Hospital Practices and Research

Abstract The Qur’an, the word of God, is the best book that has been revealed to guide human beings contains a complete plan of human life. However, in addition to educational, ethical, and religious issues, it also contains valuable scientific information. Several verses in the Holy Qur’an discuss the importance of breast milk and its proper planning. Qur’an also orders up parents, especially mothers, for getting this goddamn blessing to their children. Qur’an verses as well as Islamic hadiths emphasize that breast milk is an unparalleled and comprehensive food that plays a valuable and unique role in the improvement of mental health, physical development, and desirable development of children. Based on Islamic sources, such as the Holy Qur’an and the traditions of the Prophet (PBUH) and Islamic hadith, there are some interesting and important points about breastfeeding, its benefits and its provisions. The Qur’an verses and Islamic hadiths emphasize the importance of breastfeeding and the importance of continuing it until 24 months. The description of these hadiths and verses is presented in the text. Considering the religious and Qur’an educations regarding the importance of breastfeeding infants, it can be concluded that breastfeeding contains the most complete immune and growth factors in the infant. In addition to physical needs, breastfeeding provides emotional and mental development and also gives countless benefits to the mother.

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

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

Abstract Background: 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: Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. The role of MDRs as a source of ethnic health disparities is, however, still unknown.
Objectives: The current study had two aims: first, to explore the association between years of schooling and having taken a prostate-specific antigen (PSA) test among men in the US, and second, to explore ethnic differences in this association.
Methods: This study was a secondary analysis of data from the National Health Interview Survey (NHIS-2015). The data of 5,053 men aged 55 years or older who were either Latino, non-Latino, African–American, or White were analyzed. Years of schooling was the independent variable. The dependent variable was taking a PSA test sometime during one’s lifetime. Age, region, and employment were the control variables. Ethnicity was the focal moderating variable. Binary logistic regression was used for data analysis.
Results: A higher number of years of schooling was associated with higher odds of having taken a PSA test, net of all confounders. Ethnicity showed a significant statistical interaction with years of schooling on having taken a PSA test. This interaction was suggestive of a smaller slope for Latino men than non-Latino men. White and African American men did not show differential effects of years of schooling on having taken a PSA test.
Conclusion: Similar to the MDRs patterns in other domains, non-Latino White men show more health gain from their years of schooling than Latino men. Highly educated Latino men still need programs to encourage their use of prostate cancer screening.

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 Introduction: A case of pulmonary sarcoidosis is reported because of difficulties in diagnosis and treatment, including the co-existence of ankylosing spondylitis (AS) and severe corticosteroid dependence.
Case Presentation: A 48-year-old nonsmoking woman referred to the hospital because of chronic nonproductive cough and dyspnea with a 10-year history of AS. Bilateral rhonchi was detected in lung auscultation. There was a significant limitation in lumbar activity and range of motion in flexion (positive Schober’s test), extension, and lateral bending. In lumbosacral magnetic resonance imaging (MRI), irregularities in the sacroiliac joint and bilateral sacroiliitis were evident. The angiotensin-converting enzyme level was elevated. Biopsy in hilar lymphadenopathy by transbronchial lung biopsy was done, and the histopathological findings showed chronic non-necrotizing granulomatosis inflammation compatible with sarcoidosis. Anti-tumor necrosis factor drugs was effective on steroid-dependent coexisting of sarcoidosis and AS. The symptoms were absent in regular follow up.
Conclusion: Pulmonary fibrosis due to sarcoidosis can be prevented by suitable treatment. Clinical trials are needed to confirm the impact of treatments with monoclonal antibodies against tumor necrosis factor (TNF), for curing sarcoidosis.

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