Irish Teaching Hospital Research Articles

Frequency of metabolic syndrome and its associated factors in health care workers

BackgroundIn recent decades, metabolic syndrome is one of the most important public health risk factors. Having this in mind, the present study was conducted to evaluate the frequency of metabolic syndrome and its associated risk factors in healthcare workers. MethodThis study is a cross-sectional study conducted on 410 healthcare workers in a teaching hospital in Iran. Demographic, occupational, and psychosocial characteristics were assessed using questionnaire. Assessment of metabolic syndrome of hospital staff was performed at workplace during their medical examination. ResultsThe frequency of metabolic syndrome was found to be 22.4%. This relationship was found among blood pressure and occupational stress, despite the fact that there was no significant relationship between metabolic syndrome and occupational stress. Higher age, having shift work, and inactivity were associated with metabolic syndrome. ConclusionConsidering the high frequency of metabolic syndrome among Iranian healthcare workers, it is advised that effective management should be employed to correct the occupational and psychosocial factors associated with this syndrome.

Causes of medical errors and its under-reporting amongst pediatric nurses in Iran: a qualitative study.

To explore the causes of medical errors (ME) and under-reporting amongst pediatric nurses at an Iranian teaching hospital. A qualitative study, based on individual, in-depth, semi-structured interviews and content analysis approach. The study was conducted at the Pediatric Department of the largest tertiary general and teaching hospital in Shiraz, southern Iran. The study population was all pediatrics nurses who work at Pediatric Department and they had been trained on ME, as well as methods to report them through the hospital's ME reporting system. Purposive sampling was used by selecting key informants until data saturation was achieved and no more new information was obtained. Finally, 18 pediatric nurses were interviewed. Pediatrics nurses' views on the causes of ME and under-reporting. We found five main factors causing ME and under-reporting: personal factors, workplace factors, managerial factors, work culture and error reporting system. These factors were further classified into proximal and distal factors. Proximal factors had direct relationship with ME and distal factors were contextual factors. Causes of ME and under-reporting amongst pediatric nurses are complex and intertwined. Both proximal and distal factors need to be simultaneously addressed using context-specific approaches. Further research on other groups of healthcare workers and using a quantitative approach will be beneficial to elucidate the most appropriate interventions.

Accreditation in one teaching hospital: a phenomenology study among Iranian nurses

PurposeAccreditation helps to ensure safe and high-quality services in hospitals. Different occupational groups have various hospital accreditation experiences. The purpose of this paper is to investigate nurses’ accreditation experience and its effects on Iranian teaching hospital service quality.Design/methodology/approachThis was a qualitative study involving a phenomenological approach to studying nurses’ hospital accreditation experience and understanding the effects on Iranian teaching hospital service quality. Data were collected using two focus groups in which nurses were selected using purposive sampling. Transcripts were analyzed using content analysis.FindingsNurses’ experiences showed that hospital administrators and nurses had greater role in implementing accreditation than other occupational groups. Accreditation improved patient-centeredness, patient safety, logistics and managerial processes and decision making. However, a weak incentive system, extra documentation and work stress were negative experiences.Practical implicationsNurse experience, as the most important care team member, reveals accreditation’s strengths and weaknesses and its effects on service quality.Originality/valueThe author used a phenomenology approach to measure accreditation effects on service quality – a valuable tool for understanding a phenomenon among those that experience hospital accreditation processes.

Providing Nutrition Care to Patients with Chronic Disease: An Irish Teaching Hospital Healthcare Professional Study

An increasing prevalence of noncommunicable diseases (NCDs) and chronic illness is putting an ever increasing burden on healthcare services and delivery worldwide. Diet contributes significantly to the development of NCDs. Nutrition should therefore be viewed as an important aspect of patient care and be addressed by all healthcare professionals (HCPs). Previous work has highlighted a lack of competency around providing nutrition advice in HCPs; however, positive attitudes towards the importance of nutrition care are well documented in this group. The aim of this study is to document and compare Irish HCPs self-perceived competency towards incorporating nutrition care into practice. The NUTCOMP questionnaire was completed by 206 HCPs in Sligo University Hospital. The findings showed positive attitudes towards the incorporation of nutrition care into HCP practice; however, confidence in knowledge and skills was low, thus missing vital opportunities to prevent and/or treat chronic diseases and improve outcomes in acute illness. Previous nutrition education was associated with greater self-perceived knowledge about and skills in providing nutrition care to patients and positively associated with attitudes towards incorporating nutrition care into practice. HCPs expressed a desire and unmet need for additional and ongoing educational intervention in the area of nutritional intervention.

Effects of breast milk on pain severity during muscular injection of hepatitis B vaccine in neonates in a teaching hospital in Iran

Introduction and aimsHuman breast milk is a natural pain reliever that contains endorphins. The aim of this study was to compare the effects of breast milk and powdered milk on pain severity after a muscular injection in 1-day-old neonates. Materials and methodsOne hundred neonates admitted to a teaching hospital in Ilam city, Iran, participated in a randomized clinical trial in 2016. One-day-old neonates were divided into four equal groups including: the control group (no feeding); the breastfed group; the bottle-fed mother's milk group and the powdered formula group. All infants received the hepatitis B vaccine by muscle injection in the same position of the thigh. The severity and duration of pain were compared among all groups during and after injection using the DAN scoring method (evaluation behavioral scale of acute pain in newborn infant). ResultsOne hundred neonates (57% boys) participated in this study. The mean±SD age and weight for participants were 39.15±0.05 weeks and 3016±28g, respectively. Crying duration either during or after the injection in breastfed infants was significantly shorter compared to the control and powdered formula groups (9.2±3.9 and 16±4.6s vs. 38.2±8.9 and 30.0±4.4s, respectively, during injection, P<0.003); (11.8±3.4 and 20.6±5.1s vs. 56.2±6.5 and 49.8±9.6s, respectively, after injection, P<0.006). There was also a significant relationship between behavioral variations and pain during injection (P<0.0001). ConclusionsThe results of this study showed that breastfeeding decreases pain severity during painful experiences in neonates, which is in accordance with other reports. Based on this finding, neonates are advised to be breastfed if a painful intervention such as vaccination is needed. The pain-relieving effect of breast milk could also be added to its other suitable effects.

Reaching for the stars: Iranian nurses' perceptions of career success.

The aim was to explore nurses' perceptions of career success. Career success is a concept which leads to improving professional behaviours. Research that focused on conceptualizing career success found it to be a complex, value-driven construct likely to be perceived differently across work and cultural contexts. It is not yet clear what constitutes career success, and how it is perceived by nurses in Iran. More comprehensive exploration of this concept in nursing is needed, so research and policymaking can advance in informed, data-driven manner. This is a qualitative descriptive study. The setting was teaching hospitals of Iran. Twenty-seven nurses participated in face-to-face interviews, and six field notes were collected. Data were analysed using conventional content analysis. Analyses identified five themes of career success: providing high-quality care, being exemplary employee, embarking on career growth, having positive personal attributes and being internally satisfied. Findings confirmed that career success in Iranian nurses was a multidimensional concept that represented five internally and externally driven dimensions set within its cultural and religious context. Policymakers and clinical educators can now plan interventions aimed at fostering career success in nursing staff. Future nurses could use these finding to reflect on their developed attributes throughout their studies and clinical placements and adjust their career preparation and learning to bridge any identified gaps. Organizational values and intervention for nursing staff could also be redesigned to align with the aspects of career success.

Perspectives of Oncology Unit Nurse Managers on Missed Nursing Care: A Qualitative Study

Objective:The main objective of this study was to explore factors affecting missed nursing care in oncology units from the perspective of nurse managers.Methods:Twenty nurse managers working at oncology units of referral teaching hospitals in Iran participated in this study. Data were collected through individual face-to-face and telephonic interviews using an interview guide. Focus groups were also conducted. Data were analyzed using conventional content analysis.Results:System structure, underlying factors, and barriers to missed-care reports were identified as factors that affect missed nursing care.Conclusions:Nurse managers should reduce the effects of nursing staff shortages and increased workloads in addition to providing materials and equipment. They need to distribute experienced staff according to the type of ward or patients' needs. Nurse managers should create a favorable environment for reporting missed nursing care by having an open relationship with nurses by teaching and emphasizing nursing practice. Moreover, using a nonpunitive managerial approach and minimizing the use of an apathetic management style can be helpful.

Evaluation of Pralidoxime Use in an Iranian Teaching Referral Hospital

Background: Organophosphorus (OP) poisonings, a common source of pesticide poisoning, are an important cause of morbidity and mortality in the developing countries. Combination therapy with atropine and oxime is a common practice in the management of OP poisoning. However, the additive benefit of using pralidoxime in addition to atropine remains controversial. Due to inappropriate and widespread use of this relatively expensive and low available antidote, we aimed to evaluate its usage in an Iranian teaching hospital. Methods: Medical files of patients with pesticide poisoning who had been admitted to the poisoning ward between September 2013 and September 2014 were reviewed. Patients with definite diagnosis of OPs poisoning were selected to evaluate rational use of pralidoxime in their treatment regimen. Data were collected using a checklist containing demographic, clinical, and para clinical characteristics, as well as the type of pesticide poisoning. Appropriateness of the pralidoxime therapy was determined based on clinical practice guideline and endorsed by an attending medical toxicologist. Results: 68.8% of patients had been poisoned with insecticides, 27.1% with aluminum phosphide, 2.1% with herbicides, and 2% with rodenticides, respectively. OPs were responsible for 43.8% of all poisoning. All patients with OPs poisoning received pralidoxime after they had been admitted to emergency department, while only 55% of them were eligible to receive pralidoxime. Moreover, pralidoxime had been administered for 59% of patients with non-OPs poisoning, which all of them were clinically inappropriate. Conclusion: The use of pralidoxime in the northwest of Iran is not appropriate and thus, it is highly recommended that a patient-tailored treatment guideline be provided and implemented regionally.

Biosimilar infliximab introduction into the gastroenterology care pathway in a large acute Irish teaching hospital: a story behind the evidence

Biosimilar infliximab introduction into the gastroenterology care pathway in a large acute Irish teaching hospital: a story behind the evidence

AB103. 39. Emergency Department Intubations at an Irish Teaching Hospital—a 12-month analysis

AB103. 39. Emergency Department Intubations at an Irish Teaching Hospital—a 12-month analysis

Meropenem Utilization Evaluation in a Referral Teaching Hospital in Iran.

Objective:Inappropriate use of antibiotics is associated with detrimental effects including emergence of antibiotic resistance. This study aimed to evaluate the use of meropenem, an extended-spectrum antibiotic, in a referral teaching hospital to detect different types of errors in its prescription.Methods:In a cross-sectional study performed over a 6-month period (2014–2015), hospitalized adult patients who received meropenem for any indication were randomly selected. The collected data included the indication for prescription and its correctness, the basis of prescription (empirical or culture based), administered dose, duration of treatment, the status of demanding sample culture in the case of empirical prescription, the status of dose adjustment in the case of renal impairment, and the treatment outcome.Findings:Over the study period, 123 patients were evaluated. The most frequent indication for prescription of meropenem was pneumonia (31.7%) and soft-tissue infections (18.7%). Out of these prescriptions, 62.6% (77 prescriptions) were incorrect. All meropenem prescriptions were initially empirical. Furthermore, sample culture and antibiotic susceptibility test were requested for only 52% of patients (n = 66). Treatment duration was correct for 53.7% of patients. Seventeen patients (13.8%) received an inappropriate dose of the antibiotic. Furthermore, of 51 patients who needed meropenem dose adjustment because of renal impairment, 17 patients (33.33%) received unadjusted dose.Conclusion:High rate of errors exists in the utilization of meropenem in our hospital, especially in the rank order of selection for treatment (indication), dose adjustment, and treatment duration. Therefore, modification strategies are necessary to promote the rational use of meropenem in this center.

Albumin Utilization Evaluation in a Major Teaching Hospital in Iran: Recommendations for Guideline Development.

Objective:Human albumin solution is an expensive colloidal preparation which is commonly used in clinical practice. Due to high cost of albumin, increased rate of the inappropriate use worldwide, and many other reasons, it is imperative to establish a practical protocol to use albumin products and limit its usage. The aim of this study was to identify albumin utilization patterns in a teaching hospital and to demonstrate the importance of the need to reconsider prescribing strategies for albumin administration.Methods:This retrospective cross-sectional study was performed between August 2016 and December 2016 at Firoozgar Hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. All albumin prescriptions for adult patients during the study period were enrolled for appropriateness evaluation according to the latest evidence-based studies and guidelines.Findings:Among 320 albumin prescriptions, 168 (52.5%) were inappropriate according to the current evidence. The most common irrational causes for the albumin usage were hypoalbuminemia (23.4%), nutritional support (13.7%), neuroprotection in subarachnoid hemorrhage (3%), pretreatment for cancer surgery (2.8%), edema (1.6%), hepatic failure (1.6%), and paracentesis (3%). The total amount of albumin used for 320 patients was 52,050 g, from which 28,470 g was inappropriate resulting in $97,398 wastage.Conclusion:These findings, along with aforementioned guidelines, support the requirement for physicians' educational programs and proper strategies for appropriate prescriptions and could also be important in modifying the available guidelines concerning expensive drugs such as albumin.

40 ED crowding: the acceptability of dysfunction

BackgroundCrowding in the Emergency Department is internationally recognised as one of the greatest challenges to healthcare provision. Numerous studies have highlighted the ill-effects of crowding, including increased length of stay,...

Medication Reviews by a Clinical Pharmacist at an Irish University Teaching Hospital.

Purpose: Pharmacist-led medication reviews in hospitals have shown improvement in patient outcomes. The aim of this study is to describe the prevalence and nature of pharmacist interventions (PIs) following a medication review in an Irish teaching hospital. Methods: PIs were recorded over a six-month period in 2015. PIs were assessed by a panel of healthcare professionals (n = 5) to estimate the potential of adverse drug events (ADEs). Descriptive statistics were used for the variables and the chi square test for independence was used to analyse for any association between the variables. Results: Of the 1216 patients (55.8% female; median age 68 years (interquartile range 24 years)) who received a medication review, 313 interventions were identified in 213 patients. 412 medicines were associated with PIs, of which drugs for obstructive airway disease (n = 82), analgesics (n = 56), and antibacterial products for systemic use (n = 50) were the most prevalent. A statistically significant association was found between PI and patient’s age ≥65 years (p = 0.000), as well as female gender (p = 0.037). A total of 60.7% of the PIs had a medium or high likelihood of causing an ADE. Conclusion: Pharmacist-led medication review in a hospital setting prevented ADEs. Patients ≥65 years of age and female patients benefited the most from the interventions.

A retrospective audit of the ‘Back in Motion Programme': A stratified group based, physiotherapy programme for patients with Chronic Low Back Pain

Background: Low back pain (LBP) is one of the leading causes of disability worldwide with an estimated 632 million people affected. With LBP linked with a huge financial and societal burden much research has focused on developing the best treatment approach for this patient population. Recent research would present that by stratifying patients, utilising the Keele ‘STarT Back’ tool, into more homogeneous groups and providing them with targeted treatment that results achievable are more clinically cost effective. More recently, research by an Irish physiotherapist has suggested that if this stratified care approach is employed in a group setting, favourable results are also observed, specifically in patients with LBP. Objectives: To determine the efficacy of the physiotherapy lead ‘Back in Motion Programme’: a stratified group exercise/education intervention, aimed at managing a cohort of patients with chronic LBP, run in an Irish Teaching Hospital. Method: A retrospective audit of the chronic LBP patients who were referred into the ‘Back in Motion Programme’ was completed from June-August 2016. Two hundred and thirty-eight charts were audited of patients who were referred into the programme between January 2015 and June 2016. Details on what happened patients upon referral into the programme was gathered. Patient profiles including age, gender, LBP duration, waiting time to be seen by physiotherapy and referral source were recorded. Initial and final outcome measure scores were recorded (Rowland Morris Disability Questionnaire, Keele STarT back tool and Brief Pain inventory). Patient class attendance records were also noted. Information on patient follow up care, if any, on programme completion was also recorded. Results: Two hundred and thirty-eight patients were referred into the ‘Back in Motion Programme’, of this 37 (15.4%) patients completed the programme in full. Improvements in all three patient outcome measures were observed to be of statistical significant. The greatest improvements were observed in the Rowland Morris Disability Questionnaire (p= 0.000198). The average change in Rowland Morris Disability Questionnaire was 3 units, a score greater or equal to the MDC of 2-3 units for this outcome measure. Conclusions: The ‘Back in Motion Programme’ was seen wo be effective in the management of patients with chronic LBP who completed the programme in full. Despite the large patient non-attendance numbers these finding have implications for future rehabilitation programmes for this patient population.

Does Intradisciplinary Conflict Influence to Outcomes of Emergency Medicine Residency Program? A Mixed Methods Study.

To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors. A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital. The second phase included semi-structured interviews with five individuals which purposively selected to participate in qualitative design. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach. The most patients were admitted to the hospital in night shift, both before and after the resident EMS. No statistically significant differences were found among all of the waiting times during the two time periods except for the average time interval between admission and physician start time (p<0.0001), which increased (instead of reducing), and the average time interval between physician start time and first treatment measure (p<0.0001), which decreased during the year the residents began. The interviewees revealed the intradisciplinary conflicts and interferences existing between ED and other specialist departments, are main important factor to delayed processing of patients visits. This study has shown that intradisciplinary conflict would affect the outcomes of emergency medicine residency program and ED process. These new findings enhance the understanding of the nature of conflicts and will persuade policy makers that design a set of clinical practice guidelines to clarify the duties and responsibilities of parties involved in ED.

Does Intradisciplinary Conflict Influence to Outcomes of Emergency Medicine Residency Program? A Mixed Methods Study

To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors.A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital. The second phase included semi-structured interviews with five individuals which purposively selected to participate in qualitative design. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach.The most patients were admitted to the hospital in night shift, both before and after the resident EMS. No statistically significant differences were found among all of the waiting times during the two time periods except for the average time interval between admission and physician start time (p<0.0001), which increased (instead of reducing), and the average time interval between physician start time and first treatment measure (p<0.0001), which decreased during the year the residents began. The interviewees revealed the intradisciplinary conflicts and interferences existing between ED and other specialist departments, are main important factor to delayed processing of patients visits.This study has shown that intradisciplinary conflict would affect the outcomes of emergency medicine residency program and ED process. These new findings enhance the understanding of the nature of conflicts and will persuade policy makers that design a set of clinical practice guidelines to clarify the duties and responsibilities of parties involved in ED.

088Frail, Falling, Alone – 30-Day Readmissions not just about Hospital Care. A Prospective Study in a Large Irish Teaching Hospital

088Frail, Falling, Alone – 30-Day Readmissions not just about Hospital Care. A Prospective Study in a Large Irish Teaching Hospital

Investigating the Use of Human Albumin in a Non-Teaching Hospital in Iran.

Albumin is an expensive drug which imposes relatively high cost on the health care system. Doing ABC analysis in Shahid Motahari Hospital, it was revealed that albumin is categorized in class A. Therefore, the present study aimed to evaluate the pattern of albumin use and the physicians' adherence to evidenced-based albumin guidelines in this large general non-teaching hospital in Shiraz, Iran. This study is an observational retrospective research on drug utilization. All patients admitted to Shahid Motahari hospital that had received albumin during the study period of one year (December 2013 to December 2014), were included in the study. To evaluate the appropriate use of albumin, an internal guideline was prepared using several evidence-based guidelines. Prescriptions were considered correct and appropriate if they were compliant with the standard guideline. The result of this study indicated that about 87.3% of patients had received albumin improperly. Nephrotic syndrome without hypoalbuminemia (23.6%) was the most prevalent reason for albumin misuse and internal ward was the most consuming unit. The findings of this study, similar to those of previous investigations in Iran, revealed the high percentage of inappropriate albumin usage in Iranian teaching and non-teaching hospitals. Regarding the high cost and short supply of this drug, educating physicians through educational programs to best implement the standard guidelines is highly recommended.

The Prevalence of CTX-M-15 Extended-spectrum β-Lactamases Among Salmonella spp. and Shigella spp. Isolated from three Iranian Hospitals.

Bacterial antimicrobial resistance mediated by the production of extended-spectrum β-lactamases (ESBLs) is considered a major threat for treatment of Salmonella and Shigella infections. This study aimed to investigate antibiotic resistance patterns of Salmonella and Shigella spp. and presence of CTX-M from three teaching hospitals in Iran. In the present study, 58 clinical Shigella and 91 Salmonella isolates were recovered between 2009 and 2013 from 3 teaching hospitals in Iran. After culture and antimicrobial susceptibility testing, ESBL-positive isolates were subjected to further investigations. These included polymerase chain reaction (PCR) amplification and DNA sequencing of blaCTX-M-15 encoding plasmid. In both genera, high sensitivity to gentamicin and amikacin, but high resistance to ampicillin, tetracycline, and trimethoprim–sulfamethoxazole, was found. Molecular investigation showed that 31.8% isolates of Salmonella spp. and 34.48% isolates of Shigella spp. were CTX-M positive and all of them were also positive for ISEcpI. Protein translation, comparing with reference sequences, showed that all CTX-M isolates belong to CTX-M-15. The present study suggests that the resistance of ESBLs-producing Salmonella and Shigella spp. in Iran hospitals is very serious. Therefore, strategies to minimize the spread of ESBL-producing isolates should be implemented.