Effective Factors on Maintaining Neonatal Resuscitation Skills among the Nurses and Midwives in Kerman Province Hospitals

Background & Objective : Many cases of neonatal deaths which are caused by asphyxia could be prevented by appropriate resuscitation. Successful resuscitation depends on several factors including the skill of nurses and midwives involved in taking care of sick neonates. Methods : In this study, 88 nurses and midwives in Kerman Province Hospitals participated and all completed an 11-hour neonatal resuscitation course. Among the participants, 25 were selected for the based line survey. After five months, all of them sat for a theoretical and practical test including nine stations. Results : Five months after the workshop, the mean theoretical and practical scores of the participants in different hospitals showed a significant difference (P=0.0001). Scores of the practical test varied in different stations. The highest score belonged to “neonate’s tactile stimulation” while the lowest was given to “resuscitating a non vigorous meconium stained neonate”. There was a weak inverse yet significant relationship between age and the time past from graduation with the practical score (P=0.035, r=-0.23 and P=0.017 and r=-0.25 respectively). Practicing on mannequin and studying the provided notes on resuscitation led to getting a significantly higher score (P=0.0001 and P=0.046 respectively). Conclusion : This study shows that teaching resuscitation alone may not guarantee skill in people. Maintaining resuscitation skill is influenced by factors such as age, job status, practicing on mannequin, and participation in neonatal resuscitation. Keywords: Neonatal resuscitation, Maintaining resuscitation skills, Nurse, Midwife, Neonate

Personal and Scientific Characteristics of Positive and Negative Role Models among Medical Educators from the Viewpoint of Dentistry and Pharmacy Students in Kerman University of Medical Sciences, Iran

Background & Objective: Several factors play an integral role in the quality of higher education and improving its processes. Professional role modeling is one of the most determining factors in achieving educational goals and fostering better learning. Hence, the aim of this study was to investigate the scientific characteristics of positive and negative role models among medical educators from the viewpoint of the dentistry and pharmacy students in Kerman University of Medical Sciences (Kerman, Iran). Methods: In this descriptive, analytical, cross-sectional study, a structured and self-administered questionnaire was completed by 94 senior pharmacy and dentistry students. The questionnaire contained pre-specified items in 3 sections relating to the demographic characteristics of respondents and scientific characteristics of positive and negative role models. Results: The highest mean scores for positive role models were given to features as being respectful to colleagues (8.75), being knowledgeable (8.52), having teaching competencies (8.49), being good tempered (8.45) and being kind (8.43). There was not a statistically significant difference between the positive role models [age, gender, education level (basic-clinical)] and the scientific rank. The highest mean scores for negative role models were given to the features as deserving blame (-6.97), having no teaching competencies (-6.41), not being kind (-6.09), not being a good manager (-6.08) and not being respectful to students (-6.03). There was only a significant difference between the negative role models and scientific rank (P = 0.029). Totally, 2 positive and 3 negative characteristics were identified for professional and non-professional role models. These characteristics can be classified into ethical behavior and communication, educational and managerial skills, and scientific competencies. There was not a statistically significant difference regarding the association between the scientific characteristics of positive and negative role models and the general characteristics of the respondents in terms of age variable. Conclusion: Our results suggested that the positive and negative characteristics of teachers formed a significant part in their acceptance and choosing them as role models from the perspectives of students. To achieve the educational goals and improving our higher education system, special attention should be given to these aspects as personality, professionalism and scientific characteristics. Keywords Clinical lecturer Role models Dentistry students Pharmacy student

Educational Environment Assessment at Outpatient Clinics in Teaching Hospitals of Kerman University of Medical Sciences, Iran, from Residents' Perspective Based on the ACLEEM Questionnaire

Background & Objective: Outpatient educational environments are used for the teaching of a broad range of medical disciplines. Therefore, it is of utmost importance to assess these environments with valid and reliable tools. The Ambulatory Care Learning Education Environment Measure (ACLEEM) can be used for this purpose. The objective of this study was to assess the educational environment at outpatient clinics in teaching hospitals of Kerman University of Medical Sciences, Kerman, Iran. Methods: This descriptive-analytical study which was cross-sectional in nature was conducted in Kerman University of Medical Sciences in 2013-14. The study population, based on census sampling, consisted of 70 residents specializing in internal, gynecological, pediatric, and surgical disciplines. The data collection tool was a valid and reliable questionnaire consisting of 2 sections, demographic questions and 50 questions in 8 domains. Data were analyzed using SPSS software and descriptive tests (frequency, mean, and standard deviation) and analytical tests (ANOVA and t-test). Results: The total score of the questionnaire was 62.90 which showed the partially desirable status of the outpatient educational environment in the studied population. In terms of the total scores for each domain, the domains of clinical teacher competence (14.91 ± 2.99), clinical activity and patient care (12.85 ± 2.78), and time allocation for nonclinical activities (8.94 ± 2.93) obtained the highest scores, respectively. There was no significant relationship between sex, age, and educational year and mean score of each domain (P > 0.05). However, this relationship was significant for the field of study variable (P < 0.05). The highest mean score was related to gynecology residents (65.68 ± 5.7) and the lowest mean score was related to surgery residents (60.60 ± 5.9). Conclusion: The findings showed that the residents' perspective of the outpatient environment is not satisfactory. Therefore, it is expected that the related authorities provide a favorable and conducive environment for teaching and learning through planning. Keywords: Educational environment; Ambulatory Care Learning Education Environment Measure (ACLEEM); Residents; Kerman; Ira

Design, Implementation, and Evaluation of a Medical Education Fellowship Program for the Faculty Members of Kerman University of Medical Sciences Based on the Kirkpatrick Model

Background: Attempts to increase the development of faculty members can improve their ability to assume different roles. Objectives: The purpose of this study was to design, implementation, and evaluation a medical education fellowship program for the faculty members of Kerman University of Medical Sciences and to propose practical recommendations for the future design of development programs. Methods: In this semi-experimental study, a total of 53 faculty members of Kerman University of Medical Sciences participated in a one-year development program, which was designed by the Education Development Center and included the main disciplines of medical education. The program was evaluated in several steps, using the Kirkpatrick model. Results: In the first level of Kirkpatrick model, the majority of the participants were satisfied with the general quality of the fellowship program. Based on the findings, the program led to an increase in the knowledge of faculty members and promoted a more positive attitude towards education and these programs. The findings related to the second level of Kirkpatrick model showed a significant difference between the pretest and posttest results (P < 0.05). In addition, analysis of the effects of the program on the participants’ behaviors and practical learning indicated positive changes. Conclusions: The medical education fellowship program led to positive changes in the participants’ attitudes towards education and faculty development programs and increased their knowledge about educational principles and strategies and achieving of training skills. It can be concluded that the medical education fellowship program could achieve many of its preset goals. Keywords Faculty Development Programs Medical Education Faculty Member

Investigation of Arterial Geometry as a Local Risk Factor for Carotid Atherosclerosis

There is little doubt that disturbed hemodynamic forces play a role in the development of focal atherosclerotic lesions; however, these forces are difficult to measure directly. Instead, it has been proposed that artery geometry, as the primary determinant of local hemodynamics, could be a clinically feasible surrogate &ldquo;local&rdquo; risk factor for atherosclerosis. To date this hypothesis has not been satisfactorily tested, owing to superficial geometric surrogates of disturbed flow, small sample sizes (effect of systemic factors) and/or confounding effects of disease on geometry. The primary objective of this thesis was to test this &ldquo;geometric risk hypothesis&rdquo; via direct association of definitive geometric factors and an early atherosclerosis marker (e.g. wall thickness), made possible through our access to magnetic resonance imaging and risk factor data from the Atherosclerosis Risk in Communities&rsquo; Carotid MRI sub-study. First, it was shown that the 3D geometry of the carotid bifurcation could be characterized rapidly and reliably, even for routine clinical acquisitions. Second, two novel individual geometric variables were proposed, inspired by the influence of flare and tortuosity on flow separation, which were shown to improve the prediction of disturbed flow burden compared to &ldquo;conventional&rdquo; shape-based geometric variables. Third, these redefined geometric factors, but not their shape-based counterparts, were shown by multiple regression to be independent predictors of wall thickness, but only after thoroughly accounting for the secondary effects of wall thickening on geometry. These findings provide strong evidence for the geometric risk hypothesis of atherosclerosis in humans group study, and provide important guidance for future investigations of geometric risk; however, the incremental value of optimized geometric risk factors is questionable relative to conventional cardiovascular risk factors, which challenges their future clinical usage as additional non-modifiable local risk factors.Ph

The Etiology of Acute Renal Failure in the Newborn Infants Admitted to the NICU at Afzalipour Medical Centre, Kerman, IRAN

Abstract: Introduction: Despite the countless benefits of breast milk, each year many infants are admitted to NICU's with clinical symptoms and laboratory indicators of dehydration and renal failure due to the lack of a national program to monitor post discharge breastfeeding over the first few days of life. In addition to identifying the role of inadequate breast milk intake as a cause of renal failure, the purpose of this study was to assess causes, clinical presentations and laboratory tests in acute renal failure and to identify the most available and practical laboratory test to differentiate prerenal from renal azotemia. Methods: A cross-sectional prospective study was performed between April 2005 and May 2006 (14 months) at Afzalipour Medical Centre in Kerman, Iran. All neonates with high serum blood urea and creatinine were included in the study. The percentage of weight loss, breast feeding, mode of delivery, and clinical presentations were recorded. Laboratory tests such as blood urea, serum and urine sodium and creatinine and, urine specific gravity were done. Data were analyzed by SPSS software, chi- square test and t- test. Results: Among 36 neonates, who were eligible for the study, 29 cases (80%) had dehydration (group I) and 7 cases (20%) had intrinsic renal failure (group II). In the first group, mean weight loss was 14% and mean age at admission was 10 days. Reasons for admission were poor feeding (69%), lethargy (58%), fever (30%), jaundice, vomiting and seizure. The mode of delivery in 69% of cases were vaginal route and 82% of cases were breast-fed. Decreased urine frequency in the previous day (<6 times per day) was considered more significant than decreased stool frequency (< 3 times per day). Serum sodium and urine specific gravity in group I was significantly higher than group II (P< 0.05). Conclusion: This study confirms that an excessive weight loss over the first few days of life and decreased urine and stool frequency might be considered as a warning for failure of receiving enough milk. Serum sodium and urine specific gravity are the most sensitive laboratory parameters, for the assessment of dehydration. Keywords: Acute renal failure, Newborn infant, Dehydration, Azotemia, Breastfeedin

Nasal Colonization Rate of Community and Hospital Acquired Methicillin Resistant Staphylococcus Aureus in Hospitalized Children

Background & Aims: Prevalence of community and hospital acquired methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing. The primary reservoir is the anterior nares; and nasal carriage is a risk factor for infection in a variety of populations. Infection due to hospital-acquired colonization is different from community acquired in clinical manifestations and antibiotics susceptibility. In this study, we investigated nasal colonization rate and antimicrobial susceptibility of community and hospital acquired staphylococcus aureus nasal colonization at childhood. Methods: This cross-sectional study was conducted in children admitted at Kerman Afzalipour hospital, Iran, during June to November 2011. Sample was taken from nostrils of 180 patients in the beginning and after 48 hours of admission for staphylococcus aureus nasal colonization and antibiotics susceptibility test. Results: Of 180 samples at the beginning of hospitalization, 22 (12.2%) had staphylococcus aureus nasal colonization; from these, 18.1% were methicillin-resistant (2.2% of total population). Methicillih-resistant staphylococcus aurous colonized children had significantly greater mean age than non-colonized (P < 0.001). After 48 hours, 22 (12.2%) were colonized with staphylococcus aurous; from these, 11 (50%) were hospital acquired methicillih-resistant. All methicillih-resistant staphylococcus aurous isolates were sensitive to vancomycin. The rate of resistance to the other current in-use antibiotics was more common in hospital acquired staphylococcus aureus. Conclusion: Community acquired methicillih-resistant staphylococcus aurous is sensitive to many anti- staphylococcus agents in our region. Methicillin-resistant Staphylococcus aureus (MRSA) colonization in admitted patients can occur. Empirical antibiotics recommendation in nosocomial infection should be on the base of periodic culture and antibiotics susceptibility test. Keywords: Nasal colonization, Community acquired, Methicillih-resistant staphylococcus aurous, Hospital acquired, Childre

Predictive Value of Nucleated Red Blood Cell Counts in Cord and Peripheral Blood of Asphyxiated Term Neonates in the First Week of Life

Introduction: Increased numbers of nucleated red blood cells (NRBC) circulating in the blood of neonates can be associated with relative hypoxia and adverse outcomes. Thus, the aim of this study was to assess the NRBC count during the first week of life in neonates diagnosed with asphyxia as compared to healthy neonates and to determine the short-term morbidity and mortality for the affected babies. Methods: The cross-sectional study compared 15 healthy neonates with 15 neonates diagnosed with asphyxia confirmed by pH of cord blood or Apgar scores. The nucleated red blood cell (NRBC) counts were calculated right after birth, and on days 3 and 7, and the hematological parameters of umbilical cord blood were also evaluated. The infants were followed for mortality and associated morbidity. Statistical analysis was conducted using the Mann-Whitney U test, analysis of variance, chi-square tests, and Pearson’s correlation coefficient. A p-value < 0.05 was considered as statistically significant. Results: The initial NRBC counts were significantly higher in the asphyxiated group than in the control group and the difference remained significant through the end of first week. All of the umbilical cord blood parameters were significantly lower in the study group and were negatively correlated with the NRBC count. At birth, higher NRBC count correlated with higher mortality. conclution: Results show that NRBC count is a useful predictive factor for neonatal asphyxia through the end of the first week of life, although a larger study population and a longer follow up period seems to be necessary

The role of education methods, on knowledge and skills of neonatal resuscitation in nursing students

Background: Birth is probably considered as the most highly dangerous event in every one’s life. Although a few percent of newborns may require resuscitation in this stage, wrong methods or failures would lead to death or leave some irreversible complications. That is why it is of great importance to learn the proper methods and become skilful in resuscitation. This study was conducted to compare the effectiveness of conventional and recommended methods of teaching resuscitation to nursery students.Methods: The research is an interventional–semi experimental study. The samples were 46 nursery students of the third semester who were divided into two groups of 23 according to their place of residence. The resuscitation was taught through the conventional and recommended methods. The conventional method consists of teaching all the theoretical subjects by different instructors and performing the related team work. In recommended method the time specified to theoretical subjects is less, and most of the subjects are somehow included in practical work. A pretest was given in the two groups and after the training a final theoretical and practical test was held through the OSCE methods. The findings were analysed by using the SPSS software and some statistical tests as: Mann Whitney U-test, Independent sample t-test, Pearson correlation, paired t-test.Findings: The findings of this study show that there is no significant difference between the primary knowledge of the students in the two groups. The post-test scores are higher in both groups and the difference is significant which suggests that training has been efficient in both groups. Comparing the post-test scores (practical and theoretical) shows no significant difference. There is no significant difference between the increase in practical and theoretical scores of both groups either. Conclusions: considering less time (1/2) and lower costs (1/4) spent on training in the recommended method, there was no change in efficiency

Can we Replace Arterial Blood Gas Analysis by Pulse Oximetry in Neonates with Respiratory Distress Syndrome, who are Treated According to INSURE Protocol?

Neonates with respiratory distress syndrome (RDS), who are treated according to INSURE protocol; require arterial blood gas (ABG) analysis to decide on appropriate management. We conducted this study to investigate the validity of pulse oximetry instead of frequent ABG analysis in the evaluation of these patients. From a total of 193 blood samples obtained from 30 neonates <1500 grams with RDS, 7.2% were found to have one or more of the followings: acidosis, hypercapnia, or hypoxemia. We found that pulse oximetry in the detection of hyperoxemia had a good validity to appropriately manage patients without blood gas analysis. However, the validity of pulse oximetry was not good enough to detect acidosis, hypercapnia, and hypoxemia