Teaching Hospitals In Tehran Research Articles

Body-Image Disturbance: A Comparative Study among Haemodialysis and Kidney Transplant Patients.

As a chronic disease, End Stage Renal Disease (ESRD) changes the patients' body and affects their body image negatively. Although the changes in body image are expected in all types of renal replacement therapies, different renal replacement therapy methods could represent different levels of impact on body image. Present study was conducted to examine and compare the level of body-image disturbance between haemodialysis and kidney transplant patients. This descriptive study was conducted in two teaching hospitals in Tehran, Iran. Using convenient sampling, 84 patients (42 patients under haemodialysis and 42 patients with transplant) were invited to participate in the study. A self-designed questionnaire was developed to examine the level of body-image disturbance. Out of 42 haemodialysis patients, 64.3%, 19% and 16.7% of patients reported low, moderate and high level of body-image disturbance respectively. The mean score of body-image disturbance was 21.1±18.3(rang=1-71) in haemodialysis patients. Of 42 transplant patients, 69%, 26.2% and 4.8% reported low, moderate and high level of body-image disturbance respectively. The mean score of body-image disturbance was 17.1±13.3 (rang=1-48). According to the results of independent t-test, difference between mean score of body-image disturbance in two groups was statistically significant (p < 0.05). The findings of the present study showed that both haemodialysis and renal transplant patients experienced some levels of body-image disturbance. This problem was more prevalent among haemodialysis patients as compared to kidney transplant ones. We recommend more studies may be conducted in this regard.

Epidemiological aspects and clinical outcome of patients with Rhinocerebral zygomycosis: a survey in a referral hospital in Iran.

IntroductionNo comprehensive reports have been published on epidemiological status of Rhinocerebral zygomycosis infections and its outcome in our population, Hence, the current study came to address epidemiological characteristics as well as clinical outcome of patients with Rhinocerebral zygomycosis infection referred to a referral hospital in Iran.MethodsThis retrospective study was performed at the Rasoul-e-Akram hospital, an 800-bed tertiary care teaching hospital in Tehran, Iran. The pathology recorded charts were reviewed to identify all cases of Rhinocerebral zygomycosis from patients admitted between April 2007 and March 2014. A diagnosis of Rhinocerebral zygomycosis was based on histopathological assessments.ResultsSixty four patients with Rhinocerebral zygomycosis were assessed. The mean age of the patients was 46.07 ± 22.59 years and 51.6% were female. Among those, 67.2% were diabetic, 26.6% were hypertensive and 29.7% had history of cancer. Different sinuses were infected in 73.4% of the patients. Out of all the patients 26.6% underwent surgical procedures and 17.2% were controlled medically. Extensive debridement was carried out in 40.6%. Neutropenia (<1500 cell/ µl) was revealed in 12.5%. In-hospital mortality rate was 35.9% and prolonged hospital stay (> 14 days) was found in 60.9%. According to the Multivariable logistic regression analysis, the main predictors of in-hospital mortality included female gender, advanced age, the presence of sinus infection, and neutropenia, while higher dosages of amphotericin administered had a protective role in preventing early mortality. In a similar Multivariate model, history of cancer could predict prolonged hospital stay, whereas using higher dose of amphotericin could lead to shortening length of hospital stay.ConclusionThere is no difference in demographic characteristics between our patients with Rhinocerebral zygomycosis and other nations. The presence of diabetes mellitus is closely associated with the presence of this infection. Sinus involvement is very common in those with Rhinocerebral zygomycosis leading to high mortality and morbidity. Besides female gender, advanced age, and presence of neutropenia was a major risk factor for increasing early mortality. The use of higher doses of antifungal treatment such as amphotericin can prevent both mortality and prolonged hospital stay. The cancer patients may need longer hospital stay because of needing comprehensive in-hospital treatment.

The barriers to the application of the research findings from the nurses' perspective: A case study in a teaching hospital

Background:The application of the nursing research findings is one of the most important indicators of development in the nursing profession, which leads to providing efficient and effective patient care and improving the quality of nursing care. According the result of some studies, transferring the evidence-based findings to the nurses’ practice and education in the world has been slow and sometimes unsuccessful. This study aimed to investigate the most important barriers to the application of research findings from the nurses’ perspective.Materials and Methods:This cross-sectional study conducted on a sample of 210 nurses in a teaching hospital in Tehran in 2013. The data were collected using a researcher-made questionnaire consisted of two parts, including items about nurses’ demographic characteristics and 30 items to identify the most important barriers to the application of research findings from the studied nurses’ perspective.Results:“The lack of sufficient time for reading the studies,” “the lack of sufficient time to implement the new ideas,” “the lack of adequate facilities to implement the ideas,” “nurses’ little interest in conducting studies,” and “the lack of authority to change the methods and patterns of care” with, respectively, 85%, 84.6%, 83.8%, 83.4%, and 80.5% agreement with the existence of barriers were the most barriers to application of research findings from the studied nurses’ perspective.Conclusion:The lack of time was the most important barrier to the use of research findings from the perspective of studied nurses. Therefore, some effective strategies should be used by hospital managers and health policy makers to overcome this barrier. Some of these strategies can be employing new personnel and hiring skilled and efficient human resources in order to decrease the workload of nurses, organizing the nurses’ work shifts, providing right balance between patients and nurses in the wards, etc.

Needle-Stick Injuries Among Healthcare Workers in a Teaching Hospital.

Background:Needle-Stick Injuries (NSIs) are among the hazards and problems that can expose health workers to infections.Objectives:This study aimed to determine the rate of NSIs in a teaching hospital in Tehran, Iran.Materials and Methods:This cross-sectional, analytical and descriptive study was conducted at one of the teaching hospitals in Tehran, Iran, in 2013. The study population was 344 employees in various occupational groups selected via census. Data were collected using a researcher-made questionnaire. The collected data were analyzed using some statistical tests, including independent-samples t-test with SPSS software version 21.0.Results:The results showed that only 50.2% of injuries had been reported; 67.8% of all participants (n = 211) had at least one NSI. Most NSIs had been reported in the emergency department (33.5%). Most participants mentioned the injection syringe needles as the main cause of their injuries (71.1% of all NSIs). Among NSIs, those caused by insulin syringe needles (6.2%) were the second cause. In this study, females had NSIs more than males. There was a statistically significant relationship between sex and the rate of NSIs (P < 0.05).Conclusions:Considering the high rate of occupational injuries, further preventive measures should be implemented to prevent these injuries from occurring. Providing initial and continuing training for employees is very important. Directing special attention to emergency department employees may be effective in reducing occupational injuries.

Epidemiology and short-term mortality in traumatic patients admitted to Shariati Hospital in Iran between 2012 and 2013

PurposeTrauma is an inevitable part of the health burden in every country. Both the preventive and rehabilitative aspects of traumatic injuries are expensive. Since most of the injuries happen in low- and middle-income developing countries, a judicious allocation of the limited resources to the most cost-efficient strategies is necessary. The present study was designed to report the causes of trauma, injured body regions, trauma severity scores and the one year survival rate of a randomly selected sample of trauma patients in a major referral hospital in Tehran, Iran. MethodsWe chose and analyzed a random subgroup of traumatic patients admitted during the one-year period of May 2012 to May 2013 to Shariati Hospital, a major University Teaching Hospital in Tehran, Iran. Patients who stayed at the hospital for less than 24 h were excluded. In total, 73 traumatic patients were registered. The mean age was (40.19 ± 20.34) years and 67.1% of them were male. ResultsIn general, the most common cause of injury was falls (47.9%), followed by road traffic crashes (RTCs, 40.8%). Assault and exposure to inanimate mechanical forces each were only associated with 5.6% of all injuries. The only cause of injury in ages of more than 65 years was fall. The most common cause of injury in ages between 15 and 45 years was RTCs. During the study, two deaths occurred: one was at ICU and the other was at home. The most commonly injured body region was the head (23.8%), followed by the elbow and forearm (19%), hip and thigh (15.9%), and multiple body regions (14.3%). The mean abbreviated injury score was 2.23 ± 1.02; injury severity index was 7.26 ± 7.06; and revised trauma score was 7.84, calculated for 38 patients. ConclusionPrevention strategy of traumatic injury should focus on falls and RTCs, which are respectively the most common cause of trauma in older aged people and young males.

Acinetobacter baumannii clonal lineages I and II harboring different carbapenem-hydrolyzing-β-lactamase genes are widespread among hospitalized burn patients in Tehran.

The aim of this study was to analyze antimicrobial resistance patterns and their encoding genes and genotypic diversity of Acinetobacter baumannii isolated from burn patients in Tehran, Iran. The presence of extended-spectrum beta-lactamase- and blaOXA-encoding genes among 37 multidrug resistant (MDR) A. baumannii strains isolated from patients hospitalized in a teaching hospital in Tehran was evaluated. Susceptibility to 7 antibiotics was tested by disk agar diffusion and to polymyxin B and colistin was tested by E-test, according to CLSI guidelines. All isolates were then analyzed by PCR for the presence of blaIMP, blaVIM, blaSIMblaOXA-23, blaOXA-24, and blaOXA-58-like carbapenemase genes, and blaOXA-51-like, blaTEM, blaSHV, blaPER, blaVEB, and blaGIM genes. Genotyping of A. baumannii strains was performed by repetitive sequence-based (REP)-PCR and cluster analysis of REP-PCR profiles. A. baumannii isolates were assigned to international clones by multiplex PCR sequence group analysis. Twenty-five A. baumannii isolates were classified as MDR, and 12 were classified as extensively drug resistant. All isolates were susceptible to colistin and polymyxin B. Eighty-one percent of the isolates was resistant to imipenem or meropenem and harbored at least one or both of the blaOXA-23-like or blaOXA-24-like carbapenemase genes. Co-existence of different resistance genes was found among carbapenem-resistant isolates. Multiplex PCR sequence group analysis most commonly assigned A. baumannii isolates to international clones I (18/37; 48.6%) and II (18/37; 48.6%). An alarming increase in resistance to carbapenems and the spread of blaOXA-23-like and/or blaOXA-24-like carbapenemase genes was observed among A. baumannii strains belonging to clonal lineages I and II, isolated from burn patients in Tehran.

Device-associated infection rates and bacterial resistance in six academic teaching hospitals of Iran: Findings from the International Nocosomial Infection Control Consortium (INICC).

Device-associated health care-acquired infections (DA-HAIs) pose a threat to patient safety, particularly in the intensive care unit (ICU). However, few data regarding DA-HAI rates and their associated bacterial resistance in ICUs from Iran are available. A DA-HAI surveillance study was conducted in six adult and pediatric ICUs in academic teaching hospitals in Tehran using CDC/NHSN definitions. We collected prospective data regarding device use, DA-HAI rates, and lengths of stay from 2584 patients, 16,796 bed-days from one adult ICU, and bacterial profiles and bacterial resistance from six ICUs. Among the DA-HAIs, there were 5.84 central line-associated bloodstream infections (CLABs) per 1000 central line-days, 7.88 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator-days and 8.99 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. The device utilization ratios were 0.44 for central lines, 0.42 for mechanical ventilators and 1.0 for urinary catheters. The device utilization ratios of mechanical ventilators and urinary catheters were higher than those reported in the ICUs of the INICC and the CDC's NHSN reports, but central line use was lower. The DA-HAI rates in this study were higher than the CDC's NHSN report. However, compared with the INICC report, the VAP rate in our study was lower, while the CLAB rate was similar and the CAUTI rate was higher. Nearly 83% of the samples showed a mixed-type infection. The most frequent pathogens were Acinetobacter baumannii, Staphylococcus aureus and Pseudomonas aeruginosa, followed by Klebsiella pneumoniae and Enterococcus spp. In the S. aureus isolates, 100% were resistant to oxacillin. Overall resistances of A. baumannii and K. pneumonia to imipenem were 70.5% and 76.7%, respectively. A multiple drug resistance phenotype was detected in 68.15% of the isolates. The DA-HAI rates in Iran were shown to be higher than the CDC-NHSN rates and similar to the INICC rates. Resistance to oxacillin and imipenem was higher as well. Comparing device use, DA-HAI rates, and bacterial resistance for the primary isolated bacteria indicated a direct association between urinary catheter use and the rates of CAUTI.

Dietary patterns and risk of gallbladder disease: a hospital-based case-control study in adult women.

Gallbladder disease is one of the most prevalent gastrointestinal disorders that may result from a complex interaction of genetic and environmental factors. This study examined the association of dietary patterns with gallstone disease among Iranian women. This case-control study was conducted in general teaching hospitals in Tehran, Iran. Participants were 101 female cases and 204 female controls aged 40-65 years who were admitted for problems other than GBD. Dietary patterns were identified using principal components analysis based on food frequency questionnaire. Compared to the control group, cases were less educated, less physically active, and consumed more total energy (p<0.02). Having ≥ 3 livebirths increased the risk of gallstone by more than 5 times, followed by having rapid weight loss, being single, having familial history of gallstone, and consuming high total energy. Two distinct dietary patterns were identified in women (healthy and unhealthy). After adjustment for several confounding variables, healthy dietary pattern was associated with a decreased risk of gallstone disease (OR=0.14, 95% CI 0.048-0.4) while unhealthy dietary pattern was associated with an increased risk (OR=3.77, 95% CI 1.52-9.36). These findings confirm that dietary pattern approach provides potentially useful and relevant information on the relationship between diet and disease. Identifying risk factors will provide an opportunity for prevention of gallbladder disease in developing countries facing an increased risk of obesity.

Chronic Sorrow in Mothers of Children With Cancer

Chronic sorrow, a progressive, persistent, and endless feeling of grief, is seen in parents of children with chronic diseases. This study aimed to investigate chronic sorrow in mothers of children with cancer in selected hospitals in Tehran, Iran. It also sought to clarify the relationships between chronic sorrow and some demographic characteristics. In this descriptive, cross-sectional study, 264 mothers attending 3 pediatric teaching hospitals in Tehran were selected using convenience sampling. The subjects completed a demographic questionnaire and Kendall Chronic Sorrow Questionnaire (Persian version). Data were analyzed with descriptive and inferential (Mann-Whitney and Kruskal-Wallis tests) statistics in SPSS 16.0. The mean score on the Kendall Chronic Sorrow Questionnaire was 76.39 ± 15.81. Chronic sorrow was likely present or present in 97.7% of the mothers (n = 252). The mean scores on the Disparity, Sadness, and Getting Along subscales were 30.26 ± 104.209, and 33.38 ± 42.777, respectively, and the mean score for coping was 12.75 ± 11.922. The relationships between most demographic characteristics and scores on the Kendall Chronic Sorrow Questionnaire were not significant. Chronic sorrow is a concept experienced by families of children with cancer. The health care provider's knowledge about this concept and its components can facilitate the development of better support and treatment programs and lead to improved quality of life for children and their families.

Risk Factors of First Acute Myocardial Infarction: Comparison of Elderly and Non-Elderly: A 24-Year Study

Although risk factors of Ischemic Heart Disease (IHD) are well known, knowledge about the distribution of these risk factors in different subgroups of patients can be used for designing preventive programs. The aim of this study was to assess differences of prevalence of IHD risk factors in elderly and non-elderly patients in their first Acute Myocardial Infarction (AMI). In this retros-pective study, elderly (age > 65; n = 1060) and non-elderly (age ≤ 65; n = 2228) patients with first AMI who were admitted into four teaching hospitals in Tehran between 1982 and 2005 were recruited. Risk factors containing male gender, systolic and diastolic hypertension (HTN), diabetes, hypertriglyceridemia, hypercholesterolemia, smoking and family history of IHD were compared between the two groups. Among different risk factors, diabetes and systolic HTN were more common in elderly than their non-elderly counterparts, and male gender, smoking, family history of IHD and dyslipidemia were more common in non-elderly patients than elderly ones (p < 0.05 for all comparison). Diastolic HTN showed no significant difference between the two groups. Findings of this study, stating difference of prevalence of risk factors in two elderly and non-elderly groups, can be used by health policy makers to conduct preventive programs for AMI in this country.

The exploration of challenges in clinical knowledge management in nurses: A qualitative study

Background and Purpose: Clinical knowledge management (CKM) is considered as a dominant approach for information management and expansion of knowledge in clinical settings. Health care executives have recently begun to focus on CKM. Therefore, identification of challenges against proper CKM planning is of paramount importance. The aim of this study was to explore challenges in clinical knowledge management in nurses. Methods: This qualitative study was conducted at four teaching hospitals in Tehran, Saqqez and Mahabad, Iran through 24 semi-structured interviews with 18 nurses, head nurses and nursing supervisors. Data analysis was performed using conventional content analysis. Results: In this study, three main themes emerged from data analysis. The main theme was “organizational culture of less attention to the creation and dissemination of knowledge in nurses”, which was due to poor scientific interactions between clinical and academic settings. Other factors involved in this theme were disregard of research in job description of nurses, authoritarian management in research centers, inadequate support and reward from medical officials, and non-observance of research in the evaluation of nurses. Another theme was “poor scientific documentation in nursing”, which was due to lack of awareness on the significance of clinical ideas, and proper dissemination of nursing knowledge. Finally, the main theme of “hardness of working conditions” represented high work pressure and lack of opportunity for research among nurses. Conclusion: It is suggested that nursing managers consider the improvement of organizational culture in strategic plans proposed by the Ministry of Health, in addition to reducing work pressure for nurses. Furthermore, scientific promotion of nursing practice should be taken into account through implementation and documentation of useful and relevant workshops.

Nurses exposure to workplace violence in a large teaching hospital in Iran.

Workplace violence is one of the factors which can strongly reduce job satisfaction and the quality of working life of nurses. The aim of this study was to measure nurses' exposure to workplace violence in one of the major teaching hospitals in Tehran in 2010. We surveyed the nurses in a cross-sectional design in 2010. The questionnaire was adapted from a standardized questionnaire designed collaboratively by the International Labor Office (ILO), the International Health Organization (IHO), the International Council of Nurses (ICN), and the Public Services International (PSI). Finally, in order to analyze the relationships among different variables in the study, T-test and Chi-Square test were used. Three hundred and one nurses responded to the questionnaire (a response rate of 73%). Over 70% of the nurses felt worried about workplace violence. The participants reported exposure to verbal abuse (64% CI: 59-70%), bullying-mobbing (29% CI: 24-34%) and physical violence (12% CI: 9-16%) at least once during the previous year. Relatives of hospital patients were responsible for most of the violence. Nurses working in the emergency department and outpatient clinics were more likely to report having experienced violence. Nurses were unlikely to report violence to hospital managers, and 40% of nurses were unaware of any existing policies within the hospital for reducing violence. We observed a considerable level of nurse exposure to workplace violence. The high rate of reported workplace violence demonstrates that the existing safeguards that aim to protect the staff from abusive patients and relatives are inadequate.

Characterization of Staphylococcus epidermidis isolates from hospitalized patients in Isfahan and Tehran teaching hospitals

Coagulase-negative Staphylococci especially Staphylococcus epidermidis is considered as an important reason of medical implant devices and nosocomial infections. Different virulence factors such as biofilm formation, delta toxin and autolysin increase the pathogenicity of this microorganism. However the ability of biofilm production is one of the main causes of microorganism attachment to various surfaces and may lead to chronic infections. On the other hand resistance to antimicrobial agents containing penicillinase resistant penicillins (i.e. oxacillin, methicillin) has been predominantly emerged in the past several years. PBP2a is encoded by mecA gene that conferred as meticillin resistant main reason. The mentioned gene is carried by the Staphylococcal chromosomal cassette mec (SCCmec) as a mobile genetic element. The aim of this study was evaluating the S. epidermidis isolates biofilm production and determining the various types of SCCmec elements in hospitalized patients. A total 115 Staphylococcus epidermidis strains were studied for the ability of biofilm formation, the frequency of both ica and mecA gene and also the existence of various SCCmec types in hospitalized patients. In CRA (70.4%) of isolates formed black colonies while in the molecular PCR method the prevalence of ica gene among isolates was (82.6%) and 96 were mecA positive. By multiplex PCR method five different types of SCCmec have been identified. Determination of biofilm formation in nosocomial infections, and also evaluation of SCCmec elements may be lead to a significant solution to prevent the infection prevalence in health care units.

Strategic planning, implementation, and evaluation processes in hospital systems: a survey from Iran.

Aim & Background:Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals.Methods:The present study was accomplished in 24 teaching hospitals in Tehran, Iran from September 2012 to March 2013. The data collection instrument was a questionnaire including 130 items. This questionnaire measured the situation of formulation, implementation, and evaluation of strategic plan as well as the requirements, facilitators, and its benefits in the studied hospitals.Results:All the investigated hospitals had a strategic plan. The obtained percentages for the items “the rate of the compliance to requirements” and “the quantity of planning facilitators” (68.75%), attention to the stakeholder participation in the planning (55.74%), attention to the planning components (62.22%), the status of evaluating strategic plan (59.94%) and the benefits of strategic planning for hospitals (65.15%) were in the medium limit. However, the status of implementation of the strategic plan (53.71%) was found to be weak. Significant statistical correlations were observed between the incentive for developing strategic plan and status of evaluating phase (P=0.04), and between status of implementation phase and having a documented strategic plan (P=0.03).Conclusion:According to the results, it seems that absence of appropriate internal incentive for formulating and implementing strategies led more hospitals to start formulation strategic planning in accordance with the legal requirements of Ministry of Health. Consequently, even though all the investigated hospital had the documented strategic plan, the plan has not been implemented efficiently and valid evaluation of results is yet to be achieved.

Spiritual wellbeing of Iranian patients with acute coronary syndromes: a cross-sectional descriptive study

Spiritual wellbeing harmonises several dimensions of human life and is essential for coping with diseases. Acute coronary syndromes (ACS) cause crisis in physical, psychological aspects and spiritual dimensions of patients’ lives. The purpose of this study was to determine the level of spiritual wellbeing and its dimensions in patients with ACS. For this, a cross-sectional descriptive study was conducted. For data collection, Paloutzian and Ellison’s Spiritual Wellbeing Self-report Questionnaire was filled in by 364 patients with ACS. Patients referred to the cardiac wards of five teaching hospitals in Tehran between August 2011 and April 2012 were recruited using the convenience sampling method. The data were analysed using descriptive and inferential statistics. The findings revealed that the majority of patients (97.9%) benefited from moderate spiritual wellbeing, although religious wellbeing was higher than existential wellbeing in the patients. It is concluded that nurses are required to improve their cultural and contextual knowledge of patients’ spiritual wellbeing to meet patients’ needs in nursing care. Spiritual beliefs can influence coping with diseases, help patients to find meaning and purpose in life to deal with problems resulting from physical and mental illnesses. These findings can be used to suggest the incorporation of religious aspects of spirituality into care programmes designed to improve the quality of life of patients with ACS.

Barriers to Nurse-Patient Communication in Cardiac Surgery Wards: A Qualitative Study

Background:An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff.Objectives:The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards.Design and Methods:This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim.Results:Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients).Conclusions:Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care.

A Survey on Clinical Governance Awareness Among Clinical Staff: A Cross-Sectional Study

Objective:Clinical Governance (CG) program has been raised in Iran in order to improve the quality of clinical care. The purpose of this study is to investigate the awareness of clinical governance program among clinical staff working in selected teaching hospitals in Tehran, Iran.Methods:To investigate the CG awareness, a cross-sectional survey was conducted among 345 clinical staff working in 20 selected public hospitals in Tehran. Data were gathered using the standardized clinical governance awareness questionnaire. Descriptive statistics were used to analyze the data.Result:The results showed that the level of staff awareness about the concept of CG was low. They perceived continuous quality improvement, responsibility, medical errors reduction and patient safety as the main concepts of the CG framework. Reaching agreement of standards concepts among staff and positive changes in attitudes were considered as two most observed changes. The main perceived barriers to the implementation of clinical governance included lack of proper management and leadership, lack of full support, inappropriate organizational culture, lack of knowledge, poor communication system and insufficient training.Conclusions:The concepts and goals of clinical governance have not been effectively conveyed to the staff and despite its implementation in the hospitals, there has been low clinical governance awareness among the staff. Clinical Governance must be implemented through comprehensive management support and participation of all staff and health professionals at both hospital and policy making level.

Acute Kidney Injury in Iranian Children -What Do We Know About It? - Part 2

Acute kidney injury (AKI) is reversible deterioration of renal function in which waste products accumulate and fluid imbalance occurs. The epidemiology of AKI has been changing over years. The aim of this study was to evaluate the epidemiology of AKI in hospitalized children in Iran. A literature search from March 2000 to March 2014 was conducted through MEDLINE, EMBASE, Scholar.google, IranMedex, MagIran, SID, and manual reference search of identified articles. Retrospective and prospective cross-sectional studies with a clear definition of acute kidney injury or failure were included. Seven out of twenty three articles which were found met the criteria. The incidence of AKI declined from 36% (2006-2008) to 15.4% (2010-2011) in the PICU setting of three referral teaching hospitals in Tehran. According to the classification, 10% had pre-renal failure, 86% had intrinsic renal failure, and 4% had post-obstructive uropathy. Follow-up was limited to the days of hospitalization. The overall reported mortality rate was 18% in pediatric departments. Acute glomerulonephritis including hemolytic uremic syndrome was the most common underlying disease (46.5%). Acute tubular necrosis was reported in 33% of the cases. One third of the cases of acute renal failure occurred in children less than two years. The real incidence of acute kidney injury might be higher considering a unified standard definition. Acute glomerulonephritis and acute tubular necrosis comprised the majority of the etiologies. Keywords: Acute Kidney Injury; Middle East; Iran; Etiology; Child; Incidence; Review Systematic.

Persian couples’ experiences of depressive symptoms and health-related quality of life in the pre- and perinatal period

Objectives: The aim of this study was to estimate the effect of changes in depressive symptoms on health-related quality of life (HRQoL) in couples. This was examined before, during and after the pregnancy. In addition, (HRQoL) was examined in relation to the mode of delivery.Methods: A prospective longitudinal study of 416 couples was conducted in two teaching hospitals in Tehran, Iran. The translated Medical Outcomes Study-Short Form 36 (SF-36) and the Edinburgh Postnatal Depression Scale (EPDS) were used to measure health-related quality of life and depressive symptoms respectively, and are reported here.Results: The results showed that women and their spouses experienced a noticeable decline in their physical HRQoL during and after the pregnancy. However, their mental health functioning showed a significant improvement following conception. The prevalence of depressive symptoms was high but decreased over the course of the pregnancy. Finally, HRQoL was affected by mode of delivery.Conclusions: The results show that women and their husbands experienced marked changes in perceived health-related functioning and depressive symptoms during and after pregnancy. In addition, the study found that those women who had undergone Cesarean section had higher mental well-being scores. Future research should determine the benefits of extending pre-conception and pre-natal guidelines on the benefits of regular physical activity throughout and after pregnancy in Persian couples.

Types and Frequency of Errors during Different Phases of Testing At a Clinical Medical Laboratory of a Teaching Hospital in Tehran, Iran.

Background:According to official data, 60–70% of clinical decisions about hospitalization and discharge are based on laboratory results.Aims:The objective of this study is to examine the frequency of errors before, during, and after analysis in a major medical laboratory.Materials and Methods:This descriptive, cross-sectional study was conducted throughout 2012 (January–December 2012). Errors are recorded by the Quality Control Committee in a specially designed record.Results:A total of 303,866 samples, 2,430,928 tests were received for analysis. The total number of errors was 153,148 (6.3%) (116,392 for inpatients and 36,756 for outpatients). Analysis of the results revealed that about 65.09% of the errors occur across preanalytical phase, whereas 23.2% and 11.68% are related to analytical and postanalytical phase, respectively.Conclusion:More than half of the laboratory errors are related to preanalytical phase; therefore, proper training and knowledge of intervening factors are essential for reducing errors and optimizing the quality.