Irish Teaching Hospital Research Articles

Nurses’ knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus

BackgroundThe prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses’ role in nutritional management of diabetes. This study aimed to evaluate nurses’ knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes.MethodsThis cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses’ KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis.ResultsThe mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses’ attitudes positively (B = -7.59, p = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p = 0.008).ConclusionNurses’ knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally.

Molecular Detection and Characterization of the Staphylococcus epidermidis and Staphylococcus haemolyticus Isolated from Hospitalized Patients and Healthcare Workers in Iran.

The present study is aimed at surveying the antibiotics resistance profile, biofilm formation ability, staphylococcal cassette chromosome mec (SCCmec) types, and molecular epidemiology of Staphylococcus epidermidis and Staphylococcus haemolyticus isolated from hospitalized patients and healthcare workers in four teaching hospitals in Iran. In total, 43 Staphylococcus epidermidis and 12 Staphylococcus haemolyticus were isolated from hospitalized patients, and 19 Staphylococcus epidermidis and 7 Staphylococcus haemolyticus isolated from healthcare workers were included in the present study. The antimicrobial resistance profile of isolates was determined using the disk diffusion method. Moreover, the resistance of isolates to methicillin was identified using the cefoxitin disk diffusion test. The microtiter-plate test was used for quantifying biofilm formation. Moreover, the frequency of icaA and icaD genes was determined using PCR assay. The molecular epidemiology of methicillin-resistant isolates was determined using SCCmec typing and pulsed-field gel electrophoresis methods. Among all coagulase-negative staphylococci isolates, the highest resistance rate (81.5%) was seen for cefoxitin and cotrimoxazole. All of the isolates were susceptible to linezolid. Out of the 66 mecA-positive isolates, the most common SCCmec type was the type I (n = 23; 34.8%) followed by type IV (n = 13; 19.7%). Using pulsed-field gel electrophoresis (PFGE) assay, 27 PFGE types including 14 common types and 13 singletons were obtained among 51 methicillin-resistant S. epidermidis (MRSE) isolates. Moreover, among 12 methicillin-resistant S. haemolyticus (MRSH) isolates, 8 PFGE types were detected, of which 5 PFGE types were singletons. The high rate of resistance to antibiotics as well as the possibility of cross-infection shows the importance of a pattern shift in the management and controlling programs of coagulase-negative staphylococci, especially in healthcare centers. Clinical trial registration. The present study is not a clinical trial study. Thus, a registration number is not required.

The experiences of hospitals in changing the function of a non-teaching hospital to a teaching hospital: Short-Communication.

In recent years, there have been many non-teaching hospitals that have become teaching hospitals. Although the decision to make this change is made at the policy level; But the unknown consequences can create many problems. The present study investigated the experiences of hospitals in changing the function of a non-teaching to a teaching hospital in Iran. A Phenomenological qualitative study was conducted using semi-structured interviews with 40 hospital managers and policy makers who had the experience of changing the function of hospitals in Iran through a purposivesampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis. According to the results extracted 16 main categories and 91 subcategories. Considering the complexity and instability of command unity, understanding the change of organizational hierarchy, developing a mechanism to cover client's costs, considering increase management team' legal and social responsibility, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering change the performance appraisal system and pay for performance were the solutions for decrease problems of changing the function of non-teaching to teaching hospital. Important matter about the improvement of university hospitals is evaluating the performance of hospitals to maintain their role as progressive actors in hospital network and also as the main actors of teaching future professional human resources. In fact, in the world, hospital becoming teaching is based on the performance of hospitals.

Nurses' Lived Experiences of Moral Courage Inhibitors: A Qualitative Descriptive Study.

Moral courage (MC) has been characterized among the vital strategies, adopted by nurses, for dealing with moral distress; even though there are some factors hindering the development of this behavior in clinical settings. The present study accordingly aimed to shed light on Iranian nurses' lived experiences regarding MC inhibitors. This qualitative descriptive study was fulfilled, using conventional content analysis. For this purpose, the participants comprised of 15 nurses were recruited purposively from teaching hospitals in Iran. As well, in-depth, individual semistructured interviews in a face-to-face mode were held for data collection. The data were further analyzed by Graneheim and Lundman's method. The analysis of the interviews revealed some MC inhibitors, including the individual factors (viz., personality traits, fear of job loss, poor scientific/practical skills, lack of ethical knowledge, and phobia of unpleasant experience recurrence), and the organizational ones (namely, no reward system, lack of power at work and physician dominance, inadequate organizational support, and suppressive environment). The study findings demonstrated that the MC inhibitors in the nursing practice could be split into two general themes, that is, the individual and organizational ones. Accordingly, organizations could motivate nurses to make ethical decisions courageously, using supporting strategies, such as giving importance to nurses and empowering them, applying appropriate evaluation criteria, and appreciating ethical performance in these frontline healthcare workers.

Iranian women's birth experiences: a cross-sectional study

Background/Aims Women's childbirth experiences are an essential measure of childbirth and have a significant role in evaluating and improving the quality of care given during birth. This study's aim was to evaluate women's experiences during labour and childbirth in a teaching hospital in Iran. Methods This cross-sectional study was conducted in a public hospital in Guilan from July to August 2018. The study recruited 126 low-risk postpartum women. The childbirth experience questionnaire and a researcher-developed questionnaire were used for data collection. Linear regression was used to assess the effect of factors on birth care experience (significance level: P<0.05). Results Women's experiences of childbirth were not optimal. Women's overall experience score was 2.56±0.42. The desire to have a normal birth (P<0.001), the freedom to drink, change position or walk during labour (P=0.01), receiving respectful care (P<0.001) and emotional support (P=0.009) were contributing factors to women's perceptions of their experiences. Conclusions Quality improvement strategies are needed to implement evidence-based care in Iran. Interventions to ensure that healthcare professionals’ behaviour promotes women's psychological wellbeing and creates a respectful birth environment are required to promote high-quality childbirth care and improve birth experiences in Iran.

Analysis of the cost of surgeries before and after the start of the day care department in a teaching hospital in Iran during 2015-2019

Analysis of the cost of surgeries before and after the start of the day care department in a teaching hospital in Iran during 2015-2019

Analysis of the Pattern of Poisoning in Patients Admitted to a Large Teaching Hospital in Iran

Introduction: Poisoning is one of the most common causes of hospital admission. This study aims at 1- to determine the characteristics of poisoning, 2-to discover the relationship of the patients’ characteristics, and 3- to suggest a pattern of characteristics of poisoning.
 Methods: The current cross-sectional study was conducted at Edalatian Emergency Center in 2016. Characteristics of patients with poisoning were extracted from the hospital information system (HIS) in a large teaching hospital. Gender, type of admission, the priority of admission, type of referral, cause of referral, insurance organization, age, and month of referral were the variables extracted. Data were analyzed using descriptive and analytical statistical methods in SPSS software version 21. 
 Results: Of the 15204 patients included in this analysis, 55.2% of the patients were men. Also, 68.5% had nonurgent triage level, and the cause of the 60.7% of the poisoning was medication overdose. Most of the patients (86.2%) aged from 20 to 30 years with the most frequent referral in May, June, July, and August. According to logistic regression results, opium, toxin, alcohol and medication poisoning had the highest odds of being at urgent triage level (OR= 1.609, 1.559, 1.358, 1.218 respectively) and the food poisoning was the lowest cause of poisoning ( OR=0.018). Triage level was found to be significantly different in months of the year (P<0.001). But, a routine trend was not observed.
 Conclusion: The use of preventive measures from the occurrence of poisoning is necessary for the country because this problem occurs due to the lack of awareness about its causative factors. Regarding the more prevalence of intentional poisoning, the necessary steps are needed to be taken to identify the Psychological causes and prevent suicide in at-risk groups.

Nurse preceptors’ perceptions of benefits, rewards, support, and commitment to the preceptor role in a new preceptorship program

BackgroundNurse preceptorship is a new concept emerging in the Iranian health care system. The purpose of this research was to assess preceptor nurses’ perceived benefits, rewards, support, and commitment to the role in a new nurse preceptorship program in Iran and to examine the relationships between these concepts.MethodsA descriptive correlational study was employed, and using total population sampling method, 45 preceptor nurses were recruited from a tertiary referral teaching hospital in Iran. Data were collected using the Preceptor’s Perception of Benefits and Rewards Scale, the Preceptor’s Perception of Support Scale, and the Commitment to the Preceptor Role Scale. Descriptive statistics and correlational analysis were used to analyse data.ResultsPreceptors’ commitment to their role was positively and moderately associated with their perceived benefits and rewards (r = 0.503, p = 0.001) and perceived support (r = 0.430, p = 0.003). None of the examined demographic and practice variables showed statistically significant association with commitment to the preceptor role.ConclusionsCommitment to the preceptor role was associated with benefits, rewards and support that preceptor nurses perceive in relation to their role. To optimise the effectiveness of nurse preceptorship programs, benefits, rewards, recognition, and support should be integral to planning of these programs.

Nurse’s Experiences of Care Challenges of Admitted Patients with Obesity: A Qualitative Content Analysis Study

Background: Nurses have difficulties in caring for patients with obesity (PWO) due to their large size and complex care needs. As there have been few studies on these challenges, it is necessary to identify them for PWO through access to nurses’ experiences. Objectives: This study aimed to explain the nurses’ experiences of the challenges of caring for admitted PWO. Methods: This qualitative study was performed on 12 nurses working in two large urban teaching hospitals in Iran. They were selected using the purposive sampling method. Data were collected using semi-structured interviews during 2018-2020. Content analysis and MAXQDA software (version 10) were used to analyze data. Results: According to the results, "threat to the patient safety" was the main theme extracted from nurses’ experiences, which included three categories, namely "from care difficulty to inaccurate care", "exacerbation of clinical complications", and "limited self-care". The category of "from care difficulty to inaccurate care" consisted of the subcategories of "care difficulty" and "inevitability of performing inaccurate care". The category of "exacerbation of clinical complication" was composed of the subcategories of "domino-like deterioration of the clinical condition", "multiple physical problems", "patient injury", and "death". The category of "limited self-care" included the subcategories of "patient difficulties with personal hygiene", "limited ability to move/change position", and "inability to meet defecation needs". Conclusion: According to nurses, "threat to patient safety" was the main challenge of caring for PWO. Patients with obesity could receive competent care from nurses who have a thorough awareness of the obesity threat to patient safety.

Development and delivery of an allied health team intervention for older adults in the emergency department: A process evaluation.

There is encouraging evidence that interdisciplinary teams of Health and Social Care Professionals (HSCPs) can enhance patient care in the Emergency Department (ED), especially for older adults with complex needs. However, no formal process evaluations of implementations of ED-based HSCP interventions are available. The study aimed to evaluate the development and delivery of a HSCP team intervention for older adults in the ED of a large Irish teaching hospital. Using the Medical Research Council (MRC) Framework for process evaluations, we investigated implementation and delivery, mechanisms of impact, and contextual influences on implementation by analysing the HSCP team's activity notes and participant recruitment logs, and by carrying out six interviews and four focus groups with 26 participants (HSCP team members, ED doctors and nurses, hospital staff). Qualitative insights were analysed thematically. The implementation process had three phases (pre-implementation, piloting, and delivery), with the first two described as pivotal to optimise care procedures and build positive stakeholders' involvement. The team's motivation and proactive communication were key to promote acceptability and integration in the ED (Theme 1); also, their specialised skills and interdisciplinary approach enhanced patient and staff's ED experience (Theme 2). The investment and collaboration of multiple stakeholders were described as essential contextual enablers of implementation (Theme 4). Delivering the intervention within a randomised controlled trial fostered credibility but caused frustration among patients and staff (Theme 3). This process evaluation is the first to provide in-depth and practical insights on the complexities of developing and delivering an ED-based HSCP team intervention for older adults. Our findings highlight the importance of establishing a team of HSCPs with a strong interdisciplinary ethos to ensure buy-in and integration in the ED processes. Also, actively involving relevant stakeholders is key to facilitate implementation. ClinicalTrials.gov, NCT03739515; registered on 12th November 2018.

Factors Related to Nurses and Physicians’ Knowledge and Attitudes Towards Palliative Care

Background: Changes in the course of diseases, their treatment, and care provision result in the need for a specific type of care known as palliative care. Medical staff’s knowledge and awareness of palliative care is important in this regard. Objectives: This study aims to examine the caregivers’ knowledge and awareness of palliative care and to determine the related predictors. Methods: In this cross-sectional study, 277 subjects were selected from among the caregivers working in the selected teaching hospitals in Iran through non-randomized sampling method. The subjects were asked to fill the online questionnaire which consisted of 3 sections including demographic data, knowledge, and attitude toward palliative care. Descriptive, inferential statistics, correlation and regression analyses were performed. Results: The mean scores of care providers’ attitude and knowledge were 140.90 ± 11.56 and 19.36 ± 2.73 respectively. There was a significant relationships between some variables such as working place, education level, age, palliative care-related working experience, and the necessity to pass training courses and the mean scores of attitude and knowledge. Conclusions: Since palliative care providers’ level of knowledge and attitude were reported to be moderate, training courses at different levels in the form of clinical courses should be offered with the aim of improving care providers’ skills and scientific abilities. It is essential to include the related topics in the curricula of academic programs.

A feasibility study of a pharmacist led proton pump inhibitor deprescribing intervention in older patients in an Irish hospital

Abstract Introduction Proton pump inhibitors (PPIs) are over-prescribed and prescribed inappropriately in the older population and have the potential for long-term adverse effects e.g. increased fracture risk, C. difficile infection, chronic kidney disease and drug interactions (1). Hospitalisation of older patients presents an opportunity for review of the PPI indication and potential for deprescribing. Aim The study aimed to assess the feasibility of a pharmacist led intervention to deprescribe inappropriately prescribed PPIs in patients ≥65 years in an Irish teaching hospital. Methods A multi-component feasibility intervention consisting of an education session for the medical team, followed by pharmacist-led screening of patients for potential PPI deprescribing, was conducted. The education session was delivered by the pharmacist to a geriatric medical team and the content outlined the prevalence of PPI prescribing, potential long-term effects of PPIs, and implementation of a PPI deprescribing algorithm. Over an eight-week period (May-June 2021), new admissions to the geriatric team were screened daily by the pharmacist and PPI prescribing patterns and indications were recorded. Patients ≥65 years were reviewed for PPI appropriateness based on their medical history and use of a PPI deprescribing algorithm (2). If the PPI was eligible for deprescribing (i.e. dose reduction or discontinuation) this was discussed with the geriatric team and the patient’s primary care general practitioner (GP) and the patient. Patients were counselled and educated on this by the pharmacist. Patients whose PPI was deprescribed were followed up at 4- and 12- weeks post deprescribing to assess their symptoms and satisfaction with deprescribing in the interim period. An online survey was sent to the geriatric team doctors evaluating their views on the study process and implementation of PPI deprescribing in practice; data was analysed descriptively using Microsoft Excel®. Written, informed consent was obtained from all patients and doctors involved. Results Of a total of 133 patient charts reviewed over the 8-week period, 94 patients were prescribed a PPI, with esomeprazole 40mg (43/94, 45.7%) being most commonly prescribed PPI, followed by pantoprazole 40mg (17/94, 18.1%). PPIs were inappropriately prescribed as per the indication in 36 cases (36/94, 38.3%). Following GP and Geriatric team discussion, 7/94 (7.4%) of patients were eligible for deprescribing, of which 5 had their PPI dose reduced (5/94, 5.3%). One patient declined the deprescribing, in another case the GP declined the deprescribing recommendation. The 5 patients deprescribed had their esomeprazole 40mg daily dose reduced to 20mg daily. This was sustained at the 12-week follow up and patients reported satisfaction with the change with no negative outcomes reported. Of the 12 geriatric doctors in the study, 6 completed the online survey. The majority reported barriers to PPI deprescribing being uncertainty regarding the indication (5/6) and being unable to monitor the patient after hospital discharge (5/6). All doctors agreed that pharmacists have a positive role to play in implementing PPI deprescribing. Conclusion This study found that esomeprazole 40mg daily was the most commonly prescribing PPI in this hospital cohort, with the majority of PPI prescribing found to be inappropriate according to the indication. The feasibility study resulted in a number of patients having their PPI safely deprescribed with a dose reduction. Despite the limitation of a small sample size and small rates of deprescribing, a strength of the study was that a pharmacist led PPI deprescribing initiative resulted in reducing inappropriate PPI prescribing in older patients, with positive engagement from the geriatric medical team. Further resources and research are required to implement this initiative on a wider scale. References (1) Wilsdon TD, Hendrix I, Thynne TR, Mangoni AA. Effectiveness of Interventions to Deprescribe Inappropriate Proton Pump Inhibitors in Older Adults. Drugs Aging. 2017 Apr;34(4):265-287. doi: 10.1007/s40266-017-0442-1. PMID: 28220380. (2) National Health Service. Proton Pump Inhibitor (PPI): Deprescribing algorithm (adult) [Internet]. [cited 2021 Aug 6]. Available from: https://www.dorsetccg.nhs.uk/Downloads/aboutus/medicines-management/Other Guidelines/prescqipp proton-pump-inhibitor-desprescribing-algorithm.pdf

Patient safety culture in Iranian teaching hospitals: baseline assessment, opportunities for improvement and benchmarking

BackgroundPatient safety culture is an essential factor in determining the ability of hospitals to treat and reduce patient risks. Healthcare professionals, especially nurses, play an important role in patient safety because they are responsible for direct and ongoing patient care. Few studies in Iran examine the patient safety culture in Iranian teaching hospitals, particularly from the perspective of nursing staff. This research assessed patient safety culture in teaching hospitals in Iran from the nurses’ point of view and compared the outcomes with similar regional and global studies. Furthermore, the study identified the factors influencing patient safety culture and its association with outcomes.MethodsA cross-sectional study was accomplished in thirty-two teaching hospitals in five provinces of Iran. A total of 2295 nurses were chosen through convenience sampling. Collection data were done using the Hospital Survey of Patient Safety Culture (HOPSC) from October 2018 and September 2019. We analyzed the data using descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis.ResultsThe results demonstrated the overall percentage of positive response rate for the HOPSC tool (36.4%). The average percentage of positive responses among all dimensions ranged from 27.1% in “Staffing” to 53.8% in “Teamwork across Hospital Units”. Benchmarking analysis shows that Iranian hospitals are equal or better performance than the benchmark on several composites compared to regional and global findings. The results of multiple linear regression analysis showed that the age, gender, total years of experience in nursing, work area or unit, work hours, and size of the hospital were significant predictors of the perceptions patient safety culture of nurses (p < 0.05).ConclusionsThis is one of few studies that examine nurses’ perceptions of patient safety culture in public hospitals in Iran. Although the results of the present study showed that the results of Iran were at or better than the many composites in Jordan, Turkey, KSA, and the Philippines. The findings confirmed that all 12 dimensions can be considered as areas requiring improvement, and these results demonstrated that there was a severe shortage in patient safety culture among the included hospitals.

The Effect of Prospective Payment Systems on Health Care Providers' Behavior: A Case Study of Global Surgeries Payment System in Iran.

Background: Global payment system is a kind of case-based payment system which pays for 60 commonly surgical operations by the average cost for each specified surgery case in Iran. The aim of the study was to determine the effect of this payment system on the number of services provided for each global surgical case versus fee-for-service (FFS) for the same operation. Methods: This is a retrospective study based on data from a large referral teaching hospital in Iran in the period of 2012-2015. Information related to 46 surgeries was performed which both global and FFS documents were gathered (N=7672). Statistical analysis was done on variables including Length of stay (LOS), Blood test (BT), Radiology (RA) and a mixed variable named VC (visit and consult number). Data were analyzed by a zero-inflated negative binomial regression model using STATA 11. Results: Descriptive analysis showed the mean of each service was significantly (p<0.001) higher in the FFS document’s group rather than the global payment group. Regression estimates showed the amounts of each service including LOS, BT, RA and VC were significantly (p<0.001) higher in FFS surgery than global documents for the 15 selected surgery. LOS and BT have shown a significantly higher amount in 100% of surgeries for FFS above global document. Same as for Radiology test and VC variables, there were significantly higher amounts in 93% of surgeries for FFS above global hospital documents. Conclusion: The findings can reinforce the presence of a relationship between providing more clinical services in FFS document form and providers’ incentives to adjust profits against their Costs. The significantly higher service provision in FFS documents can be controlled with a prospective global payment mechanism.

Bullying and burnout in critical care nurses: A cross-sectional descriptive study.

Employee bullying and burnout are two crucial, prevalent and challenging concepts that adversely affect organizational staff behaviours. Also, adverse patient care is associated with nurse bullying and burnout. This study aimed to assess the incidence and association between workplace bullying and occupational burnout among nurses in critical care units in Iran. A cross-sectional descriptive study. The subjects were 184 nurses from critical care units in 6 teaching hospitals in Iran. Three questionnaires were distributed among the study population; (a) demographic characteristics questionnaire, (b) Maslach Burnout Inventory (MBI) and (c) bullying at Workplace Questionnaire. Descriptive statistics were used to present the workplace bullying and occupational burnout status among nurses. Linear and logistic regression analyses were conducted to estimate the relationship between workplace bullying with MBI and nurses' demographic characteristics, respectively. 62% of the nurses had moderate emotional exhaustion, 59.8% had moderate depersonalization and 46.2% had a moderate individual achievement. 75.5% faced workplace bullying. There was a positive and significant association between bullying scores and burnout in total (Pearson's r=0.598, p < 0.001). Linear regression test showed a positive and significant relationship between bullying with MBI dimensions (R=0.613, p < 0.001) for emotional exhaustion, (R=0.679, p < 0.001) for depersonalization and (R=-0.417, p < 0.001) for individual achievement. Among Iranian nurses, bullying is a prominent and substantial issue that significantly correlates with their negative performance by enhancing job burnout. It is suggested that some measures are adopted to avoid workplace bullying and to reduce occupational burnout for nurses. Managers should create an environment that encourages nurses to voice their concerns - informing nurses about their rights and creating a positive atmosphere in the hospital.

Health Care Professionals' Perception of Stress During COVID-19 Pandemic in Iran: A Qualitative Study.

BackgroundThe health care professionals have a unique role in controlling the pandemic of COVID-19 and decreasing its mortality and morbidity. The burden of care and psychological impact of working in this circumstance can be unfavorable for many caregivers. In this qualitative study, the health care professionals' perception of stress during COVID-19 pandemic in Iran was assessed and several implications were proposed.Materials and MethodsThe participants were selected among staff who were providing medical services to patients with COVID-19 infection at the largest teaching hospital in Iran. Quota sampling was used to include physicians, nurses, and other paramedics. The grounded theory was selected to develop interview questions. Moreover, the thematic approach was applied to analyze the data content and data analysis was performed based on open and axial coding following the implementation of codes in MAQDA software.ResultsA wide range of psychological reactions including anxiety, feelings of guilt, depression, and anger were detected in the staff. Uncertainty accompanied by the pandemic of COVID-19 and shortcomings in preparation for crisis management were recognized as the two main sources of stress among health care professionals.ConclusionBased on the findings of the study, it is important to identify and evaluate the mental health needs of healthcare professionals. To reduce stress among health staff at COVID-19 care centers, it seems that the optimal strategy is simultaneous improvement in equipment and crisis management.

Colonoscopy Complications in an Iranian Teaching Hospital.

BACKGROUND: Colonoscopy is generally a safe procedure with a limited number of adverse events. Few studies have addressed the rate of adverse events in teaching hospitals. This study aimed to investigate the rate of complications after colonoscopy performed by gastroenterology fellows in a teaching hospital in Tehran. METHODS: A historical cohort study was carried out to link the colonoscopy reports and the hospital information system to identify serious adverse events leading to unplanned hospitalization, unplanned procedures or interventions (e.g. surgery), prolongation of existing hospitalization, or death within 30 days after colonoscopy. RESULTS: We included 9928 colonoscopies (mean age of the patients 53.0±15.9 years, 52.3% men) in this study. In-hospital patients comprised (34.8%) of the procedures. The indications of colonoscopy included 7137 diagnostic (71.9%), and 2519 screening (25.4%) reasons. Colorectal polyps were found in 2005 (20.2%) patients. Major complications were seen in 17 patients (0.2%), including serious bleeding in seven patients, cardiopulmonary complications in five patients, perforation in four patients, and sepsis in one patient. CONCLUSION: Serious adverse events after colonoscopy are relatively rare. The rate of complications does not appear to be higher in an academic teaching hospital when performed by fellows under supervision.

The Effect of Short Messaging System-Based Feedback on Physicians' Head CT Scan Ordering Behavior in Neurology and Neurosurgery Departments.

Short messaging system (SMS) works as one of the most popular strategies for physicians' behavior change via sending feedback and reminder messages. One of the areas in which SMS feedback can be effective on physicians' behavior is CT scan ordering. This study investigates the effect of mobile phone SMS feedback on residents' head CT scan ordering at a general teaching hospital in Iran. Through a three-month before-after experimental study, an intervention was conducted, and the CT scans ordered by an individual resident were evaluated every two weeks. Consequently, personal SMS-based feedback was provided to the residents, and the rate of CT per patient in the two phases of the study was analyzed. The mean CT scan ordered per patient decreased from 1.98 ± 1.09 to 1.74 ± 1.45, and this decrease was insignificant (P = 0.106). SMS-based feedback can reduce head CT scan ordering among residents; whereas this decline was not significant further studies are required to investigate its effectiveness.

Hardiness in Family Caregivers During Caring From Persons With Alzheimer's Disease: A Deductive Content Analysis Study.

Objective: This study was designed to describe the experiences of family Caregivers' hardiness in caring for Alzheimer's Patients.Methods: The deductive content analysis method was performed between April 2020 and February 2021 in one of the teaching hospitals in Iran. Fourteen family caregivers of Alzheimer's patients were selected using purposive and snowballing sampling and the data were collected by semi-structured interviews. After that, data were analyzed using Elo and Kingas steps.Results: The results of this study showed that based on the experiences of family caregivers, the family caregivers' hardiness in caring for Alzheimer's patients is a feature of cognitive ability to deal with stressful care situations and consists of five dimensions of commitment, control, challenge, communication and culture with 22 generic categories that they were nested into this five dimension.Conclusion: Family caregivers' hardiness is a trait related to the individual and environmental factors, and the prevailing social and cultural conditions affect the individual's perception and experience of hardship and threats, as well as his/her understanding of protective factors and how to use them. Therefore, hardiness should not be interpreted as a simple approach regardless of culture.

Compliance of imipenem and meropenem administration with the national antimicrobial stewardship program in a referral teaching hospital in Iran

ABSTRACT Introduction Considering the great significance of antimicrobial resistance, implementation of antimicrobial stewardship programs (ASPs) in healthcare facilities is of particular importance. This study aimed to evaluate the compliance of imipenem and meropenem administration with the ASP guidelines in a referral teaching hospital in Iran. Methods In this retrospective cross-sectional study, the medical records of patients, who received either imipenem or meropenem at xx Hospital in Semnan, Iran, from 21 March 2017 until 20 March 2019, were reviewed using the developed ASP, according to the instructions issued by the Ministry of Health of Iran. The obtained findings were recorded in a checklist consisted of six items. If the action taken for the patient complied with the item requirement specified in the ASP, it would receive a score of one; otherwise, a score of zero. The sum of scores (range: 0–6) was reported and analyzed. Data were analyzed in SPSS version 23, using Chi-square, ANOVA, and independent t-test, and P < 0.05 was considered as significant. Results The mean duration of imipenem/meropenem administration was 9.2 ± 8.0 days. A total of 6,032 imipenem/meropenem vials (1 g/vial) were prescribed during the study (meropenem for 210 patients and imipenem for 87 patients). In 64.2% of the patients, there was no indication, and the mean score of the subjects was 1.55 ± 1.2. The obtained score was three in 53 (17.8%) records and four in 18 (6.1%) records. The mean score of ASP in the intensive care units was higher, while it was lower in the surgical ward as compared to the other wards (P = 0.002). Discussion Antibiotic prescription was inappropriate in our center, and compliance with the ASP guidelines was very low, especially in the surgical wards. It seems necessary to take effective steps for planning continuing education programs on rational antibiotic prescription and supervision of prescription patterns.