Hospital Practices and Research

Abstract Background: Identifying risk factors for surgical site infection (SSI) after appendectomies could be useful in focusing prevention programs.
Objective: The current study aimed to identify the risk factors associated with SSI in a cohort of patients from a single center in Western Qatar.
Methods: This cross-sectional study was carried out at The Cuban Hospital (Dukhan, Qatar) on patients who had undergone an appendectomy from January 2013 through September 2016. Data extracted from the patient files included demographics, comorbidities and toxic habits, surgery type, procedure duration, wound type, appendicitis-type, American Anesthesiology Score, body mass index, selected laboratory tests, and compliance with antibiotic prophylaxis.
Results: The study variables, type of surgery performed, procedure duration, wound and appendicitis type, serum albumin, and timing of antibiotic prophylaxis, were found to be related to the occurrence of SSI in univariate analysis (P = 0.000). Logistic regression showed that open appendectomies (odds ratio [OR] = 22.90, 95% CI; 8.04-65.21), low serum albumin (OR = 0.92, 95% CI; 0.85-0.99), and improper timing of antibiotic prophylaxis (OR = 44.92, 95% CI; 3.39-594.91) were independently associated with the occurrence of SSI.
Conclusion: Cases of complex appendicitis, open procedure, low serum albumin level, and improper timing of antibiotic prophylaxis constituted the risk factors for SSI in the setting of this study. The infection control program should focus on improving the quality of antibiotic prophylaxis and closely monitoring patients who undergo open surgical procedures.

Abstract Background: Opioids added to local anesthetics for peripheral nerve blocks may intensify analgesia and prolong analgesic and sensorial block duration. These agents may also cause potentiation and prolongation of motor block.
Objective: This study compared the postoperative effects of 30 mL of 0.25% bupivacaine +50 mcg fentanyl and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl solutions for the ultrasound-guided infraclavicular block in patients undergoing elbow and forearm surgery.
Methods: In this randomized double-blind study, thirty-six patients with risk of ASA class I-III were randomly allocated into 2 randomized groups. Ultrasound-guided infraclavicular blocks with 30 mL of 0.25% bupivacaine + 50 mcg fentanyl for group 1 and 30 mL of 0.25% bupivacaine + 100 mcg fentanyl for group 2 were performed before patients emerged from general anesthesia. After surgery, pain levels at rest and during movement were evaluated using the 10-cm visual analog scale (VAS) at recovery room admission, at the 15th and 30th minutes in the recovery room, and at the 2nd, 6th, 12th and 24th hours postoperatively. Both morphine and rescue analgesic requirements were recorded. Sensorial and motor block durations, patient satisfaction, and complications related to the infraclavicular block were recorded.
Results: In both groups, no significant difference in VAS pain scores, total morphine and total rescue analgesic requirements, duration of sensorial and motor block, or patient satisfaction were observed. None of the patients experienced any complications.
Conclusion: The mixtures of 0.25% bupivacaine + 50 mcg fentanyl and 0.25% bupivacaine + 100 mcg fentanyl showed similar postoperative effects.

Abstract Background: Avoidable mortality (AM) is one of the most important health indicators (HI) and represents the quality of care in a hospital.
Objective: This study measured the efficacy of a training program for a hospital healthcare staff to reduce AM.
Methods: This epidemiological study on community intervention analyzed time-series data on HI by semesters from 2008 to 2015. The pre-intervention phase was examined from January 2008 to December 2014; the intervention phase was investigated in the first semester of 2015; and the post-intervention phase was examined in the second semester of 2015.
Results: Resindicate a series with a rising tendency until the 14th semester and a pronounced descent in the 16th semester. The relative variation rate (RVR) was -20% to +20% with some exceptions. HI was 0.53% in the 16th semester rather than the expected 0.70% observed in the pre-intervention phase; therefore, 0.17% additional deaths were avoided because of the training seminar.
Conclusion: The positive results suggest that this strategy is an important element in decreasing avoidable deaths in hospitals.

Abstract Background: Mental disorders are generally a significant reason for increased morbidity. They constitute a serious disease burden. One of the main reasons for this disease burden is long hospitalization periods.
Objective: The current study investigated the length of hospital stay and the variables affecting it in patients treated in the Gazi University Hospital Psychiatry Department between 2005-2016.
Methods: Patient diagnoses were analyzed according to the International Classification of Diseases 10th Revision (ICD-10). Data was obtained for 7027 hospitalizations over a 12-year period. Records of repeated hospitalizations, non-psychiatric primary diagnoses, and missing data were not included in the analysis. As a result, data from 5129 hospitalizations were included in the analysis.
Results: Mean age of the sample was 45.27±14.69, and 62.5% (n=3204) of the patients were male. Mean hospitalization period was 28.66±17.25 days. Schizophrenia and depressive disorder significantly prolonged hospital stay, while substance addiction shortened the duration of hospitalization (P < 0.001). It was found that the duration of hospitalization decreased significantly over the years (P < 0.001). Advanced age (P < 0.001), recurrent admission (P < 0.001), and female gender (P = 0.029) were other variables affecting this period.
Conclusion: Schizophrenia and depression are the most common psychiatric disorders in the inpatient service, and these disorders prolong hospitalization periods. The duration of hospital stay is considerably less in substance addiction than in other psychiatric disorders. Non-clinical variables, such as year of hospitalization, may affect the length of hospital stay.

Abstract Background: Absence from work for health reasons is known as “sickness absenteeism”. Frequent sick leave is a major concern to any organization, especially hospitals.
Objective: This study analyzed the extent and causes of sickness absenteeism in a teaching hospital and evaluated its corelation with demographic and occupational factors.
Methods: In a cross-sectional study, data was extracted from computerized records regarding sickness absenteeism of healthcare workers (HCWs) in the Occupational Health Department of a teaching hospital in Tehran. Studied variables included demographic characteristics, occupational factors, and causes of sickness absenteeism. The sickness absence rate (SAR) and absence frequency rate (AFR) in the study period were calculated. Chi-square and Mann-Whitney tests were used for the comparison of categorical and quantitative variables, respectively.
Results: In the current study, SAR and AFR were 0.011 and 0.68, respectively. Job type was the only factor that had a significant correlation with sickness absenteeism. The major disease-causing sicknesses were flu (21%) and musculoskeletal disorders (18.9%).
Conclusion: A significant relationship was found between the nursing group and sickness absence episodes. Flu, musculoskeletal disorders, and infectious diseases were the most frequent causes of sickness absence. Based on these findings, it can be concluded that factors such as availability of the flu vaccine and providing principles of personal protection and infection control can reduce sickness absence due to infectious disease.

Abstract Background: In sub-Saharan Africa (SSA), the trend in the number of patients admitted for maintenance hemodialysis is on the rise. The identification of risk factors for chronic kidney disease (CKD) ensures adequate primary and secondary preventive measures geared at reducing the burden of CKD in low-resource settings. A family history of CKD is an established risk factor for CKD in high-income countries. However, data on family predisposition to CKD is scarce in the literature on SSA.
Objective: The current study aimed to determine the prevalence and risk factors of CKD in family relatives of a Cameroonian population of hemodialysis patients (HDP) followed-up in a major hemodialysis referral center in Cameroon.
Methods: The current cross-sectional study was conducted over four months on a consecutive sample of first-degree family relatives of end-stage renal disease patients undergoing maintenance hemodialysis at the hemodialysis unit of the General Hospital of Yaoundé. For each participating family relative, socio-demographic characteristics, clinical data, and biological data including fasting blood glucose, proteinuria, and serum creatinine were collected.
Results: A total of 82 first-degree family relatives of HDP were recruited. The prevalence of CKD among the participants was 15.8%. The main identified risk factors for CKD were age (P=0.0015), female gender (P=0.0357), hypertension (P=0.0004), regular intake of herbal remedies (P=0.0214), and diabetes mellitus (P=0.0019).
Conclusion: Overall, the current findings suggest an urgent need for population education, routine screening of CKD, and the identification of risk factors in first-degree family relatives of HDP in Cameroon.

Abstract Background: Clinical research is a specific phase of the production process in the pharmaceutical industry in which companies test candidate drugs on patients in order to collect clinical evidence about safety and effectiveness.
Objective: This paper is an operational research which aimed to support the hypothesis that pharmaceutical clinical research is like any other production process which could be localized where the cost is most competitive. In other words, this work aimed to demonstrate that the localization process of this specific phase of the pharmaceutical industry’s R&D is based on the price of clinical evidence.
Methods: Considering Europe and taking panel data into account, an efficiency frontier through data envelopment analysis (DEA) was estimated. The efficiency of countries in maximizing the number of innovative medical treatments, given their available resources was estimated. Afterwards, focusing on European macro-regions, authors analyzed whether a significant concentration of clinical research exists.
Results: Results suggest that, taking the expected principal investigators’ fee into account, Southeastern Europe and Central Eastern Europe are the most attractive macro-regions for the pharmaceutical industry’s foreign direct investments in clinical research.
Conclusion: The results of the proposed operational research cannot reject the suggested evolution of the pharmaceutical industry’s clinical research. In other words, results confirm the localization process of the testing phase in East Europe, where the expected principal investigators’ fee is more competitive.

Abstract Background: Congenital hepatic fibrosis (CHF) is an autosomal hereditary disorder affecting the porto-biliary system. It is a rare hereditary disorder often presenting in childhood or adolescence with hepatomegaly, splenomegaly, and gastrointestinal bleeding. A timely diagnosis of organomegalies by sonography can prevent esophageal varices. Liver transplantation is now the only cure for CHF.
Objectives: The current study aimed to determine clinical and paraclinical findings in patients diagnosed with CHF from 2008 to 2017.
Methods: This was a descriptive cross-sectional study of all children Results: Overall, 32 CHF patients were included during the study period. Of these, 12 (37.5%) and 20 (62.5%) were female and male, respectively. The most frequent clinical presentations at diagnosis were hepatomegaly (81%), splenomegaly (68%), gastrointestinal bleeding (43%), abdominal protrusion (40%), ascites (21%), and epistaxis (6%). Severely enlarged livers were observed in 2 patients. Only 5 patients showed a normal-sized spleen, and kidney sonographic findings were normal in 30 patients. Liver enzymes were not severely deviated from the normal range. There was a significant association between spleen size and esophageal varices (P = 0.01). Overall, 8 patients were liver transplanted due to decompensated cirrhosis. One patient developed bone marrow suppression secondary to the Epstein bar virus and ultimately succumbed to post-transplant lymphoproliferative disorder. In the study period, 2 girls and 2 boys died of disease complications.
Conclusion: The results of the present study indicated that the most common clinical findings of CHF in pediatric patients are splenomegaly and hepatomegaly presenting as abdominal distention and gastrointestinal bleeding. Laboratory data can be normal in most cases, but ultrasonographic findings (in liver, spleen, and even kidneys) can be helpful. The present study also showed that patients with splenomegaly are at higher risk of esophageal varices.

Abstract Background: Intravenous catheterization is a routine technique in medical centers which can cause diverse problems such as thrombophlebitis.
Objective: This study aimed to resolve replacement scheduling and proper cannula diameter and position issues for intravenous catheters.
Methods: In this 2015 experimental cohort study, 232 hospitalized patients receiving medication intravenously were assessed for the occurrence of thrombophlebitis (TF). Involved TF factors such as age, gender, cannula size, site of cannula in hand veins, duration of usage, and underlying disease were evaluated in patient and healthy control groups.
Results: TF developed in 55 of 232 patients. The percentages of incidence were similar in men and women (30%). The patient mean age was lower than that of the control, but the difference was not significant. Average weight was significantly higher in the patient group than in the control group. The average duration of cannula in situ was significantly lower in patients than in the control group. The highest rate of TF occurred in the narrowest cannula usage and dorsal hand vein positions. The mean time of developing TF was lower than that indicated in CDC guidelines. Furthermore, 24 patients with TF (34%) had diabetes mellitus.
Conclusion: In the current study, the percentage of TF occurrence was higher in patients with weight increase, use of narrower cannulae, dorsal hand vein positions, and a history of diabetes. Furthermore, TF can develop within 72 hours. It was concluded that some patients may be more susceptible to TF and require more care. Accordingly, the CDC guidelines’ offered scheduling for intravenous catheter replacement is not trustworthy.

Abstract Background: The risk of developing diabetes mellitus for an individual with a positive family history of the disease is two- to fourfold higher in an offspring of a diabetic compared with offspring of non-diabetic shown by serum glycated hemoglobin (HbA1c) levels. There is paucity of data on pre-diabetes in our environment.
Objectives: This study was designed to determine the baseline HbA1c levels of normoglycemic offspring of type 2 diabetes mellitus (T2DM) patients in Ijebu-ode, Nigeria.
Methods: This is a cross-sectional study of offspring of T2DM patients (ODP) and those of offspring of non-diabetic parents (ONDP). Diabetic offspring were exempted from the study. FBS was determined using enzymatic hexokinase method to determine glucose concentrations and exclude diabetes. Serum HbA1c was measured using standard method. Height and weight were measured using standard methods. Body mass index (BMI) was calculated.
Results: There were 100 ODP and 100 ONDP aged 16 to 40 years. The most populated aged group was 21 to25 years which is 44% (n = 88). 6% (n = 12) of the study group were obese. 19% were overweight (n = 38). The mean weight of ODP was significantly higher than that of ONDP (P = 0.020). Also, the mean HBA1c of ODP was significantly higher than that of ONDP (P < 0.001).
Conclusion: The serum HbA1c level was significantly higher among ODP than ONDP. The mean weight was significantly higher in ODP than ONDP. 

Abstract Background: As the rate of renal transplantation increases, more immunosuppressive drugs such as cyclosporine A (CsA) are consumed, particularly during the early months following transplantation, leading to post-transplant diabetes mellitus (PTDM) which can cause death.
Objective: The present study examined the role of CsA in causing PTDM and other effective factors among patients with chronic kidney disease (CKD) who had undergone renal replacement therapy.
Methods: The present investigation was a quantitative case-control study carried out on 30 CKD patients who had undergone renal transplantation and 30 healthy individuals. A questionnaire was utilized to gather their demographic information, and direct interviews were conducted with the subjects. To examine random blood sugar (RBS), white blood cell (WBC) count, creatinine level, and blood urea nitrogen (BUN), blood samples were obtained from the subjects. The mentioned parameters were analyzed using SPSS 22.0.
Results: According to the results, the groups were homogenous in age, body mass index (BMI), and male-to-female ratio. However, there were significant differences between the two groups in RBS (P = 0.011), WBC count (P = 0.031), creatinine level (P = 0.001), and BUN (P = 0.001).
Conclusion: Failure of allograft survival of renal transplantation was found to be a leading cause of death, which has been reportedly been treated by the consumption of immunosuppressive drugs such as CsA. However, this drug can increase the patient’s chances of developing PTDM. PTDM development can be reduced by applying a dosage of 10 mg/kg/d during the first week and 8-9 mg/kg/day during weeks 2-5 following transplantation.

Abstract Background: The lack of specialist physicians is a major concern in developing countries, especially in deprived cities.
Objectives: This study aimed to identify the predictive variables of the turnover intention of physicians working in an undeveloped and deprived city in Iran.
Methods: Participants were 100 physicians working at North Khorasan University of Medical Sciences, Iran. The data were collected using a standard questionnaire of Turnover Intention, Interpersonal Conflict, Work-Family Conflict, Work Overload, and Organizational Support scales. We proposed a hybrid methodology to identify factors influencing turnover intention, which combines clustering and classification methods. RStudio 1.1, SPSS Clementine 12, and SPSS 22 programs were used for data analysis. After data clustering, we made a CART decision tree model for each cluster and used the variable importance feature of SPSS Clementine to discover the factors influencing turnover intention in each cluster.
Results: We found two significant clusters of physicians’ turnover intention. In both clusters, interpersonal conflict (work ambiguity and work conflict) was the most important predictor of physician turnover intention, but physicians in the first cluster compared to the second had a higher turnover intention. In cluster 1, work overload, organizational support, and work-family conflict were respectively the predictors of physician turnover intention and in cluster 2, organizational support, work-family conflict, and final work overload were respectively the predictors of physician turnover intention.
Conclusion: Cultural differences and the resulting interpersonal conflicts are the most important predictors of physician turnover intention in deprived areas. Turnover intention predictions of physicians with a longer work experience are different from that of others, and human resource managers must implement appropriate strategies to keep physicians in the deprived areas.

Abstract Background: Common cancers such as colon, breast, and lung cancer are increasing in developing countries. Objective: This study was conducted to determine 10-year trends and changes in common cancers in patients from a referral hospital in Tehran, Iran. Methods: This cross-sectional study investigated a study population comprising colon, stomach, lung, prostate, and breast cancer patients registered at the cancer center of a referral hospital in Tehran, Iran from April 1, 2007 to the end of March, 2016 (n=4472). Inclusion criteria were a definitive diagnosis of cancer and an age between 15 and 75 years. Data was entered into SPSS (version 18) software and analyzed using the Time Series analysis and Scatter IO graph. Results: Significant correlations (P value <0.001) were seen between age increases in patients and the increasing number of patients in any type of cancer. With almost all of the five studied cancers, incidence increased with aging (P value <0.001). The incremental linear trend in the age of patients with lung (P value = 0.008) and colon (P value = 0.004) cancers and the decreasing trend in the age of prostate cancer patients (P value = 0.001) were statistically significant. Conclusion: The incidence of cancer has increased over the past 10 years in both genders and ages. It is suggested that future studies should address the causes and factors behind the increasing incidence of common cancers.

Abstract Background: Acute appendicitis is one of the most common acute surgery events. Its main treatment is surgery. However medical management before and after the surgery has an important impact on the treatment.
Objective: The aim of study was evaluating the outcomes of single dose and quadruple doses of prophylactic antibiotic therapy in patients with acute non-complicated appendicitis.
Methods: This randomized double blind clinical trial was carried out on 294 patients in single dose (136 patients) and the quadruple doses (158 patients) groups. In single dose group, a dose of 1g Cefazolin + 500mg Metronidazole was prescribed intravenously about half an hour before surgery. The quadruple doses group received three more doses after surgery.  Two groups were followed for fever, erythema, seroma, wound infection, intra-abdominal abscess formation and readmissions within one month after discharge.
Results: The mean age of patients was 31±5.14 years. 203(69%) of patients were men while 91(31%) were women. There were no significant statistical differences between groups in age, sex and body mass index (BMI) variables. No significant statistical differences were observed during surgery and hospitalization period between two groups. In the single dose group, wound infection was 8(5.9%), while it was 6(3.8%) in the quadruple doses group; hence, there were no significant statistical differences in this regard. There was no abdominal abscess in groups. There were significant statistical differences regarding erythema, seroma and antibiotics consumption costs between groups.
Conclusion: A single dose of prophylactic antibiotics is sufficient in patients with acute suppurative non-complicated appendicitis.

Abstract Background: Nowadays, one of the most important social troubles is the sleep disorder that more than 40% of some population faced. Biofeedback (BFB) as a complementary method could reduce many of its effects.
Objectives: This study aims to show the effects of BFB on the promotion of sleep quality and control sleep disorder impacts.
Methods: An interventional study was conducted on 48 volunteer patients with sleep disorders. Twelve patients were included in each of four groups consisting of control. Pittsburgh Sleep Quality Index (PSQI) was used as a standard tool for sleep quality measurement in both groups. Abdominal breathing via chest breathing was trained as a BFB training exercise for patients. Heart rate variability (HRV) was measured before and after BFB training. Data were checked for outliers and normal distribution. SPSS version 22 and a diagram prepared by sigma plot version 14 did data analysis.
Results: The finding showed the promotion of sleep quality by pulse regulated abdominal breathing (PRAB) by a significant difference before and after BFB for four weeks.
Conclusion: Based on the finding of this study, polyvagal BFB training was utilized as a complementary method for HRV thus not only can it treat the patients with a sleep disorder but also promote sleep quality of the normal persons. Hence, the PRAB can be used for the patients with chief complain of sleep disorder.

Abstract Background: There are very few studies in the literature evaluating the effects of mask use on physiological parameters.
Objectives: This study aims to examine physiological changes due to masks in healthcare workers who use respiratory masks for long hours in the emergency room during the pandemic process.
Methods: Cross-sectional and prospective study was carried out with healthcare professionals with an FFP2 type valve mask. The participants’ transcutaneous oxygen saturation, pulse, and respiratory rate were measured before wearing the respirator mask and at 30 and 60 minutes after wearing the mask.
Results: SPO2 values of the participants decreased gradually at 0th, 30th, and 60th minutes and respiratory rate increased gradually at 0th, 30th, and 60th minutes. The statistically significant difference arises from the 0 and 60 minutes values. Higher SPO2 values were found at 0 and 30 minutes in non-smokers. SPO2 value gradually decreased in non-smokers at 0, 30, and 60 minutes, but no significant decrease was observed in non-smokers. Pulse rate was found to be higher at 60th minute compared to 0th minute in non-smokers. No significant difference was found between smokers and non-smokers. The respiratory rate gradually increased in smokers at 0th, 30th, and 60th minutes. SPO2 values were lower at the 60th minute compared to the 0th minute in both women and men. There was no significant difference in pulse rates. Respiratory rate was found to be higher at 60th minute in men than at 0th minute.
Conclusion: It is recommended to follow the physiological parameters and to regulate the working conditions when necessary.

Abstract Introduction: Nurses who have difficulty balancing their family role and responsibilities because of intense work pressure tend to leave their current jobs to work in organizations which offer better working conditions, lower workloads, and more managerial support.
Objective: This study aimed to determine nurses’ work-family conflict (WFC), job satisfaction, and intention to leave the job in a private hospital.
Methods: This descriptive study is based on a methodological and causal research design. The population of the study included 98 nurses working in a private hospital. The research model is tested with structural equation modelling (SEM).
Results: Nurses working changing shifts reported statistically higher levels of work-to-family conflict and workload than those consistently working daytime shifts. Managerial support and workload explained 48% of WFC. Work structure alone explained 44% of job satisfaction. Job satisfaction and WFC explained 17% of the variance in intention to leave.
Conclusion: Nurses who have difficulty balancing their family roles and responsibilities because of intense work pressure tend to leave their current jobs to work in organizations which offer better working conditions, lower workload, and more managerial support. The work structure of nurses should be reorganized in order to enhance nurses’ job satisfaction.

Abstract Background: Hospital malnutrition, usually secondary to various diseases and their treatments, is an important problem in our clinical practice. For its proper assessment, it is crucial to use a nutritional alert system, such as the CONUT (COntrol NUTrition) program; this tool uses 3 analytical parameters: serum albumin, total cholesterol, and total lymphocyte count.
Objective: The current study assessed the results of the implementation of this program in the University Hospital Ramón y Cajal.
Methods: The CONUT program has been used in the University Hospital Ramón y Cajal since 2013. This retrospective study, throughout 2016, was conducted in the Central Laboratory of Chemical Biochemistry at the University Hospital Ramón y Cajal. All blood tests with serum albumin, total cholesterol, and total lymphocyte count were studied. The degree of malnutrition was assessed using the scale of normal (=0), mild (=4), moderate (=8), and severe (=12).
Results: In 2016, there were 405406 analytics performed in the laboratory of University Hospital Ramón y Cajal. The CONUT tool was applied to 3.64% of them (14741 analytics). In the outpatient setting, the highest malnutrition index comprised patients from the liver transplant consultation department, followed by the cardiology, rheumatology, and oncology departments. With inpatients, the hematology, cardiology, and endocrinology departments showed the most severe malnutrition index.
Conclusion: The CONUT system seemed to provide useful information about the cohort of the studied hospital. The results showed that 94% of the patients were not classified with malnutrition, there was no gender predilection, and they were younger than the rest. Patients with more severe malnutrition were usually older and male.

Abstract Background: Breast cancer is one of the most common cancers in women.
Objective: This study was performed to determine the symptoms of menopause and quality of life in women with and without breast cancer.
Methods: This descriptive-analytical and cross-sectional study was performed in hospitals of Babol, Mazandaran province, Iran, in two groups of women with and without breast cancer. The study population included all women with menopausal symptoms who were divided into two groups containing 100 women apiece. A checklist containing menopausal symptoms was collected from these two groups and the standard questionnaire EORTC-QLQ-C30 was utilized to assess the quality of life in the case group and the standard questionnaire SF-36 was used in the control case. Data were analyzed by SPSS software.
Results: Depression and insomnia were significantly higher in the case group and control group, respectively (p <0.05), but other symptoms of menopause were not significantly different in the two groups (P>0.05). In the case group, the overall quality of lifewas assessed as good in 36.3% of patients. Also, the quality of life in the control group had the lowest score relevant to the item Neshat with an average of 55.6 and the highest score related to the item of social performance with an average of 73.25.
Conclusion: According to the results, the symptoms of menopause in women with breast cancer were not much different from women without breast cancer. Meanwhile, the quality of life of women with a history of cancer was good.

Abstract Background: Septic shock (SS) is a health priority in sub-Saharan Africa. However, there is a dearth of data in this regard.
Objective: This study aimed to determine the epidemiology, therapeutic patterns, outcome, and challenges in managing SS in a tertiary intensive care unit (ICU) of sub-Saharan Africa.
Methods: The hospital files of 36 consecutive patients admitted to the ICU of the Douala General Hospital (DGH), Cameroon over the year 2018 were reviewed for SS. SS was diagnosed based on Sepsis-3 definition. Demographic and clinical characteristics, treatment details, and outcomes of patients with SS were reviewed. Data was analyzed using the chi-square or Fisher exact tests and Bonferroni correction.
Results: SS accounted for 36 (9.4%) ICU admissions. The majority of patients were males (63.9%). The most common site of infection was the lungs. The mean age, average mean arterial pressure (MAP), and mean sequential organ failure assessment (SOFA) score of patients were 52.9±25.2 years, 52±18 mm Hg, and 9.2 ±2.3, respectively. Noradrenaline was the sole vasopressor used. Therapeutic challenges included the inability to have a specific antibiogram before a mean duration of 7 days. The mortality rate was 39% and associated with age ≤1 year, MAP ≤ 65 mm Hg, Glasgow Coma Score (GCS) ≤8, and mechanical ventilation, which were not attenuated after Bonferroni correction.
Conclusion: SS is a frequent cause of ICU admission and is associated with a high mortality rate. SS mortality-related factors can be screened during SS management for more aggressive ICU management geared at preventing death.

Abstract Background: Surgical site infections (SSIs) are the most frequent healthcare-associated infections worldwide. Identifying risk factors is a key priority to focus prevention efforts, reduce their incidence, and improve patient safety.
Objectives: We aim to identify the risk factors for SSI in patients from various nationalities cared for in Qatar.
Methods: A nested case-control study was conducted at a community hospital in Dukhan, Qatar.
Results: One hundred and twenty-six patients from 45 nationalities were included in the study, with 42 SSI cases. The risk of SSI was 3.48 times greater when non-compliance with the timing of antibiotic prophylaxis was documented, 9.69 times for improper antibiotic selection, and the risk decreased by 63% for each postoperative consultation.
Conclusion: The study has identified key risk factors for SSI and areas for prevention and research in patients who underwent cesarean section.

Abstract Background: Today, in order to provide desirable health care services, too much emphasis is placed on the physical and mental health of nurses, and job burnout among nurses is introduced as harmful elements to the health of nurses.
Objective: This study was performed to evaluate job burnout in Shiraz Nemazee Hospital in relation to demographic characteristics.
Methods: This research is a cross-sectional and descriptive-analytic study. The research community included all nurses in the whole sections of Nemazee Hospital out of which 245 were selected by classified random sampling as the study sample. A questionnaire was used to collect the data. After collection, data were entered in statistical package for social sciences SPSS software (version 18) and T-test, and analysis of variance (ANOVA) and Kruskal-Wallis tests were used to analyze the variables.
Results: The mean score of emotional exhaustion, lack of personal accomplishment and job burnout were at an average level, and depersonalization was at a low level. As regards the intensity of burnout, most nurses were moderate. Between components of depersonalization of job burnout with marital status and age, there was a significant relationship (P<0.05). Also, nurses in neurological wards were allocated the most (62.28%) while nurses in children ward recorded the lowest (49.92%) mean of burnout.
Conclusion: According to the findings of this study and in terms of the stressful nature of nursing profession, it is necessary that hospital managers and healthcare authorities pay attention to job burnout in nurses, its level, as well as provide and implement strategies for its prevention, thereby decreasing its effects and risks.

Abstract Background: For over 2 decades, Ghana’s Ministry of Health (MOH) has been resolved to continuously improve the quality of healthcare in a cost-effective manner. Strategies have been adopted to enhance client satisfaction with healthcare services and delivery.
Objective: The current study examined patient satisfaction with the quality of healthcare in Ghana by comparing healthcare services at the University of Ghana Hospital (UGH) and the University of Cape Coast Hospital (UCH).
Methods: This cross-sectional study was conducted in 2014-2015 with primary data collected from patients at UGH and UCH. Structured questionnaires were administered based on the stratified and convenience sampling methods to select patients receiving healthcare at the outpatients departments of the 2 hospitals. Descriptive statistics and linear regression analysis were used to analyze the data with the help of SPSS version 20.
Results: The findings indicated that empathy (β=0.14, P=0.003), communication (β=0.26, P=0.00), culture (β=0.17, P=0.008), tangibles (β=0.12, P=0.040), and priority (β=0.18, P=0.002) are significant predictors of patient satisfaction.
Conclusion: Management at the 2 studied hospitals should streamline their quality healthcare policies based on the dimensions of effective communication, empathy, culture, tangibles, and priority to enhance patient satisfaction.

Abstract Background: Three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) techniques are used for the treatment of patients with laryngeal cancer.
Objective: This study aimed to investigate the effects of these 2 treatment techniques on the planning target volume (PTV) (laryngeal cancer), dose homogeneity, dose of organs at risk (OARs) (parotid glands), and conformity index.
Methods: This study compared 2 treatment techniques and was conducted from October 2018 to April 2019 at the Zhianawa Cancer Center (ZCC), Sulaimaniyah, Iraq. Eight patients with laryngeal cancer were selected for this study. 3D-CRT and IMRT were used to produce the maximum dose of target volume coverage and minimum dose to the parotid glands. Elekta synergy with a photon beam of 6 MV was used for all measurements. Data analysis was performed using the available statistical package of SPSS 25.
Results: The comparison of 3D-CRT with IMRT showed that the mean conformity index value for IMRT was more conformal than the 3D-CRT plan (0.956, 0.945, respectively), but the homogeneity index was better with 3D-CRT than with IMRT (0.175, 0.202, respectively). The mean dose for Rt. parotid glands was higher with IMRT than with 3D-CRT (232.71, 23.26, respectively), and in both plans the mean dose was less than 26 Gy (the standard tolerance value). While in the Lt. parotid gland the mean dose was higher with 3D-CRT than with IMRT (26.95, 23.71, respectively), the mean dose with 3D-CRT was greater than 26 Gy. The amount of PTV was significantly greater with the IMRT technique than with 3D-CRT (52.15±1.61, 51.09.4±0.74 Gy, respectively).
Conclusion: This study further supports that IMRT has improved the long-term quality of life of patients with laryngeal cancer.

Abstract Background: The fertility rate is high and the contraceptive prevalence rate is very low in Nigeria. Thus, women in Nigeria are exposed to the dangers of unwanted and unplanned pregnancies.
Objective: The current study aimed to determine the levels of knowledge, attitudes, and contraceptive preferences among couples in selected health facilities in Ebonyi State so as to recommend a package of intervention to increase contraception uptake.
Methods: This cross-sectional descriptive quantitative study used questionnaires administered by the researchers themselves among 128 postpartum women who were current users of contraceptive methods in Izzi, Ezza South, and Ikwo local government areas of Ebonyi State, Nigeria from January 1, 2016 to June 30, 2017. Informed consent was obtained from participants. Data was analyzed using SPSS version 20. Simple percentages were used to report categorical variables.
Results: The study results showed that most of the respondents (49%) had a secondary education, were aged above 20 years, and were mainly employed as civil servants with an average monthly income of $47.20. About 69% had less than 5 living children. Most respondents knew about contraception as a means of delaying pregnancy or limiting the number of children (37%) and recommended its use for family/society (46%). The most commonly used contraceptive methods were implants and injectable ones, while the IUD was the least preferred. Both implants and injectable contraceptives were recommended by friends and believed to be highly effective.
Conclusion: The current study showed that knowledge and positive attitude of participants towards family planning was high, comparable to studies in other parts of the world. Further research on determinants of postpartum use of family planning methods among this population is recommended.