Hospital Practices and Research

Abstract Background: In the treatment and health process, there are a lot of dangers to patients, and the increased number of medical errors is one of the most important circumstances of this process.
Objective: The present research purposed to decrease medical errors through disclosure of them in hospitals of Tehran University of Medical Sciences.
Methods: This qualitative-quantitative study included a population of 232 individuals, selected through targeted non-random selection, who were somehow connected with medical errors made in hospitals affiliated with Tehran University of Medical Sciences. The triangulation technique was utilized to collect data. Data was analyzed using the factor analysis technique. After the effective factors were determined, their internal correlation was determined through regression correlation.
Results: Disclosure is made up of organizational culture, the factors related to the patient, the factors related to the presenter, the factors involved in the error, structural factors, and disclosure situation indexes, and is an effective factor in managing the medical errors in hospitals of Tehran University of Medical Sciences. Disclosure increases the immunity of patients.
Conclusion: Disclosure is an effective factor in managing the medical errors that occur at hospitals affiliated with Tehran University of Medical Sciences. It is essential that managers identify the effective factors in disclosure and take steps to apply a suitable disclosure system to decrease errors.

Abstract Background: The literature on Minorities’ Diminished Returns (MDRs) have shown worse than expected health of the members of racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational attainment on preventive care and disease management in highly educated racial and ethnic minorities.
Objectives: The current study explored the racial and ethnic differences in the effect of baseline educational attainment on % adherance to the routine physician visits among middle-aged and older adults in the US.
Methods: This is a prospective study with 24 years of follow up. The Health and Retirement Study (HRS: 1992-2016) included 10 880 middle-aged and older adults who were Hispanic, non-Hispanic, Black or White. The independent variable was educational attainment. The dependent variable was adherance to the routine physician visits (%). Age, gender, marital status, income, health behaviors (smoking and drinking) and health (depression, self-rated health, and chronic diseases) were the covariates. Race and ethnicity were the focal moderators. Linear regression was used for data analysis.
Results: Overall, higher educational attainment was associated with higher % of adherance to the routine physician visits over the course of follow-up, net of all confounders. Race showed a significant statistical interaction with educational attainment suggesting of a smaller effect of high education attainment on % adherance to the routine physician visits for Black than White middle-aged and older adults. Similar interaction could not be found for the comparison of Hispanic and non-Hispanic middle-aged and older adults.
Conclusion: Educational attainment is associated with a larger increase in preventive and disease management doctor visits for White than Black middle-aged and older adults. This is a missed opportunity to improve the health of highly educated middle-aged and older adults. It is not race/ethnicity or class that shapes health behaviors but race/ethnicity and class that shape people’s pro-health behaviors. At least some of the racial health disparities is not due to low SES but diminished returns of SES.

Abstract Background: Serum lipid levels are known to be affected by the level of smoking of individuals in an environment. The prevalence of current smokers in Nigeria is 10.4%.
Objectives: This study aimed to assess the blood lipid levels of selected people of Sagamu, Nigeria.
Methods: This study involved 100 subjects selected using random sampling method in Sagamu, aged 25 to 54 years. Hypertensive and Diabetic subjects were exempted. The weight in kg and height in meters of each subject were measured. The body mass index (BMI) (kg/m²) was calculated. Lipid profile (LP) was determined by analytical method. Data were analyzed using descriptive statistics.
Results: There were 80 males and 20 females in the study population. 40 (80.0%) males and 10 (20.0%) females were smokers in the study group. There were 24 (48.0%) smokers and 27 (54.0%) non-smokers in the age group 25 and 34 years. Two (4.0%) smokers of the study group were obese while 4 (8.0%) were obese non-smokers. Eighteen (36.0%) smokers and 14 (28.0%) non-smokers were overweight. The average total cholesterol (TC) of 198.71 ± 2.30 mg/dL in smokers was significantly greater than 174.62 ± 1.51 mg/dL in non-smokers (P < 0.05). The mean high-density lipoprotein (HDL) of 56.74 ± 1.15 mg/dL in non-smokers was significantly higher than 40.87 ± 1.32 mg/dL in smokers (P < 0.05). The average TC of 195.38 ± 2.22 mg/dL in male smokers was significantly greater than 166.04 ±1.51 mg/dL in male non-smokers (P < 0.05).
Conclusion: The HDL levels in smokers are lower than non-smokers. Low-density lipoprotein (LDL), triglycerides (TG), and TC in smokers are however higher. The lipid levels of smokers gotten from this study can be used as a baseline for future study.

Abstract Background: Cognitive errors have been presented as effective factors in the creation and continuation of obsessive–compulsive disorder and social anxiety disorder. Psychological resilience is an important factor in the tolerance of cognitive errors.
Objective: The present study aimed to compare cognitive errors and the psychological resilience of patients with social anxiety disorder and those with obsessive–compulsive disorder.
Methods: This cross-sectional study investigated a total of 60 patients, 30 with social anxiety disorder and 30 with obsessive-compulsive disorder (OCD), seen at a hospital in Zanjan city, Iran, in 2017. Participants were aged between 15 and 50 years. Participants were chosen using convenience sampling and on the basis of psychiatrist diagnosis and structured diagnostic interviews (SCID-I, II) according to the inclusion and exclusion criteria. The Cognitive Errors Questionnaire (CET) and the Connor-Davidson Resilience Scale (CD-RISC) were used to assess the variables.
Results: A significant difference was observed between the two patient groups in the cognitive errors components (P ≤ 0.05). In patients with OCD, the highest average rate of cognitive errors was related to catastrophizing and splitting error. In patients with SAD, the highest mean rate of cognitive errors was related to catastrophizing. There was no significant difference in psychological resilience between the two groups.
Conclusion: Cognitive errors play an important role in OCD and social anxiety disorder (SAD). OCD patients were observed to make more cognitive errors than SAD patients. However, psychological resilience was equal between both groups.

Abstract Background: The organizational culture, justice, and ethical practices found in nursing services and health services have numerical superiority and a significant importance.
Objective: This descriptive study aimed to determine the relationship among ethical behavior, organizational justice and culture in public and private hospitals.
Methods: One hundred fifty-three nurses working for at least 6 months in a private or public hospital in Ankara participated in this study. The questionnaire used in this study consisted of three parts: participant demographic data, the ethical leadership scale, and organizational justice.
Results: The perceptions regarding organizational culture and ethical behavior of nurses working in a private hospital were found to be greater than those of nurses working in a public hospital. A statistically significant relationship was found between the nurses’ perceptions of organizational culture and justice. A similar relationship between perceptions of nurses regarding organizational culture and ethical behavior was also noted. The results showed that organizational culture explained 30% of the ethical leadership behavior of managers and 35% of organizational justice.
Conclusion: The perceptions of nurses regarding justice and ethical behaviors are significantly affected by their work culture exposed in the case of increasing of non-ethic and non-fair behaviours it was the nurses perceive more strength and role culture.

Abstract Background: One way to improve hospital food provision is certainly by understanding the management of hospital foodservices, but there is limited detailed information about staff roles in food provision in many hospitals around the world.
Objective: The hospital meal experience of patients, a part of the services provided by hospitals, is becoming important. Therefore, the role of various hospital staff members was studied through their behavior, attitudes, and practices so as to understand how the foodservice system works to address patients’ food consumption.
Methods: This qualitative research used the convenient sampling method. Data was collected by interviewing twenty hospital employees with different job scopes (nurses, doctors, dietitians, foodservice managers, and directors of hospital foodservices) in 6 public hospitals.
Results: Themes such as providing familiar food, food as the motivational factor for consumption, empathy shown by staff, and influences of the eating environment were identified using content analysis.
Conclusion: The viewpoints and experiences of key stakeholders facilitated the understanding of various factors involved in the provision of hospital food which affect patients’ decisions to accept and consume food.

Abstract Background: Length of stay is one of the most important indicators in assessing hospital performance. A shorter stay can reduce the costs per discharge and shift care from inpatient to less expensive post-acute settings. It can lead to a greater readmission rate, better resource management, and more efficient services.
Objective: This study aimed to identify the factors influencing length of hospital stay and predict length of stay in the general surgery department.
Methods: In this study, patient information was collected from 327 records in the surgery department of Shariati Hospital using data mining techniques to determine factors influencing length of stay and to predict length of stay using three algorithms, namely decision tree, Naïve Bayes, and k-nearest neighbor algorithms. The data was split into a training data set and a test data set, and a model was built for the training data. A confusion matrix was obtained to calculate accuracy.
Results: Four factors presented: surgery type (hemorrhoid), average number of visits per day, number of trials, and number of days of hospitalization before surgery; the most important of these factors was length of stay. The overall accuracy of the decision tree was 88.9% for the training data set.
Conclusions: This study determined that all three algorithms can predict length of stay, but the decision tree performs the best.

Abstract Background: Diabetic foot ulcers (DFUs) are responsible for days of costly hospitalization and are the major cause of medical lower limb amputations. Determining the appropriate antimicrobial therapy for DFUs is highly dependent on recognizing the microorganisms that cause them. Many reports have indicated that there has been a remarkable increase in antibiotic resistance.
Objectives: The present study examined various cultures of patients with DFUs to detect the prevalence of microorganisms and their antibiotic sensitivity profiles.
Methods: This cross-sectional study was carried out on 92 patients with DFUs admitted to Shar Teaching Hospital and Shahid Hemin Teaching Hospital. Wagner Classification was used to assess the severity and location of the DFUs. Patients were asked questions about their practices of foot care and hygiene, and their answers were recorded. Samples required for testing were taken using sterile swabs.
Results: A total of 100 microorganisms were isolated from 92 patients with DFUs, 10 of which were polymicrobial and 2 were culture-negative. There was a highly significant association between the isolated gram-negative microorganisms and higher grades of DFU (P < 0.001). A highly significant association was also observed between bad patient knowledge of hygiene practices and gram-negative microorganisms (P < 0.001). Osteomyelitis was present in 40 (43.4%) patients.
Conclusion: Among gram-positive and gram-negative bacteria, Staphylococcus spp. and E. coli were, respectively, the most frequent organisms isolated. The antibiotic imipenem was found to be effective against microorganisms. Tetracycline, erythromycin, and ceftriaxone, however, were highly resistant to antibiotics. To sum up, since different microorganisms are involved and multidrug-resistant strains might emerge, clinicians are recommended to take cultures into account before they initiate empirical therapy.

Abstract Background: Esophageal cancer is the eighth-most common cancer and the sixth-most common cause of cancer death worldwide. In Iran, its prevalence is high. Surgery is recommended for tumors in early stages.
Objectives: This study aims to determine demographic data, therapeutic approaches, postoperative mortality, and survival rate in patients with esophageal cancer who were managed in a referral hospital.
Methods: In a cohort study, the patients hospitalized during six-year period were evaluated. Demographic data, tumor characteristics, laboratory data, surgical approaches, and survival time were obtained. Statistical analysis was performed using life tables, proportional hazard Cox regression, and the Kaplan-Meier method by SPSS version 20 software. Survival curves were compared by log-rank analysis.
Results: Over six years, 92 patients were admitted of which 54 (58.7%) were male. The average age was 63.08±12.03 years. Ten patients (10.8%) were below 50 years old. Squamous cell carcinoma (SCC) was the most common type (85.8%). Fifty-three patients (57.6%) were selected for the surgery. Postoperative mortality in 30 days occurred in 7 patients (13.2%). The median survival rate was 12.8±2.92 months. The survival rate for one, three and five years were 51.94%, 24.67% and 19.48%, respectively. Two factors that had significant statistical correlation with median survival time were metastasis (P = 0.01) and vomiting (P = 0.003).
Conclusion: Esophageal cancer is a poor prognostic disease and esophagectomy is a morbid operation. To reduce postoperative mortality and increase the survival time, better patient selection and operations by expert surgeons must be considered. 

Abstract Background: Open heart surgery is a prevalent therapeutic intervention for cardiovascular diseases. Significant adverse effects occur after heart surgery, one of which is patient readmission to the hospital.
Objective: The present study aimed to determine the relationship between performance indicators and the readmission of patients with open heart surgery in a teaching hospital in Iran.
Methods: This study was performed using a cross-sectional and descriptive method with a retrospective approach. Data was collected on a data collection form. The statistical population of this study comprised all patients who underwent open heart surgery from mid-September 2015 to mid-September 2016 in a teaching hospital in the north of Iran (n=849). Those patients readmitted to the hospital within 90 days after discharge, based on a review of patient records, were included in the study. Descriptive statistics and Spearman correlation coefficient were used for data analysis by SPSS 20.
Results: Among the patients who had open heart surgery in the selected hospital, 12.5% were readmitted within 90 days after discharge. The most important reasons for readmission in this study were infection in surgery place (25.8%), pleural effusion (18.7%), warfarin toxicity (9.8%), and tamponade (8.9%). There were inverse relationships between patient readmission and the two performance indicators of bed occupancy percentage (r = -0.594, P = 0.042) and bed turnover rate (r = -0.664, P = 0.018). There were no statistically significant relationships between any of the other indicators (length of stay, mortality, and bed turnover interval) and readmission rate (P > 0.1).
Conclusion: Hospital authorities can use these results for bed management and targeting interventions to reduce costs and readmissions as a measure of hospital quality. However, further research into readmission factors in other hospitals is recommended.

Abstract Background: Endotracheal intubation (EI) associated with mechanical ventilation (MV) is frequently performed in critically ill patients admitted to intensive care unit (ICU) with sepsis.
Objectives: This study aimed to assess the impact of important factors on the duration of tracheal intubation in patients with sepsis at the ICU admission.
Methods: Adult patients admitted to the mixed medical–surgical ICUs with sepsis at the ICU admission who needs prolonged mechanical ventilation (PMV) (≥ 21 days) were included in this retrospective secondary analysis study. The primary outcome was ICU mortality. Baseline demographic and clinical characteristics of all patients were assessed as risk factors associated with the duration of MV by univariate and multivariate Binary logistic regression.
Results: Eighty-five patients required more than 21 days of MV. Out of the 85 patients, 52 (61.2%) patients were intubated within 30 to 34.50 days and 33 (38.8%) patients had intubation within 34.51 to 65 days, and categorized as PMV and very prolonged MV groups, respectively. Two parameters were significantly associated with very prolonged MV which are as follows: older age 1.229 (95% CI: 1.002-1.507, P = 0.048) and long hospital stay (LOS) 2.996 (95% CI: 1.676-5.356, P < 0.001). No significant survival difference was observed between the two groups of study. (33.3% vs. 25%, P = 0.406).
Conclusion: Our observations showed that the older age and LOS as pre-ICU stay in patients with positive sepsis at the ICU admission can prolong the duration of intubation. In addition, no significant survival difference was observed between patients with PMV and very prolonged MV.

Abstract Background: Breast cancer is one of the most common women’s cancers, and the number of cases is increasing worldwide.
Objective: The current study compared invasive lobular carcinoma (ILC) and invasive ductal carcinoma with regard to the prevalence of estrogen receptor (ER), progesterone receptor (PR), and age prevalence.
Methods: This cross-sectional study recruited 225 women diagnosed with invasive ductal or lobular carcinoma who were admitted to the Department of Surgery of Baqiyatallah hospital between March 2014 and March 2015. The ER and PR levels reported were based on the pathologists’ interpretation of assay results; both ER and PR were estimated to be positive when immunoperoxidase staining of the tumor cell nucleus was more than 10%.
Results: The most common malignancy was invasive ductal carcinoma found in 213 patients (94.7%) with a mean age of 49.30 ± 12.25 years (0.706). The most common subtype of invasive ductal carcinoma was NOS (82.6%); patients of this type had a mean age of 49.68 ± 12.27 years. Among patients with infiltrative ductal carcinoma (IDC), 129 (60.6%) of them were ER positive. In patients with ILC, 11 cases (91.7%) were ER positive (P < 0.03). Among the patients who had IDC, 107 (50.2%) of them were PR positive. Also, 6 patients who had ILC (50.0%) were ER positive (P < 0.98).
Conclusion: The results of this study indicate that the age prevalence of breast cancer in Iran is about 10 years sooner than the rest of the world. In addition, the prevalence rates of positive estrogen and progesterone receptors were lower in this study than in the majority of other studies, and these 2 features worsen the prognosis in the treatment of Iranian patients.

Abstract Background: The birth of a child with a hearing disability is a stressful event in the family. Since consanguineous marriages are associated with the incidence of congenital hearing loss, it is expected that such parents will experience greater psychological problems.
Objective: The current study investigated and compared anxiety, depression, and stress in parents of children with severe hearing loss who have undergone cochlear implantation with a focus on the relation between parents (consanguineous vs. non-consanguineous).
Methods: This cross-sectional study was conducted on all 180 couples (360 individuals) who had become parents and attended Baqiyatallah hospital’s Cochlear Implant Center from 2007 to 2009. The participants included two groups of consanguineous (125 couples) and non-consanguineous (55 couples) parents. After providing consent to participate in this study, the participants completed the short form of the Depression and Anxiety and Stress Scale questionnaire (DASS-21). Data analysis was done using SPSS 17 and t test.
Results: The participating parents had high levels of depression, anxiety, and stress. Depression and anxiety were significantly higher among the consanguineous parents (P=0.001 and P=0.005, respectively). However, stress levels were not significantly different between the 2 groups. Moreover, compared to the fathers, the mothers had higher levels of depression, anxiety, and stress (P<0.05).
Conclusion: Based on these findings, it may be concluded that the birth of a child with hearing loss can be the source of psychological problems in parents, particularly in consanguineous parents. Furthermore, mothers are more psychologically vulnerable than fathers.

Abstract Background: Optimal allocation of resources commensurate with performance improvement is the concerns of all countries including Iran. Estimation hospitals production function is important in the economic management of hospitals.
Objective: The aim of this study was to estimate the production function of Iranian selected public hospitals as well as analyze the economic behavior in use of hospital resources.
Methods: The study was conducted by using the input data of 67 Iranian selected public hospitals at 2013. In this study, expected production level of hospitals and marginal productivity of inputs were calculated by regression estimation of Cobb-Douglas production function.
Results: The results showed that a 10% increase in net working hours of specialized human resources in public hospitals would cause 8.8% increase in average production level of inpatient services. Moreover, 10% increase of active beds would cause 1.1% increase in average production level of inpatient services in the studied hospitals. Also, the production levels in 40% of hospitals were lower than the average expected production level and did not have full performance.
Conclusion: With the proper utilization of human resources and beds, production level in a significant number of hospitals can be improved.

Abstract Background: From Gaya and adjoining regions, the trend in patients admitted with acute neurological illness was investigated. Illnesses were identified as sudden outbreaks of Japanese virus encephalitis (JE), Herpes simplex virus encephalitis (HSV-1&2), and other acute encephalitis syndrome (AES).
Objective: In the current study, an investigation was carried out to assess potential infectious pathogens in patients aged 16 years or younger who were admitted to Anugrah Narayan Magadh Memorial Medical College Hospital, Gaya, with encephalitis-like symptoms.
Methods: Cross-epidemiological, serological, and molecular biological studies were performed on samples collected from 71 patients below 16 years of age. Patients’ clinical histories, i.e. fever, socio-demographic characteristics, and other clinical data, were extracted from patient files.
Results: The results showed confirmed AES cases, including 49.30% JE and 7.04% HSV positive patients. A higher case-fatality rate of 40% in JE and 40% HSV cases below 7 years of age were observed during treatment would become an unavoidable concern. The epidemical sex ratio was observed to be higher in girls than in boys (1.26:1).
Conclusion: The results suggested that JE virus was found to be a main causative risk factor responsible for disease transmission in the outbreak area.

Abstract Background: Assessing patient satisfaction with care is crucial for healthcare quality improvement. However, little is known about patient satisfaction with care in adolescent-friendly health facilities in Ghana.
Objectives: This study aimed to assess patient satisfaction with quality of healthcare in adolescent-friendly health facilities.
Methods: A cross-sectional survey was conducted of four adolescent-friendly health facilities in Tema, Ghana. In all, 386 adolescent clients/patients were recruited using the convenience sampling technique. A structured questionnaire was administered to respondents, and data was analyzed using Statistical Package for Social Sciences (SPSS) software, version 22.0.
Results: It was found that the majority (62%) of respondents were satisfied with the quality of care in adolescent-friendly health facilities. It was also found that overall satisfaction with quality of care was significantly influenced by the availability of health information materials (AOR = 4.99; 95% CI: 1.90-3.96) and positive provider attitudes (AOR = 25.76; 95% CI: 8.01-109.78).
Conclusion: This study demonstrated that most adolescents were satisfied with the quality of care in adolescent-friendly health facilities. This is one of the few studies that have assessed adolescent satisfaction with the quality of care in Ghana. Stakeholders can leverage these findings to improve the quality of adolescent health services.

Abstract Background: Recently, some studies have investigated type D personality as a critical factor in developing depression and reducing the quality of life.
Objectives: This study aimed to compare depression and quality of life after coronary artery bypass graft surgery in patients with and without type D personalities.
Methods: Sixty-nine participants who underwent coronary artery bypass grafting at Imam Khomeini hospital, Ahvaz, Iran, referred to the cardiac surgery clinic for their first visit (1 to 1.5 months after surgery) were included in the study. All participants completed the World Health Organization Quality of Life questionnaire, type D personality scale, and Beck’s Depression Inventory. Finally, depression and quality of life were compared in two groups with and without type D personalities using ANOVA and correlation tests.
Results: The two groups were significantly different in depression and quality of life scores after coronary artery bypass graft surgery. Depression and quality of life impairment were higher in participants with type D personality. There was no significant relationship between depression and quality of life with age, gender, and occupation in participants with type D personality.
Conclusion: Depression and quality of life were higher in patients with type D personality after coronary artery bypass graft surgery than patients without type D personality. Episodic screening of these patients can prevent future somatic and psychological problems.

Abstract Background: Data on the frequency of hereditary bleeding disorders (HBDs) and associated mortality and morbidities during a long-term follow-up from Iran are scarce.
Objective: This study evaluated the epidemiologic features among patients with HBD in one of the largest referral centers in southern Iran.
Methods: In this cross-sectional study, 619 patients with HBD were evaluated during the period 1996 to 2011. Aside from baseline characteristics and type of factor deficiency, associated morbidities including viral infections, neurological disorders, asthma, thalassemia, glucose-6-phosphate dehydrogenase (G6PD) deficiency, diabetes, hypertension, cardiac and renal diseases were evaluated. Furthermore, among patients who died, the underlying disease and etiology of death were also evaluated.
Results: Patients’ mean age was 24.4 ± 13.5 years. Factor VIII deficiency was the most prevalent type (50.4%) of HBD, and combined Von–Willebrand and factor XIII deficiency (2.3%) was the most prevalent type of combined factor deficiency. A total of 0.5% had hepatitis B and 11.5% had hepatitis C. Cardiac disease was seen in 1.5%, hypertension in 0.2%, renal disease in 0.2%, and diabetes in 1.3% of patients. Overall, 5.2% had intracranial hemorrhage, 2.1% had epilepsy, and 0.8% had mental retardation. During the 15-year follow-up, 22 patients died; car accident was the leading cause of death in this population.
Conclusion: Associated morbidities were seen in 24.3% of patients with HBD. Most prevalent morbidities were HCV infections (11.5%) and neurological disease (7.3%). The mortality rate among patients with HBD was 3.4%, and the most common cause of death was accident, which is similar to that of normal Iranian populations.

Abstract Background: The treatment and hospitalization of psychiatric patients has been a dilemma for many years. Many countries have different specific legislations regarding the hospitalization and treatment of mental patients.
Objective: In the current study, 4100 voluntary/involuntary psychiatric admissions and readmissions to a university hospital in Turkey were investigated, and patient groups were compared in terms of demographic variables and psychiatric diagnoses based on DSM IV-TR.
Methods: The records of patients who had been hospitalized approximately 4–6 weeks were reviewed by two psychiatrists, and the patients were then divided into groups on the basis of single/multiple admissions and voluntary/involuntary admissions. The groups were compared based on psychiatric diagnoses.
Results: Schizophrenia was the most common diagnosis in 71.5% (n = 865) of patients with multiple admissions. The second most common diagnosis was bipolar affective disorder with 13.1% (n = 159). The rate of schizophrenia in both voluntary and involuntary hospitalizations was significant (34.5% and 54.6%, respectively). However, depression, the second most common diagnosis requiring hospitalization with a rate of 23.2% of voluntary hospitalizations, accounted for only 3.7% of involuntary hospitalizations.
Conclusion: Males constituted almost 75% of the single admission group. This difference may result from the socioeconomic and cultural profile of Turkey, as mental disorders make marriage impossible and are hidden in females suffering from them. Different findings from different cultures on single/multiple admissions and voluntary/involuntary admissions of patients lead to the conclusion that specific legislation covering treatment or hospitalization for mental disorders is needed in every country.

Abstract Background: Overcrowding is an important problem for outpatient services in healthcare facilities. Patient flow analysis (PFA) is a useful method for identifying inefficiencies in and facilitating patient flow.
Objective: PFA was used to estimate patient wait time and determine how different clinical disciplines impact wait times in the studied hospital.
Methods: This cross-sectional study investigated a study population comprised of outpatients who referred to clinics at a general hospital in Tehran, Iran. A total of 3836 samples were selected from different stations. Nonrandomized quota sampling was used, and data was gathered using workflow checklists, the content validity of which was proven by experts and hospital authorities. SPSS statistical software was used for data analysis.
Results: Total patient stay in the outpatient setting was an estimated 77 minutes (without considering para-clinic units and pharmacy). More than 90% of this time was spent waiting. The wait time of patients at the clinic was greater than that at other stations, and it was less at the cash station than at other stations. Wait times varied at different clinics (P value < 0.001) and were correlated with physician delay (P value < 0.001).
Conclusion: The most important result of using PFA in the outpatient setting was managing wait times. This study indicated that a considerable amount of a patient’s total stay in the system was related to waiting for physical examinations. This suggests that the first priority in improving the system should be managing patient wait times for physical examinations.

Abstract Background: The implementation of patient education within a hospital is a difficult task that plays a key role in improving and controlling diseases and providing quality healthcare services.
Objective: The current study evaluated the effect of patient education on the quality of nursing care and inpatient satisfaction in surgical wards of selected hospitals in Isfahan, Iran.
Methods: This quasi-experimental study was conducted in 2014. The sample group consisted of 64 patients admitted to the surgical wards of select hospitals in Isfahan and selected using the voluntary sampling method. Participants were randomly divided into experimental (n=32) and control (n=32) groups. A patient education program was implemented for each subject in the experimental group (during hospitalization and after discharge), but no intervention was conducted for the control group. Data was collected from both groups before and after the educational intervention using the standard questionnaire SERVQUAL to measure expectations (with a reliability of 87%), perceptions (with a reliability of 85%), and inpatient satisfaction (with a reliability of 83%). Data was analyzed using descriptive statistics, univariate and multivariate analysis of covariance, Kolmogorov-Smirnov, Chi-square, and t-tests in SPSS software (ver. 20).
Results: The results of covariance analysis showed that the patient education program significantly increased the mean scores of the quality of nursing services and inpatient satisfaction in the experimental group compared with the control group (p<0.01).
Conclusion: A patient education program is an important pillar for improving public health. It is also a low-cost intervention to increase a patient's hope in living a good quality life.

Abstract Background: As shown by Minorities’ Diminished Returns (MDRs), ethnic minorities show weaker than expected effects of education level on health outcomes. However, this pattern is better demonstrated for health behaviors and health care utilization than satisfaction with care. Additionally, more is known about MDRs in African Americans than the Latino population. Thus, there is a need to study MDRs of education on healthcare satisfaction in highly educated African American and Latino individuals.
Objectives: We tested ethnic differences in the association between education level and satisfaction with healthcare among American adults.
Methods: The National Health Interview Survey (2015) included 24,835 adults who were Latino, non-Latino, African American, or White. The independent variable was education level. The dependent variable was satisfaction with healthcare. Age, gender, marital status, employment, region, physical health (self-rated health, and chronic diseases, body mass index), and mental health (psychological distress) were the covariates. Ethnicity was the moderator. Logistic regression was used for data analysis.
Results: Higher education level was associated with higher satisfaction with healthcare in White but not African Americans. In the pooled sample, African American ethnicity showed a significant statistical interaction with education level suggesting a significantly smaller effect of high educational attainment on satisfaction with healthcare for African Americans than White adults. A similar interaction could not be found for Latino ethnicity, suggesting that education similarly enhances healthcare satisfaction for Latino and non-Latino adults.
Conclusion: High education level boosts satisfaction with healthcare for Whites but not African Americans.

Abstract Background: Several studies have been performed to evaluate the efficacy of different pain management techniques in patients with trauma, using different methods.
Objectives: To compare Intravenous (IV) morphine vs. fentanyl for analgesic response, the time to reach lowest pain score, and adverse effects in patients with trauma who were referred to Emergency Department (ED) was investigated.
Methods: This double-blind randomized controlled trial (June-December 2017) was performed on adult traumatic patients, who were referred to the EDs of two main trauma centers (Affiliated to Shiraz University of Medical Sciences), in southern Iran. The inclusion criteria were acute pain >4 on a Numeric Rating Scale (NRS) 0-10 upon presentation. The patients were randomly allocated to receive a single dose of IV morphine (0.1 mg/kg) or IV fentanyl (2 µg/kg). The pain score was recorded at baseline, 5, 10, 30, and 120 minutes after administration of either morphine or fentanyl, as well as adverse effects. Then, the data were analyzed.
Results: In order to carry out this study, 167 patients were enrolled. The initial NRS in both groups were similar. The mean ± SD of NRS at all times was higher in the fentanyl group, except in 10 minutes, but only in 120 minutes, this difference was statistically significant (p= 0.01). The mean ± SD of pain reduction in all times was similar in both groups. The incidence of adverse effects in both groups were not different (p = 0.18).
Conclusion: According to findings, IV fentanyl had a similar analgesic effect to IV morphine in traumatic patients with acute pain. Also, there was no significant difference in terms of adverse effects between groups.

Abstract Background: Understanding the relationship between social support and spiritual health with death anxiety in patients with cancer is crucial for developing effective interventions to improve their quality of life and reduce distress.
Objectives: The objective of this study was to investigate the impact of social support and spiritual health on death anxiety in cancer patients, with a specific focus on determining the relative contributions of each factor.
Methods: This descriptive-correlational study included all patients with cancer in Tehran as the study population in 2023. A total of 302 patients with cancer were selected as the sample using a convenience sampling method. The instruments included questionnaires on death anxiety, social support, and spiritual health. Data were analyzed using the Pearson correlation coefficient and stepwise regression.
Results: Findings revealed a significant negative association between social support and death anxiety (P<0.001). Additionally, a significant negative association was found between spiritual health and death anxiety (P<0.001). According to the results, spiritual health had a greater association with death anxiety in patients with cancer.
Conclusion: Based on these findings, both social support and spiritual health contribute to mitigating death anxiety among cancer patients. Notably, spiritual health appears to have a more pronounced impact on reducing death anxiety compared to social support in this population. These findings highlight the importance of incorporating psychosocial interventions that address both social support and spiritual well-being into comprehensive cancer care.

Abstract Background: Recent advancements in medical technology have significantly influenced social life through the advancement of scientific research.
Objectives: This study examined the Generic Structure Potential (GSP) of medical diagnostic reports in Iran, specifically focusing on Radiology Case Reports (RCRs), Magnetic Resonance Imaging (MRI) reports, and Computed Tomography-Scan (CT-scan) reports.
Methods: This descriptive corpus-based study analyzed a corpus of 300 diagnostic medical reports collected from Tabriz Medical Science University over a three-month period during the autumn of 2024. The research employed Hasan's (1989) Generic Structure Potential (GSP) model, integrated with Halliday's Systemic Functional Linguistics (SFL) framework, to investigate both the macro-structural elements (obligatory, optional, and recursive) and the micro-structural features (field, tenor, and mode) of these reports.
Results: The analysis revealed that the obligatory elements dominated medical diagnostic imaging reports (94.3%), with "Findings" being the most frequent (59.1%), underscoring their central diagnostic role. Normal structures appeared less frequent (23.4%), highlighting the emphasis on pathological findings over normal observations. Optional elements (5.7%) like impressions and recommendations were rare, while recursive elements were entirely absent. The study found no significant presence of recursive elements, indicating a preference for a clear and concise reporting style.
Conclusion: The findings of the present study suggest that this structured approach enhances the utility of diagnostic medical reports in supporting accurate diagnosis and patient care within the Iranian healthcare context. These findings have significant implications for researchers, emphasizing the crucial role of understanding and embracing the generic structure of medical reports as a fundamental aspect of scholarly writing within their respective domains.