Hospital Practices and Research

Abstract Background: Digital transformation through the use of technologies like blockchain, Artificial Intelligence (AI), and the Internet of Things (IoT) is the main focus of the 4th generation technology. In smart hospitals, the 4th generation technology boosts productivity while cutting expenses, permits monitoring and early diagnosis, and enhances the quality of medical services.
Objectives: This study was carried out with the intention of implementing the 4th generation technology tools in smart hospitals, given the current technological breakthroughs and the need for smart hospitals in Iran.
Methods: The current research is bibliometric in nature. All the papers published between 2000 and 2024 that had focused on the themes of smart hospitals and the 4th generation technologies which contained keywords like blockchain, AI, the IoT, and smart hospitals make up the study's population. Advanced searches in the citation ScienceDirect and PubMed databases were used to gather the data for this investigation. The citation network was visualized and examined using VOSviewer software.
Results: According to this survey, when it comes to the use of the 4th generation technology tools in smart hospitals, 40% of the articles mention improving patient care, 35% highlight operational efficiency, and 25% stress data driven decision making as important elements.
Conclusion: In addition to boosting patient safety, monitoring, early diagnosis, and the quality of medical services, the 4th generation technology tools are essential for converting a conventional hospital into a smart hospital and cutting expenses. These instruments are therefore crucial for enhancing patients' comfort and well-being in smart hospitals.

Abstract Background: Infection prevention, control, and health workers’ safety in the face of biological agents are among the vital issues in healthcare systems worldwide. Considering the high prevalence of COVID-19 infection and its high mortality rate, this epidemic can be tackled to some extent through infection control in the general population and promoting the safety of health centers.
Objectives: The aim of this study was to scrutinize the literature regarding measures adopted for infection control and safety of healthcare workers in health centers during the beginning of COVID-19.
Methods: A systematic review following the PRISMA guidelines was performed. Keywords related to the study namely, “prevention and control”, “safety”, “coronavirus”, “COVID-19”, and “health personnel” in PubMed, Web of Science, ScienceDirect, Scopus databases, and Google Scholar using AND/OR functions from February 2020 to July 2020 were searched. To select the documents, the titles of the retrieved studies were first evaluated for relevance; then, the abstracts and full texts of the papers with relevant titles were inspected.
Results: Out of 136 retrieved studies, 10 were relevant and their data were analyzed. Four articles highlighted the importance of prevention, three enunciated the importance of control, and three related to care providers’ safety. The results showed that the COVID-19 epidemic has affected the healthcare providers’ health; however, it is possible to prevent a catastrophe through strategic planning, prevention, and control measures.
Conclusion: Considering the importance of healthcare workers’ health, it is necessary to implement COVID-19 prevention and control management principles based on scientific evidence.

Abstract Background: Treatment adherence is a critical factor in controlling symptoms and determining the success of treatment in chronic disease management.
Objectives: The aim of this study was to investigate the relationship between health literacy levels and adherence to pharmacological treatment in patients with Rheumatoid Arthritis (RA).
Methods: This cross-sectional study included 196 patients. The mean age of participants was 47.35 ± 15.95 years. Socio-demographic and clinical characteristics of the patients were recorded. Health literacy levels were assessed using the Türkiye Health Literacy-32 (THL-32) Scale. Medication adherence to the pharmacological treatment was assessed using the Medication Adherence Report Scale (MARS).
Results: THL-32 and MARS scores were compared according to the demographic characteristics, and a significant difference was found between the education level and place of residence groups. A multivariate regression model was used to assess the connection between them. Health literacy was found to be 3.88 times higher in urban areas compared to rural areas, 4.12 times higher in those with high school education compared to primary school, and 4.39 times higher in those with higher education compared to other levels. In terms of medication adherence, it was found to be 4.18 times higher in urban areas compared to rural areas, 3.1 times higher in those with high school education compared to primary school, and 3.6 times higher in those with higher education compared to other levels.
Conclusion: This study demonstrated that health literacy is positively associated with medication adherence in patients with rheumatoid arthritis. These findings highlight the importance of focusing on health literacy to improve adherence to treatment. Health professionals should prioritize enhancing health literacy to support better disease self-management and treatment outcomes.

Abstract Background: Psychosomatic disorders, characterized by the interplay of psychological and physical factors, often manifest as gastrointestinal symptoms, and traditional medical treatments alone may not effectively address the underlying psychological factors, leading to persistent or recurring issues.
Objective: The present study aimed to investigate whether Intensive Short-Term Dynamic Psychotherapy (ISTDP) is more efficacious than a control group in enhancing ego strength and alleviating gastrointestinal symptoms in individuals diagnosed with psychosomatic disorders.
Methods: A quasi-experimental study with pre- and post-assessments, a two-month follow-up, and a control group was conducted on 32 randomly assigned participants in District 3 of Tehran in 2020. The experimental group received 15 sessions of 90-minute ISTDP, while the control group received no intervention. Participants were assessed using the Psychological Inventory of Ego Strength (PIES) and the Gastrointestinal Symptom Rating Scale (GSRS). Repeated measures ANOVA was used to analyze the data using SPSS-22. Bonferroni post hoc tests were conducted to compare the experimental and control groups at each time point (pre-test, post-test, and follow-up).
Results: Findings revealed a significant difference between the experimental and control groups in terms of ego strength and gastrointestinal dysfunctions at the post-test (P<0.001). ISTDP led to a significant improvement in ego strength and a reduction in gastrointestinal symptoms in psychosomatic patients with gastrointestinal complaints at post-test (P<0.001).
Conclusion: ISTDP is a promising treatment for psychosomatic disorders, particularly those involving gastrointestinal symptoms. ISTDP effectively enhances ego strength, a key factor in mental health, and can also alleviate physical symptoms.

Abstract Background: The process of discharge is one of the important factors related to patient satisfaction. As the final step in the hospital experience, the discharge process is likely to be well remembered by the patient. Even if everything else goes satisfactorily, a slow, frustrating discharge process can result in low patient satisfaction.
Objectives: The present study was carried out with the aim to reduce the time taken in the discharge process. The objectives were to find the average duration in the process of discharge in major clinical wards and to find key steps affecting the duration of discharge.
Methods: A mixed methodology observational study involving Google forms for recording observations and focus group discussions of key stakeholders were used to carry out this study.
Results: The mean duration of discharge process was 372 minutes with the standard deviation of 68.5. The mean time of 248 minutes with a SD of 43.3 was taken for preparation of discharge summary. The mean time of completing files was 164 minutes with a SD of 37.
Conclusion: The biggest bottleneck in the process of discharge was the preparation of discharge summary, followed by the clearance of files from various departments. The common found reasons were overburdened junior residents, lack of planning of discharge, untrained nursing staff, incomplete documentation, patient counseling, lack of manpower, and lack of coordination among nursing staff and junior residents. It is recommended to plan the discharge better and hold regular workplace meetings of junior residents, nursing staff, billing department, and medical superintendent to manage the communication gaps and better coordination.

Abstract Background: Students who have lost a parent often experience low levels of self-efficacy and quality of academic life due to the psychological distress caused by this loss.
Objectives: The study aimed to determine if positive psychology training could improve the self-efficacy and academic performance of students who had lost a parent.
Methods: This quasi-experimental research adopted a pretest-posttest design with a two-month follow-up. The study focused on female senior high school students in Ahvaz, Iran, who had lost a parent in 2022. Forty eligible students were selected through purposive sampling and then randomly assigned to either an experimental group or a control group. The participants in the experimental group received a ten-week positive psychology training intervention, consisting of weekly 90-minute sessions. The control group served as a no-intervention comparison group. The research data, collected using questionnaires on self-efficacy and quality of academic life, were analyzed using a repeated measures ANOVA in SPSS-23.
Results: The results showed that positive psychology training significantly affected the self-efficacy and quality of academic life in participants (P<0.001). The positive psychology group exhibited significantly higher mean post-test scores on both self-efficacy (83.90 ± 7.56) and quality of academic life (146.40 ± 10.64) compared to the control group (45.20 ± 5.35 and 101.05 ± 6.88, respectively).
Conclusion: The study found that positive psychology training can significantly improve the self-efficacy and quality of academic life of students who have experienced the loss of a parent. This suggests that such interventions could be beneficial for supporting the overall well-being and academic success of these students.

Abstract Background: Health Literacy (HL) is closely related to health status. Measuring public HL levels helps to warn about health status and manage health problems through timely interventions. The items of relevant evaluation tools are complex and numerous in Iran, and there is no recognized HL brief scale for the whole population.
Objectives: The aim of this study was to translate the Health Literacy Scale Short-Form (12-item) (HLS-SF12) and test the validity and reliability of the Persian version of the HLS-SF12 in the Iranian population.
Methods: This research was descriptive with a psychometrics aim. The research population included 289 male and female students from four faculties of Islamic Azad University of Dezful, who were selected using a random sampling method. The Persian version of HLS-SF12 was used to collect data. The construct validity (exploratory factor analysis and confirmatory factor analysis) and internal reliability of the instrument were evaluated. The research data was analyzed using SPSS-26 and AMOS-26 software.
Results: The Cronbach's alpha reliability of the HLS-SF12 and subscales were in the range of 0.72 to 0.88. Exploratory factor analysis confirmed the existence of three factors in HLS-SF12. Confirmatory factor analysis supported the original three-factor model of the questionnaire, and fit indices indicated a good model fit index for Persian HLS-SF12 (GFI=0.961, CFI=0.974, IFI=0.966, TLI=0.971, and RMSEA=0.073).
Conclusion: The Persian version of HLS-SF12 has good reliability and validity, and can be used as a tool to evaluate the HL of Iranian students. In addition, due to the strength of the structure and having appropriate psychometric specifications, HLS-SF12 had the capability to be used by researchers.

Abstract Introduction: Histoplasmosis is a granulomatous fungal disease, caused by Histoplasma capsulatum; an intracellular dimorphic fungus, usually found in soil contaminated with bird and bat excreta; transmitted by aerosolized microconidia inhalation. The most common clinical presentation is acute or chronic Pulmonary Histoplasmosis.
Case Presentation: In this case report, a perplexing diagnostic scenario involving a 56-year-old patient who was HIV-negative but had diabetes mellitus and hypertension, in conjunction with unclear dermatological lesions has been presented. Despite treatment, the lesions did not respond favourably, posing a diagnostic dilemma. The identification of yeast forms in skin biopsy indicated progressive disseminated histoplasmosis, a diagnosis validated by PCR analysis, detection of Histoplasma galactomannan antigen in urine, and a positive fungal culture. A course of IV Liposomal Amphotericin B followed by oral Itraconazole, resulted in a favourable response.
Conclusion: Immunocompromised patients often exhibit mucocutaneous involvement, which is uncommon in immunocompetent individuals without specificity, leading to diagnostic difficulties. Although the patient lived in a non-endemic region, a travel history to Gangetic Plains, an endemic area for histoplasmosis, was elicited. Therefore, a comprehensive patient history is essential for diagnosis, in addition to microbiological and histopathological results.