Grief experience among ICU staff with loss of family members during COVID-19 outbreak in IRAN: A qualitative study

IntroductionThe COVID-19 crisis created a lot of problems in people's lives. Different lifestyles, mental health, communication, rituals and traditions, particularly those involved in mourning, have changed drastically. Medical staff faced numerous critically ill patients every day. This greatly distressed the staff, especially the ICU staff. The end result was considerable amounts of mental distress for the medical staff who lost family members to COVID-19 making the distress even more complex.MethodsWe carried out this qualitative research to study the grief experiences of 12 Iranian ICU staff members at the Rasoul Akram Hospital who had experienced the loss of a family member to the COVID-19 pandemic. We studied the effects of how their own grief experience and how constant exposure to critically ill patients influenced their work with patients. All semi-structured interviews were held in the presence of a faculty member of the psychiatry department of Iran University of Medical Sciences. The interview on the grief experience among ICU staff during the COVID-19 pandemic, consists of 4 issues: Familiarity, Experience during the COVID-19 pandemic, Grieving the loss of a family member and Effects of parallel grief.ResultsWe found five common themes in the result of the experiences of the participants based on content analysis. These consisted of: complex grieving process, new experiences for coping with loss, more empathy for patients, change the meaning of death, and the need for support in work places. Likewise, there were 22 sub themes.ConclusionPaying attention to the details of staff members' life, gender differences, and cultural aspects can give us a better understanding and perception of their grief experiences. This understanding brings out valuable points which can help policy makers pass better laws for the wellbeing of society and people in order to promote leadership in turbulent times

Actual Costs of Residency Training in Teaching Hospitals: A Case of Iran

Background: There was a challenge for teaching hospitals to accept residents for educational goals due to their training costs. Objectives: The present study aimed to estimate the actual costs of residency training in hospitals for policymaking, budgetary impact, and negotiation. Methods: This retrospective study was performed in eight teaching hospitals affiliated with the Iran University of Medical Sciences, Tehran, Iran, in 2018. Two scenarios were designed to estimate the costs of education per resident. All of the resources used by residents in the hospitals were identified. Cost items attributed to the training goals were allocated to the internal medicine and surgical fields; however, for cost items that were used for treatment and education, such as disposables and consumables and equipment, the cost drivers were used. Therefore, the difference between the scenarios was related to the cost drivers. Results: Overall, the selected hospitals had spent $586,720.35 and$ 572,358.10 based on scenarios 1 and 2, respectively. The residency training per surgical resident in the hospitals was about 1.2 times higher than an internal medicine resident. Surgery, neurology, urology, and anesthesiology were the f ields with the highest costs in the hospitals. Conclusion: Although residency training accounts for a large proportion of hospital costs, employing residents reduces the costs of human resources. Monitoring and controlling costs, as well as resource quotas for resident training, can be a way to reduce educational course costs in hospitals. Universities can cover some parts of the educational costs to motivate hospitals to make an appropriate setting for residents. Keywords: Cost Analyses, Academic Medical Centers, Internship and Residenc

Educational environment of operating rooms in teaching hospitals of Tehran, Iran, and Shahid Beheshti Universities of Medical Sciences based on ATEEM questionnaire: anesthesiology residents` perspective

Introduction:Teaching experience in operating room is the core of learning for residents of anesthesiology. Therefore, the present study was carried out to evaluate the learning environment of operating rooms from viewpoints of anesthesiology residents in teaching hospitals of Tehran, Iran, and Shahid Beheshti Universities of Medical Sciences based on ATEEM questionnaire. Methods:In this descriptive cross-sectional study, views of 156 anesthesiology residents regarding the learning environment of operating rooms in hospitals associated with Tehran, Iran and Shahid Beheshti Universities of Medical Sciences were collected by means of census method using ATEEM (Anesthetic Trainee Theatre Educational Environment Measure) questionnaire in 2014-2015. Data were analyzed using independent t-test and one-way ANOVA. Results:Final mean score of the questionnaire was 114. 03±23. 59 (out of 160) and at a desired level. Total mean scores of all domains were 113. 59±25. 12 and 114. 85±21. 78 for female and male residents respectively and were not significantly different (p=0. 742). Comparison of mean scores in terms of academic year showed significant difference (p=0. 032, F=3. 025) regarding the domain of residents’ perception of faculty members and teaching however, no significant difference was found in other domains. Conclusion:Results showed that residents’ perspective of the learning environment in operating rooms was favorable. It seems that high workload and interference with training programs and lack of learning opportunity during practice are weaknesses of this learning environment that needs to be further investigated and handled by the competent authorities

Superior hypogastric plexus block as an effective treatment method for endometriosis-related chronic pelvic pain: an open-label pilot clinical trial

We aimed to investigate the effect of superior hypogastric plexus (SHP) block on pain relief and quality of life of patients with refractory endometriosis. Sixteen patients with refractory endometriosis underwent SHP block. The outcome measures included visual analogue scale (VAS) for chronic pelvic pain, VAS for dysmenorrhoea, and VAS for dyspareunia. The short-form endometriosis health profile (EHP-5) was used to measure quality of life. All the outcome measures were evaluated at weeks 0, 1, 4, 12 and 24. The mean baseline VAS scores significantly improved after the SHP block (p < .001 for all). The mean overall EHP-5 score also significantly improved from 54.3 ± 18.2 to 24.6 ± 13.3 (p < .001). The positive effects of SHP were not diminished over time. No serious adverse effect was noticed in any of the patients. Preliminary results suggest that SHP block could be used as an effective method in pain control and improvement of quality of life in refractory endometriosis.IMPACT STATEMENT What is already known on this subject? Safety and efficacy of SHP block in the treatment of CPP has been revealed in earlier investigations. However, the efficacy of SHP block for pain management in patients with refractory endometriosis has not been investigated in earlier investigations. What do the results of this study add? SHP block is an effective method for pain control and improvement of quality of life in patients with refractory endometriosis. The positive effects of this treatment did not diminish over 24-weeks follow-up of the study. No serious adverse effect was noticed in any of the patients. What are the implications of these findings for clinical practice and/or further research? Preliminary results suggest that SHP block could be used safely and effectively for controlling pain and improvement of quality of life in patients with refractory endometriosis