Study endoscopic and colonoscopy findings in children under 16 years of age with gastrointestinal bleeding from 2018 to 2021

Background: One of the most common reasons for Children to visit clinics is gastrointestinal issues in which endoscopic studies are used occasionally to investigate it’s etiology more accurately. GI bleeding eventhough uncommon in children, can be life threatening. The aim of this study was to study endoscopic and colonoscopic findings in children with GI bleeding. Methods: This descriptive analytical study was done on 73 children under 16 years in Ardabil with the diagnosis of gastrointestinal bleeding. A checklist including demographic and treatment information of patients like severity of bleeding, bleeding type (melena, hematochezia, occult blood), laboratory results (hemoglobin, hematocrit) and clinical findings (abdominal pain, nausea and vomiting, ETC), endoscopic and colonoscopic results were collected and then analyzed by statistical methods in SPSS version 21. Results: Total 38 cases (52.1%) were gone under upper endoscopy and 35 cases (47/9%) were gone under colonoscopy. The most common indications for upper endoscopy was GI bleeding (76.3%) and the most common involved anatomical part was lower portion of esophagus (44.7%). The most common indication for colonoscopy was recurrent abdominal pain (62.9%). Pathologic cases were often seen in sigmoid, rectum and anus (52/8%). The most common colonoscopic findings were nodular hyperplasia (25/7%) and solitary nodule (20%). Conclusions: Results of study showed that, the frequency of endoscopic evaluation has been significantly lower in female children. According to the most common indications for upper and lower endoscopy, it is important to consider the frequency pattern of indications for endoscopic study

Development and psychometric evaluation of data collection tools for Iranian integrated road traffic injury registry: Registrar-station data collection tool

Background: Comprehensive and accurate data are fundamentally needed for effective management of road traffic injuries (RTIs). Existing sources of RTI reports have a huge underestimation and inaccuracy at some levels. The aim of this study was to develop and validate the registrar-station data collection tool as a part of the Iranian Integrated Road Traffic Injury Registry (IRTIR). Materials and Methods: This study was conducted in Tabriz University of Medical Sciences in 2018. A data collection tool was developed to be used by the registrar for inpatient section of IRTIR by information retrieved from the literature review and road traffic experts' need assessment. The content validity of the preliminary tool was assessed. The feasibility of the tool was tested in two regional referral injury hospitals. Intra- and inter-rater reliability of the tool was evaluated using the individual/absolute intra-class correlation coefficient (ICC) and Kappa. Validity was revisited after 1 year of the pilot study. Results: The registrar-station data collection tool of IRTIR included 53 items, in five categories. Content validity was approved (modified content validity index was 0.8-1 and content validity ratio was one for all items). ICC was >0.6 for all items, and kappa index ranged between 0.69 and 0.92. The nurse data collection tool of IRTIR was applicable in the pilot phase. Conclusions: The Registrar-Station data collection tool of IRTIR was confirmed as a valid and reliable tool for inpatient traffic injuries as a part of the Iranian IRTIR

Functional Consequences of Road Traffic Injuries: Preliminary Results from PERSIAN Traffic Cohort (PTC)

Introduction: Traffic injuries are one of the main causes of death worldwide. After decreasing mortality rates and improving the recovery of injured patients, long-term functional consequences need to be addressed. The purpose of this study was to assess the functional outcomes of road traffic injuries and their predictors six months after hospital discharge, based on the preliminary results from PTC.Methods: A cross-sectional study based on PERSIAN Traffic Health and Safety Cohort Study was performed. Data were collected using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) with six domains (cognition, mobility, self-care, getting along with others, life activities, and participation), filled-in by 180 injured adults (age >18 years) at six-month follow-up after hospital discharge during October 2019. These patients were hospitalized after road accidents at two referral trauma centers, (from 23 September 2018 to 20 March 2019).Results: The majority of participants were men (82.7%), (Mean age =38.8). The mean score of WHODAS 2.0 was 17.8) SD=9.1). The highest score was estimated for the self-care dimension 3.3 (SD=1.8), and the lowest score for getting along with others 2.4 (SD=1.2). Age, gender, physiotherapy, injury localization including head and face, spinal cord, and upper extremity were predictors of WHODAS 2.0 score in various dimensions (p<0.05).Conclusion: The current study identified some functional disabilities among patients sustaining road traffic injuries. It is evident from the results that a proportion of patients do not recover six months after the injury and suffer a disability, especially in self-care, mobility, and life activities, which potentially prevent them from returning to normalcy. In addition, age, gender, physiotherapy, injury localization was related to WHODAS 2.0 score

What they fill in today, may not be useful tomorrow: Lessons learned from studying Medical Records at the Women hospital in Tabriz, Iran

<p>Abstract</p> <p>Background</p> <p>The medical record is used to document patient's medical history, illnesses and treatment procedures. The information inside is useful when all needed information is documented properly. Medical care providers in Iran have complained of low quality of Medical Records. This study was designed to evaluate the quality of the Medical Records at the university hospital in Tabriz, Iran.</p> <p>Methods</p> <p>In order to get a background of the quality of documentation, 300 Medical Records were randomly selected among all hospitalized patient during September 23, 2003 and September 22, 2004. Documentation of all records was evaluated using checklists. Then, in order to combine objective data with subjective, 10 physicians and 10 nurses who were involved in documentation of Medical Records were randomly selected and interviewed using two semi structured guidelines.</p> <p>Results</p> <p>Almost all 300 Medical Records had problems in terms of quality of documentation. There was no record in which all information was documented correctly and compatible with the official format in Medical Records provided by Ministry of Health and Medical Education. Interviewees believed that poor handwriting, missing of sheets and imperfect documentation are major problems of the Paper-based Medical Records, and the main reason was believed to be high workload of both physicians and nurses.</p> <p>Conclusion</p> <p>The Medical Records are expected to be complete and accurate. Our study has unveiled that the Medical Records are not documented properly in the university hospital where the Medical Records are also used for educational purposes. Such incomplete Medical Records are not reliable resources for medical care too. Some influencing factors external to the structure of the Medical Records (i.e. human factors and work conditions) are involved.</p

Determining a National Trauma Prognostic Scale (TPS) to Predict Preventable Trauma Death in Iran: the Research Protocol

Methods: A 7-phases methodology will be applied to conduct this study as following; 1- Identification of trauma severity parameters and scales predicting mortality from literature, 2- Developing a data collection tool for research data collection), 3- Data collection in selected clinical settings, 4- Statistical modeling, 5- Model adaptation with three levels of trauma care settings including pre-hospitals, general hospitals and trauma specialty hospitals, 6- Scale-up and extrapolation, and 7- comparison with international models and selection of Iranian national model. Results: The content validity of the tool was confirmed with a total scale-level content validity (S-CVI) = 0.93. The reliability of the final instrument was calculated using the Pearson correlation coefficient and the Spearman correlation was evaluated above 0.7 for all cases. Up to date April 2020, From the hospital of the study, 210 patients participated in the study. The mean and standard age deviation of patients was 35.18 ± 18.44 and 165 (78.57 %) of these patients were male. The most important cause of trauma in patients was a motorcycle accident (27.62 %). Keywords: Trauma, Modeling, Injury severity assessment, Mortality predictor, Trauma scal

Determining a National Trauma Prognostic Scale (TPS) to Predict Preventable Trauma Death in Iran: the Research Protocol

Methods: A 7-phases methodology will be applied to conduct this study as following; 1- Identification of trauma severity parameters and scales predicting mortality from literature, 2- Developing a data collection tool for research data collection), 3- Data collection in selected clinical settings, 4- Statistical modeling, 5- Model adaptation with three levels of trauma care settings including pre-hospitals, general hospitals and trauma specialty hospitals, 6- Scale-up and extrapolation, and 7- comparison with international models and selection of Iranian national model. Results: The content validity of the tool was confirmed with a total scale-level content validity (S-CVI) = 0.93. The reliability of the final instrument was calculated using the Pearson correlation coefficient and the Spearman correlation was evaluated above 0.7 for all cases. Up to date April 2020, From the hospital of the study, 210 patients participated in the study. The mean and standard age deviation of patients was 35.18 ± 18.44 and 165 (78.57 %) of these patients were male. The most important cause of trauma in patients was a motorcycle accident (27.62 %). Keywords: Trauma, Modeling, Injury severity assessment, Mortality predictor, Trauma scal

Role of information technology on documentation and security of medical data

Information technology (IT) is increasingly used in medicine, mainly for processing medical data. Understanding how IT affects the documentation and security of medical data and how users adapt IT systems can help to improve the quality of medical data and consequently the quality of medical care. Aim: The aim of this thesis was to explore the impact of IT on the documentation and the security of medical data in a middle-income country, in order to identify influencing factors on the quality of medical data. Method: In study I, a set of 300 randomly selected paper-based medical records (PBMR) was evaluated for the completeness of data (quantitative). Additionally ten physicians and ten nurses were interviewed for their opinions on the quality and the use of PBMR at a university hospital (qualitative). In study II we used similar approach to analyse the quality of medical data after an electronic medical record (EMR) system had replaced the PBMR system. The completeness of data was explored in 300 randomly selected EMR (quantitative) and then the opinion of medical staff (ten physicians and ten nurses) on the quality of data and potential barriers for using EMR was sought (qualitative). Study III was an interventional study which investigated the impact of a computer-generated physician-oriented reminder system on the quality of documentation in two randomly selected intervention (n=188) and control (n=188) groups of EMR. In study IV the security of medical data in EMR in six university hospitals was explored by observing users interaction with hospital information systems (HIS), analysing the databases and log files in HIS (quantitative) and interviewing six computer network administrators and four representatives of four HIS developing companies for technical details (qualitative). Descriptive analysis for quantitative materials and content analysis for qualitative materials were applied in the studies. Results: All PBMR investigated were incomplete in terms of medical data. The quality of data varied among different fields of the PBMR, with the lowest percentage of documentation of demographical and administrative information and highest percentage of documentation of diagnostic and treatment information and also care providers identity information. Illegible handwriting, missing sheets, high workload and insufficient quality control for documentation of medical data were prominent influencing factors that were highlighted by the interviewees (study I). Findings in study II indicated that after introducing EMR, the documentation of medical data was improved in some fields, especially where nurses documented the data, but physicians involvement in documentation of medical data in the EMR was low. Neglecting physicians in the development and implementation phases of the EMR and their concerns about security of medical data influenced their acceptance of the EMR system. High workload, shortage of bedside hardware and lack of software specification to identify incompleteness of medical records were other negatively influencing factors on documentation of medical data in the EMR. The results of study III showed that an automatic physician-oriented reminder system has the potential to improve documentation of medical data in EMR in a high workload environment. In the intervention group 165 of 188 EMR (88%) were documented completely (X2 = 75.6, p < 0.0001). In the control group only 91 (48%) of EMR were completely documented. The findings of study IV underlined that the security mechanisms for protecting medical data in the HIS environment were inadequate. All six HIS investigated suffered from lack of policy for information security, weak authentication techniques, absence of functions for managing users and log files. Conclusions: EMR is a good substitute for PBMR. However, in order to successfully transfer from PBMR to EMR and to have comprehensive documentation of medical data, some requirements have to be met. Establishing organizational policy for both documentation and security of medical data is fundamental. Involving medical staff in the development and implementation phases can facilitate staff s acceptance of the new system. EMR needs to have functions to identify and remind users of incomplete records. Concerning the security of medical data, HIS and EMR systems should implement all up-to-date information security services, including strong authentication techniques, data encryption and digital signature