Antibiotic utilization evaluation of inpatient and outpatient prescriptions in a rural general hospital in Iran

Background: High rate of antibiotic prescription is commonly encountered in hospital settings. Although the problem of the irrational use of antibiotics is particularly acute in rural health centers of developing countries, antibiotic utilization studies in such areas are scarce. In this study, we aimed to compare antibiotic prescription patterns between inpatients and outpatients in a rural general hospital.Methods: Inpatient and outpatient records were evaluated during a 1-month period. Data including patients’ demographics, length of hospital stay, final diagnosis, antibiotic regimen, dosing, rout of administration, microbiological culture/sensitivity tests and other laboratory data were retrieved from the hospital information system.Results: The number of prescriptions with at least one antibiotic was 686/1410 (48.6%) cases and 3812/6126 (62.2%) cases for inpatient and outpatient prescriptions, respectively. The mean number of antibiotic per prescription was 1.7±0.7 and 1.3±0.8 for inpatient and outpatients, respectively (p<0.05). Ceftriaxone had the highest rate of prescription among hospitalized patients with 791 (35.2%) times encounter while penicillin constituted the largest proportion of outpatient administrations with 2505 (29.8%) times. About 79% of inpatient and 62% of outpatient prescriptions containing final diagnosis data had the correct indication.Conclusion: Our study showed that implementation of strict regulations for antibiotic use is extremely needed in this rural hospital. Establishing local guidelines, providing adequate education for healthcare professionals and putting restrictions for broad-spectrum antibiotic use can be beneficial

Effect of Some Evaluation Methods on the Consequence of Final Exam for Freshman Medical Students

Background & Objective: In Iran, evaluation is one of the most important bases of medical education and one of the best criteria for the categorization of medical universities. Therefore, we aimed to compare some methods of evaluation for medical students. Methods: The target group included all basic level medical students studying medical mycology during the fifth semester. The tested methods of evaluations were: development test, post-test, class reports, and final exam. Three groups of evaluation were compared as a course plan of mycology for nine sessions. Results: There was a significant direct relation between the midterm and final exam, so that the increased midterm and post-test marks caused improvement in the final exam. Moreover, there was a relative correlation between the class reports and final exam. Conclusion: The results of the present study showed that each tested continuous evaluation is able to improve the final exams. Keywords Evaluation Medical students Final exam Midterm Post-tes

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Antibiotic utilization evaluation of inpatient and outpatient prescriptions in a rural general hospital in Iran

Background: High rate of antibiotic prescription is commonly encountered in hospital settings. Although the problem of the irrational use of antibiotics is particularly acute in rural health centers of developing countries, antibiotic utilization studies in such areas are scarce. In this study, we aimed to compare antibiotic prescription patterns between inpatients and outpatients in a rural general hospital. Methods: Inpatient and outpatient records were evaluated during a 1-month period. Data including patients’ demographics, length of hospital stay, final diagnosis, antibiotic regimen, dosing, rout of administration, microbiological culture/sensitivity tests and other laboratory data were retrieved from the hospital information system. Results: The number of prescriptions with at least one antibiotic was 686/1410 (48.6%) cases and 3812/6126 (62.2%) cases for inpatient and outpatient prescriptions, respectively. The mean number of antibiotic per prescription was 1.7±0.7 and 1.3±0.8 for inpatient and outpatients, respectively (p<0.05). Ceftriaxone had the highest rate of prescription among hospitalized patients with 791 (35.2%) times encounter while penicillin constituted the largest proportion of outpatient administrations with 2505 (29.8%) times. About 79% of inpatient and 62% of outpatient prescriptions containing final diagnosis data had the correct indication. Conclusion: Our study showed that implementation of strict regulations for antibiotic use is extremely needed in this rural hospital. Establishing local guidelines, providing adequate education for healthcare professionals and putting restrictions for broad-spectrum antibiotic use can be beneficial

Etiologic assessment of maternal mortality in west Azerbaijan, Iran: a retrospective descriptive study

Background: The occurrence of maternal death threatens the family foundation and children's health. Determining factors affecting maternal mortality can help us adopt more effective strategies to prevent similar events. This study aimed to determine the factors involved in maternal deaths in West Azerbaijan between years 2007 and 2012.Methods: A descriptive retrospective study was performed. Data were collected from health vice chancellor of West Azerbaijan database.Results: According to the results of this research the average Maternal Mortality Rate (MMR) was 22.38 per 100000 live births which constituted change 4.45% of overall maternal mortality in Iran. Hemorrhage was the most prevalent cause of maternal death (26.82%) followed by eclampsia, preeclampsia and pulmonary embolism, respectively. MMR was higher in 18-35 age group, unintended pregnancies and women with low socioeconomic status. Assessment of the impact of any delay in three stages (family, referral and treatment) indicated that incidence of delay in treatment stage was more prevalent than two others.Conclusions: Maternal mortality is still considerably high in West Azerbaijan. Increasing the coverage and the quality of prenatal and postpartum care, family planning counseling, and improving the skills and knowledge of the medical and midwifery staff would be effective in reducing maternal mortality rates

Etiologic assessment of maternal mortality in west Azerbaijan, Iran: a retrospective descriptive study

Background: The occurrence of maternal death threatens the family foundation and children's health. Determining factors affecting maternal mortality can help us adopt more effective strategies to prevent similar events. This study aimed to determine the factors involved in maternal deaths in West Azerbaijan between years 2007 and 2012.Methods: A descriptive retrospective study was performed. Data were collected from health vice chancellor of West Azerbaijan database.Results: According to the results of this research the average Maternal Mortality Rate (MMR) was 22.38 per 100000 live births which constituted change 4.45% of overall maternal mortality in Iran. Hemorrhage was the most prevalent cause of maternal death (26.82%) followed by eclampsia, preeclampsia and pulmonary embolism, respectively. MMR was higher in 18-35 age group, unintended pregnancies and women with low socioeconomic status. Assessment of the impact of any delay in three stages (family, referral and treatment) indicated that incidence of delay in treatment stage was more prevalent than two others.Conclusions: Maternal mortality is still considerably high in West Azerbaijan. Increasing the coverage and the quality of prenatal and postpartum care, family planning counseling, and improving the skills and knowledge of the medical and midwifery staff would be effective in reducing maternal mortality rates

A Systematic Review of Delirium Biomarkers and Their Alignment with the NIA-AA Research Framework

Objectives: To identify whether delirium biomarkers aligned with the National Institute on Aging-Alzheimer's Association (NIA-AA) research framework, a conceptual model that describes the use of diagnostic biomarkers for Alzheimer's disease and other related dementias (ADRD). Design: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Setting: Acute care and outpatient settings. Participants: Adults diagnosed with delirium. Methods and measurements: MEDLINE, PsycInfo, Embase, and the Cochrane Library were searched for English-language studies published from January 2010 to February 2020. Studies included adults older than 18 years, identified delirium with a standardized assessment tool, and measured an ADRD biomarker. Independent reviewers determined whether an association between delirium and ADRD biomarker was found, the quality of biomarker data based on the REMARK (REporting recommendations for tumor MARKer prognostic studies) checklist, and the study bias based on the Newcastle-Ottawa Scale. Results: A total of 61,256 citations were identified; 113 studies were included. Most studies did not examine amyloid, tau, or neurodegeneration biomarkers. Delirium may be associated with neurodegeneration biomarkers, but few to no studies found an association with amyloid and tau biomarkers. Delirium was not consistently associated with inflammatory biomarkers. The quality of biomarker data was moderate, and the risk of bias was moderate to high. Studies often did not collect prehospital and posthospital cognitive data. Conclusion: Most delirium diagnostic biomarker studies did not measure amyloid, tau, and/or neurodegenerative biomarkers, making characterization of the relationship between delirium and ADRD difficult. Future delirium biomarker diagnostic studies could improve the understanding of pathophysiologic links between delirium with other conditions affecting cognition

A Survey of Medical Students’ Knowledge and Attitudes Toward Complementary and Alternative Medicine in Urmia, Iran

Personal beliefs of medical students may interfere with their tendency for learning Complementary and Alternative Medicine concepts. This study aimed to investigate the knowledge and attitudes of medical students toward complementary and alternative medicine in Urmia, Iran. A structured questionnaire was used as data collection instrument. One hundred questionnaires were returned. Thirty-one percent of students reported use of alternative medicine for at least once. Iranian Traditional Medicine was the main type of alternative medicine used by medical students (93.5%). Neuromuscular disorders were the main indication of alternative medicine use among students (34.4%). Ninety percent of participants demonstrated competent knowledge about acupuncture while the lowest scores belonged to homeopathy (12%). Study results showed that 49% of medical students had positive attitudes and demonstrated a willingness to receive training on the subject. Thus, there appears a necessity to integrate complementary and alternative medicine into the medical curriculum, by taking expectations and feedbacks of medical students into consideration