Challenges and Obstacles to Clinical Guidelines from the Perspectives of Urology Residents: A Qualitative Study

Background and Objectives: Clinicians rely on clinical guidelines for decision making. Carefully formulated clinical guidelines are the result of a combination of relevant researches that links evidence to clinical practice. The purpose of this study was to determine the barriers to the use of clinical guidelines from viewpoints of residents. Material and Methods: This study is a qualitative phenomenological study that examines the experiences of the residents of Urology Department of Imam Reza Hospital in Tabriz City of Iran. The sampling method was purposive. Qualitative content analysis used to analyze this study. To validate the results, the interviews were repeatedly read and the opinions of colleagues were regularly used. External monitoring was used to increase its reliability. Results: 11 semi-structured interviews were conducted with the urology residents of Imam Reza Hospital. The results showed that the challenges and barriers to the implementation of clinical guidelines were classified into three main themes: 1. Structural challenges: doctors' distrust of clinical guidelines, Illegitimacy and lack of local clinical guidelines. 2. Executive challenges: routine processes, Lack of agreeable atmosphere, resistance to change among physicians and high number of patients and lack of facilities. 3. Educational challenges: lack of residency time and lack of practical educational structure for students. Conclusion: Given the importance of proper implementation of clinical guidelines as a link to up-to-date knowledge and practice and given the existing structural, executive and educational problems, obstacles and challenges, it is hoped that researchers, managers, policymakers and Patients should take steps to remove barriers to the proper implementation of clinical guidelines and provide high quality services to patients.</jats:p

The Factors Influencing the Implementation of Clinical Guidelines in the World; a Systematic Review Protocol

Abstract Background: Clinical guidelines are a systematic collection of the latest and most authoritative scientific evidence that describes thediagnostic steps and methods of clinical treatment of a patient in a categorized manner, taking into account priorities, effectiveness, and cost-effectiveness. It is necessary to explore and categorize influencing factors in the implementation of clinical guidelines worldwide to pave the way for their implementation in medical centers.Methods: In this systematic review we will search Scopus, PubMed, Web of sciences, clinical key, Google Scholar (Search Engine as well as Iranian data bases including: Magiran, SID, Irandoc, Iranmedex. We will include all related original studies that generally cover all relevant outcomes to determine the factors influencing the success of the implementation of clinical guidelines and to identify barriers and facilitators as well.The quality of the included studies will be assessed by appropriate Joanna Briggs Institute (JBI) Checklists according to the type of studies. The selection and appraisal process will be performed by two members of the research team; and in case of disagreement between the two researchers, the third person will review the articles.Discussion: Identifying the facilitators and factors affecting the implementation of clinical guidelines as well as the related obstacles is expected to pave the way for helping managers, policymakers and health planners in implementing them correctly.Systematic review registration: CRD42020201350</jats:p

Infrastructures and Necessary Actions Parallel to Reforms of Medical Service Tariffs to Improve Health System Performance in Iran: A Qualitative Study

Background: Perhaps the most important challenge in provision of health services is the issue of tariffs. The roles of the Ministry of Health, Treatment, and Medical Education, the Supreme Council of public health services insurance, Ministry of Cooperatives, Labor, and Social Affairs, as well as the Medical Council are specified in law. But it is faced with serious problems in implementation. The purpose of this study was to identify and introduce infrastructures and necessary actions parallel with reforms of medical service tariffs to improve health system performance in Iran. Methods: Purposeful sampling was used and continued until data saturation in this qualitative study. Participants included 12 Health Managers of Tehran, Isfahan, and Tabriz, who were selected based on the study goals. These people were investigated with deep interview. Data analysis was based on a thematic analysis. Criteria such as &quot;credibility&quot;, &quot;reliability&quot;, &quot;validity&quot;, and &quot;stability&quot; of data were considered. Results: Findings showed that the infrastructure and reforms, according to participants' viewpoints were divided into 3 parts: first, the reform of the Ministry of Health, including structural reforms, reforms related to the provider, and establishment of correct informing; second, health insurance reforms, consisting of structural reforms and actions that should be taken by the government about the insurance; and third, the necessary reforms by the government. Conclusion: First, it seems that various issues and aspects related to tariff determination should be considered. Furthermore, some preliminaries should be provided before tariffs' reformation or some actions should be taken in line with that for the success of tariff reformation process. These measures and reformations&nbsp; are related to the Ministry of Health, insurances, and the government

Solutions of clinical guideline implementation in Iran: A qualitative study

BACKGROUND: Despite all of the positive effects that are considered for clinical guidelines, according to studies, it has been determined that there is a gap between the development of clinical guidelines and their implementation. This study was conducted to explore the practical solutions to smooth the way of implementing clinical guidelines in this country through interviews with experts. MATERIALS AND METHODS: This descriptive qualitative study was conducted between January 2023 and October 2023. Data were collected through focused group discussions (FGDs) and semi-structured interviews. A purposive sampling method was used. The participants included specialist doctors, faculty members, employees, policymakers, and managers. Data collection continued until data saturation. The data of this study were analyzed by the qualitative content analysis method. Four criteria of validity, verifiability, trustworthiness, stability, and transferability were used for the reliability. RESULTS: The implementation solutions were classified into five main strategy categories, including providing necessary infrastructures, improving the development process of clinical guidelines, reforming the educational system of doctors and paramedics, providing a suitable implementation context, and creating a mechanism to follow up the implementation of guidelines. CONCLUSION: The implementation of clinical guidelines in Iran should be paid attention to the form of a continuous process. Therefore, policymakers must have a process perspective. It is important to note that in addition to the need to provide the necessary infrastructure; this process begins with the development of clinical guidelines and continues with steps, such as the need for a proper educational system, proper implementation, and appropriate supervision

Fatigue, stigma, and mood in patients with multiple sclerosis: effectiveness of guided imagery

Abstract Background and objectives The present study aimed to assess the effectiveness of guided imagery on fatigue, stigma, and mood in patients with multiple sclerosis. Methods This clinical trial is a double-blind study that was conducted on 60 patients with multiple sclerosis referred to the largest center for special diseases in the southeast of Iran in 2020. The convenience sampling method was used to select the participants who were later divided into two groups of intervention (n = 30) and control (n = 30) using block randomization method. The intervention group listened to the guided imagery audio file at home for 25 min. The control group did not receive any intervention. Data were collected by demographic information questionnaires, Fatigue Severity Scale (FSS), Reece Stigma Scale for Multiple Sclerosis (RSS-MS), and the Profile of Mood States (POMS) before and one month after the intervention. Results According to the results, there was no significant difference between the two groups before the intervention in terms of the score of fatigue (P &lt; 0.0 = 67), stigma (P &lt; 0.64), and mood (P &lt; 0.17). However, after the intervention, a significant differences was observed in this regard (P &lt; 0.0001). In the intervention group, the mean score of fatigue decreased from 59.72 ± 18.32 to 35.8 ± 16.15, and the mean score of stigma decreased from 17.31 ± 15.62 to 5.09 ± 8.06, showing a significant reduction in the levels of fatigue (P &lt; 0.0001) and stigma (P &lt; 0.0001) compared to before intervention. Also, the mean score of mood decreased from 36.90 ± 12.21 to 28.55 ± 11.87, indicating an improvement in the mood of samples in the intervention group (P &lt; 0.0001). Conclusions The results indicated that guided imagery, as a cost-effective method, can decrease the fatigue and stigma, and enhance the mood of patients with MS. Therefore, nursing staff can use this method to improve MS patients’ mood and decrease their fatigue and stigma. </jats:sec

Fatigue, Stigma, and Mood in Patients with Multiple Sclerosis: Effectiveness of Guided Imagery

Abstract Background and objectives : The present study aimed to assess the effectiveness of guided imagery on fatigue, stigma, and mood in patients with multiple sclerosis. Methods This clinical trial is a double-blind study that was conducted on 60 patients with multiple sclerosis referred to the largest center for special diseases in the southeast of Iran in 2020. The convenience sampling method was used to select the participants who were later divided into two groups of intervention (n=30) and control (n=30) using block randomization method. The intervention group listened to the guided imagery audio file at home for 25 minutes. The control group did not receive any intervention. Data were collected by demographic information questionnaires, Fatigue Severity Scale (FSS), Reece Stigma Scale for Multiple Sclerosis (RSS-MS), and the Profile of Mood States (POMS) before and one month after the intervention. Results According to the results, there was no significant difference between the two groups before the intervention in terms of the score of fatigue (P&lt;0.0=67), stigma (P&lt;0.64), and mood (P&lt;0.17). However, after the intervention, a significant differences was observed in this regard (P&lt;0.0001). In the intervention group, the mean score of fatigue decreased from 59.72±18.32 to 35.8±16.15, and the mean score of stigma decreased from 17.31±15.62 to 5.09±8.06, showing a significant reduction in the levels of fatigue (P&lt;0.0001) and stigma (P&lt;0.0001) compared to before intervention. Also, the mean score of mood decreased from 36.90±12.21 to 28.55±11.87, indicating an improvement in the mood of samples in the intervention group (P&lt;0.0001). Conclusions The results indicated that guided imagery, as a cost-effective method, can decrease the fatigue and stigma, and enhance the mood of patients with MS. Therefore, nursing staff can use this method to improve MS patients’ mood and decrease their fatigue and stigma.</jats:p

Survey ofAn Investigation of the Relationship between Emotional Labor and Job Satisfaction among the Executives and Nursing Managers of the Teaching Hospitals Affiliated to Isfahan University of Medical Sciences

Introduction and Purpose: Due to vast and varied nature of their work, managers need to operate in a wide range of emotions. In addition, managers must be able to determine when to show certain emotions. This shows the important role of emotional labor in management positions which can in turn affect the managers' job satisfaction. Therefore the current study aims to investigate the relationship between emotional labor and job satisfaction among executives and nursing managers of educational hospitals of Isfahan University of Medical Sciences.   Methods: This is a descriptive, correlation study using field survey method. The study population consisted of executives and nursing managers of educational hospitals of Isfahan University of Medical Sciences. The sample size of 250 people was selected using census method. Data collection was carried out using a translated version of a questionnaire whose validity and reliability were approved (&alpha=0/81). The questionnaires were distributed among the study population and the resulting data was analyzed using descriptive and analytical statistics with the help of SPSS18 software.   Results: The rate of emotional labor among the executive and nursing management of the selected hospitals was average while the job satisfaction, deep interaction and genuine emotions were reported to be above average and the rate of surface interaction was lower than average. The results showed that there is a direct and significant statistical relationship between the genuine emotions dimension of emotional labor and job satisfaction (P<0/05). However there was no statistically significant relationship between the other dimensions of emotional labor (surface interaction and deep interaction) and job satisfaction of the managers.   Conclusions: It can be concluded that, like in general population, the closer the emotional labor of the managers is to what they really feel (genuine emotions) the greater their job satisfaction

Effect of Cinnamon Essential Oil on the Chemotherapy-Induced Nausea and Vomiting of Cancer Patients

Background: Despite progress made in antiemetic control, most cancer patients still experience chemotherapy-induced nausea and vomiting. In oncology departments, nurses can evaluate the effects of complementary therapies such as use of essential oil on reducing nausea and vomiting of patients undergoing chemotherapy. Therefore, this study was conducted to explore the effect of cinnamon essential oil on the chemotherapy-induced nausea and vomiting of cancer patients. Materials and Methods: This is a two-group experimental study with a pretest-posttest design that was conducted between January 20 and March 15 of the year 2020. Through convenience sampling, 70 patients experiencing chemotherapy-induced nausea and vomiting were recruited to participate in this study. The participants were randomly allocated to two control and intervention groups. A pad moistened with 2 ml of isotonic saline and 0.2 ml of cinnamon essential oil was first placed inside a plastic bag, and then patients in the intervention group were asked to take three deep breaths while their face was towards the bag for two times at five-minute intervals. Patients in the control group used a placebo (a pad moistened with 2 ml of isotonic saline) instead of cinnamon essential oil during the intervention period. Participants in the two groups received routine antiemetic treatment. Using Visual Analog Scale (VAS), the severity of nausea and vomiting was measured in both groups before the intervention. For this reason, the severity of nausea and vomiting was measured after the first three breaths, and then after the second three breaths. Data were analyzed by SPSS software, using independent t-test, Chi-squared test, and Fisher’s exact test. Repeated measures ANOVA were also used to evaluate nausea and vomiting between the two groups across times. The significant level of 0.05 was considered for all tests. Results: There were no significant differences between the two groups in terms of demographic characteristics and the severity of chemotherapy-induced nausea and vomiting before the intervention. The severity of chemotherapy-induced nausea and vomiting was significantly lower in the cinnamon group than the control group after the first 3.08 (0.55), (F2 = 13.27, p < 0.001) and second breaths 1.91 (0.33) (F2 = 11.39, p < 0.001). Conclusions: Nurses can educate patients and their families to use of cinnamon essential oil. Nursing managers can also emphasize on the use of cinnamon essential oil, which is one of the non-pharmacological, low-cost, and effective methods of reducing chemotherapy-induced nausea and vomiting, by holding in-service training classes