Determining attitude and readiness of Medical students in Kerman University of Medical Sciences concerning acceptance of Decision Support Systems for Electronic Prescription in 2017

Introduction: Clinical Decision Support Systems (CDSS) are any computer program designed to assist health care professionals in making clinical decisions, especially at the moment of action. These information systems are flexible and interactive, helping people by making use of models and rules of a comprehensive database, or on the basis of clinical guidelines, to make applicable decisions, especially solving difficult problems with common scientific methods. Therefore, these systems support complex medical decisions, increase their effectiveness, and can lead to a reduction in the types of medical errors, such as medication errors. However, knowledge and attitude of the future physicians in the country about these systems is unclear. The purpose of this study was Determining attitude and readiness of Medical students concerning acceptance of Decision Support Systems for Electronic Prescription. Methods: This research is descriptive-analytic. The research population included general medical students of Kerman University of Medical Sciences in 2017. Out of these students, a sample of 226 people was selected by proportional sampling. Data collection was done using a standard questionnaire. The questionnaire was first translated into Persian and then its validity was confirmed by three medical informatics specialists. Data analysis was done descriptively-analytically using SPSS 19. Results: The findings of this study showed that 17% of students (n=36) knew about this system and how to use it, and 83% of them (n=177) were willing to learn and use this system to practice their profession in the future. More than half of them (n=121) believed that using this system would Reduce errors in prescribing. 80% of them (n=170) lacked a strategic plan to implement a decision support system for electronic prescription and a lack of standard and acceptable software, and about 60% (n=128) lack of financial incentives and lack of sufficient evidence Concerned about the usefulness of using it as a potential obstacle to the implementation of this system. There was no significant difference between the age, sex and term of the students with their familiarity with this system (P>0.05). Conclusion: The results of this study showed that while many students lack sufficient knowledge about the clinical decision support system, they are interested in learning and using it, especially in the field of prescribing drugs. This result indicates that the system is likely to be admitted if it is implemented and educated to medical students and doctors

Development of an Innovative Co-treatment Technology for Produced Water and Blowdown Water: A Regional Approach of Water Management for Energy Production

Freshwater use for power generation represents the second-largest water use globally. In the United States, freshwater withdrawals for thermoelectric power accounted for 38% of the total freshwater withdrawals for all uses in 2010. Cooling systems are the most water-intensive part of the thermoelectric generation process. For instance, one 300 MW power generator required about 20,000 m3/h circulating cooling water. The cooling operation discharges a large volume of wastewater in the form of blowdown water (10-20% of the consumed water) that requires treatment for reuse or surface discharge. Produced water (PW), the fluid which returns to the surface from hydraulic fracturing during oil and gas production, is one of the largest waste streams in the petroleum industry. More than 70 billion barrels of PW were generated globally in 2009, and 21 billion barrels were produced in the US. It was estimated that approximately 1 million gallons per gas well on average was generated in the Marcellus Shale region. In such a region where blowdown and produced waters are often in close proximity, opportunities exist to develop innovative approaches for water recovery and the generation of useful products from co-managing both waters. This research aims at developing a co-treatment process to manage BD water and PW jointly for water recovery and generation of useful products. The treatment process consists of mixing, softening, activated carbon filtration, and reverse osmosis (RO) followed by thermal desalination. It is designed to take advantage of the complimentary chemistry of two waters to create chemical and energy synergisms that reduce the chemical and energy footprints of the treatment process. First, sulfate and carbonate from BD water could form chemical precipitation with scale-forming cations in the PW (e.g., Ca, Ba, Sr), which can be achieved by mixing both waters. Second, the high salt content of PW can increase the TDS concentration of the feed stream to the RO, which in turn generates RO reject with a higher TDS concentration that can be more economically concentrated to 10-lb brine by the thermal desalination. Additional opportunities also exist for using the RO reject or the concentrated brine in electrolysis to generate useful products (e.g., NaOH and Cl2) that can be used for softening and other beneficial uses. The research objectives include 1) development of a co-treatment process and evaluate its feasibility of targeted contaminants removal, treatment footprint reduction, and useful products generation, 2) development of a brine electrolysis system to generate sodium hydroxide and chlorine from the concentrate stream of the co-treatment process, and 3) techno-economic analysis of the co-treatment approach and process optimization. Two treatment scenarios: BD/PW co-treatment and BD water treatment were conducted to evaluate the feasibility and efficiency of the co-treatment compared to the treatment of a single waste stream. Experiments in both scenarios were conducted in batch and continuous operation modes. In all the BD/PW co-treatment experiments, mixing the two streams at a BD: PW volumetric ratio of 10:1 without any chemical addition resulted in \u3e90% Ba removal. In both treatment scenarios, the softening treatment using alkaline chemicals resulted in \u3e99% removal of divalent metals (Ca2+ and Mg2+, Ba2+, and Sr2+), and \u3e90% TOC removal was achieved by activated carbon filtration. RO treatment of the softened mixture resulted in 97-99% TDS rejection and 40-95% water recovery in different experiments. Brine electrolysis using a two-compartment electrochemical cell reliably generated sodium hydroxide (NaOH, pH \u3e12, faradic efficiency 93%) and free chlorine (faradic efficiency 32%) from NaCl solutions. The generated sodium hydroxide was applied alone or combined with sodium carbonate for softening of three produced water samples Finally, in the last chapter, the techno-economic analysis was conducted in two different ways: 1) economic comparison between two different scenarios on a lab scale using the experimental and 2) techno-economic analysis of the BD/PW co-treatment on a real-world scale using experimental data and data from published works. In addition, a sensitivity analysis was performed on all major costs and revenues to indicate the parameters which have the greatest effect on the economy of the treatment plant. Experimental data along with similarly published works confirmed the feasibility of BD/PW co-treatment. Economics analysis also showed that in terms of chemical consumption, the co-treatment process has a unit chemical cost two times less than the sum of the unit chemical cost of BD water and PW treated separately. In terms of energy consumption for 10-lb brine production, considering that 1) RO has significantly lower energy consumption than thermal desalination, and 2) PW alone cannot be fed into RO due to high TDS, the RO treatment of BD/PW can generate concentrate stream for downstream thermal desalination and 10-lb brine production, more economically than BD alone

Impact of computerized order sets on practitioner performance.

Order sets have the potential to provide evidence at the point of care and improve healthcare practice. In this study we reviewed the literature to assess the effect of computerized order sets on practitioner performance. Our search in PubMed and Science direct identified 442 studies of which 16 met our inclusion criteria. In 15 studies order sets contributed to the improvement of at least one performance outcome. The effect of order sets was evaluated on 34 performance outcomes, of which 19 were improved and the rest remained unchanged. The results provide evidence that the use of order sets can improve health care practice

Evaluating factors associated with implementing of evidence-based practice in nursing

Rationale, aims and objectives Evidence-based practice (EBP) has emerged as an innovation for quality improvement in health care. Nurses have important role in implementing EBP but they face many challenges in this context. Evaluation of factors influencing implementation of EBP seems necessary. The aims of this study were to examine nurses’ attitude towards EBP, their self-efficacy and training needs, as well as supporting factors and barriers for implementing EBP. Methods A cross-sectional study was conducted on 182 nurses from four teaching hospitals in Kerman, Iran. Data were collected using a questionnaire consisting of two main sections; a section to collect socio-demographic information of participants and a section collecting information on five topics (staff’s attitude, self-efficacy skills of EBP, supporting factors, barriers and training needs for implementing EBP). Results The majority (87.4%) of the nurses had not attended any formal training on EBP and 60% of them were not familiar with the concept of EBP. Nurses’ attitude towards EBP was unfavourable (2.57 ± 0.99) and their self-efficacy skills of EBP were poor (2.93 ± 1.06). The most important supporting factor was mentoring by nurses who have adequate EBP experience (3.65 ± 1.17) and the biggest barrier was difficulty judging the quality of research papers and reports (2.46 ± 0.95). There was a moderate demand for training in all areas of EBP (3.62 ± 1.12). Conclusions Nursing care needs to move towards quality improvement using EBP. It is necessary to equip nurses with knowledge and skills required for EBP. Managers should design an appropriate strategic plan by considering supporting factors and barriers for integrating EBP into clinical settin

Evaluation methods used on health information systems (HISs) in Iran and the effects of HISs on Iranian healthcare: a systematic review.

OBJECTIVES: The most important goal of a health information system (HIS) is improvement of quality, effectiveness and efficiency of health services. To achieve this goal, health care systems should be evaluated continuously. The aim of this paper was to study the impacts of HISs in Iran and the methods used for their evaluation. METHODS: We systematically searched all English and Persian papers evaluating health information systems in Iran that were indexed in SID, Magiran, Iran medex, PubMed and Embase databases until June 2013. A data collection form was designed to extract required data such as types of systems evaluated, evaluation methods and tools. RESULTS: In this study, 53 out of 1103 retrieved articles were selected as relevant and reviewed by the authors. This study indicated that 28 studies used questionnaires to evaluate the system and in 27 studies the study instruments were distributed within a research population. In 26 papers the researchers collected the information by means of interviews, observations, heuristic evaluation and the review of documents and records. The main effects of the evaluated systems in health care settings were improving quality of services, reducing time, increasing accessibility to information, reducing costs and decreasing medical errors. CONCLUSION: Evaluation of health information systems is central to their development and enhancement, and to understanding their effect on health and health services. Despite numerous evaluation methods available, the reviewed studies used a limited number of methods to evaluate HIS. Additionally, the studies mainly discussed the positive effects of HIS on health care services

Information seeking and retrieval skills of nurses: Nurses readiness for evidence based practice in hospitals of a medical university in Iran.

BACKGROUND: With the explosion of medical information, and emergence of evidence-based practice (EBP) in healthcare system, searching, retrieving and selecting information for clinical decision-making are becoming required skills for nurses. AIMS: The aims of this study were to examine the use of different medical information resources by nurses and their information searching and retrieving skills in the context of EBP. METHOD: A descriptive, cross-sectional study was conducted in four teaching hospitals in Iran. Data were collected from 182 nurses using a questionnaire in 2014. RESULTS: The nurses indicated that they use more human and printed resources than electronic resources to seek information (mean=2.83, SD=1.5; mean=2.77, SD=1.07; and mean=2.13, SD=0.88, respectively). To search online resources, the nurses use quick/basic search features more frequently (mean=2.45, SD=1.15) than other search features such as advanced search, index browsing and MeSH term searching. (1.74≤mean≤2.30, SD=1.01). At least 80% of the nurses were not aware of the purpose or function of search operators such as Boolean and proximity operators. In response to the question measuring skills of the nurses in developing an effective search statement by using Boolean operators, only 20% of them selected the more appropriate statement, using some synonyms of the concepts in a given subject. CONCLUSION: The study showed that the information seeking and retrieval skills of the nurses were poor and there were clear deficits in the use of updated information resources. To compensate their EBP incompetency, nurses may resort to human resources. In order to use the latest up to date evidence independently, nurses need to improve their information literacy. To reach this goal, clinical librarians, health information specialists, nursing faculties, and clinical nurse educators and mentors can play key roles by providing educational programs. Providing access to online resources in clinical wards can also encourage nurses to learn and use these resources

Evaluating factors associated with implementing evidence-based practice in nursing

RATIONALE, AIMS AND OBJECTIVES: Evidence-based practice (EBP) has emerged as an innovation for quality improvement in health care. Nurses have important role in implementing EBP but they face many challenges in this context. Evaluation of factors influencing implementation of EBP seems necessary. The aims of this study were to examine nurses' attitude towards EBP, their self-efficacy and training needs, as well as supporting factors and barriers for implementing EBP. METHODS: A cross-sectional study was conducted on 182 nurses from four teaching hospitals in Kerman, Iran. Data were collected using a questionnaire consisting of two main sections; a section to collect socio-demographic information of participants and a section collecting information on five topics (staff's attitude, self-efficacy skills of EBP, supporting factors, barriers and training needs for implementing EBP). RESULTS: The majority (87.4%) of the nurses had not attended any formal training on EBP and 60% of them were not familiar with the concept of EBP. Nurses' attitude towards EBP was unfavourable (2.57 ± 0.99) and their self-efficacy skills of EBP were poor (2.93 ± 1.06). The most important supporting factor was mentoring by nurses who have adequate EBP experience (3.65 ± 1.17) and the biggest barrier was difficulty judging the quality of research papers and reports (2.46 ± 0.95). There was a moderate demand for training in all areas of EBP (3.62 ± 1.12). CONCLUSIONS: Nursing care needs to move towards quality improvement using EBP. It is necessary to equip nurses with knowledge and skills required for EBP. Managers should design an appropriate strategic plan by considering supporting factors and barriers for integrating EBP into clinical setting

Molecular characterization of the faecal fungal flora in healthy horses

There is a lack of knowledge on the composition and dynamics of the intestinal micro-eukaryotes of horse and to date their functional role for the health and physiology of the host has been described merely to some extent. Particularly, no culture-independent surveys of the dynamics of the intestinal fungal flora in horse are available. Two culture-independent approaches, terminal restriction fragment length polymorphism (T-RFLP) and cloning & sequencing, were combined to study the composition and dynamics of the intestinal fungal flora in healthy horses. The fungal internal transcribed regions (ITS) and the eukaryotic 18S rRNA genes, recovered from faecal samples of 16 Swedish Standardbred geldings, were used as phylogenetic marker genes in the analyses. Faecal samples were analyzed by TRFLP and two clone libraries were constructed, one library for the 18S gene and the other for the ITS gene from which later 44 random clones were sequenced. T-RFLP profiles and sequencing data together, indicate that the fungal community is temporally stable, has a low diversity and it is dominated by three genera of the Neocallimastigaceae family including Orpinomyces sp., Anaeromyces sp. and Piromyces species. These fungal species have been isolated and characterized previously in different types of herbivores including the Equidae family. These anaerobic fungi have been suggested to exist prevalently in the GI tract of large herbivores which in this aspect, there is no disparity between the data presented in this experiment and those from previous publications. T-RFLP, as a high-throughput culture-independent method which so far has been implemented mainly on the studies targeting the prokaryotic members of the microbiota, is suitable for the survey of the faecal fungal flora of horses, however requires further adaptations

Information seeking and retrieval skills of nurses: Nurses readiness for evidence based practice in hospitals of a medical university in Iran

BACKGROUND: With the explosion of medical information, and emergence of evidence-based practice (EBP) in healthcare system, searching, retrieving and selecting information for clinical decision-making are becoming required skills for nurses. AIMS: The aims of this study were to examine the use of different medical information resources by nurses and their information searching and retrieving skills in the context of EBP. METHOD: A descriptive, cross-sectional study was conducted in four teaching hospitals in Iran. Data were collected from 182 nurses using a questionnaire in 2014. RESULTS: The nurses indicated that they use more human and printed resources than electronic resources to seek information (mean=2.83, SD=1.5; mean=2.77, SD=1.07; and mean=2.13, SD=0.88, respectively). To search online resources, the nurses use quick/basic search features more frequently (mean=2.45, SD=1.15) than other search features such as advanced search, index browsing and MeSH term searching. (1.74≤mean≤2.30, SD=1.01). At least 80% of the nurses were not aware of the purpose or function of search operators such as Boolean and proximity operators. In response to the question measuring skills of the nurses in developing an effective search statement by using Boolean operators, only 20% of them selected the more appropriate statement, using some synonyms of the concepts in a given subject. CONCLUSION: The study showed that the information seeking and retrieval skills of the nurses were poor and there were clear deficits in the use of updated information resources. To compensate their EBP incompetency, nurses may resort to human resources. In order to use the latest up to date evidence independently, nurses need to improve their information literacy. To reach this goal, clinical librarians, health information specialists, nursing faculties, and clinical nurse educators and mentors can play key roles by providing educational programs. Providing access to online resources in clinical wards can also encourage nurses to learn and use these resources