS. No difference was found between the demographic/clinical characteristics and the number of affected relatives in the family. Significant differences were found among different groups of patients in terms of demographical and clinical characteristics.

Investigating the relationship between religious orientation and spiritual intelligence with general health dimensions in women with breast cancer.

Breast cancer is the most common type of cancer and the second leading cause of death among women. Religion and spiritual behaviors are effective strategies for maintaining human health. The aim of this study was to determine the relationship between religious orientation and spiritual intelligence with general health dimensions in women with breast cancer. The present study is a correlational study that was performed on 50 women with breast cancer referred to medical centers affiliated to Isfahan University of Medical Sciences in 2020. Data were collected through questionnaires of religious orientation, spiritual intelligence, and general health. Data were analyzed by Spearman and regression tests. The results showed that religious orientation had a significant positive relationship with the overall score of general health, but the components of religious orientation had a significant negative relationship with the number of components of public health (p < 0.05). Spiritual intelligence also had a significant positive relationship with general health. However, the number of components of spiritual intelligence has a significant negative relationship with the number of components of general health (p < 0.05). Considering the relationship between religious orientation and spiritual intelligence with public health and considering educational programs based on spiritual intelligence and religious orientation in this group of people can be an important step in promoting their general health.

Psychological distress, perceived stress and nocebo effect (multifood adverse reaction) in irritable bowel syndrome patients.

Psychological distress and perceived stress may complicate the clinical presentation, course, and treatment of patients with functional gastrointestinal disorders. The correlation between psychological distress, perceived stress, and the nocebo effect (multifood adverse reaction) in patients with irritable bowel syndrome (IBS) was the main aim of the present study. In this cross-sectional correlation study, data on 4,763 Iranian adults, 748 of whom by purposive sampling were patients with IBS (65.1% female), working in 50 different health centers affiliated to the Isfahan University of Medical Sciences across Isfahan province were examined. For assessing dietary intake, a 106-item self-administered Dish-based Semi-Quantitative Food Frequency Questionnaire that was specifically designed and validated for Iranian adults was used. General Heath Questionnaire 12 and Stressful Life event Questionnaire were used to assess psychological distress and perceived stress. By using a modified Persian version of the Rome III questionnaire, IBS was assessed. Based on researcher-made definition of nocebo effect (multiitem food intolerance), 164 people had the nocebo phenomenon in IBS group. Age, sex, education, marital status, antidepressant use, and specifically chronic underlying disease (odds ratio [OR]: 3.54, 95% confidence interval [CI]: 1.73-7.23) of general characteristics had a significant correlation (P <.05) with presenting nocebo responses in IBS patients. Psychological distress (OR: 1.415; 95% CI: 0.992-2.020; P = 0.056) had a significant correlation with nocebo effect and did not find significant correlation with perceived stress (OR: 0.999; 95% CI: 0.990-1.008; P = 0.865). Data were analyzed by Chi-square test, analysis of variance, and OR. The present study showed that psychological distress with chronic underlying disease and antidepressant use are important elements in presenting multifood adverse reactions that we named here as the nocebo effect in IBS patients. Reducing psychological distress and managing chronic underlying diseases appear to be an effective factor in reducing the nocebo phenomenon in IBS patients. For managing the nocebo responses in IBS patients, these findings may help clinicians to improve their interventions. Further studies are required to confirm these findings.

Correlation of flow cytometry and bone marrow biopsy in marrow involvement of lymphoma patients

Introduction: Non-Hodgkin’s lymphomas (NHLs) are hematolymphoid malignancies. Bone marrow biopsy (BMB) is performed for staging. BMB findings are an important indicator of prognosis and treatment planning. In this study, we compared flow cytometry and BMB in marrow involvement of lymphoma patients. Objectives: This study aimed to compare the frequency of involvement in bone marrow in flow cytometry and biopsy, compare the frequency of involvement in bone marrow in flow cytometry based on gender, compare frequency of bone marrow involvement in biopsy based on gender, compare mean age between two groups with bone marrow involvement and without bone marrow involvement in biopsy, compare mean age between two groups struggling with bone marrow involvement and without bone marrow involvement in flow cytometry, and compare mean ages between all genders struggling with bone marrow involvement and without bone marrow involvement in flow cytometry and biopsy. Patients and Methods: This study was cross-sectional, and the population included all patients affected by NHL, which bone marrow flow cytometry and biopsy performed for disease staging referred to Seyed Al-Shohada hospital affiliated with Isfahan University of medical sciences during 2016-2020. Four color flow cytometry devices (PARTEC CyFlow Space, Germany) with EXBIO antibody kits (Spain) were used. Results: In this study, the number of samples was 107, of which 68 (63.6%) were male, and the mean (standard deviation) of the total age was 40.87 (18.98) years. All samples were diagnosed as lymphoma and were examined by bone marrow flow cytometry and biopsy. Flow cytometry frequency of bone marrow involvement was 14 (13.1%), and biopsy frequency of bone marrow involvement was 22 (20.6%). In 97 cases (90.6%), the diagnosis of both methods was the same. Nine patients (8.4%) had bone marrow involvement in biopsy only, and one case (1%) had bone marrow involvement in flow cytometry only. As a result, bone marrow involvement in patients with lymphoma who participated in this project is about 21.5%. Conclusion: We concluded that evaluation of bone marrow involvement using combined methods is more efficient than biopsy or flow cytometry alone. We also recommended physicians use both methods at the same time.

Acute pesticide poisoning in the central part of Iran: A 4-year cross-sectional study.

Intoxication with pesticides is a well-known public health problem. We aimed to describe the demographic and toxico-clinical characteristics and outcomes of patients with pesticide poisoning. This retrospective cross-sectional study was performed in Khorshid Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. All patients with pesticide poisoning (insecticides, herbicides, fungicides, rodenticides, and acaricides) were evaluated. The patients' demographic, toxicological, clinical, and laboratory findings from March 2016 until March 2021 were collected and analyzed. During the study period, 25,659 patients with acute poisoning were admitted, of which, 1567 (6.1% of the total poisoning) with pesticide poisoning were included. The mean ± SD age of the patients was 31.34 ± 13.7 years and 55.3% were men (male/female ratio = 1.23). In approximately 75% of the patients, poisoning occurred by suicidal attempts, while in 14.3% (n = 224), it was accidental. Insecticides caused about 51.30% of the poisonings. However, rodenticides were most commonly used in completed suicide attempts (79.9%). The frequency of previously attempted suicide, and self-harming was different among the patients with respect to the type of pesticide poisoning (p < 0.05). Previous suicidal attempts (35.3%) and self-harming (17.3%) were reported more in patients poisoned with the combination of pesticides. Half of the patients were employed. Nausea and vomiting (56.7%, n = 889) were the most common clinical manifestations; 8.3% (n = 130) of the patients died, 64 of whom had rodenticide poisoning. The prevalence of pesticide poisoning was relatively low; most were insecticide poisoning. Poisoning occurred most through attempted suicide. Rodenticides and herbicides had higher mortality rates than other pesticides. Patients with previously attempted suicide and self-harming behavior may use a combination of pesticides.

Medication safety climate from the perspectives of healthcare providers: A cross-sectional study.

Medication safety as an indicator of care quality is the measures taken by healthcare team members to prevent or adjust adverse drug events at the time of medication administration. This study was conducted to investigate the medication safety climate from healthcare providers' perspectives. This cross-sectional descriptive study was conducted in a selected educational hospital affiliated with the Isfahan University of Medical Sciences, Isfahan, Iran, in 2021. Participants were healthcare providers who are involved in the medication process. The sampling was done using the quota method. The study instruments were a demographic questionnaire and the Medication Safety Climate (MSC). The total mean of positive responses to MSC items was 64.11%, denoting a moderate-level MSC. Collected data were managed using the SPSS software (v. 16.0) and were summarized using the measures of descriptive statistics, namely mean, standard deviation, frequency, and percentage. The lowest and the highest dimensional mean scores were related to the management support for medication safety dimension (mean: 48.42%) and the Teamwork dimension (mean: 80.43%), respectively. Managers' inattention and insufficient understanding of safety provide the basis for medication errors and threaten patient safety. Healthcare team members are highly motivated to provide quality and safe care by observing the managers' positive performance regarding patient safety. To improve the medication safety climate, healthcare team members are required to work in a safe workplace and have sufficient job satisfaction. Health center managers need to employ a proactive approach to prevent errors.

Effect of Oral Prednisolone on Pain after Tonsillectomy with Sutures: A Randomized Clinical Trial.

Tonsillectomy, one of the most common otolaryngology surgeries, often results in postoperative complications such as pain and bleeding. Currently, there is no consensus on postoperative pain management. This study aimed to determine the efficacy of oral prednisolone on postoperative pain after tonsillectomy with sutures. This pilot, double-blind, randomized clinical trial was conducted at two tertiary care centers affiliated with Isfahan University of Medical Sciences. Patients who underwent tonsillectomy with sutures were included. Participants were randomly divided into experimental and control groups. In the experimental group, patients received oral prednisolone in addition to acetaminophen; in the control group, patients received acetaminophen and a placebo. Post-operative pain was evaluated by a visual analog scale daily for ten days. Initially, 60 patients were enrolled in the study; however, four were excluded due to non-attendance at follow-up visits. The groups were similar in terms of age and sex (both P values >0.05). In the study, postoperative pain from 1st day to the 10th day was lower in the experimental group than in the control group (P value <0.05). Numerous studies have been conducted on the effect of intravenous corticosteroids on this pain. However, there is no consensus on the analgesic role of oral corticosteroids for post-tonsillectomy pain. The present study showed that oral prednisolone is effective on post-operative pain compared to a placebo.