Hospital Practices and Research

Abstract Background: Medical equipment plays an important role in community health in critical situations such as the COVID-19 pandemic.
Objectives: This study was conducted to determine and identify the factors affecting the management of medical equipment in crisis situations.
Methods: The present study was conducted as a mixed qualitative and quantitative study in 2020. In the qualitative section using the targeted sampling method, ten medical equipment management experts and in the quantitative section using available sampling method, 200 managers and experts active in this field from hospitals and related companies were selected for this study. The qualitative part was conducted in two stages of reviewing texts and interviewing experts and in the quantitative part we evaluated the validity of the structure and the reliability of the questionnaire.
Results: The validity of the structure was assessed using heuristic factor analysis. KMO index was 0.971 and Bartlett test was significant (P < 0.05). All six approved components in the content validity section, based on the mathematical model, explain and determine more than 77% of the variance related to the purpose of the study which is the management of medical equipment in COVID-19 pandemic situations.
Conclusion: The results showed that the instructions, management, information technology, equipment, manpower, and physical space components had the highest and lowest priority in the management of medical equipment in critical situations, respectively. In this regard, appropriate instructions should be provided first and localized protocols should be communicated from the same source at the same time.

Abstract Background: The quantity and quality of manpower, especially in health systems, are major factors affecting speed of service delivery, cost, and accuracy, or, in other words, the quality of service.
Objective: This study purposed to investigate the manpower required in various units of the laboratory at Shiraz Faghihi Hospital.
Methods: This is a cross-sectional and descriptive-analytical research conducted on all testing processes in the fields of parasitology, hormone biology, microbiology, and urinalysis performed at the studied hospital. The Westinghouse ergometer and timing method was used to estimate manpower requirements, and SPSS₁₈ software was used to analyze data.
Results: The average standard time of every duty cycle in parasitology units, hormone biology, microbiology, and urinalysis are 12, 5, 9, and 5 minutes, respectively. The numbers of human resources required in said units were estimated to be 2.6, 3, 4, and 3.7 respectively. In parasitology unit there is lack of 1 manpower. In hormone unit there are two manpower surpluses. In biology unit there is one manpower surplus and urinalysis unit is estimated to be proportional to the number of troops.
Conclusion: It is suggested that new, scientific tools be used to evaluate the status of department staff and make improvements to avoid the high costs and difficulties that manpower shortages and surpluses cause for the organization.

Abstract Background: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI ) are common types of acute coronary syndrome which are associated with the risk factors of age, obesity, hypertension, and diabetes.
Objective: The present study aimed to examine the effects of age on the risk factors and clinical symptoms of acute coronary syndrome.
Methods: A cross-section prospective study was conducted on 125 patients with acute coronary syndrome chosen by non-probability convenience sampling method in the coronary care unit in Sulaimani, the Kurdistan region of Iraq. Acute coronary syndrome types were diagnosed through clinical presentations, electrocardiography (ECG), and troponin test. Data was collected using a researcher-based checklist through face-to-face interviews.
Results: The results indicated that males were the dominant group. The age group 45-65 had the highest prevalence rate of acute coronary syndrome. The most frequent risk factors for acute coronary syndrome were hypertension (54.4%), dyslipidemia (52%), smoking (42.4%), and diabetes mellitus (38.4%). Typical chest pain was found to be the most frequent clinical presentation (88%). There was a significant difference between the age groups in terms of the effect of age on typical and atypical symptoms; however, neither age nor typical/atypical symptoms had a significant effect on type of acute coronary syndrome. Similarly, family history, hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and dyslipidemia had no effect on type of acute coronary syndrome.
Conclusion: Age is a predictive factor for acute coronary syndrome, but family history, hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and dyslipidemia cannot predict acute coronary syndrome.

Abstract Background: Nowadays, quality of patient care is one of the major and important concerns of health care delivery which is extremely dependent on the medical staff.
Objectives: The purpose of this study was to investigate the relationship between Quality of Work Life (QWL) and quality of patient care.
Methods: This study was a descriptive-analytic study based on correlation which was conducted in the educational hospitals of Kermanshah. A total of 320 medical staffs were selected for the study. Quality of Work Life and Quality of Patient Care questionnaires were used to collect the data. For data analysis, descriptive statistics, person correlation coefficient, t-test and multivariate regression were used by using SPSS₁₆
Results: Data analysis showed that the Quality of Work Life of medical staffs was in a medium level. Our findings indicate that there is a significant, negative relationship between stress at work and quality of patient care (P-value=0.001 & r=-0.247) and there is a significant, positive relationship between control & job satisfaction and quality of patient care (P-value=0.001 & r=0.217). Results of multivariate regression analysis showed that stress at work net account for 6% of the variance of the quality of patient care.
Conclusion: Focusing on improving the working conditions of medical staffs can be incredibly useful in increasing the quality of health care.

Abstract Background: Although all jobs can be stressful, occupational stress is an important issue in jobs that deal with human health. Evidence indicates that nursing is a stressful occupation.
Objective: This research evaluated factors affecting occupational stress and strategies for coping with it.
Methods: This cross-sectional descriptive-analytic study was conducted in 2015. The study population comprised all nurses at Shahid Rajaee hospital, from whom 190 nurses were selected by random sampling. Data was collected by questionnaire and analyzed using SPSS software (version 19), Pearson correlation coefficient tests, Mann-Whitney tests, and t tests.
Results: Occupational stress was rated as moderate among the studied nurses. Significant positive correlations were found between occupational stress level and less effective coping method, occupational stress level and work experience level, and ineffective coping methods and age. Moreover, a significant difference was seen between men and women in terms of emotion-focused coping.
Conclusion: According to the research findings, occupational stress was at a moderate level among the studied hospital nurses, indicating that the authorities need to focus on efforts to reduce occupational stress for nurses.

Abstract Background: To test the effectiveness of concept maps used in the education of nursing students in the field of health, we need to use measurement tools.
Objectives: The purpose of the study was to develop “Scale for the Effectiveness of Concept Maps in Nursing Education (SECMNE)”.
Methods: This was a methodological instrument development study. This study was conducted in a university’s health of nursing department in Tokat, Turkey, between September and December 2019. The universe of this study, which used a methodological design, consisted of third and fourth-year nursing students, and the sample size was 174. The item pool was formed with 86 items. The content validity was assessed by 9 experts. The 86-item draft scale that had a 4-point Likert type scoring system. Content validity ratio (CVR), Kaiser-Meyer-Olkin (KMO) test, Bartlett test, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), Cronbach’s alpha, and Pearson product-moment correlation analysis techniques were used for the validity and reliability analyses of the scale.
Results: The scale consists of 3 subscales (integration of information, integration of the care plan, perception) and 30 items. Scale’s Cronbach alpha is 0.97.
Conclusion: The scale developed in this study was concluded to be a valid and reliable measurement tool that can be used to measure the effectiveness of the concept maps in nursing education. The SECMNE can help nursing student identify the lack of knowledge and negative attitudes about concept map in nursing education and prepare nursing care plan. 

Abstract Background: Physicians’ satisfaction is closely related to the effectiveness of health services, including quality of services as well as patient compliance, satisfaction, and outcomes.
Objectives: This study was designed to examine the job satisfaction level of physicians working at a referral hospital in Tehran.
Methods: This research was a descriptive study performed on a population of physicians working at a referral hospital from April to August 2019. The sample size was calculated as 120 subjects. The Physicians’ Job Satisfaction Questionnaire (PJSQ), which is a valid questionnaire, was used as the data collection tool. The collected data was entered into SPSS Statistics 20. Mann-Whitney and t tests were used for data analysis.
Results: The frequency of female and male physicians was 50 (38.2%) and 81 (61.8%), respectively. The total mean of Job satisfaction in physicians was 51±7.05. Overall satisfaction scores were 70.7±15.1, 51.5±11.1, 49.8±13.1, 49.5±11.2, 44.1±9.3, and 40.5±11.9 in domains of income satisfaction, physicians’ satisfaction with management, relationship between physicians and their colleagues, patients, staff, and physicians’ job satisfaction, respectively. 87% of physicians participating in this study were not willing to leave their jobs. The income satisfaction of the female physician group was significantly higher than that of men (P=0.029). The income satisfaction of subspecialists was significantly higher than that of specialists (P=0.022). The job satisfaction of physicians who were not faculty members was significantly higher than that of physicians who were faculty members (P=0.034).
Conclusion: The job satisfaction level of physicians working at a referral hospital in Tehran was moderate. Income satisfaction and job satisfaction were the highest and lowest levels of satisfaction, respectively.

Abstract Background: The ‘Organizational Justice’ concept is used in order to determine whether the administrator is fair to his personnel or not. It is said that those who get bullied are usually terrorized, annoyed, excluded, belittled, deprived of resources, isolated and prevented from claiming rights.
Objective: The purpose of this study is to determine nurses’ perception of organizational justice and its effect on the bullying behaviour they are exposed to.
Methods: The cross-sectional study was conducted on nurses at a university hospital and a private hospital in Ankara. In this regard, 250 nurses who had been serving in their respective hospitals for 6 months participated in the study. The variables were measured under 2 categories: bullying and perception of organizational justice. A simple regression analysis was carried out in order to determine the bullying behaviour which causes the nurses’ justice perceptions.
Results: According to the survey, the nurses are most likely to perceive injustice in the area of distributional justice. Results revealed that the ratio of nurses who were exposed to bullying in the workplace was 28%. There was a significant and negative relation between the nurses’ distributional justice perception and the bullying they were exposed to.
Conclusion: The employees whose organizational justice perceptions are low, display a threatening and negative behaviour towards their colleagues and the institution. They feel themselves to be threatened when they think that they can’t communicate with upper management respectfully and also when they believe that their managers are unjust in performance assessment, in assessing salaries and promotion.

Abstract Background: In providing optimum medical and health services, great pressure is put on the physical and mental health of family physicians. Job burnout is damaging to the health of family physicians and medical treatment personnel. It leads to reduced job productivity, increased absenteeism, increased healthcare costs, elevated turnover rates, a reduced level of service provided to patients, and ultimately, patient dissatisfaction.
Objective: The current research investigated job burnout among family physicians in rural areas of Isfahan province during the years 2017-2018.
Methods: This cross-sectional study was carried out in Isfahan province during the years 2017-2018. The research population included all family physicians working in Isfahan province, and 155 of whom met the inclusion criteria and participated in this research. Questionnaires were used as the data collection tool. Data was analyzed using SPSS software, and the analytical variables were analyzed using the independent t test and Pearson correlation coefficient.
Results: A total of 45 men (29%) and 110 women (71%) comprised the research population. Participants’ mean age and mean duration of work experience were 35.3±8.1 and 7.5 years, respectively. The scores for overall job burnout, emotional exhaustion, depersonalization, and lack of personal accomplishment dimensions were low among the family physicians in Isfahan. The results showed no significant difference between male and female, single and married participants in any of the dimensions. The results also revealed a direct relationship between years of work experience and the overall job burnout and lack of personal accomplishment scores.
Conclusion: According to the findings of the present research and considering the stressful nature of a family physician’s job, healthcare authorities need to pay special attention to job burnout and implement measures to prevent it or at least reduce its subsequent adverse effects.

Abstract Background: Gastrointestinal surgery is one of the procedures that result to produce inflammatory reactions and pain to patients. Administrate of high-safe analgesia in surgery is very essential, to reduce pain and improve inflammatory reactions.
Objectives: The present study compared inflammatory markers and pain relief with the epidural infusion of bupivacaine-fentanyl and intravenous morphine bolus in gastrointestinal cancer surgeries.
Methods: This randomized control clinical trial study was carried out from December 2018 to October 2020, on ASA I and II patients aged between 30-80 years who referred for gastrointestinal cancer surgery. Cases were randomly distributed into two groups. Group I received epidural catheter with bupivacaine (18 cases), and group II received fentanyl and morphine bolus injection (18 cases). On the first and second days post-operation, data on pain scores based on visual analogue scale (VAS) score, inflammatory markers (procalcitonin [PCT] and C-reactive protein [CRP]), platelet (PLT), white blood cells (WBCs), and erythrocyte sedimentation rate (ESR) was recorded.
Results: The mean age was 52.21±16.13 years (41.6% male, 58.4 female). The mean of ESR, CRP and PCT postoperative were significantly higher than preoperative (P < 0.05). There were no differences between the two groups regarding PLT, ESR, CRP, and PCT preoperative postoperative (P > 0.05). The mean of pain was less in the epidural group than in the morphine group postoperative (P = 0.02).
Conclusion: The results showed that epidural fentanyl-bupivacaine infusion was more effective in pain reduction than the intravenous infusion of morphine in cases undergoing gastrointestinal cancer operation. However, both analgesic approaches were similar in inflammatory functions.

Abstract Background: The study of neuromuscular blocking agents (NMBAs) in the management of acute respiratory distress syndrome (ARDS) has provided conflicting results in terms of their effect on mortality.
Objectives: The main purpose of this study was to evaluate mortality in ARDS patients who underwent NMBA.
Methods: A retrospective secondary analysis of 4200 patients with ARDS was collected from two academic medical centers, Tehran, Iran. This study was performed to assess the impact of NMBAs use in ARDS patients with different subgroups including mild and moderate-to-severe ARDS, age more and less than 65 years, having medical turnover vs. not-having, and high acute nursing care vs. moderate to low nursing care.
Results: Intensive care unit (ICU) mortality has occurred in 1169 (27.8%) participants. The mortality rate was 28.6% and 27.5% in patients with mild and moderate-to-severe ARDS, respectively. In the subjects without medical turnover, the moderate dose of NMBAs significantly reduces the mortality of patients (P = 0.044). In patients who need high acute nursing care, increasing the NMBAs dose significantly reduces patients’ mortality (P = 0.010). In addition, increasing the NMBAs doses significantly reduces ICU length of stay (LOS).
Conclusion: This study provides evidence that the administration of different doses of NMBAs had no effect on patients’ mortality with mild or moderate-to-severe ARDS. However, higher doses of NMBAs than low doses increased the risk of mortality in patients over 80 years and can reduce the risk of death in patients less than 55 years.

Abstract Background: One of the most important issues in the health system is to provide the necessary resources to present health services. To increase the role of charities and facilitate public participation in the treatment area and to develop hospital units, the cooperation between charity organizations and public hospitals must be highlighted.
Objectives: This study aimed at identifying the type of contract for the transfer of health services to charities in the teaching hospitals of Shahid Beheshti University of Medical Sciences in Tehran, Iran.
Methods: This study was conducted in hospitals of Shahid Beheshti University of Medical Sciences in 2019. The statistical population of the study consisted of 411 people, including managers, chiefs, and deputies, contracting experts, hospital social workers, managers and lawyers of the university, trustees, and managers, and charity experts. The research sample consisted of 330 people who were selected using a stratified random sampling method. SPSS version 18 and AMOS software were used to analyze the data.
Results: By identifying the selection criteria of a charity to operate in the hospital, identifying the contract model, identifying the share of capital and current costs, and selecting the type of department in the contract with path coefficients of 0.78, 0.72, 0.68, 0.73, and 0.73, respectively, it can be ensured that the costs of an inpatient ward were supplied by the charity during the contract term.
Conclusion: The study showed that the partnership contract model is the most appropriate type of contract in the transfer of health services to charities.

Abstract Background: COVID-19 has altered and challenged healthcare and childbirth services provision. Midwives are among the first and most influential childbirth care providers during the COVID-19 pandemic. However, there is insufficient information about their experiences in delivering healthcare services, especially in Iran.
Objectives: This study aimed to explore midwives' challenges in providing prenatal care during the COVID-19 pandemic.
Methods: This qualitative study utilized conventional content analysis and was conducted from February 2021 to July 2021 in Shushtar, Iran. A total of 15 midwives were purposively selected with maximum diversity as participants. Data were collected through in-depth, semi-structured online interviews. MAXQDA (V10) software was used for data analysis.
Results: Data analysis resulted in 271 codes, 10 subcategories, and four main categories: "Care Environment", "Management of the Care Process", "Maternal Self-Care", and "Psychosocial Stress".
Conclusion: The findings of this qualitative study highlight the challenges midwives face in providing prenatal care, offering valuable insights for achieving quality care during crises. Focusing on these dimensions can help health policymakers design quality healthcare services during emergencies.

Abstract Background: Iatrogenic dural tear is a relatively common complication in lumbar spine surgery; however, little information exists about the frequency of this condition and its complications in our country.
Objectives: This study aimed to assess the frequency of dural tear and its complications in lumbar spine surgery.
Methods: This cross-sectional descriptive study was conducted on 884 patients who underwent lumbar spine surgery and were referred to Kashani and Alzahra hospitals from 2020 to 2021. Information including age, gender, type of surgery, duration of surgery, duration of hospitalization, number of hospitalizations, need for a second surgery, number of previous surgeries, complications of surgery, involved vertebrae, and underlying diseases were extracted from the checklist.
Results: Among 884 patients who underwent lumbar spine surgery, iatrogenic dural tear was observed in 62 patients (7%). Fever, headache, and wound site complications were observed in 8 (12.9%), 22 (35.5%), and 4 patients (6.5%), respectively. Moreover, the duration of surgery in the total group and the dural tear group was 195 ± 76.2 and 204.13 ± 71.69 minutes, respectively. The duration of hospitalization in the total group and the dural tear group was 3.10 ± 1.3 and 4.08 ± 2.68 days, respectively. Laminectomy was performed in 24.09% and 24.2% of patients in these two groups, respectively.
Conclusion: According to the findings of this study, the frequency of dural tear was 7%, which may be affected by several factors, including age, duration of surgery and hospitalization, underlying disease, smoking, and history of previous surgery.

Abstract Background: Patients undergoing hemodialysis often experience significant suffering, encompassing various psychological and existential components that negatively impact their quality of life.
Objectives: This study aimed to compare the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) and Spiritual Self-Care Training (SSCT) in reducing the components of suffering—physical, psychological, and existential—among patients undergoing hemodialysis.
Methods: This study utilized a three-group quasi-experimental design, employing a pre-test, post-test, and follow-up protocol with MBCT, SSCT, and control groups. The target population comprised hemodialysis patients residing in Isfahan, Iran, during the autumn of 2024. A convenience sample of 60 participants was drawn from this population and subsequently randomly allocated to three distinct groups (n = 20 per group). The Life Suffering Questionnaire served as the instrument for measuring the dependent variable across all three assessment time points. The experimental groups received 10 weekly therapeutic sessions each lasting for 90 minutes, with MBCT and SSCT administered, while the control group was a waitlist control receiving no intervention during the study period. Data were analyzed using repeated-measures analysis of variance (ANOVA), supplemented by Bonferroni post-hoc tests, via SPSS version 26.
Results: The findings revealed statistically significant differences across three domains of suffering—physical, psychological, and existential—when comparing MBCT, SSCT, and the control group (P<0.01). Notably, SSCT exhibited superior efficacy relative to MBCT in alleviating both physical and psychological suffering (P<0.05). Conversely, no significant difference in effectiveness was observed between the two intervention groups with respect to existential suffering.
Conclusion: SSCT outperformed MBCT in reducing physical and psychological suffering in hemodialysis patients, while both interventions equally mitigated existential suffering. These findings highlight the need for tailored interventions, specifically by integrating spiritual components into cognitive therapies, to address the multifaceted suffering of chronically ill patients. Clinically, incorporating such integrated interventions into hemodialysis care could enhance patient well-being and quality of life.

Abstract Background: Retraction of articles occurs as a result of scientific misconducts or honest errors.
Objectives: This study aimed to identify the frequency of retracted Iranian publications, compared to those of other countries and adjust them with influential parameters.
Methods: All publications that were indexed on the Scopus database from 2008 to 2017 and then retracted, due to scientific misconduct were extracted through the Retraction Watch database and selected as the research community. To calculate the growth of retraction for each proposed country (or region), first, the rate of an absolute number of retracted papers for the years 2013-2017 was divided by the similar number for years 2008-2012, then this rate was adjusted to the retracted rate which is similarly computed for the total retracted statistics of the world.
Results: Overall, 545 Iranian retracted publications from 2008 to 2017 were identified, of which 240 and 305 retracted articles were related to the first five years and the second five years of the study, respectively. The results showed that less than 1% (0.82) of all scientific articles published by Iranian researchers were retracted. However, the rate of retracted scientific articles in Iran compared to this rate in the world was significantly higher.
Conclusion: Although retracted Iranian publications make up a small percentage of all Iranian publications, the number of retracted publications is increasing. It is important to recognize the reasons for scientific misconducts and to provide researchers with proper education.

Abstract Background: A patient's satisfaction with nursing service is one of the main indices for measuring the quality and effectiveness of health care.
Objective: The purpose of this study was to investigate and compare patients' satisfaction with the nursing service provided in selected training hospitals in Tehran.
Methods: This cross-sectional study was conducted in 2013 using Patient's Satisfaction Standard questionnaire (PSI) in 7 selected training hospitals in Tehran. In this study, 336 patients discharged from 4 major units of each hospital namely internal, surgery, obstetrics and gynecology and pediatrics, were selected and studied randomly. Data were analyzed using the SPSS₁₈ software.
Results: The results of this study showed that the pediatric unit recorded maximum patients’ satisfaction with nursing care with a mean and SD of 3.78±0.68, while the surgery unit recorded minimum satisfaction with a mean and SD of 3.35±0.65. Also, a significant difference was observed between patients' satisfaction with nursing service in major units such as internal, surgery, obstetrics and pediatrics (P=0.015).
Conclusion: However, significant differences were found in terms of degree of satisfaction with nursing service between the major units of the hospitals. These differences may be due to the characteristics of providing care, unit, patient or family. Therefore, future research should be conducted in order to identify the cause of the difference in satisfaction between the different hospital units.

Abstract Background: Patient safety is a serious global public health issue. Estimates show that every day many patients are harmed while receiving hospital care. Health care staff plays a key role in providing quality and safe patient care, especially physicians who are main members of the medical team and a critical element in patient safety efforts.
Objective: The current study used a Theory of Planned Behavior (TPB) framework to investigate predictors of patient safety intentions and behavior of physicians.
Methods: This descriptive analytical study was conducted in 8 hospitals with 52 physicians participating. A researcher-designed questionnaire was prepared to investigate patient safety behaviors and behavior constructs of physicians based on the guidelines of constructing a TPB Questionnaire: Conceptual and Methodological Considerations. The content validity and reliability of the questionnaire were confirmed. Binary logistic regression analysis was performed using SPSS₁₈.
Results: The total mean score of physician safety behavior indicated that 3.8±0.92. 42% of physicians reported their safety behavior at a good level. There was no significant difference between the patient safety function of physicians in public and private hospitals (P=0.8) and working in medical or surgical wards (P=0.4). Among TPB constructs, “normative beliefs” had the greatest influence on physician intention for safety behaviors (wald=3.828, P=0.05).
Conclusion: The results showed that “normative beliefs” had the greatest influence on physician intention for safety behaviors; therefore, it seems that patient safety must be the most important concern of all health care staff, specifically managers and executives throughout health care centers.

Abstract Background: Endophthalmitis is a severe and sight-threatening complication of ocular surgery or ocular trauma. The identification of common types and causative organisms is essential for prevention and management.
Objective: The current study describes the prevalence of various types of endophthalmitis and the causative microbiological spectrum of each type treated in the Tertiary Referral Center in Iran.
Methods: All cases of endophthalmitis admitted to the Emergency Department of Farabi Eye hospital (Tehran, Iran) between July 2013 and December 2014 were included in this study. The patients’ demographic data, type of endophthalmitis, aqueous or vitreous culture results, and treatment methods were recorded.
Results: From 108 presumed endophthalmitis cases, post-operative endophthalmitis (68.5%) was the most frequent type followed by post-traumatic (25%), bleb-associated (4.6%), and endogenous (1.9%) types. Streptococcus viridians (37.5%) was the most common isolated organism in post-operative cases. In post-traumatic endophthalmitis patients, the most frequent causative organism was Staphylococcus epidermidis (70%).
Conclusion: Many studies from other countries have reported that S. epidermidis is the leading cause of endophthalmitis after either intraocular surgeries or open-globe injuries, but the current study has shown that S. viridians is the most common isolated organism in post-operative endophthalmitis.

Abstract Background: The COVID-19 pandemic has impacted the socioeconomic situation worldwide, but another issue is the impact of socioeconomic status on the rate of coronavirus infections.
Objectives: This study aims to examine the socioeconomic status of individuals infected with COVID-19.
Methods: This case-control study was conducted on 768 hospitalized patients at 7 hospitals in Tehran, Iran from 2020 to 2021. The study included two groups: a case group of 384 hospitalized COVID-19 patients and a control group of 384 individuals hospitalized. A socioeconomic status questionnaire was used for data collection. The data were analyzed using SPSS v.26 software, descriptive statistical tests, and logistic regression. A significance level of less than 0.05 was considered.
Results: The findings indicated a significant relationship between age (OR = 1.017), marital status (OR = 0.316), and education level (OR = 0.348) with the rate of infection. Individuals over 60 years old, married, and those with higher education had a greater chance of infection. The regression results for two components of economic class and housing status, categorized by housing prices and purchasing ability, were not significant (P >0.05). However, there was a significant relationship between income level (P <0.05, OR = 0.497) and the rate of infections; individuals with lower income had a lower chance of infection.
Conclusion: The researchers concluded that the Hygiene Hypothesis may influence the rate of COVID-19 infection among individuals; however, further research in this area is needed.

Abstract Background: Anxiety disorders are highly prevalent among adolescents, particularly girls. These disorders can significantly impair academic performance, social relationships, and overall quality of life, with long-term consequences into adulthood.
Objectives: The research aimed to predict anxiety in adolescent girls using a multilayer perceptron model based on self-awareness and metacognitive beliefs.
Methods: In this correlational study, the statistical population consisted of adolescent girls aged 16-18 enrolled in secondary schools in Ahvaz during the academic year 2022-2023. A total of 215 individuals were selected using multi-stage cluster sampling. Data were collected using the Beck Anxiety Inventory (BAI), the Five Facet Mindfulness Questionnaire (FFMQ), and the Metacognitions Questionnaire (MCQ-30) to assess anxiety, self-awareness, and metacognitive beliefs, respectively. The data were analyzed using Pearson’s correlation coefficient, simultaneous regression, and a multilayer perceptron model, performed with SPSS version 27 and MATLAB version 2019.
Results: The results revealed a significant negative correlation between self-awareness and anxiety in adolescent girls (r = -0.60). Furthermore, metacognitive beliefs also showed a significant negative correlation with anxiety in adolescent girls (r = -0.53). Additionally, a significant combined predictive effect was found for self-awareness and metacognitive beliefs on anxiety in adolescent girls (P<0.001). The results of the multilayer perceptron model indicated that self-awareness had the strongest predictive power in relation to anxiety in adolescent girls.
Conclusion: Higher self-awareness and stronger metacognitive beliefs correlate with lower anxiety levels in adolescent girls. Interventions aimed at improving these cognitive factors, such as mindfulness and cognitive restructuring, could effectively reduce anxiety. Integrating these strategies into clinical and educational settings can empower adolescent girls with crucial coping mechanisms. By fostering self-awareness and healthier metacognitive beliefs, we can equip them to manage anxiety, improve their overall mental well-being, and enhance their academic and social functioning.

Abstract Background: The high workload of nurses in hospitals has been identified as a patient safety and worker stress problem. Psychological empowerment is a motivational concept demonstrated in four dimensions: meaning, competence, self-determination, and impact.
Objective: This study investigated the relationship between nurses’ workloads and psychological empowerment using structural equations modeling (SEM).
Methods: This descriptive correlation study was conducted using SEM. The study was conducted at 17 public hospitals affiliated with Iran University of Medical Sciences (IUMS) in the city of Tehran. The population study was nurses employed in critical care departments. Two questionnaires were used to gather data: the NASA and the Psychological Empowerment Questionnaires. Differences in categorical variables were analyzed using one-way analysis of variance (ANOVA). Confirmatory factor analyses were used to confirm the relationships between latent variables and indicator variables; SEM was used to find the direct and indirect effects of nurse’s workload on psychological empowerment. Data analyses were performed using SPSS 18, and all models were tested in LISREL 8.8.
Results: Correlations among indicators of nurse’s workload showed that highest correlations were performances (0.61), and the highest correlations among psychological empowerment were competence (0.03). The overall correlations among nursing workloads and psychological empowerment were 0.74. The proposed structural model fit was acceptable (χ2 = 525.5, df = 89, RMSEA = 0.13, GFI = 0.91).
Conclusion: Increasing the workload of nurses in hospitals will better engage the nurses and allow them to face new problems they encounter in their jobs.

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in the diversion of all the resources, attention, and energy of the medical personnel and administration towards the management of COVID-19 patients. This resulted in unforeseen difficulties and hazards for non-COVID-19 patients in accessing healthcare professionals and facilities.
Objectives: The objective of this study was to analyze the impact of the COVID-19 pandemic and repeated lockdowns on the non-COVID patients; to understand the social, psychological, and medical issues faced by them; and propose solutions for difficulties faced by this specific cohort of patients.
Methods: We conducted a retrospective observational study on all non-COVID patients reporting for non-COVID-19 illnesses. We conducted the data analysis by comparing the trends for 15 months each in the pre-pandemic (1 January 2019 to 31 March 2020) and pandemic periods (1 April 2020 to 30 June 2021).
Results: There was a 65.92% decrease in Out Patient Department (OPD) attendance, a 56.05% decrease in admissions, and a 90.33 % decrease in elective surgical procedures in non-COVID-19 patients. However, there was a significant increase in emergency surgeries by 62.16%.
Conclusion: There has been a significant albeit much-needed diversion of time, energy, and resources to manage COVID-19 patients in recent times. This has led to a paucity of care opportunities for non-COVID-19 patients, which has been further compounded by the frequent lockdowns. We attempted to understand the impact of the pandemic on non-COVID-19 patients, particularly in peripheral hospitals in Hilly Terrains. We propose the solutions to tackle these issues and describe our experience with them.

Abstract Background: The world is still witnessing a largely ongoing spread of coronavirus disease 2019 (COVID-19); therefore, the scientific findings in this area need to be shared promptly.
Objectives: This study aimed to assess the usefulness of Atorvastatin treatment in reducing COVID-19 mortality in patients with or without diabetes mellitus (DM) and to correlate them with C-reactive protein (CRP) levels.
Methods: This study consecutively enrolled patients with pneumonia symptoms, positive lung CT scan, and confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on reverse transcription-polymerase chain reaction (RT-PCR). The outcome was defined as intensive care unit (ICU) admission and death. Clinical data and history of atorvastatin administration were evaluated. CRP levels were measured at baseline and repeated after one week in all patients.
Results: A total of 200 patients were included. Their mean age was 60.5 (SD = 16.5) years, 113 (56.5%) patients were male, 47 (23.5%) with pre-existing diabetes, and 64 (32%) patients were taking atorvastatin routinely. 68 (34%) required ICU admission of all the studied patients. No gender differences were found in ICU admission and death. The baseline CRP was not significantly different, but the secondary CRP was significantly different between DM and non-DM groups. Secondary CRP also showed a significant reduction in patients receiving atorvastatin (P = 0.017). The mortality was the same in atorvastatin or non-atorvastatin groups (P = 0.715).
Conclusion: It seems that taking statin has only some beneficial effects on improving CRP levels in patients with COVID-19. To achieve a reliable result, clinical trials are recommended.

Abstract Background: Efficient hospital bed utilization is an important function of hospital administrators. Scarcity of beds, overcrowding, and flooring are often the picture of tertiary hospitals.
Objectives: This study aims to find out hospital bed utilization indicators such as average daily census, bed occupancy rate (BOR), average length of stay (ALS), bed turnover rate (BTR), and bed turnover interval (BTI) in Medicine ward of a tertiary hospital in West Bengal, India.
Methods: A descriptive cross-sectional study was conducted in acute male and female as well as chronic male and female wards under medicine department of a tertiary hospital in West Bengal from June to August 2018.The record of active beds, patient days, daily admissions and discharge were reviewed for May 2018 by complete enumeration method from admission, discharge and death registers and recorded in a pre-designed pretested checklist. Average daily census, BOR, ALS, BTR, and BTI were computed using standard formula. Pabon Lasso model was used to analyse the performance of the nedicine ward.
Results: Average daily census, ALS, BOR, BTR, BTI in medicine ward were 261.81 patients, 8 days, 108.55%, 4.22 patients/ bed and -0.63 days respectively. Pabon Lasso graph reflected high BOR and high discharges per bed (productivity) in acute medicine wards reflecting good quantitative performance in contrast to chronic medicine wards with low discharges per bed (productivity or BTR) and higher ALS.
Conclusion: Medicine ward reflected higher BOR and ALS but lower BTR (productivity) as per the Pabon Lasso graph. Efforts must be made to reduce ALS in chronic medicine wards.