Hospital Practices and Research

Abstract Background: In December 2019, in Wuhan, China; a new coronavirus emerged that had not been previously identified in humans. Hence is crucial to characterize the infection risk among infected health care workers (HCWs), being responsible for secondary transmission to patients, and others.
Objectives: The current study aimed to assess the disease burden among the front-line warriors and efficiently planned the preventive and management strategies for such infections.
Methods: HCWs with clinical suspicion of COVID-19 infection, who reported to Fever Clinic for possible diagnosis by Truenat testing, were enrolled through a self-reporting Risk Assessment form. An oropharyngeal swab was subjected to Truenat testing based on the principle of Real time reverse transcription polymerase chain reaction (RT-PCR).
Results: Doctors comprised 60% of our HCWs. Eighty-three percent of the HCWs under study reported either the presence of BCG scar or gave a history of BCG immunization at birth. The maximum number of HCWs (29.16%) took Hydroxychloroquine prophylaxis for four weeks. Seventy-four percent of the HCWs affirmed the use of personal protective equipment (PPE) at the time of exposure. The most common mode of infection reported was the exposure to COVID-19 patients. Fever was the most common reported symptom. Truenat was positive in 9 of 100 HCWs who were tested, giving an infection rate of 9%.
Conclusion: The study provides insights into the burden of COVID-19 infection among HCWs, and guides us to evaluate and plan our preventive measures and management strategies for such infections.

Abstract Background: Complementary medicine claims that biofeedback affects the reduction of blood glycemia.
Objective: The current study aimed to determine the effects of biofeedback on decreasing blood glucose levels and tension and increasing the quality of life in diabetic patients.
Methods: The current retrospective evidence-based study used pretest-posttest accidental sampling to select a group of 30 diabetic patients admitted to Glenview Clinic in the Aghdasiyeh region, Tehran, Iran, as the sample. Participants were divided into two 15-membered groups, the experiment and the control groups, matched by age and gender. Data gathering tools included the Quality of Life questionnaire in diabetic patients by Thomas et al, the Perceived Tension Index by Cohen et al, a glucometer, and the fasting blood glucose test. Data was analyzed using analysis of covariance (ANCOVA).
Results: The results showed that biofeedback training was effective in decreasing blood glucose levels in diabetic patients.
Conclusion: Biofeedback can reduce tension and improve the quality of life of diabetic patients; thus, it could be used as a complementary service in healthcare centers.

Abstract Background: Evaluating and monitoring the performance of emergency departments (EDs) are steps in one of the most important processes to improving the efficiency of hospitals. Indicators such as patient wait time until being visited by a doctor, patient wait time from the order until admission, percentage of patients with a determined order, time of conversion of a patient’s condition, time of physical exit of discharged patients from ED, percentage of discharge with personal responsibility, and percentage of unsuccessful cardiopulmonary resuscitation (CPR) have been used for this measurement.
Objective: The current study compared performance indicators in Baqiyatallah Hospital from December 2011 to June 2015.
Methods: For this cross-sectional, retrospective study, the study population contained completed checklists of performance indicators in Baqiyatallah Hospital’s ED from December 2011 to June 2015. Five indicators were selected and analyzed using SPSS software and χ2 and analysis of variance (ANOVA) tests.
Results: The mean ED performance indicators showed that 71.72% ± 13.29 of patients were determined within 6 hours, 57.53% ± 27.54 were discharged within 12 hours of ED admission, 63.36% ± 12.74 had unsuccessful CPR, 4.57% ± 0.84 left the ED with personal responsibility, mean duration of triage level 1 was 1 minute ± 0.55, mean duration of triage level 2 was 2.83 minutes ± 0.48, mean duration of triage level 3 was 8.58 ± 13.09 minutes, mean duration of triage level 4 was 19.24 minutes ± 13.24, and mean duration of triage level 5 was 40.53 minutes ± 11.66. Statistical analysis of the results showed significant differences in all indicators.
Conclusion: The general performance of the Baqiyatallah Hospital ED was estimated to be favorable, and the general process of change during the study was positive compared to previous years; however, the level and quality of services can be increased through some proposed means.

Abstract Background: The cerebral performance category (CPC) score is widely used in research and quality assurance to assess neurologic outcome following cardiac arrest. However, little is known about the results of the CPC in Turkey.
Objective: This study aimed to determine whether the CPC is associated with the initial rhythm and resuscitation time following resuscitation from in-hospital cardiac arrest.
Methods: This study compared the CPCs (CPC 1-2 and CPC 3-4-5) of patients discharged from the hospital after surviving cardiopulmonary arrest (CPA) during a 2-year period between June 2013 and June 2015 (at discharge, and at 6th, 12th, 18th, and 24th months) based on the initial rhythm (asystole/pulseless electrical activity and ventricular fibrillation/pulseless ventricular tachycardia) and resuscitation time (0–14 min and 15–30 min) at the time of arrest.
Results: No difference was found between CPC 1-2 and CPC 3-4-5 scores at discharge or at 6th, 12th, 18th, and 24th months in terms of the first rhythm and resuscitation time (P > 0.05).
Conclusion: Patients discharged from the hospital following in-hospital cardiopulmonary resuscitation (CPR) were found to have no difference in 2-year CPC scores with respect to cardiac rhythms and resuscitation durations at the onset of resuscitation.

Abstract Background: Motivation is a driver to health worker performance in most Ghanaian hospitals. In view of this, Ghana’s Ministry of Health has rolled out enough motivational policies to accentuate work performance of health workers.
Objective: The focus of this study was to examine the impact of motivation and identify how intrinsic and extrinsic motivating factors affect the work performance of health workers at Korle-Bu Teaching Hospital (KBTH). 
Methods: A qualitative approach was adopted for the study, and purposive sampling was used to select fifteen (15) health workers including both medics and paramedics. An in-depth interview guide and one-on-one interviews were adopted to collect data from the staff at Korle Bu Teaching Hospital. A thematic content analysis was used to analyze the transcribed data.
Results: Key findings from the study revealed that job satisfaction, logistic provision, and an enabling work environment are intrinsic motivating factors that affect the work performance of health workers; extrinsic factors such as financial reward, accommodation, and transportation also impact work performance. Furthermore, motivation is key to the work performance of nurses.
Conclusion: It is recommended that the National Midwifery and Nursing Council (NMC) and the Ministry of Health (MOH) adopt motivational policies based on the intrinsic and extrinsic motivational blocks.

Abstract Background: Better healthcare outcomes in health services are obtainable from frequently observing ongoing healthcare activities, gathering data, and assessing outcomes.
Objectives: This study aimed to establish the basic principles of nursing care standards and practices in wards, develop a nursing audit tool for periodically monitoring and controlling ongoing nursing activities, and evaluate nursing care quality.
Methods: A methodological investigation of field visit data gathered between November 2017 and April 2019 was conducted. A nursing service audit tool was used to collect data. Based on the literature and expert consideration, a conceptual structure of the nursing audit criteria containing 63 items and four factors (patient care, indirect care, unit criteria, and head nurse) was developed. The hospital supervisors visited all the wards and evaluated all the items of the tool accordingly. Nursing outcomes of units were used for determine the predictive validity of the tool. Two supervising nurses collected the data using the tool during their shifts. Supervisors were trained on the use of the tool to avoid any differences between evaluators. Each supervisor collected 309 tools. A total of 618 data were collected.
Results: The level of validity and reliability of the tool is within acceptable limits; thus, it can be regarded as a valid and reliable tool for monitoring nursing care processes in the general wards of the hospital.
Conclusion: The developed tool will help nurse managers monitor the nursing care process in accordance with the quality standards.

Abstract Background: High income is a protective factor against suicidality for children, youth, and adults, however, recent research has documented weaker health effects of high income for Black than White individuals, a pattern also called marginalization-related diminished returns (MDRs).
Objectives: In this study, we tested racial variation in the association between high income and suicidality in a national sample of 9-10-year-old Black and White American children.
Methods: This cross-sectional study used data from the Adolescent Brain Cognitive Development (ABCD) study, which included 7298 White or Black children between the ages of 9 and 10. Of all the participants, 5652 were White and 1646 were Black. The predictor variable was family income, treated as a continuous measure. Race was the moderator. The outcome variable was suicidality, treated as a dummy variable, reflecting any positive suicidal thoughts or behaviors endorsed over the lifecourse. Covariates included sex, age, family structure (parental marital status), parental education, trauma, history of depression, neighborhood poverty, and family conflict. Logistic regression was used for data analysis.
Results: Overall, family income was inversely associated with children’s suicidality, net of all covariates. A statistically significant interaction was found between race and family income, suggesting that the inverse association between family income and suicidality is weaker in Black than White children.
Conclusion: The observed weaker association between income and suicidality in Black than White children suggests that family income does not provide the same protection against suicidality for Black as White children. Due to racism, income and some other socioeconomic status indicators show weaker than expected health effects on Black families in the US. 

Abstract Background: One third of the world’s population is infected with TB, and the disease is known as the second deadly global infection, even more severe than measles. The disease kills about 2 million people a year. Approximately 8 million people in the world are affected by advanced tuberculosis (TB).
Objective: The current study aimed to determine the frequency of resistance to the antibiotics isoniazid and rifampin in positive culture pulmonary TB patients in Zahedan city during 2013-2016.
Methods: This descriptive cross-sectional study studied 100 samples from patients who referred to Boo-Ali hospital of Zahedan city from 2014 to 2016. First, the isoniazid solution was prepared, and then the rifampin solution was prepared. After that, 200 μL of mycobacterium suspension was added to the antibiotic and antibiotic-free control.
Results: Of 100 patients participating in the study, 50 (50%) were male and 50 (50%) were female. Participants had an average age of 51.69 ± 20.41 years (95-12 years), 79 (79%) were Iranians and 21 (21%) were Afghans. Of the 100 samples, 55 (55%) were from the year 2013, 21 (21%) were from 2014, 10 (10%) were from 2015, and 14 (14%) were from year 2016. The samples examined showed that 4 (4%) were resistant and 96% were sensitive.
Conclusion: The results of the current study showed that out of 100 samples, 4 cases (4%) had resistance and 96% were sensitive; 2% were resistant to isoniazid, and 2% were resistant to isoniazid and rifampin.

Abstract Background: Provision of quality and accessible health services comes with its challenges. Therefore, the need to highlight how motivation and job satisfaction can impact nurses’ performances at the Korle-Bu teaching hospital.
Objectives: The research aimed to practically highlight nurses’ motivation and job satisfaction by identifying what constituted motivation packages of nurses and how the work they did could give them satisfaction at the Korle-Bu teaching hospital.
Methods: The research employed a qualitative method with a case study design. In-depth interviews and focus group discussions (data triangulation) were used for primary data collection. A total of 40 respondents, including ten key informants, were selected using the purposive and convenience sampling techniques.
Results: The research found that the recognition of needs of nurses, improved remunerations, enhanced conditions of service of the nurses’, regular payment of nurses’ salaries’, the institution of study leave with pay policy, among others, were considered as factors that could contribute to nurses’ motivation and job satisfaction. These findings are consistent with the findings of other studies. Again, the study found that professional allowances paid to nurses, reduced rent, and the like are current motivation packages directed at nurses at the Korle-Bu teaching hospital.
Conclusion: It is important to state that for motivation to accomplish its intended purpose, there is the need for the hospital to identify the individual needs to satisfy to enhance job satisfaction.

Abstract Background: Neonatal respiratory distress syndrome (NRDS), a life-threatening pulmonary disorder, involves 1% of all deliveries worldwide. Shallow breathing causes restlessness in infants, which itself affects pulmonary function; thus, sedative medications are used to preserve better pulmonary function. There are different opinions about the benefits and superiority of these drugs.
Objective: The study purposed to assess and compare the effects of fentanyl and midazolam on the required time of mechanical ventilation in infants with respiratory distress syndrome (RDS).
Methods: In this randomized clinical trial, 60 infants with RDS were randomly allocated to 2 groups (30 infants each); the first group underwent sedation with midazolam (0.1 mg/kg), and the second group received 0.5 mcg/kg of fentanyl during ventilation. The duration of hospitalization, required time of ventilation, drug complications, feeding intolerance, as well as pneumothorax incidence and need for re-intubation were recorded and compared between the 2 groups.
Results: Eventually, 60 infants (45 male and 15 female) with a mean gestational age of 37.13±1.22 weeks in the midazolam group and 36.73±1.50 weeks in the fentanyl group underwent analysis (P value=0.449). Infants in the midazolam group had a mean length of stay of 11.96 ± 3.41 days, while mean length of stay was 10.36±3.57 days for infants in the fentanyl group (P value=0.039). Mean duration of mechanical ventilation was 4.6±2.14 days in the midazolam group and 4.06±2.04 days in the fentanyl group (P value=0.252).
Conclusion: The findings suggest that midazolam is a more suitable medication for the sedation of infants under mechanical ventilation in comparison with fentanyl; however, its side effects, such as apnea, pneumonia, and seizure, should be considered.

Abstract Background: Infections due to the hepatitis B (HBV) and hepatitis C (HCV) viruses constitute a global public health problem. Although screening of these infections remains a pivotal tool for timely detection and management of carriers, this preventive measure has been neglected in Africa.
Objective: The current study determined the prevalence of hepatitis B surface antigen (HBsAg) and anti-HCV as well as their risk factors through a screening campaign organized in a rural setting in northern Cameroon.
Methods: A cross-sectional analytical study was conducted during a screening campaign for viral hepatitis organized at the Mokolo District Hospital, Cameroon, from January 19, 2017 to February 27, 2017. Sociodemographic data from all consenting participants was collected and examined for signs of chronic liver disease. Participants were then screened for HBsAg and anti-HCV using a rapid diagnostic test (ACON®).
Results: Of the 364 participants enrolled, 28.6% tested positive for HBsAg and 2.2% for anti-HCV. All HBsAg-positive and anti-HCV-positive individuals were asymptomatic and unaware of their infection status prior to testing. None of the socio-demographic factors assessed was associated with a positive HbsAg status.
Conclusion: HBV and HCV infections are endemic in this rural health district. Participants who tested positive were apparently healthy and completely unaware of their infection status. Transmission of the hepatitis virus may be a public health concern in this district. It is recommended that community health education activities on preventive measures for HBV and HCV infections, regular screening for disease surveillance, and close follow-up of disease progression in these asymptomatic individuals be conducted.

Abstract Background: As suggested by the Minorities’ Diminished Returns (MDRs) theory, educational attainment shows a weaker protective effect for racial and ethnic minority groups compared to non-Hispanic Whites. This pattern, however, is never shown for hospitalization risk.
Objectives: This cross-sectional study explored racial and ethnic variations in the association between educational attainment and hospitalization in the United States.
Methods: Data came from the National Health Interview Survey (NHIS 2015). The total sample was 28,959 American adults. Independent variables was educational attainment. The main outcome was hospitalization during the last 12 months. Age, gender, employment, marital status, region, obesity, and number of cardiovascular conditions were covariates. Race and ethnicity were the effect modifiers. Logistic regression models were utilized to analyze the data.
Results: From all participants, 16.2% were Black and 11.6% were Hispanic with a mean age of 51 years. Overall, higher education levels were associated with lower odds of hospitalization, independent of all confounders. Educational attainment showed significant interactions with race (odds ratio [OR] =1.04, 95% CI = 1.01-1.08) and ethnicity (OR = 1.04, 95% CI =1.01-1.07) on hospitalization, indicating smaller protective effects of educational attainment on hospitalization of Hispanics and Blacks than non-Hispanic Whites.
Conclusion: The protective effects of educational attainment on population health are smaller for Blacks and Hispanics compared to non-Hispanic Whites. To prevent health disparities, the diminished returns of educational attainment should be minimized for racial and ethnic minorities. To do so, there is a need for innovative and bold economic, public, and social policies that do not limit themselves to equalizing socioeconomic status, but also help minorities leverage their available resources and gain tangible outcomes.

Abstract Background: Hospitalization compared to outpatient care leads to better diagnosis. Stability of diagnosis varies among different psychiatric disorders and is associated with some demographic and mental health variables.
Objective: The current study evaluated the stability of diagnosis in Baqiyatallah Hospital Psychiatric Ward. 
Methods: In this retrospective study, 908 inpatient records from the psychiatric ward of Baqiyatallah Hospital in the years 1997-2015 were randomly selected. Having primary and final diagnoses was the inclusion criterion. Demographic variables (age, sex, marital status, education, and employment) and mental health variables (primary and final psychiatric diagnoses, duration of hospitalization, psychiatric history, and medication history) were recorded. Ultimately, 429 cases were entered into the study.
Results: The overall diagnostic stability rate was 57.6%. In mood, anxiety, psychotic, and personality disorders, the diagnostic stability rates were 84%, 63.8%, 46.3%, and 36.4%, respectively. For depressive and bipolar disorders, the stability of diagnosis rates were 85.5% and 86%, respectively. A significant relation between diagnosis axis, number of diagnoses, drug abuse and somatic disease history and diagnostic stability was seen (p<0.05).
Conclusion: According to the present study, the maximum diagnostic stability rate was related to mood disorders with anxiety disorders ranking second. The minimum stability was related to personality disorders. Other studies have reported completely different results which may be due to different situations. Future studies in this field seem to be essential.

Abstract Background: Abnormal uterine bleeding (AUB) is a major health problem for many women. Homeopathy is one of the treatments for this disease.
Objectives: This study was performed to evaluate the efficacy of homeopathic Ipecacuanha (Ipecac) in the treatment of bleeding, pain, and in the quality of life in patients with AUB compared to the control group.
Methods: This double blind randomized clinical trial study was performed on women aged 35-55 years with AUB in Tehran, Iran during the years 2017-2018. In this study, patients were assigned to first group: 25 patients with routine treatment (mefenamic acid capsule) + homeopathic “Ipecac” and second group: 25 patients with mefenamic acid + placebo. Pictorial Blood Loss Assessment Chart (PBAC) score, Visual Analogue Scale (VAS) questionnaire, and General Health Questionnaire (GHQ) were utilized to assess bleeding, pain, and quality of life, respectively.
Results: This study was performed on 50 women with AUB. In this study, the two groups were similar in demographic characteristics. The results showed that despite the relative improvement in PBAC score, duration of bleeding, and depression score in the homeopathic treatment group, this decrease was not statistically significant. The homeopathic treatment group compared to the control group showed more improvement in pain score, physical symptoms, anxiety and insomnia, social dysfunction, and mental health.
Conclusion: Considering the efficacy of homeopathic “Ipecac” in reducing pain and increasing the quality of life of women with AUB in this study, it can be suggested in AUB without the complication of this treatment.

Abstract Background: Device-associated infections (DAIs) like ventilator-associated pneumonia (VAP), central-line-associated blood stream infections (CLABSI), and catheter-related urinary tract Infection (CAUTI) constitute predominant healthcare-associated infections (HAIs) in intensive care units (ICUs).
Objectives: The study aims to elucidate their trends in an adult ICU.
Methods: Over 21 months, monthly VAP, CLABSI, and CAUTI rate, and device utilization ratios were calculated in an adult ICU of a tertiary care hospital as part of routine surveillance activity. All cases of VAP, CLABSI, and CAUTI during these 21 months were included. In addition, monthly hand hygiene compliance rates were assessed during the latter period of the study by direct observation method.
Results: Nosocomial DAI rate was 49.38 DAI/1000 ICU days. CAUTI, CLABSI, and VAP rates were 17.38, 26.85, 21.08 per 1000 device days, and device utilization ratios were 0.99, 0.61, and 0.02, respectively.
Conclusion: The institute had high DAI rates in comparison to other studies from the same city. The declining trend of CAUTI rates roughly coincided with surveillance for hand hygiene compliance in ICU. Thus, it establishes baseline data and underscores the need for focused HIC to maximize patient outcomes.

Abstract Background: Respiratory distress syndrome (RDS) is a medical emergency in infants resulting from a lack of or deficiency in surfactant, and leads to pulmonary failure. Surfactant and mechanical ventilation are among the primary treatments for helping infants with respiration. Some sedative drugs, such as benzodiazepines and opioids, are used to reduce stress and restlessness in infants under mechanical ventilation.
Objective: This study aimed to evaluate the effect of 2 different dosages of Fentanyl on sedation of infants under mechanical ventilation.
Methods: In this randomized clinical trial, infants with RDS were assessed, and restless infants under mechanical ventilation were included in the trial. Infants were randomly allocated into 2 groups. Infants in group A underwent treatment with 0.5 μg/kg fentanyl, and those in group B received 1 μg/kg of fentanyl. Demographic information as well as data on the duration of mechanical ventilation, length of hospital stay, and need for re-intubation were recorded on a pre-designed checklist.
Results: Ultimately, 60 infants (46 male and 14 female) with a mean gestational age of 36.7±1.48 weeks in group A and 36.2±1.42 weeks in group B underwent analysis (P=0.087). Patients in group A were hospitalized for 10.36±3.59 days, and those in group B were hospitalized for 10±3.95 days (P=0.642). Mean duration of mechanical ventilation was 3.96±2.02 days in group A and 3.51±1.5 days in group B infants (P=0.459).
Conclusion: The findings of the present study suggest that both doses of fentanyl (0.5 μg/kg and 1 μg/kg) reduced all parameters of respiratory distress, such as heart rate and respiratory rate, with no significant difference between the 2 doses.

Abstract Background: Quantification of fetal red blood cells (RBCs) in maternal blood is of great importance to calculate appropriate dose of post-deliver anti D immunoglobulin in a rhesus D (RhD)-negative woman.
Objective: The aim of this study is to evaluate a direct immunofluorescence flow cytometry technique in artificial and clinical samples and compared it to the Kleihauer-Betke test (KBT).
Methods: This study was a prospective cohort design. Blood samples from 26 pregnant women who gave birth to RhD positive babies were tested using direct immunofluorescence flow cytometry and KBT techniques to determine the amount of FMH in the maternal circulation. The zone of D-positive cells was identified employing artificial samples including 0.3%, 0.6%, 1%, 1.5%, 2%, 5%, 10%, and 50% of D-positive fetal cells in D-negative maternal cells.
Results: Analysis of 26 clinical samples for FMH showed consistent quantification with the flow cytometry and Kleihauer techniques. Although a good correlation was found between the KBT and flow cytometry results, in artificial samples containing more than 2% of fetal RhD positive cells, the flow cytometry results were closer to theoretical percentages. In a patient with FMH >4 mL, the FMH and consequently the required vial of Ig were overestimated using KBT.
Conclusion: Most of the FMH calculated could have been neutralized by doses less than 625 IU, whereas the routine dose in Iran is more than double that amount (1500 IU). This achievement demonstrates that adjusting between the RhD immune globulin (RhDIg) dose and FMH size is inevitable.

Abstract Background: Patients with schizophrenia can experience a deteriorated performance in many of the skills needed in daily life, the workplace, the family circle, or in social interactions.
Objective: This definitive study used comparison to evaluate the functionality, treatment compliance to therapy, and styles of coping with stress of schizophrenic patients who work and are members of an association.
Methods: The individuals participating in this study were divided into four groups. Group 1 were members of an association and employed; Group 2 were members of an association and unemployed; Group 3 comprised non-members who were employed; and group 4 were non-members and unemployed. A total of 60 patients (15 in each group) comprised the sample. Data was collected by means of the Individual Information Form, the Adaptation Rate Scale for Medical Therapy, the Functional Recovery Scale in Schizophrenia Patients, and the Scale for Coping with Stress. Statistical analyses and interpretations were conducted using frequency and percentage, t test, and analysis of variance (ANOVA) to assess the data.
Results: It was observed that being a member of an association and working at a job affected the social and occupational functionalities in schizophrenia patients participating in the study, but the styles of therapy adaptation and coping with stress did not affect these areas.
Conclusion: Results indicated that the use of current antipsychotic drugs did not affect functional areas, therapy adaptation, or styles of coping with stress.

Abstract Background: The Minorities’ Diminished Returns (MDRs) theory suggests that the health effect of educational attainment is considerably smaller for members of racial and ethnic minority groups than for Whites.
Objective: The current study explored the racial and ethnic differences in the association between educational attainment and Breast Physical Exam (BPE) among women in the U.S.
Methods: The National Health Interview Survey (NHIS 2015) included 12 510 women who were Hispanic or non-Hispanic Black or White people. The independent variable was the level of educational attainment. The dependent variable was lifetime BPE. Age, region, marital status, and employment were the covariates. Race and ethnicity were the focal moderators. Logistic regressions were used for data analysis.
Results: Overall, higher educational attainment was associated with higher odds of BPE, net of all confounders (odds ratio [OR]=1.11, 95% CI=1.09-1.13). Ethnicity showed a significant statistical interaction with educational attainment on BPE (OR=0.96, 95% CI=0.93-1.00), which was suggestive of a smaller effect of high education attainment on BPE for Hispanic than non-Hispanic women. The same interaction could not be found for the comparison of White and Black women (OR = 0.98, 95% CI =0.94-1.02).
Conclusion: In line with other domains, non-Hispanic White women show a larger amount of health gain from their educational attainment than Hispanic women. It is not ethnicity or class but ethnicity and class that shapes how people engage in pro-health behaviors. This result may help hospitals and healthcare systems to better reduce health disparities in their target populations.

Abstract Background: Sepsis is a very common serious medical condition among patients admitted to the intensive care units (ICUs) that increases with age and ICU length of stay (LOS).
Objectives: The primary goal of this study was to estimate the mortality rate due to sepsis among adult patients admitted to the mixed medical–surgical ICUs for a long time. The secondary goal was to identify factors associated with predicting ICU mortality in individuals with long-term ICU LOS.
Methods: Adult patients admitted to the medical ICU for a long time (≥75 days) were included in this retrospective secondary analysis study. Baseline demographic, clinical, and laboratory data were recorded upon inclusion in the study.
Results: ICU mortality occurred in 78 (43.1%) patients, out of 188 participants. A greater portion of patients with sepsis at admission (62.7%) were observed in the death group (59.2% vs. 30.8%, P < 0.001), than the survivor group. Additionally, survived patients differed significantly in terms of age, family engagement, baseline cognitive impairment, activity, nurse anticipated turnover scale (ATS), duration of a mechanical ventilator (MV), and ICU LOS. The results of multivariate binary logistic regression showed that the older age and low family intervention can increase the risk of mortality in patients with sepsis at the time of admission, with a long ICU LOS.
Conclusion: Our findings are crucially important to increase the awareness of the impact of sepsis, highlight the need for continued research into potential preventive and therapeutic interventions, and help guide resource allocation.

Abstract Background: The COVID-19 virus has created many problems for human beings in the real world, particularly in the health sector. One of the issues is in emergency hospitals, which are vital pillars of the healthcare system in every country. Providing timely treatment and access to healthcare facilities is a major problem in developing countries.
Objectives: The aim of the study was to simulate a hospital emergency department under COVID-19 conditions.
Methods: This study simulates the operations of an emergency department in a hospital under COVID-19 conditions as a case study in Iran. This study considers several assumptions about hospital facilities, including doctors, nurses, and patients. The patients are divided into two categories: some require immediate examination, while others wait in line for appropriate services.
Results: A flow diagram for the department is provided and converted into a model, which is implemented using GPSS software. The model is then run multiple times, and the outputs are collected. The outputs of the simulation and their statistical distributions are analyzed, and the performance of various statistical tests is examined. Finally, recommendations for improving the performance of the emergency system are presented.
Conclusion: The findings of this study can be used as the first step in preparing this tool. Accordingly, this study was conducted to identify existing and valid tools for measuring hospital readiness against the COVID-19 virus, translate those tools, and compare them.

Abstract Background: Parents of children with bipolar II disorder often experience a substantial caregiver burden, encompassing emotional, psychological, and practical challenges. This burden can negatively affect both the parents' well-being and the overall family functioning.
Objectives: This study investigated the effectiveness of family-focused therapy in reducing caregiver burden among parents of children with bipolar II disorder.
Methods: This quasi-experimental pre-test-post-test control group study investigated the effects of family-focused therapy on caregiver burden. Thirty parents of children with bipolar II disorder, recruited from counseling services in Isfahan, Iran in 2023, were randomly assigned to either a family-focused therapy group (n = 15) receiving nine 120-minute sessions or a waiting-list control group (n = 15). All participants completed the Caregiver Burden Inventory at pre-test, post-test, and follow-up. Data were analyzed using descriptive and inferential statistics, including repeated measures ANOVA in SPSS v.26.
Results: In the family-focused therapy group, the mean caregiver burden scores showed a significant reduction from the pre-test (81.78 ± 8.63) to the post-test (54.50 ± 7.52), with partial maintenance of this reduction observed at the three-month follow-up (58.36 ± 6.63). Family-focused therapy had a statistically significant impact on caregiver burden (P <0.01), specifically on the time-related, developmental, and social burden subscales, as well as the total caregiver burden score at both post-test and follow-up assessments.
Conclusion: This study found that family-focused therapy effectively reduced caregiver burden in parents of children with bipolar II disorder. These results suggest that family-focused therapy is a valuable tool for enhancing the quality of life for caregivers.

Abstract Background: Urinary tract infections are among the most prevalent human infections, primarily caused by Enterobacteriaceae. Currently, a significant number of Enterobacteriaceae produce extended-spectrum beta-lactamases (ESBLs), rendering them resistant to beta-lactam antibiotics and resulting in treatment failures.
Objectives: The aim of this study was to determine the frequency of blaSHV and blaTEM genes in Enterobacter isolates from clinical samples at Amir al-Momenin Hospital in Maragheh city in 2023, as well as to assess their antibiotic and probiotic resistance patterns.
Methods: One hundred urine samples from patients with urinary tract infections hospitalized at Amir Al-Momenin Hospital were included in the study. ESBL-producing bacteria were identified using the agar disk diffusion method according to CLSI criteria, employing 30 µg ceftazidime and cefotaxime antibiotic disks, both with and without clavulanic acid. PCR was utilized to amplify the genes for examining the frequency of blaTEM and blaSHV genes. Electrophoresis of the samples was conducted on a 1% agarose gel.
Results: Of the 21 samples, the ESBL index was negative in 7 samples, resulting in a frequency of 33.33%, while it was positive in 14 samples, with a frequency of 66.67%. The frequency of the blaTEM gene in positive bacterial samples was 95.23%, and the frequency of the blaSHV gene was 92.52%.
Conclusion: The disk diffusion test on antibiotic-sensitive samples found that the highest average growth inhibition zone was associated with the CTC antibiotic, while the lowest average growth inhibition zone was related to the NA antibiotic.

Abstract Background: It is important to set up hospitals, since they play a key role in providing health care services based on the budget allocated to the health sector.
Objective:  This study evaluated factors militating against the establishment of hospitals in Iran. It also emphasized the importance of health care services.
Methods: This cross-sectional study was conducted in 2012 using a qualitative approach. The study sample consisted of 22 people, officials, administrators and health experts who were recruited by purposeful selection. In order to collect data, a semi-structured interview was conducted. Data was analyzed using an Atlas-Ti software.
Results: Analysis of the interviews suggest that the issue of providing services in terms of ease of access and equity in the allocation of health services is also the focus of particular attention. The socio-economic status of regions were examined in terms of the need for poverty alleviation, equity in health and well-being of interest to industry participants. The survey interviews revealed that the issue of financing and human resources for provincial hospitals, were the key challenges raised by participants in the study.
Conclusion: According to the findings of this study, feasibility studies and evidence-based management optimal decisions were adopted in order to build and operate hospitals in the provinces.

Abstract Background: Today, patient safety is an important issue in providing hospital services. Any failure in this area can cause undesirable consequences.
Objective:  The present study evaluated the status of patient safety culture in Educational Hospitals of Tehran, Iran.
Methods: This cross-sectional study surveyed 205 therapeutic and diagnostic personnel of three Tehran hospitals selected using the clustered method; samples were collected in a randomized manner. To examine patient safety culture, the standard questionnaire of patient safety culture with 12 dimensions was used. Data was analyzed using SPSS software.
Results: In the 12 dimensions of patient safety culture, exchange of data, expectations, and organization management had the lowest means of 3.28 (±0.87), and 3.32 (±0.74) among the various aspects of patient safety culture. Additionally, the two dimensions of teamwork within the organization’s units and frequency of reporting events with means of 3.71 (±0.79) and 3.73 (±0.7) had the highest means among the studied 12 dimensions of patient safety culture. The total mean of patient safety culture in the studied hospitals was 3.5 (±0.5).
Conclusion: Increasing the attention paid to patient safety culture will lead to the development and progress of hospitals in the country and will guide them toward becoming patient-friendly hospitals. Those dimensions which had low mean values in this study should be paid more attention so as to promote and protect them.