فهرست مطالب

  • Volume:21 Issue: 21, 2020
  • تاریخ انتشار: 1399/06/11
  • تعداد عناوین: 8
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  • Hamed Tavan, Siros Norouzi, Masoumeh Shohani * Page 1
    Background

    Cardiac arrhythmias are among the most prominent causes of mortality in patients with heart diseases. By timely diagnosis of arrhythmias, nurses can provide necessary therapeutic measures to these patients.

    Objectives

    The purpose of this study was to determine the effects of teaching cardiac arrhythmias using educational videos and simulator software in nurses.

    Methods

    In this quasi-experimental study, 22 novice nurses were selected based on the census method. Evaluations were performed before and after educational interventions for cardiac arrhythmia. The interventions included using simulator software and face-to-face education. A questionnaire with 20 questions regarding cardiac arrhythmias organized in 4 parts of sinus arrhythmias, atrial arrhythmias, ventricular arrhythmias, and blocks and junctional rhythm, and each with 5 questions was used to collect data. Each question was scored 1 point, and the final score ranged from 0 to 20. The scores were categorized into poor (< 10), moderate (11 - 15), and good (16 - 20) levels. Data were analyzed using SPSS V.20 software.

    Results

    There was a significant difference in the mean of total score regarding the diagnosis of arrhythmias before (9.9) and after (15.68) the education (P value = 0.022). This indicated an increase of about 6 scores at post-intervention. The classification of the scores showed that 9 (40.9%) and 13 (59.1%) nurses had poor and moderate diagnostic abilities before training. However, following education, 10 nurses (50%) acquired moderate and 10 (50%) nurses obtained good scores.

    Conclusions

    Arrhythmia scores varied before and after training, with the mean scores after training increased, and arrhythmia detection rate was increased after the intervention. It is advisable to use modern educational methods as good alternatives for reviewing educational content and concepts.

    Keywords: Nurses, Cardiac Arrhythmias, Software, Educational Films
  • Mohammadreza Heydari, Morteza Mehraeen, Hassan Joulaei * Page 2
    Background

    In the health services, financial resources are limited. An important way to save and prevent resources from going to waste is to use clinical guidelines.

    Objectives

    The objective of this study was to estimate the wasted cost as a result of ignoring clinical guidelines for a typical disease.

    Methods

    This cross-sectional study was performed in Fars province. 392 physicians were enrolled in this study and were asked to write a prescription for a hypothetical patient with streptococcal sore throat. Prescriptions were priced and compared to standard treatment costs and analyzed by SPSS software.

    Results

    Mean, median and mode of prescribed drugs in each prescription was 3.1, 3.0 and 3.0, respectively. Only 8.4% of the prescriptions were in accordance with the clinical guidelines, and 12% had led to mistreatment. Usually, physicians with more experience prescribed more expensive medications, and 45.5% of the total medication cost had gone to waste. About 5% of household drugs are waste. Due to mistreatment, 2 patients developed acute rheumatic fever.

    Conclusions

    Waste of recourses and patients out of pocket payment was high, which reduces patient’s ability for obtain other necessary healthcare services. Hence, training the physicians and developing clinical guidelines is an urgent necessity to prevent resources from being wasted.

    Keywords: Physicians, Health Resources, Prescription, Health Care Cost
  • Ali Golkari, Mojtaba Homayouni, Zahra Ranjbar, Aira Sabokseir* Page 3
    Background

    It is vital to ensure that dental services are provided for HIV-positive (+) patients.

    Objectives

    This study was designed to evaluate dentists' knowledge, attitude, and practice towards HIV+ patients of Shiraz, Iran.

    Methods

    In this cross-sectional study, 120 general dentists of Shiraz were randomly selected. Dentists' knowledge and attitude about HIV oral manifestations and transmission, concerns and approach to HIV+ patients, and infection control in practice were assessed using a questionnaire translated in a backward-forward method. The dentists' real practice was assessed by sending simulated HIV+ patients to their practice two months later. The results were analyzed using the chi-square test and the spearman correlation.

    Results

    The response rate was 85.8%, and 71.8% of the participants were male. The average age and work experience of the participants were 42 and 14 years, respectively. Dentists' knowledge about HIV oral manifestations and body fluids, which could transmit HIV, was 14% - 59% and 31% - 97%, respectively. Concern about the possibility of being infected during the treatment of HIV+ patients was the most important reason for the unwillingness to accept these patients. The percentages of dentists who claimed would accept HIV+ patients without hesitation, accept with hesitation if the patient insisted, refer, or reject immediately were 29, 31, 30, and 10, respectively. However, in reality, the observed percentages were 17.5, 0, 65, and 17.5, respectively.

    Conclusions

    Dentists' knowledge and attitude towards HIV+ patients and the acceptance of these patients were not desirable. Moreover, there was no significant correlation between their knowledge and attitude with their real practice.

    Keywords: Practice, Attitude, Knowledge, AIDS, Shiraz, Dentist
  • Taghi Amiriani, Vahid Khori *, Ali Davarian, Niloofar Rajabli, Mahsa Niknam, Sima Besharat, Shabbou Bahramian, Ahmad Shirafkan Page 4
    Background

    Cirrhosis could lead to a long corrected QT (QTc) interval in a subgroup of patients, but there are spare data on its diurnal variation.

    Objectives

    The present study aimed to determine the diurnal variation of QTc interval and its relationship to heart rate and blood pressure variation during 24-hour Holter-monitoring in non-alcoholic cirrhosis in comparison with the healthy controls.

    Methods

    The study population comprised 15 patients with non-alcoholic cirrhosis and 15 healthy subjects, undergoing 24-hour electrocardiogram (ECG), heart rate, and blood pressure monitoring. The mean QT interval, mean QTc, maximum and minimum QT, QT dispersion (QT disp), heart rate, and mean arterial blood pressure were measured for each person for 24 hours. Liver stiffness measurement (LSM) was performed by FibroScan® 502 machine (EchoSense, Paris, France, 5 MHz). The results were demonstrated as percentages and mean ± SD. P value ≤ 0.05 was considered significant.

    Results

    Mean QTc was significantly higher in cirrhosis (438 ms) than healthy controls (401.7 ms) (P = 0.03). The mean heart rate was significantly different in cirrhotic patients (79.6 ± 2.9/bpm) compared to healthy controls (72.47 ± 2.0/bpm) (P = 0.05).

    Conclusions

    In this study, QTc was prolonged and increased with the severity of cirrhosis, and its diurnal variation in cirrhosis was different from healthy subjects.

    Keywords: Cirrhosis, QT Dispersion, QT Interval, QTc
  • Ehsan Zarei *, Ali Bagheri, Abbas Daneshkohan, Soheila Khodakarim Page 5
    Background

    One of the basic steps to quality improvement in hospitals is to obtain patients’ feedback.

    Objectives

    The aim of this study was to assess the quality of hospital services from patient’s perspective in hospitals affiliated with the Dezful University of Medical Sciences (DUMS), Dezful, Iran.

    Methods

    In this cross-sectional study, 400 patients were selected from six hospitals of DUMS. The data was collected using the SERVQUAL questionnaire including 22 pairs of questions (organized in two aspects of service importance and performance) in 5 dimensions of tangibility, reliability, responsiveness, assurance and empathy. The importance-performance analysis (IPA) was used to determine the weaknesses of service quality and prioritizing the aspects requiring improvement.

    Results

    The mean age of the patients was 38.5, 32% (n = 128) had academic degrees, 55% (n = 220) were self-employed, and 16.5% (n = 66) did not have health insurance. The average length of day was 7.8 ± 8.3 days. The mean score of the importance and performance were 4.37 ± 0.75 and 3.72 ± 0.94, respectively. The service quality gap was -0.65. Tangibility (-0.68) had the largest negative gap while the smallest gap was related to the reliability (-0.63). The gap between importance and performance was significantly negative in all attributes and dimensions (P < 0.001). The results of the IPA showed that the tangibility was located in the Q VI, reliability and assurance in the Q I, and the responsiveness and empathy in the Q III quadrants.

    Conclusions

    Quality of hospital services did not meet patients’ expectations and there is a room for improvement and obviate the gaps. Decision-makers can further use the results of the IPA to effectively allocate limited resources giving special attentions to the organizational weaknesses.

    Keywords: Patient Satisfaction, Service Quality, Importance-Performance Analysis
  • Rahim Ostovar, Nourrollah Yadegari, MohammadReza Mohammadi, Ali Khaleghi, Seyed Ali Mostafav, Majid Dousti, Parvin Angha * Page 6
    Background

    Children and adolescents are potentially at risk of different psychiatric disorders, and it is important to consider their health, especially their mental health.

    Objectives

    We aimed to design a cross-sectional study to investigate the association between lifestyle-related components with the psychiatric disorders in children and adolescents in Kohgiloyeh and Boyer-Ahmad province (Iran) and to determine its association with different lifestyle-related variables.

    Methods

    In this study, about 1000 children and adolescents aged 6 to 18 years in Kohgiloyeh and Boyer-Ahmad province were selected using stratified cluster random sampling. The reliable Persian version of Kiddie-Sads-Present and Lifetime Version (K-SADS-PL) and the Life Style Questionnaire (LSQ) were instructed using interviewing with participants by our clinical psychologists or, if they were under 14 years, with their parents. Besides, demographic data (i.e., gender, age, location, race, nation, and religion) of participants were also collected.

    Results

    The results showed that, except for the physical activity and well-being, other remaining factors have a significant correlation with psychiatric disorders (P < 0.05). The exact p-value for each factor was as follow: physical health (P = 0.007), sports and well-being (P = 0.057), weight control and nutrition (P = 0.001), prevention of diseases (P = 0.04), mental health-cognitive (P = 0.05), spiritual health (P = 0.008), social health (P = 0.05), drug avoidance (P = 0.001), accident prevention (P = 0.02), and environmental health (P = 0.001). Also, we found that the overall effect of lifestyle was significantly associated with children and adolescent mental disorders (P < 0.05).

    Conclusions

    Our findings show a significant role for lifestyle in the children and adolescents psychiatric disorders. So it should be considered in more detail in future studies.

    Keywords: Children, Adolescents, Lifestyle, Psychiatric Disorders
  • Fatemeh Ghaznavi, Payam Farhadi, Roxana Sharifian * Page 7
    Background

    Currently, many physicians use the computerized physician order entry (CPOE) system, and the adoption of this system is increasing worldwide. The technology acceptance model has been implemented and evaluated. It has become one of the most recognized empirical models. Besides, recent studies showed that this model well anticipates users’ behavioral tendencies in accepting technology in healthcare centers. The use of the technology acceptance model in the implementation of health care systems such as CPOE, which is effective in reducing medical errors, is necessary.

    Objectives

    This applied research has used a descriptive-analytical approach. In the current study the technology acceptance model in Iranian health care centers, which was proposed by Safdari and colleagues aimed to investigate the attitudes of clinical staff toward the computerized physician orders entry system, was used in the Cardiac Care Unit of Alzahra’s Heart Hospital in Shiraz to determine the importance and effectiveness of each dimension on attitudes toward using CPOE by 140 of physicians and nurses.

    Methods

    Three main dimensions, including human, monitoring-management, and organizational strategies factors, were evaluated using a researcher-made questionnaire. Data were analyzed by SPSS version 25 using the descriptive and analytical statistics (i.e., Pearson correlation test and t-test).

    Results

    The results showed that organizational strategies dimension with an average of 3.85 (out of 5) had the highest users’ attention, followed by monitoring-management and human dimensions. The overall average of all dimensions was 3.78. All dimensions had a positive and direct effect on the attitudes toward using the CPOE. Demographic characteristics did not have a meaningful relationship with any dimensions.

    Conclusions

    Finally, the average above 3 in the mean of the total dimensions, as well as each dimension, shows views of the users are appropriate to using the CPOE., the views of the users are appropriated toward using CPOE. It should be noted that the difference in the dimension means is a small amount. The centered focus on organizational strategies with the highest average should not cause to neglect other dimensions.

    Keywords: Cardiac Care Unit, Technology, Medication Error, Technology Acceptance Model, Computerized Physician Order Entry System
  • Alireza Mohebbi, Hosna Zobairy, Hesam Jahandideh, Ayda Sanaei, * Page 8