Hospital Practices and Research

Abstract The choice between disposable and reusable medical supplies remains a critical challenge in healthcare systems worldwide, particularly in low- and middle-income countries. While disposable items offer the advantage of infection prevention, they contribute significantly to biomedical waste and impose recurring financial burdens. Reusable supplies, on the other hand, present economic and environmental benefits but carry infection control risks if sterilization practices are inadequate. This paper explores the trade-offs between safety, sustainability, and cost in the context of Indian healthcare institutions, including experiences from apex institutes like AIIMS. Global trends, environmental implications, and emerging innovations in reprocessing technologies are also discussed. The findings support the need for a hybrid, risk-based strategy that optimizes both resource utilization and patient safety. Strengthening sterilization infrastructure, establishing national reuse protocols, and investing in low-cost innovations are recommended to balance the competing priorities of modern healthcare delivery.

Abstract Patient safety is a fundamental principle in healthcare, enshrined as a basic right of patients and a core responsibility of nurses. Negligence in ensuring safety can lead to adverse outcomes for patients and healthcare providers alike. Within the discourse on patient safety, two related yet distinct concepts emerge: "safe care" and "care safety." While these terms may appear synonymous, their differences have significant implications for nursing practice. This letter explores these concepts, contrasts their applications, and argues for the prioritization of safe care, supported by empirical evidence and practical examples.

Abstract Background: Klebsiella pneumoniae is a gram-negative, short, facultative anaerobic bacillus that commonly grows in laboratory culture environments, including blood agar, EMB, Mueller-Hinton agar, and nutrient agar. As an opportunistic pathogen, it poses significant treatment challenges due to increasing antibiotic resistance. Objectives: The purpose of this study is to determine the relationship between antibiotic resistance and the frequency of qnrS and qnrA genes in clinical isolates of Klebsiella pneumonia. Methods: In this study, 100 patients referred to Sina Hospital in Tabriz due to urinary tract infections (UTIs) were examined. Common biochemical tests confirmed the presence of Klebsiella in 20 samples. The antibiotic sensitivity pattern of the isolates was determined using the disc diffusion method, and the results of the antibiogram test were analyzed. The resistance of the samples to five different types of antibiotics was assessed. Results: In this study, the highest antibiotic resistance was observed against nalidixic acid. The presence of the qnrS gene was confirmed in five isolates of Klebsiella pneumoniae, while the qnrA gene was absent in all isolates. The sensitivity of the Klebsiella pneumoniae strain to iron oxide nanoparticles was evaluated using the well method at a concentration of 0.08 g in 100 ml of water. One sample in a volume of 100 ml and two samples in a volume of 200 ml formed halos with diameters of 11 mm, 14 mm, and 12 mm, respectively. Conclusion: The findings of the present study showed that the frequency of qnrS genes was high in fluoroquinolone-resistant samples of Klebsiella pneumoniae, and this factor could lead to progressive antimicrobial resistance in different hospital departments.

Abstract Background: Emergence and dissemination of resistance to carbapenems among carbapenemase-producing Enterobacteriaceae (CPE) has led to limited therapeutic options for patients infected with CPE. Objectives: This study aimed to determine the prevalence of CPE colonization among newly admitted patients scheduled for surgery, identify the risk factors for acquiring CPE, and assess post-surgical outcomes among CPE carriers. Methods: A total of 152 patients scheduled for various types of planned surgery were included in the study. Two rectal swabs were collected from each patient and processed following the CDC-recommended method for screening Carbapenem-resistant Enterobacteriaceae (CRE). Probable CRE colonies were then tested using the mCIM for carbapenemase production according to CLSI guidelines. Patients were followed up after two months to monitor for any post-surgical infections. Surveillance swab sampling was conducted to detect the spread of CPE in the hospital environment by CPE carriers. Results: A high occurrence (15.13%) of CPE colonization was recorded in patients admitted for different planned surgeries. A history of antibiotic therapy was significantly associated with CPE acquisition (P<0.001). A significantly higher proportion of CPE carriers developed post-surgical infections compared to non-carriers (87% vs. 13.1%; P<0.0001). All the patients who developed post-surgical infections with CRE were already harboring CPE in their intestines. On environmental sampling, 15 (65.2%) of the 23 CPE-colonized patients were found to be positive for CPE. Conclusion: High rates of intestinal carriage of CPE among freshly admitted patients, as detected in our study, pose a risk to individuals for CPE infection, leading to antibiotic therapy, long-term hospital stays, and loss of daily wages. Therefore, infection control policies should be formulated by hospitals to screen for CPE carriage during hospital admission, followed by containment of CPE to prevent transmission.

Abstract Background: Today, providing household health expenses for the health system is an important challenge. The increase in health service costs has created some problems. In this regard, the insurance seems to play a key role in such expenses for the household. One of the major problems between healthcare centers and insurance organizations is about the reimbursement of services provided to patients by the insurers according to the contract. Substantial amounts of these expenses, categorized as deductions, are not reimbursed to the healthcare centers by the insurance organizations.
Objectives: The purpose of this study was to investigate the effective measures in reducing insurance financial deductions with an emphasis on the role of insurance.
Methods: The current research was descriptive-analytical and cross-sectional, which was conducted in Shahid Rajaei Hospital of Gachsaran. For this purpose, 170 patients (families) were selected as research samples, and finally 165 patients (families) were included in the study. The research population consisted of 400 employees of Shahid Rajaei Hospital in Gachsaran, and a simple random sampling method was employed to select 196 participants, according to Cochran's formula. A researcher-developed questionnaire with 21 questions was used for data collection. The formal and content validity of the questionnaire was confirmed, and its reliability was verified using Cronbach's alpha. The collected data were analyzed using parametric tests by SPSS software.
Results: The research data indicated that uncompromised elements such as not distorting the date and prescription, having the stamp and signature on insurance prescriptions, transparent and digitally typed medical orders, proper completion of medical procedures descriptions by physicians, accurate and precise registration of equipment, drugs, and supplies, proper registration and documentation of daily requests, and request for basic care instructions in medical and nursing orders, have an impact on reducing insurance financial deductions at Shahid Rajaei Hospital in Gachsaran, across the inpatient, clinical, and administrative departments.
Conclusion: Based on the obtained results, by implementing effective and transparent measures, identifying and eliminating factors contributing to the increase in insurance deductions, it is possible to reduce the disputes between hospitals and insurance organizations. The findings show a significant relationship between health insurance coverage and use of preventive care services, adverse health outcomes, reduced performance, preventable health problems, severe disease at the time of diagnosis, and premature mortality.

Abstract Background: The pervasive impact of depression on cognitive-attentional processes and future hope in young individuals underscores the critical need to investigate targeted interventions. Objectives: This study aimed to evaluate the effectiveness of Acceptance and Commitment Therapy (ACT) in improving Cognitive-Attentional Syndrome (CAS) and enhancing hope for the future in young adults experiencing depression. Methods: A quasi-experimental design was employed with a pre-test/post-test control group. The target population consisted of young adults aged 18-35 years diagnosed with depression, who presented for services at psychology and counseling centers in Ahvaz during 2021. A convenience sample of 40 eligible individuals was recruited and randomized into two groups: an experimental group and a control group, each comprising 20 participants. Data were collected using the Cognitive Attentional Syndrome Questionnaire (CAS-Q) and the Adult Hope Scale (AHS). The experimental group underwent eight weekly 90-minute sessions of ACT, while the control group was placed on a waitlist with no intervention. Analysis of Covariance (ANCOVA) was employed to analyze the collected data. Results: A statistically significant reduction was found in CAS scores (F=255.28, P<0.001, η=0.83) and a significant increase in hope scores (F=296.46, P<0.001, η=0.93) among young adults with depression in the post-intervention assessment within the ACT group, relative to the control group. These findings indicate that ACT is an effective treatment for mitigating maladaptive cognitive-attentional patterns and cultivating greater hope for the future in this demographic. Conclusion: This study provides robust evidence for the efficacy of ACT in reducing CAS and enhancing dispositional hope in young adults with depression. These findings suggest ACT’s potential as a scalable clinical intervention to address core psychological processes and improve long-term mental health outcomes.

Abstract Background: Bulimia nervosa is a complex eating disorder often associated with maladaptive schemas and anxiety sensitivity. Objectives: This study investigated the effectiveness of Compassion-Focused Therapy (CFT) and Emotion-Focused Schema Therapy (EFT) individually on early maladaptive schemas and anxiety sensitivity in women with bulimia nervosa. Methods: This study employed a quasi-experimental, pretest-posttest control group design. The study population consisted of 75 female patients with a confirmed diagnosis of bulimia nervosa, recruited via convenience sampling from those seeking treatment at the Ahvaz Eating Disorders Association. Participants were assigned to one of three groups (n = 25 per group): two experimental groups and a control group. One experimental group received EFT (10 sessions, 90 minutes each), while the other received CFT (8 sessions, 90 minutes each). The control group received no intervention. The Early Maladaptive Schema Questionnaire and the Anxiety Sensitivity Index were used to assess outcomes. Data were analyzed using analysis of covariance (ANCOVA) within SPSS. Results: Results indicated that both treatments significantly reduced early maladaptive schemas and anxiety sensitivity in women with bulimia nervosa. EFT demonstrated greater efficacy, with larger reductions in early maladaptive schemas (η=0.80, P<0.001) and anxiety sensitivity (η=0.74, P<0.001) compared to CFT. The control group showed no significant changes in either outcome. Conclusion: This study revealed that EFT and compassion-focused therapy reduce maladaptive schemas and anxiety sensitivity in women with bulimia nervosa, with the former showing greater efficacy. Future research should explore the mechanisms driving these differential effects and their long-term outcomes. These findings suggest that EFT may be prioritized in clinical settings to effectively target maladaptive schemas and anxiety sensitivity in women with bulimia nervosa.

Abstract Background: Sudden Cardiac Death (SCD) and Acute Coronary Syndrome (ACS) are major public health concerns, particularly in individuals with a family history of early-onset Coronary Artery Disease (CAD).
Objectives: The impact of family history on ACS and SCD risk remains underexplored.
Methods: This retrospective study included 689 patients diagnosed with ST-Elevation Myocardial Infarction (STEMI) who underwent Primary Percutaneous Coronary Intervention (PPCI) between January 2011 and June 2015. Patients with a parental history of SCD due to Myocardial Infarction (MI) were identified (n = 29, 4.2%). Demographic data, cardiovascular risk factors, and angiographic findings were evaluated.
Results: The median age at STEMI onset in patients with a parental history of SCD was 49 (41.5-52) years, 8.9 years younger than their parents’ age at SCD. Most patients were male (96%) and smokers (83%). Hyperlipidemia was present in 80%, although only 7% had been previously diagnosed. Multi-vessel disease was observed in 80%, and 28% required Coronary Artery Bypass Grafting (CABG). Two patients (7%) died due to cardiogenic shock.
Conclusion: Patients with a parental history of SCD develop STEMI at younger ages. Smoking and low HDL levels were key risk factors. Early screening and preventive measures, including smoking cessation and lipid control, were essential for high-risk individuals. Further studies are needed to explore genetic predisposition and targeted prevention strategies.