A Qualitative Study on the Experiences of Specialists on Patient-Oriented Decision Making in a Developing Country

Introduction: Patient centered decision making is one of the main aspects of evidence –based medicine, in addition to being morally important. The aim of this study was to extract the experiences of clinicians on patient-centered decision making. Method: A qualitative study based on descriptive phenomenology method was done. Purposive sampling was used to select the clinicians from among faculty members of medical school. Focus Group Discussion (FGD) was used to gather the data .The discussion continued till the saturation of data was achieved. Content analysis was used for data analysis. Results: The participants of FGD were 6 clinicians from various specialties. 218 codes were extracted from the data and they were categorized in 4 themes and 16 subthemes. The main themes were: good relationship with patients, respect to the opinions and beliefs of the patients, taking into account the needs, preferences and experiences of the patients, comfort and safety of outpatient and inpatient setting for patient, shared decision making. Conclusion: Patient centeredness based on the experiences of clinicians in an educational hospital is similar to other studies but in developing countries like Iran clinicians have contextual and cultural barriers to apply it

In Patients with Minor Beta-Thalassemia, Cognitive Performance Is Related to Length of Education, But not to Minor Beta-Thalassemia or Hemoglobin Levels

Objective:; Thalassemia is one of the most frequent monogenic disorders, leading to impairment in the maturation and survival of red blood cells. The question examined here is whether, and if so, to what extent, people with beta-thalassemia might also be impaired in their cognitive functioning. Previous results in adults with beta-thalassemia showed cognitive impairment when compared to healthy controls. However, length of education was never taken into consideration as a possible confounder. Accordingly, the aim of the present study was to assess people with minor beta-thalassemia and compare them to healthy controls, while controlling for length of education.; Method; :; A total of 25 adults (mean age: 29.36 years; 56% females) with beta-thalassemia and 25 healthy controls (mean age: 27.84 years; 72% females) took part in this cross-sectional study. They underwent cognitive testing (executive functions, attention, working memory), and their haemoglobin levels were assessed.; Results:; Cognitive performance did not significantly differ between patients with minor beta-thalassemia and healthy controls. Irrespective of group, higher cognitive performance was strongly associated with time spent in education. No gender differences were observed.; Conclusion:; Compared to healthy controls, cognitive performance was not impaired among patients with minor beta-thalassemia when length of education was introduced as a further co-variate. In both patients with minor beta-thalassemia and healthy controls, higher cognitive performance was associated with time spent for education. Health professionals should inform patients with minor beta-thalassemia that cognitive performance is related to the length of education and not to the health status of minor beta-thalassemia per se

The Frequency of Intraventricular Hemorrhage and its Risk Factors in Premature Neonates in a Hospital’s NICU

Abstract Objective Intraventricular hemorrhage (IVH) is an important cause of mortality and disability in premature neonates. Regarding this, the present study aimed to determine the frequency of IVH and its risk factors in the premature newborns admitted to the Neonatal Intensive Care Unit (NICU)at Fatemieh Hospital in Hamedan, Iran, 2016.  Materials & Methods  This cross-sectional study was conducted on178 neonates with a gestational age of ≤ 32 weeks admitted to Fatemieh Hospital affiliated to Hamadan University of Medical Sciences, Hamedan, Iran, in 2016. The study population was selected using census method. The newborns were subjected to cranial ultrasound on the seventh day of life. and they were assigned into two case and control groups (namely neonates with IVH and those without IVH, respectively). Intra- ventricular hemorrhage was classified into four grades regarding Papile classification. The patients’ demographic specifications, including 1- and 5-minute Apgar scores, type of delivery, birth weight, use of mechanical ventilation, prenatal corticosteroid, gestational age, and some complications (e.g., Pneumothorax), were collected using a checklist. The data were analyzed using SPSS software version 16 Results According to the results, prevalence of IVH in premature infants admitted to NICU was approximately 20 %,  , 61.2% of the neonates were male. The mean gestational age of the participants was 30.39 weeks. The comparison of delivery type between the case and control groups showed no significant difference between them in this regard(P=0.197). Furthermore, there was a significant difference between the two groups in terms of need for mechanical ventilation (P=0.03), pneumothorax risk of this condition in the preterm neonates is enhanced by some factors, such as low birth weight, 5-minute Apgar score, and gestational age as well as the need for mechanical ventilation. (P=0.001), and 5-minute Apgar scores (P=0.04). Additionally,the incidence of IVH showed a significant relationship with the mean gestational age (P=0.001) and birth weight (P=0.04). Conclusion According to the findings, the premature newborns admitted to the NICU revealed a relatively high prevalence of IVH. The condition is aggravated in preterm neonates by some factors such as low birth weight, 5-minute Apgar score, gestational age, and the need for mechanical ventilation

Pain Management and Its Related Factors in the Emergency Department of Besat Hospital in Sanadaj, 2016

Abstract:Background: Pain is a distressing feeling as well as a discomfort which triggers as the result of a special stimulation of nerve endings.This study aimed to investigate the amount of sufficient pain management among patients referring to the emergency department in Besat Hospital in the city of Sanandaj in Iran.Material and Methods: in this descriptive-analytical study, 175 patients with severe pain intensity higher than 3 and definite causes of pain with physical origins admitted to the emergency department were included. Before and after analgesics injection, pain intensity was assessed by a 10-point scoring system.Results: No significant correlation showed between pain intensity in patients, administration of painkillers, and age (P>0.05).There was a statistically significant relationship between pain intensity, gender, and the type of analgesics received (P<0.05). The findings of this study also revealed that reduction of pain was not significantly correlated with age, gender, referral time, and administration of painkillers on patients (P> 0.05).Conclusion: Failure to control pain among patients can lead to physical, mental, psychological, and social health-related problems. Therefore, proper examination of pains can provide suitable interventions in order to control and manage pains among patients and consequently promote their quality of life

Move to the Fourth-Generation Universities: A Systematic Scoping Review of Educational and Management Strategies

Background: Higher education is not uniform. There are significant differences between higher education systems among different countries and even among institutions in a similar education or system; therefore, identifying the various types of entrepreneurial activities helps the mission of fourth-generation universities. Objectives: The purpose of this study was to introduce the most important educational strategies to move towards fourth-generation universities. Methods: We systematically searched the international databases, including PubMed, Web of Science, Scopus, ISC, SID, and Google Scholar, until 2021 using some relevant keywords. Then, screening and selecting eligible articles according to inclusion criteria were done by two researchers independently. Results: Soft skills training, sustainable development training, training business law, reviewing the continuous training of professors, promoting ideation and creativity to solve problems, development of interdisciplinary training, decentralization of government accelerators and deployment of private accelerators, privatization of higher education, and internationalization are the most important educational strategies to move towards fourth-generation universities. One of the critical aspects and perspectives of the fourth-generation university is the development of job skills, professions, and competencies and empowerment of students and professors in line with the process of national development and solving society's problems scientifically. Conclusion: This research's analytical results help the universities design and implement their strategies to reach the fourth-generation universities according to the standard implementation models of the fourth-generation universities. Keywords: Universities, Education, Policy, Fourth-Generatio

Adequacy of prenatal care and its association with pregnancy outcomes: A comparison of indices in Tabriz, Iran

Introduction: Improving of mother and child health is one of the most important and essential roles of public health agencies and millennium development goals. The aim of this study was to determine rates of prenatal care (PNC) utilization in Tabriz, Iran, from 1994-2013 and compare the two most commonly used models of PNC utilized in determining the proportion of the pregnant woman receiving inadequate PNC and comparing use of two indices. Methods: In this study, we conducted a descriptive cross-sectional study of 2834 women having a health record in care center of the rural region in Tabriz for 20 years. We used questioner that validated in the study Jabbari et al. for obtaining data. Random sampling quotes were done in 3 times during the years 1994-2013. Results: We found that 53% of mothers received adequate care by adequate PNC utilization (APNCU) index, but 17% by revised-GINDEX index but the most important objective of our study was identifying the relationship between adequacy of PNC and pregnancy outcome. On the other hand, the study indicated that between inadequate care and low birth weight (LBW), mother weight gaining, birth height exists significant association, but there is no meaningful correlation between birth weight and adequacy of care (P < 0.05). Conclusion: The study analyzed the effect of PNC utilization on birth outcomes and suggested that PNC decrease LBW through both increasing gestational age as well as improving fetal growth at the same time it improves birth height and mother weight gaining. All findings of this study emphasize the need for health policies to improve utilization and access PNC

In Patients with Minor Beta-Thalassemia, Cognitive Performance Is Related to Length of Education, But not to Minor Beta-Thalassemia or Hemoglobin Levels

Objective: Thalassemia is one of the most frequent monogenic disorders, leading to impairment in the maturation and survival of red blood cells. The question examined here is whether, and if so, to what extent, people with beta-thalassemia might also be impaired in their cognitive functioning. Previous results in adults with beta-thalassemia showed cognitive impairment when compared to healthy controls. However, length of education was never taken into consideration as a possible confounder. Accordingly, the aim of the present study was to assess people with minor beta-thalassemia and compare them to healthy controls, while controlling for length of education. Method: A total of 25 adults (mean age: 29.36 years; 56% females) with beta-thalassemia and 25 healthy controls (mean age: 27.84 years; 72% females) took part in this cross-sectional study. They underwent cognitive testing (executive functions, attention, working memory), and their haemoglobin levels were assessed. Results: Cognitive performance did not significantly differ between patients with minor beta-thalassemia and healthy controls. Irrespective of group, higher cognitive performance was strongly associated with time spent in education. No gender differences were observed. Conclusion: Compared to healthy controls, cognitive performance was not impaired among patients with minor beta-thalassemia when length of education was introduced as a further co-variate. In both patients with minor beta-thalassemia and healthy controls, higher cognitive performance was associated with time spent for education. Health professionals should inform patients with minor beta-thalassemia that cognitive performance is related to the length of education and not to the health status of minor beta-thalassemia per se

Evaluation of Serum Leptin Level in Psoriasis Patients and its Relation with the Severity of Disease

Background and Objective: The association of leptin with psoriasis is currently controversial. The purpose of this study was to evaluate serum leptin levels in patients with psoriasis and its relationship with the severity of the disease. Materials and Methods: In this case-control study, serum leptin levels were measured in 40 patients with psoriasis and 40 age- and gender-matched healthy controls by sandwich enzyme-linked immunosorbent assay method. The severity of psoriasis was assessed by the Psoriasis Area and Severity Index (PASI). Data were analyzed using SPSS software version 16. Results: Of 40 patients, 35 (87.5%) had plaque psoriasis, 3 (7.5%) had palmo-plantar, and one of the remaining two patients had erythrodermic psoriasis while the other one had a pustular type. The mean disease severity based on PASI was 10.2 with a range of 0.8 to 39.9. The most common sites of involvement were generalized (27.5%), upper and lower extremities together (20.0%), lower extremities alone (15%), and trunk and lower extremities (15%) in descending order. Leptin was higher in the patient group than the control group (19.2±16.3 ng/ml versus 15.5±16.1 ng/ml) (P=0.227). The correlation between leptin and body mass index was positive and significant in both groups. No significant relationship was found between the severity and duration of disease and leptin. Conclusion: The findings of this study showed that similar to most studies, serum leptin levels were higher in patients with psoriasis than in healthy subjects, and in obese people, this difference was greater than in normal-weight individual

End of life care for terminally ill-patients in North West of Iran

Introduction: Nowadays chronic disease and number of elderly population climb in low and middle-income countries and need for high-quality hospice care services for them. The aim of this study was to review the experience of hospitalized end of life (EOL) patients and their family’s regarding hospice care. Methods: In this qualitative study with the phenomenological approach, 20 patients and their families were chosen using purposive sampling to achieve data saturation from the Tabriz University of Medical Sciences Hospitals, Iran. The required data were collected using in deep semi-structured interviews and analyzed using Diekelmann method. Results: Patients and their family’s experiences included 7 main themes: lack of special education for healthcare providers, preferences, financial problems, health care quality, lack of providing information to patients and their families, limitation in life due to disease, burdens to EOL care for family. Conclusion: Due to the lack of experience in hospice care in Iran, patients, families and health care provider not have adequate knowledge about hospice. The cost of this service is high, and qualities of these services are low. Furthermore provide educational courses for patients, families and health care provider and decrease of cost and improve of quality are necessary