مجله تصویر سلامت
سال سیزدهم شماره 3 (پاییز 1401)

Antibiotics are widely used since they inhibit microorganisms without damaging human cells. Antibiotics are one of the most commonly used drugs in surgery because surgical site infection is the most common nosocomial infection and its prevalence reaches a maximum of 38%. Prescribing prophylactic antibiotics before surgery is a way to prevent infection at the surgical site, provided that its principles are observed. It is essential to study the ways of administering antibiotics to prevent overdose or misuse of these drugs. This study aimed to investigate the pattern of prescribing prophylactic antibiotics to patients admitted to the surgical wards of Shahid Sadoughi Hospital in Yazd, Iran and compare it with standard methods.

The present study was a cross-sectional, descriptive, and analytical study. For data collection, we used the patients’ medical records in Shahid Sadoughi hospital in Yazd, Iran.The sample size was 238 cases according to the total number of surgical records from 2019.3.21 to 2019.9.22. Out of 238 samples, 236 cases were considered acceptable and two cases were excluded as they were related to breast surgery, including mastectomy with axillary lymphatic dissection, reconstruction, and reoperation within six weeks of initial surgery. We excluded these cases because their number was not large enough to be able to generalize their results. Each case was randomly studied for each surgery, so that the share of each surgery was determined in proportion to their total number. A checklist was designed to collect the required information. This checklist included information about the patients' age, type of health insurance, type of general surgery ward, time of preoperative prophylactic antibiotics, type of preoperative prophylactic antibiotics, and duration of continued postoperative antibiotics. It also included two questions about re-admission resulting from wound infection and administration of oral antibiotics after discharge, as well as two questions regarding the compliance of prescribed prophylactic antibiotics with clinical guidelines. Significance level in all research tests was considered less than 0.05.

The results showed a significant relationship between the patients' age and the time of administration of preoperative prophylactic antibiotics, type of preoperative prophylaxis antibiotics, and administration of oral antibiotics after discharge based on clinical guideline (P <0.05). However, the type of preoperative prophylactic antibiotics seems to have been observed only in the age groups 1-15 and 46-60, as dictated by the standard method, while the oral antibiotic component has been prescribed for other age intervals after discharge except for the age range of 1-15 years. There was also a significant relationship between the type of general surgery and the time of administration of preoperative prophylaxis antibiotics, the type of preoperative prophylaxis antibiotics, and the administration of oral antibiotics after discharge according to the clinical guidelines; this means that the time of preoperative prophylaxis was prescribed. According to the clinical guidelines, except for thyroid and parathyroid surgeries, it was not observed in the other cases. The prescription of prophylactic antibiotics according to the standards was found to have been observed only in non-obstructive small bowel surgeries, open or laparoscopic hernia repair operations with mesh, and thyroid and parathyroid implants. It should be noted that in accordance with the administration of oral antibiotics after discharge with the type of surgery, in all cases except open or laparoscopic hernia repair surgery with antibiotics, antibiotics are also prescribed after discharge. Moreover, there was a significant relationship between the type of prophylactic antibiotics used before surgery and the type of preoperative prescription antibiotics according to the clinical guidelines, and the highest standard in the type of prescription antibiotics was related to cefazolin. In other cases, no significant relationship was observed between the compared variables.

The administration of prophylactic antibiotics in the general surgery department does not comply significantly with the standard instructions. It seems that the choice of prophylactic antibiotics is based on the surgeon's experience, patient characteristics, type of surgery, and the instructions available in different hospitals. However, it is essential to follow the recommendations mentioned in the instructions for timely administration of prophylactic antibiotics and their duration after surgery because long-term use of antibiotics leads to drug resistance and increased use of expensive, end-of-line antibiotics, which continues for a long time. The duration will have adverse effects on the economic and medical system of the hospitals as well.

The health system generally comprises a variety of players. In the health system, there are intermediary institutions of innovation, playing a key role in reducing the distance between the members of the network and building trust among them. Therefore, this study aimed to develop a pattern of relationship between the function of the intermediary institutions of open innovation in the health system.

This descriptive-analytical study was conducted in two main phases. The first phase was carried out to identify and approve the principal components of the function of the intermediary institutions in the health. The data were collected based on a researcher-made questionnaire in accordance with the existing research literature. The questionnaire was distributed among 140 managers and experts of the research and quality improvement divisions of the clinical centers, laboratories, and pharmaceutical companies. The data were analyzed using confirmatory factor analysis (CFA). In the second phase, interpretive structural modeling (ISM) was employed to design the pattern of relationship. The views of 12 experts were used for designing the pattern. ISM was used for developing various parts of the questionnaire.

The CFA findings indicated the proper relationship between the principal components and the respective indicators. Accordingly, all principal components of the pattern of the functions of the intermediary institutions were confirmed in the statistical population. Based on the ISM, the findings revealed that components of “organizing and supplying resources” and “strengthening the network and participation” were the most effective functions of the intermediary institutions. Moreover, the component of commercialization was the most susceptible function of the intermediary institutions.

The intermediary institutions can reduce the deficits in each stage of the process of innovation in the field of health according to their various functions, serving as an accelerator increasing the knowledge and innovation in the field of health.

Quality of life (QOL) and responsibility are known as fundamental issues in contemporary psychology. This study aimed to investigate the effect of problem-solving training on QOL and responsibility of paramedical students at Tabriz University of Medical Sciences, Iran.

The present quasi-experimental study had a pre-test-post-test design. The statistical population consisted of all paramedical students (490 students) in the academic year 2020-2021. The available sample was randomly divided into two groups of intervention (n = 20) and a control (n = 20). The Quality of Life Questionnaire (SF-36) and Gauff Responsibility Questionnaire were used to collect data. Problem-solving training by using scenario was provided to the intervention group in 2-hour sessions held twice a week for a period of 14 weeks. The data were analyzed using analysis of covariance (ANCOVA) in the Statistical Package for the Social Sciences (SPSS) software version 21.

The mean age of participants was 20.61 (SD=1.14) and 21.21 (SD=1.62) years in the intervention and control groups, respectively. The problem-solving training seemed to enhance the QOL scores [F(1,39)=1052.192, P<0.001, ƞ2=0.966] and students’ sense of responsibility [F(1,39)=126.111,P<0.001,ƞ2=0.773].

Problem-solving training had a significant positive effect on reducing the incidence of mental illness in students. Therefore, this approach can be used to promote students' mental health.

The selection of an elite teacher with the necessary competencies is considered as a motivational force to improve the quality of teaching. This study aimed to determine standard criteria for selecting elite lecturers in medical science universities.

Using a content analysis approach, this qualitative study was carried out in Tabriz University of Medical Sciences (TUOMS), as one of the top ranking medical universities in Iran. Data was collected by purposive sampling method from individuals with experience in the field of teacher evaluation working in the Deputy of Education and Education Development Center (EDC) of TUOMS. Focus group discussion (FGD) sessions continued until data saturation was achieved.

Based on the analysis of the interviews, four criteria for selecting elite teachers were identified as follows: "the dynamics of education", "research and educational innovation", "evaluation of fair treatment, discipline, and professional ethics", and "accountability in transformational innovation packages in education". In addition, the score of clinical teachers and basic sciences teachers was considered as 94 and 100, respectively.

In this study, a standard tool was designed to select elite lecturers in an attempt to observe educational justice and encourage teachers to perform their various roles and tasks. Our results can be used as a standard tool in other Iranian medical universities.

The concept of age-friendly cities has been introduced by the World Health Organization (WHO) in an attempt to pay more attention to the elderly. In Iran, this issue is more important due to demographic changes and age conditions. This study aimed to investigate the views of the elderly people living in Tabriz about the indicators of age-friendly cities.

In this cross-sectional descriptive-analytical study, 351 elderly people were selected from six age-friendly centers in Tabriz by simple random sampling method. The data collection tool was the standard questionnaire of the WHO in an age- friendly city. To analyze the data, both descriptive statistics (frequency, frequency percentage, mean, and standard deviation) and analytical statistics (analysis of variance and t-test) were used. Also, the Statistical Package for the Social Sciences (SPSS) software version 16 was used and significance level was considered as 0.05.

Among the four studied indicators, the health component had the highest average (44.57 (11.81)), followed by the components of social respect (38.5 (11.5)), participation in social relations (34.8 (9.12)), and the cultural and recreational index (32.86 (10.54; range 1-100)). We also observed a significant relationship between gender and marriage with cultural and recreational component (P = 0.002).

Since none of the four indicators of age-friendly cities in Tabriz were standard, the managers of aging-related organizations should plan to standardize these indicators to achieve the desired conditions.

Primary health care system provides appropriate prevention and primary mental care services only for rural population. Therefore, the Community Mental Health Center (CMHC) was developed to provide mental health services in urban areas. The present study aimed to outline the performance, achievements, and challenges of CMHC in Tabriz, Iran.

This was a qualitative pilot study with in-depth interview approach. The outcomes, implications, and challenges of CMHC in Tabriz city were evaluated from 2015 to 2019 using three methods, including conducting in-depth interviews with two executive managers, holding focus group discussion (FGD) with managers and mental healthcare providers, and collecting mental health care indicators from the patients’ health records. After evaluating the challenges, appropriate recommendations to improve mental health services in urban areas were presented.

A total of 17 specialists and general medical doctors collaborated in this study. During the study, 1053 initial visits and/or screenings and 2313 patients with psychological disorders were identified and recorded. Moreover, a total of 988 mental training sessions were held for patients and their families. Five main themes, including the necessity for establishment and objectives, implementation process, achievements, challenges, and recommendations, were identified during in-depth interviews and FGDs.

It seems that CMHC is an appropriate strategy and model for providing basic mental health services, especially in metropolitan cities. Longitudinal studies with a randomized controlled trial design as well as cost-effectiveness evaluation studies are required to confirm CMHC in the Iranian context.

Job burnout is an important factor affecting human health, and it can reduce the efficiency and effectiveness of staff in various organizations, including academic libraries. This negative phenomenon may deprive libraries of experienced manpower, disrupting the educational and information needs of library users, ultimately leading to the failure of the library and its organization in achieving the intended goals and missions. This study aimed to optimize the performance of human resources and identify the relationship between work-related musculoskeletal disorders and burnout to help in planning to reduce the rate of burnout.

This descriptive-correlational and applied research was carried out by census method on 126 librarians working in Ahvaz Jundishapur University of Medical Sciences and Shahid Chamran University of Ahvaz. The Cornell Musculoskeletal Discomfort Questionnaires (CMDQ) was used to measure the amount of physical injury caused by work and the Maslach Burnout Inventory (MBI) was used to measure the degree of burnout. Data analysis was performed in two parts: descriptive statistics and inferential statistics. P-value equal to 0.05 was considered as significant.

The findings indicated that the total rate of musculoskeletal disorders (32.96) and total job burnout (1.72) were lower than the population average. The highest rate of musculoskeletal disorders was in the neck area (78.9%) and the lowest rate was in the lower leg (37.8%). Moreover, no significant difference was observed between male and female librarians in the variables of musculoskeletal disorders caused by work and job burnout.

In general, musculoskeletal disorders had a positive relationship with all dimensions of job burnout except for individual performance. There was an increase in musculoskeletal disorders, as well as the rate of job burnout.

Given that the market environment is becoming specialized in different sectors, it is necessary to identify specialized indicators of customer loyalty and their priority to improve the provision of complementary health insurance services. This study aimed to identify, prioritize, and measure the loyalty indicators in people covered by supplemental insurance.

An exploratory study was conducted using a mixed-method (qualitative-quantitative) approach. In the qualitative section, 20 interviews were conducted with faculty members, managers, and experts of insurance companies in Ahvaz (Khuzestan province, Iran). In the quantitative section, 380 interviews were conducted with the staff of supplementary health insurance. In the qualitative section, the data were first extracted using scoping review methodology, then coded and classified using the data-driven method. Next, each indicator was prioritized using the fuzzy analytical hierarchy process (AHP). Data were analyzed using structural equation modeling (SEM) and Smart PLS software.

We included a total of 38 articles in the scoping review. After the semi-structured interview, five indicators were identified, including customer satisfaction, customer trust, repurchase intention, recommendation to others, and brand preference. Moreover, customer satisfaction (0.269), repurchase intention (0.233), brand preference (0.196), customer trust (0.155), and recommendation to others (0.147) had the greatest impact on customer loyalty.

According to the results, customer satisfaction was the most important factor influencing loyalty. Therefore, the managers of insurance companies should pay more attention to increase satisfaction of insured individuals and improve customer loyalty in companies.

One of the main activities that plays a significant role in the prevalence of mental illnesses is the issue of referral. According to the evidence, the lack of proper implementation of the referral system is one of the obvious weaknesses of the primary health care (PHC) system. Therefore, this study aimed to investigate the challenges of referring mental health clients in the PHC system in Iran. We also examined the weaknesses in this process from the perspective of mental health experts.

The present study is a qualitative study with conventional content analysis approach. Data were collected through semi-structured interviews with 15 PHC psychologists selected through purposive sampling. After transcribing the interviews, the data were analyzed based on the Graneheim and Landman model.

We identified two main themes and 12 categories. The theme of intra-centered referential challenges included categories such as weaknesses in health care providers screening and low referrals, clients' lack of trust in health care providers, clients' lack of cooperation, physicians' poor cooperation, and barriers to clients' desire to visit a psychologist. Meanwhile, outer-centered referential challenges included a shortage of referral centers, lack of transparency in referrals, lack of direct referrals, poor follow-up, barriers regarding referral to a higher level, and barriers to clients’ referral to the institute.

The findings of the present study showed that poor intra-sectoral and inter-sectoral communication is one of the main challenges that has disrupted the referral process in the field of mental health in the PHC system. Many challenges such as the lack of designated referral centers, poor follow-up due to lack of referral feedback, and clients' financial inability to refer to a higher level can be improved by strengthening cross-sectoral communications such as two-way communication with support organizations and psychiatric and psychotherapy centers.