Journal of Analytical Research in Clinical Medicine
Volume:3 Issue: 1, Winter 2015

Evidence-based medicine (EBM) is the ability and skill in using and integration of the best up-to-date evidences. The aim of this study was a systematic review of barriers, facilities, knowledge and attitude of EBM in Iran.
In this study, database and manual search was used with keywords such as, "evidence-based, EBM, evidence-based nursing, evidence-based practice, evidence-based care, evidence-based activities, evidence-based education" and their combination with the keywords of the barrier, facilitator, attitude, awareness, prospective, knowledge, practice and Iran. The databases of SID (Scientific information database), Magiran, MEDLIB, PubMed, Google scholar, IranMedex and CINAHL (Cumulative index to nursing and allied health literature) were used for data collection.
Finally, 28 papers were included in this study. The lack of facilities, time and skill in research methodology were the most important barriers to EBM. The most and least important factors were orderly creating ample opportunity and detecting needs and problems. The degree of familiarity with the terminology of evidence-based performance was low (44.2%). The textbooks have been considered as the most significant source of obtaining information. The level of awareness, knowledge, and evidence-based performance was less than 50.0%.
There are many various barriers in use of EBM and healthcare providers despite the positive attitude toward EBM had a low level knowledge in EBM setting. Consideration of the importance of EBM proper planning and effective intervention are necessary to removing the barriers and increase the knowledge of healthcare providers.

Improving of mother and child health is one of the most important and essential roles of public health agencies and millennium development goals. The aim of this study was to determine rates of prenatal care (PNC) utilization in Tabriz, Iran, from 1994-2013 and compare the two most commonly used models of PNC utilized in determining the proportion of the pregnant woman receiving inadequate PNC and comparing use of two indices.
In this study, we conducted a descriptive cross-sectional study of 2834 women having a health record in care center of the rural region in Tabriz for 20 years. We used questioner that validated in the study Jabbari et al. for obtaining data. Random sampling quotes were done in 3 times during the years 1994-2013.
We found that 53% of mothers received adequate care by adequate PNC utilization (APNCU) index, but 17% by revised-GINDEX index but the most important objective of our study was identifying the relationship between adequacy of PNC and pregnancy outcome. On the other hand, the study indicated that between inadequate care and low birth weight (LBW), mother weight gaining, birth height exists significant association, but there is no meaningful correlation between birth weight and adequacy of care (P The study analyzed the effect of PNC utilization on birth outcomes and suggested that PNC decrease LBW through both increasing gestational age as well as improving fetal growth at the same time it improves birth height and mother weight gaining. All findings of this study emphasize the need for health policies to improve utilization and access PNC.

Ureteral stenting is a common urological procedure. However, morbidity associated with ureteral stents has been identified as a potential health problem. A comprehensive, reliable and valid measure to evaluate health-related quality of life in patients undergoing this procedure is the Ureteral Stent Symptoms Questionnaire (USSQ). In this paper, we validate the Persian version of the USSQ in patients with a ureteral stent.
Linguistic validation of the USSQ was performed through a standard process that included forward and backward translation by two translators and pilot testing. Six clinical specialists scored translated questionnaires to examine content validity. Thirty patients who underwent the ureteroscopic surgery and 20 control participants completed the Persian USSQ as well as the International Prostate Symptom Score (IPSS). Patients completed the questionnaires 1 week after stent placement and again 4 weeks after stent placement while controls completed questionnaires 2 times 3 weeks apart.
To assess content validity, content validity index for items and modified Kappa was > 0.81 for the entire scale. Internal consistency using Cronbach’s alpha was > 0.78. Test-retest reliability (Kendall’s tau coefficient > 0.7) was satisfactory for urinary symptoms, general health, sexual matters, work performance and additional problem domains. Convergent validity was 0.71 for urinary symptoms and IPSS. Discriminant validity between cases and controls was meaningful.
The Persian version of the USSQ is a reliable and valid instrument that can be self-administered by patients with indwelling ureteral stent in clinical and research settings.

Radiology is a complex health science and profession, requiring experienced use of academic technology, beside the ability of thinking critically, independent judgment, solving problems creatively and communicating effectively to make the best clinical performance. The present study was designed to evaluate the practical capability of radiology technologists working in radiology wards, for determining the level of association between capability and academic education.
In a cross-sectional analytical study carried out at Tabriz University of Medical Sciences, Iran, in 2010-2012, the radiology technologists were asked to fill the previously-designed questionnaires which was included a checklist related to the participants’ social and demographic characteristics, and a questionnaire on the radiology technologists’ performance regarding the medical applications of X-ray.
The mean age was 35.03 ± 8.01 year, and 64 (53.3%) were male. The technologists’ capability had a significant relation with their educational degree, and the capability of staff with BS was more than those with an associate degree (P A great majority of the technologists do not seem to base their capability on the recognized scientific sources. Teaching or familiarizing the students with the true concept of performing on the basis of the prior training, and the significance of implementing such training in professional activities is one of the approaches, which could lead the technologists to appreciate the relationship between classical training and their providing quality services.

Expansion of strong primary health care (PHC) network as a first revolution in Iran health system has led to significant improvements in coverage of the rural population and health indicators. Considering the development of rural health insurance and family physicians programs second revolution in 2004, in this study it was tried to determine the level of family physicians’ job satisfaction and its relationship with educational performance.
All physicians who had worked as family physicians in public health care system of East Azerbaijan, Iran, between 2009 (December) and 2011 (May) were included in a cross-sectional study. The included population was composed of 367 primary care physicians. A self-administered, anonymous questionnaire was used to collect required information about job satisfaction. Educational performance scores of physicians were extracted from their educational profile in the medical faculty.
In this study, 149 questionnaires were analyzed from 238 retained questionnaires (overall response rate of 62.5%). The average score of job satisfaction was 41.84 (19.11) and the average educational performance score was 78.63 (6.66) out of 100. There was only significant relationship between gender, number of undercover population and job satisfaction while the results showed significant relationships between age and educational performance among personal and variables (P > 0.050). However, there was no significant relationship between job satisfaction and educational performance.
The low level of job satisfaction and educational performance scores of family physicians indicating the urgent need for more extensive research in identifying the root and basic causes of this situation at first step. Second, finding the appropriate mechanisms to improve the job satisfaction level is great importance. We are proposing the revising of current policies, in payment methods and work condition, educational methods in existing health system.

Increase of inflammatory markers is the most important problem in metabolic syndrome. Creactive protein (CRP) is an undefined component of metabolic syndrome, and its increase is regarded as a dependent risk factor to cause complications. Considering the high prevalence of metabolic syndrome and relation of these diseases with different inflammatory factors, it is assumed this syndrome may affect fractured bone healing process. Therefore, the hypothesis is studied for the first time in analytical study.
This analytical and descriptive study was conducted on 48 patients with isolated fracture of tibia and femur shafts resulting from low-energy trauma. In this study, 24 patients with metabolic syndrome criteria matched considering age, gender, type of fracture, and treatment method were compared with 24 metabolically health persons. Level of high sensitivity hs-CRP (High-sensitivity CRP) inflammatory marker was also determined in these patients. Union rate and duration as well as a relation between inflammatory marker and union rate were studied.
Prevalence of nonunion and delayed union were seen in 8 (33.3%) and 3 (12.5%) patients with metabolic syndrome, respectively. However, there was not any case of nonunion in the metabolically health group. There was a statistically significant difference between these groups. According to the regression model, hs-CRP level played a significant role with sensitivity of 95% considering nonunion prediction [P = 0.001, OR (Odds ratio) = 2.3 and CI (Confidence interval) 95% = 1.4-3.8] while other factors of metabolic syndrome did not play any important role in nonunion prediction.
Prevalence of nonunion in patients with metabolic syndrome suffering from a fracture and undergoing orthopedic surgery is higher than healthy people. It seems that the increase of inflammatory markers plays an important role in causing and predicting of nonunion in these patients.

Methicillin resistant Staphylococcus aureus (MRSA) has emerged as a nosocomial pathogen of major worldwide importance and is an increasingly frequent cause of community-acquired infections. In this study, different risk factors and MRSA resistance pattern were investigated.
In a 24 months period, all of the patients who were confined to bed in the surgery ward were included in the study. Then they were assessed to find out as if they had MRSA infection when hospitalized and once when they were discharged. Almost 48 h after admission, when patients were discharged, social and medical histories were acquired. Acquired samples were examined.
During the present study of 475 patients, 108 patients (22.8%) had S. aureus. About frequency of antibiotic resistance among collected S. aureus colonies, erythromycin resistance, was the most frequent antibiotic resistance, also resistance to vancomycin was 0.4% that was the least. Only hospitalization duration had statistically significant correlation with antibiotic resistance, also resistance to erythromycin had statistically significant relation with history of surgery and alcohol consumption. Of all 34 MRSA species, 22 (64.7%) samples were resistant to erythromycin, 17 (50.0%) resistant to cefoxitin, 5 (14.7%) resistant to mupirocin, 1 (2.9%) resistant to vancomycin and 1 (2.9%) resistant to linezolid.
The results of the current study show that among hospitalized patients, there is resistance against methicillin. Since based on results of the study there is resistance against oxacillin and erythromycin in most cases, administering appropriate antibiotics have an important role in minimizing the resistance burden among bacterial species.

Domestic violence is still common all around the world and children are directly or indirectly victimized. This study investigates the exposure of children to interparental physical violence.
Data were collected from a sample of randomly selected university students. Information was collected on any experience of exposure to violence between parents, the type, frequency and duration of violent acts.
From a total of 177 students, 31.5% of females and 46.6% of males have experienced interparental violence (IPV), and most of them (66.7%) directly witnessed it. The intimate violence was by fathers in 62.3%. The most frequent types were slamming a door and slapping (20.3%). Almost 40.0% of violent experiences began during pre-school age of the child, and a same number were still experiencing such events. Rate was higher reported by males and less educated parents. Males had a higher odds ratio (OR) of exposure to physical violence, as well as violence by fathers only.
This report emphasizes the high rate of children witnessing violence between their parents. Beside proper and in time intervention to reduce the psychological harm in these children, educational programs to increase social skills and problem-solving methods will improve the quality of relations within families.

Minor blunt head trauma is a common reason for children to present to the emergency department (ED). Crania computed tomography (CT) is the choice for evaluating children with blunt head trauma in the ED, but few shows abnormal findings. In this study, we aim to evaluate CT findings in children with blunt head trauma and clinical symptoms to identify clinical predictors of abnormal CT scans.
In this prospective study, 218 children under 2 years of age (121 male and 97 female with mean age of 11.24 ± 4.31 months) with compliant of minor blunt head trauma visiting the ED between April 2011 and April 2014 were included. Physical examination and clinical symptoms, as well as CT findings and patients’ outcome were evaluated.
Physical examinations were normal in 95.9%, and clinical symptoms were present only in 25.7% including vomiting in 16.1%, loss of consciousness (LOC) in 8.3%, ear/nose bleeding in 4.1% and seizure in 5.5%. CT scan was requested in 189 cases (86.7%) of which, 7.9% were abnormal including linear fracture in 5.3%, subgaleal hematoma in 1.1% and depressed fracture, subcutaneous hematoma and intracranial hemorrhage (ICH) each in 0.5%. Among all cases, 89.0% were discharged from ED with no further observation, 6.0% discharged after 48 h observation and 5.0% were hospitalized. There was a significant correlation between abnormal CT findings and having any clinical symptoms, vomiting and Ear/nose bleeding.
In children under 2 years old with minor blunt head trauma, most CT scans are unnecessary. Considering clinical symptoms as predictors of abnormal CT scans we can reduce unnecessary ones.

Road traffic injuries are a major public health problem, requiring huge efforts for effective and sustainable prevention. Because of the high occurrence of traffic accidents in Iran, basic data acquisition is highly needed to implement prevention plans. The present research is conducted as an epidemiological study of the traffic accident victims referred to a referral orthopedic center in North West of Iran.
A cross-sectional study was conducted during a 3 months period from June to September 2009 in Tabriz, Iran. A total of 16681 patients were admitted to the emergency ward, and 3246 patients (19.5%) were hospitalized during this period because of traffic related injuries. After randomization, 630 cases were selected to be enrolled in the study. The location of an accident, position of road users, type of crashed vehicle, cause of accident, type of injury, time interval from accident to hospitalization and treatment outcome were recorded. Statistical analyses were carried out using SPSS software.
The mean age of the patients was 31 years (range, 6 months to 98 years) and 77.0% of patients (468 cases) were men. A total of 193 (36.6%) patients sustained traffic accident in open roads and 335 (63.4%) in urban corridors. In 67 (12.9%) of accidents, there was only a single occupant in the vehicle. The time interval between the accident and admission was 6.6 ± 3.2 hours. Of the 608 cases, 45.7% were drivers, 30.3% passengers, and 24.0% pedestrians. Most cases of the car accident happened in urban areas, and the male victims were largely in the driver group. The most frequent type of injury was knee, leg and head trauma.
The large number of traffic-related injuries admitted to our emergency ward that comprise mostly young adults should be considered as an alarming signal to policy makers and health providers in our province. Strict control on drivers’ behavior should be taken into account if increasing human loss and injury on the roads are to be averted .