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Showing 26 results for Clinical
Mehdi Kahouei, Hassan Babamohamadi ,
Volume 7, Issue 4 (11-2013)
Volume 7, Issue 4 (11-2013)
Abstract
Background and Aim: Information technology acceptance model predicts acceptance based on end-users' perceived usefulness and ease of use of technology for a specific purpose. The aim of this study is to understand nursing staff’s adoption of clinical information systems based on information technology acceptance model.
Materials and Methods: This descriptive- analytic study was conducted on 316 nurses in hospitals affiliated with Semnan University of Medical Sciences (SUMS) and those affiliated with the Social Security Organization (SSO). The data collection tool was a valid and reliable questionnaire . The d ata were analyzed by descriptive statistics, Mann-Whitney and chi-square tests .
Results: Some 73 % of nurses agreed that the nursing information system provides them with correct information. Besides, 55.7% of nurses had accepted the information system. The results showed that male nurses had admitted clinical information systems more than female ones (P<0.05). Moreover, nurses who were aware of their duties towards the computer program or those who were aware of the goals of computer applications had adopted information technology more (P <0.05).
Conclusion : Most of the nurses had accepted the clinical information system in their daily work. However, issues such as inadequate number of computers , content design, system c apability problems, and nurses' computer skills and knowledge should be seriously examined . Moreover, several interventions should be planned and developed in technical and individual areas such as enhancement of nurses' IT knowledge , teamwork culture , organizational position , team cooperation, and updating and upgrading the network.
Fatemeh Ghazanfari , Hossein Mobaraki ,
Volume 7, Issue 6 (3-2014)
Volume 7, Issue 6 (3-2014)
Abstract
Background and Aim: Clinical governance is the application of mechanisms at the right time and place to do tasks for patients properly and obtain maximum clinical results. The implementation of clinical governance definitely requires the skills and inclinations of those working in healthcare sector. The main objective of this study is to identify the relationship between human resource management (HRM) on the one hand and the implementation of clinical governance and the optimal establishment of its framework on the other hand through offering strategies for effective human resource management.
Materials and Methods: This is a descriptive analytical study conducted in a cross-sectional way in 2012. The sampling method was a two-step cluster sampling. Shariati, Imam Khomeini, and Hashemi Nejad were randomly selected from among the hospitals of Tehran University of Medical Sciences (TUMS). The data collection instrument was a researcher-made questionnaire and a checklist. In each hospital, 30 questionnaires were randomly distributed. The gathered data were analyzed by SPSS.
Results: The minimum and maximum scores of clinical governance pertained to Imam Khomeini (594) and Hashemi Nejad (753) hospitals, respectively. Moreover, significant relationships were found between variables of training, recruitment and employment, salaries and benefits on the one hand and clinical governance on the other.
Conclusion : Considering the significant relationship between HRM and the implementation of clinical governance, investment in this aspct of clinical governance as the one that influences success in other aspects can be effective in the establishment of clinical governance.
Fatemeh Rangrazjeddi , Alireza Moraveji , Fatemeh Abazari ,
Volume 7, Issue 6 (3-2014)
Volume 7, Issue 6 (3-2014)
Abstract
Background and Aim: Evidence Based Medicine (EBM) is the explicit use of current best evidence in making decisions about the care of individual patients. Hospital information system (HIS) can act as a bridge between medical data and medical knowledge through merging of patient's data, individual clinical knowledge and external evidences .The aim of this research was to determine the Capability to establish EBM by HIS.
Materials and Methods: This descriptive cross-sectional study was carried out on HISs of 30 hospitals from March to October 2011. Data were collected using a researcher- constructed checklist including applicant’s background information as well as information based on research objectives. Validity of the checklist were assessed by the qualified specialists and then the data were analyzed using descriptive statistics and SPSS software.
Results: HISs lacked the essential components for providing access to CDSS, Reference databases and internet-based health information in 19, 16 and 20 hospitals were 63.3%, 53.3% and 66.7%, respectively. Twenty-two hospitals (70%) had more than two-thirds of the essential components to access clinical and administrative data repositories 23 hospitals (76.7%) had at least one essential component to access contextual and case specific information.
Conclusion: The Capability of HIS is better in order to place EBM in having access to the clinical and administrator data repositories while it needs more attention in other areas.
Fereshteh Farzianpour, Mohamad Reza Eshraghian, Amir Hossein Emami , Shayan Hosseini,
Volume 8, Issue 5 (1-2015)
Volume 8, Issue 5 (1-2015)
Abstract
Background and Aim: Every educational system, whether micro or macro, needs its training programs to be studied and educationally evaluated. This study aims to assess training and internship programs in hospitals based on surveying the students of Tehran University of Medical Sciences (TUMS).
Materials and Methods: This is a cross-sectional study with survey descriptive design. The data collection tool was a questionnaire with 14 five-point Likert style items. The TUMS Educational Development Center (EDC) surveyed all 185 students of training and internship programs, using a questionnaire with the Cronbach’s alpha coefficient of 0.81 in 2011, in order to adjust the education with the society’s needs and to improve its quality.
Results: The mean assessment scores of training and internship programs were 3.32%, 2.98%, 3.38%, and 3.29% for applied training, mental skills, communication skills, and practical skills courses, respectively.
Conclusion: The students’ satisfaction rate regarding the quality of educational courses of training and internship programs was 50.2%. Educational authorities have made necessary attempts to implement these programs and use potential resources for realizing the objectives and achieving the educational quality however, they should make further attempts in this regard.
Saeed Asefzadeh, Sanaz Taghizadeh, Ali Heyrani , Rafat Mohebbifar, Jalal Arabloo,
Volume 9, Issue 2 (7-2015)
Volume 9, Issue 2 (7-2015)
Abstract
Background and Aim: To improve the implementation of clinical governance (CG) in Iran's hospitals, awareness of various aspects of its implementation and assessment is important. The aim of this study was to find out the obstacles and challenges of clinical governance implementation and assessment in Qazvin teaching hospitals. Materials and Methods: Semi-structured interviews with 17 senior managers, clinical staff and clinical governance experts were conducted in six hospitals of Qazvin University of Medical Sciences (QUMS). To analyze the collected data, framework analysis was used. Results: The challenges and obstacles of CG implementation in Qazvin teaching hospitals were explained using three themes of (1) challenges of CG implementation, (2) improvement in seven dimensions of CG, and (3) challenges of CG implementation assessment. Conclusion: The results of this study show that CG implementation needs to address three issues: improving clinical staff awareness about CG, changing organizational culture so as to make it more receptive to CG, and creating higher levels of cooperation among physicians, managers, patients, specialists, and professionals. The supportive role of top management in addressing the three issues and in providing resources and other infrastructures is obviously essent
Ghafur Tavakoli , Roshanak Daei, Farshad Hashemi, Mehdi Zarei, Hoda Deli, Seyed Jamal Hashemi,
Volume 9, Issue 6 (3-2016)
Volume 9, Issue 6 (3-2016)
Abstract
Background and Aim: In medical centers, after obtaining visceral clinical samples in suitable containers under certain circumstances, they are sent to mycology laboratory. Since sometimes it is impossible to test specimens immediately, therefore, they should be kept in the refrigerator. Thus, possibility of keeping samples, the confidently time of samples keeping in a refrigerator and the appropriate guidelines for the maintenance of visceral samples for clinical centers have a particular importance for practical purposes and are the aim of this study.
Materials and Methods: At first, the specimen was examined by KOH direct microscopic examination for detection of fungal elements. After primary culture of visceral samples on the Sabouraud dextrose agar with chloramphenicol (SC) medium, the samples were sequentially placed in a refrigerator at temperature 2-8 ºc for 1, 2, 24 and 48 hs and each sample with the specific mentioned time culturing was performed on the Sabouraud dextrose agar (S) and SC media. Then the results of growth were recorded.
Results: From 100 samples, 79 samples had grown, 20 samples with lack of growth and in 1 sample reduced growth were observed.
Conclusion: After 48 hours of cold temperatures (2-8 ºc) visceral fungal clinical samples are able to grow in culture media. So samples which were not tested immediately, could be stored at temperatures 2-8 ºc in the refrigerator.
Zhila Najafpour, Abolghasem Pourreza,
Volume 9, Issue 6 (3-2016)
Volume 9, Issue 6 (3-2016)
Abstract
Background and Aim: The analysis of patients’ safety clinical indicators is considered as one of the safety improvement instruments. Therefore, the present study is aimed to analyze the indices of safety clinical services in selected hospitals of Tehran University of Medical Sciences (TUMS).
Materials and Methods: The present descriptive-analytical study was conducted in 11 TUMS hospitals in 2013. The study tool was the patient safety evaluation protocol of the World Health Organization (WHO). A checklist was completed following interviews, observations, and documentation reviews. The data were analyzed with descriptive and analytical tests, and SPSS software version 13.
Results: The average scores of the studied hospitals were 96.6, 85.6 and 66 for the required, basic and advanced indices, respectively. The figure was not acceptable in required standards, but it was acceptable in basic and advanced ones. In the studied hospitals, numbers 7, 2, 4, 11, and 9 enjoyed the highest amount of conformity with standard, and were placed in rank 2 according to the ranking protocol. Finally, there was no meaningful statistical difference among hospitals in their observance of standards.
Conclusion: Conformity with necessary standards was low in 6 studied hospitals, but in 5 hospitals, it was acceptable in basic and advanced standards. Hospitals need enhancement programs in statements of information management system, drugs management system, infection reduction system, and effective clinical system.
Mohammmad Khammarnia, Zahra Kavosi, Mohadaseh Ghanbari Jahromi, Asra Moradi,
Volume 10, Issue 1 (4-2016)
Volume 10, Issue 1 (4-2016)
Abstract
Background and Aim: Hospital complaining is an important dimension of clinical governance. This study aimed to determine the impact of clinical governance program on patients’ complaint in Shiraz public hospitals.
Materials and Methods: This applied study was conducted as descriptive-analytical in 2012 in Shiraz. The population studied was 10 public hospitals in Shiraz and the patients complaints were studied during 5 years. Data collected through Iranian Ministry of Health standard checklist of clinical governance. The data entered to SPSS version 21, and analyzed using descriptive statistics and analytical tests such as Chi-square.
Results: Registered complaints had increasing trend during the execution of the program and were 1905. Moreover, 60.5% of the complaints have been made by family members. There was significant relationship between complaints registered with the hospital wards (P=0.000) and gender (P=0.000). Therefore, both genders and in all departments of the hospital complaints of poor quality and inappropriate behavior of the staffs was greater than other complaint.
Conclusion: The number of complaints has increased in recent years. It is proposed to reduce the number of complaints attention to improve communication between physicians and patients, medical ethics, cut non-conventional financial relationaship between physicians and patients, and increased scientific and technical knowledge and skills.
Nastaran Mirfarhadi , Atefeh Ghanbari, Abbas Rahimi,
Volume 11, Issue 1 (5-2017)
Volume 11, Issue 1 (5-2017)
Abstract
Background and Aim: Early diagnosis is a tenet in oncology and enables early treatment with the expectation of improved outcome. The aim of this study was to determine the factors associated with personal characteristics and clinical signs in patients with breast cancer.
Materials and Methods: This research was a descriptive analytic that
cross-sectionally assessed 232 patients with definite breast cancer diagnosis that referred to Razi hospital located in Rasht using a researcher designed questionnaire including demographic and clinical signs. Collected data (mammography, tumor size, pathological stage of tumor) were obtained from medical records of patients. Gathered data analysis was accomplished with SPSS V.19 and for description of data from average and standard deviation for inference statics fisher test with a
P value of 0.05 were used.
Results: Mean age of subject was (49.80+10.27). 44 individuals (14%) had a precedent regular mammography before disease. Hundred and four (44.8%) in first appointment were referred to a general surgeon. Hundred and thirty six (58%) women were in stage III of the disease. Hundred and twenty nine (60%) patients had a tumor size more than 5 cm and 106 (46%) had a lymph node metastasis at the time of diagnosis. Patients referring with advanced stage of breast cancer had a low education (P=0.04) and income level (P=0.01).
Conclusions: Recognizing associated personal and clinical factors with early diagnosis can provide essential information for planning health education, screening and presenting appropriate solutions to overcome barriers to treatment and care in health system planning in this provinc
Reza Safdari, Leila Shahmoradi, Marjan Daneshvar, Elmira Pourtorkan, Mersa Gholamzadeh,
Volume 12, Issue 1 (5-2018)
Volume 12, Issue 1 (5-2018)
Abstract
Background and Aim: The Ovarian epithelial cancer is one of the most deadly types of cancers in women.Thus, the purpose of this study was to investigate the most effective factors in predicting and detecting Ovarian cancer in the form of a decision tree to facilitate the Ovarian cancer diagnosis.
Materials and Methods: The present study was a descriptive-developmental study. The main research tool applied in this study was a checklist which was designed based on the medical records, published studies, scientific references, and expert consultation.To determine the content validity of the checklist, the CVR method was applied. Next, survey research was done with aid of Likert-based checklist based on expert opinions in gynecology. Finally, to develop the decision tree, the results of the expert survey were analyzed and the final model was implemented based on the survey results.
Results: The data elements of final decision tree were derived from the result of expert surveys, guidelines, clinical pathways and strategies in context of diagnosis and screening of Ovarian cancer. The leaf nodes in the tree include different types of tumor markers, following up, therapeutic measures, and referrals. The accuracy of the decision tree was approved by the experts. The most important tumor markers that obtained from the decision model in this study were CA19-9, ROMA (CA125 + HE4) and CEA.
Conclusion: Clinical decision models can provide specific diagnosis and therapeutic suggestions by creating patient information integration framework. The model developed in this study can improve the diagnosis of epithelial Ovarian cancer considerably by facilitating decision making.
Materials and Methods: The present study was a descriptive-developmental study. The main research tool applied in this study was a checklist which was designed based on the medical records, published studies, scientific references, and expert consultation.To determine the content validity of the checklist, the CVR method was applied. Next, survey research was done with aid of Likert-based checklist based on expert opinions in gynecology. Finally, to develop the decision tree, the results of the expert survey were analyzed and the final model was implemented based on the survey results.
Results: The data elements of final decision tree were derived from the result of expert surveys, guidelines, clinical pathways and strategies in context of diagnosis and screening of Ovarian cancer. The leaf nodes in the tree include different types of tumor markers, following up, therapeutic measures, and referrals. The accuracy of the decision tree was approved by the experts. The most important tumor markers that obtained from the decision model in this study were CA19-9, ROMA (CA125 + HE4) and CEA.
Conclusion: Clinical decision models can provide specific diagnosis and therapeutic suggestions by creating patient information integration framework. The model developed in this study can improve the diagnosis of epithelial Ovarian cancer considerably by facilitating decision making.
Azita Yazdani, Reza Safdari, Roxana Sharifian, Maryam Zahmatkeshan, Marjan Ghazi Saeedi,
Volume 14, Issue 2 (5-2020)
Volume 14, Issue 2 (5-2020)
Abstract
Background and Aim: When clinical decision support systems are developed, implementing solutions that enable these systems to be -used on a large scale can reduce the production costs associated with the creation, maintenance and by sharing these systems, producing multiple clinical decision support systems will be prevented. In recent years, one of the approaches used for this purpose in combination with clinical decision support systems is the service-oriented architecture approach. The purpose of this study was to investigate the role and importance of service-oriented architecture in delivering scalable architectures of clinical decision support systems focusing on different approaches to this architecture.
Materials and Methods: This article is a simple review article. Bibliographic databases of IEEE Explore, Science Direct, Springer, Web of Science, and Scopus were reviewed. The keywords "Service Oriented Architecture" and "clinical decision support systems" were used as keywords along with related terms for searching these databases.
Results: The clinical decision support systems based on service-oriented architecture brings benefits such as Facilitate knowledge maintenance, reducing costs and improving agility. Point-to-point communication, enterprise service bus, service registry, clinical and engine guiding engine, and service choreography and orchestration are general architectural designs that are evident in the use of web-based clinical decision support systems based on a service-oriented architecture approach.
Conclusion: Service-oriented architecture is a potential solution for delivering scalable platforms for clinical decision systems.
Materials and Methods: This article is a simple review article. Bibliographic databases of IEEE Explore, Science Direct, Springer, Web of Science, and Scopus were reviewed. The keywords "Service Oriented Architecture" and "clinical decision support systems" were used as keywords along with related terms for searching these databases.
Results: The clinical decision support systems based on service-oriented architecture brings benefits such as Facilitate knowledge maintenance, reducing costs and improving agility. Point-to-point communication, enterprise service bus, service registry, clinical and engine guiding engine, and service choreography and orchestration are general architectural designs that are evident in the use of web-based clinical decision support systems based on a service-oriented architecture approach.
Conclusion: Service-oriented architecture is a potential solution for delivering scalable platforms for clinical decision systems.
Leila Shahmoradi, Niloofar Kheradbin, Ahmad Reza Farzanehnejad, Niloofar Mohammadzadeh, Atefeh Ghanbari Jolfaei,
Volume 16, Issue 2 (5-2022)
Volume 16, Issue 2 (5-2022)
Abstract
Background and Aim: Identifying risk factors is recommended as the first step for depression management in children and adolescents. This study aims to determine the data elements required for developing a clinical decision support system for screening major depression in young people.
Materials and Methods: This research was a descriptive-analytical study. The research population included a variety of mental health specialists that were both psychologists and students in psychiatry and guidance & counseling majors as well as electronic databases including Scopus, Pubmed, Embase, PsychInfo, WOS and Clinical key. The data collection tool was a questionnaire designed in three main sections which was answered by a convenient sample of 8 people who were specialists in the field. To analyze the extracted data Content Validity Ratio (CVR) and Mean measures were calculated for each item in questionnaire. Content Validity Index (CVI) and Cronbach’s Alpha (using SPSS software) were calculated which were equal to 0.74 and 0.824 respectively which confirmed validity and reliability of the research tool.
Results: According to Lawshe’s table, data elements with CVR between 0 and 0.75 and Mean less than 1.5, like “Ethnicity and race” (CVR=-0.25, Mean=1.125), were rejected. Items such as “Gender” (CVR=0.5) with a CVR equal to or less than 0.75, as well as items with a CVR between 0 and 0.75 and a Mean equal to or more than 1.5, like “Marital status” (CVR=0.5, Mean=1.625) were retained and considered to be included as the minimum data set for screening major depression in ages 10 to 25 years. Data elements were categorized in three categories: Demographic, Clinical and Psychosocial
Conclusion: Clinical decision support systems can facilitate providing healthcare at different levels such as screening major depression. These systems can be used for screening major depression risk factors to improve accessibility to mental health practitioners, assure the implementation of guidelines and provide a common language between different levels of healthcare. Determining the minimum data set for screening major depression in ages 10 to 25 years, is the first step toward developing a clinical decision support system for screening individuals for major depression.
Materials and Methods: This research was a descriptive-analytical study. The research population included a variety of mental health specialists that were both psychologists and students in psychiatry and guidance & counseling majors as well as electronic databases including Scopus, Pubmed, Embase, PsychInfo, WOS and Clinical key. The data collection tool was a questionnaire designed in three main sections which was answered by a convenient sample of 8 people who were specialists in the field. To analyze the extracted data Content Validity Ratio (CVR) and Mean measures were calculated for each item in questionnaire. Content Validity Index (CVI) and Cronbach’s Alpha (using SPSS software) were calculated which were equal to 0.74 and 0.824 respectively which confirmed validity and reliability of the research tool.
Results: According to Lawshe’s table, data elements with CVR between 0 and 0.75 and Mean less than 1.5, like “Ethnicity and race” (CVR=-0.25, Mean=1.125), were rejected. Items such as “Gender” (CVR=0.5) with a CVR equal to or less than 0.75, as well as items with a CVR between 0 and 0.75 and a Mean equal to or more than 1.5, like “Marital status” (CVR=0.5, Mean=1.625) were retained and considered to be included as the minimum data set for screening major depression in ages 10 to 25 years. Data elements were categorized in three categories: Demographic, Clinical and Psychosocial
Conclusion: Clinical decision support systems can facilitate providing healthcare at different levels such as screening major depression. These systems can be used for screening major depression risk factors to improve accessibility to mental health practitioners, assure the implementation of guidelines and provide a common language between different levels of healthcare. Determining the minimum data set for screening major depression in ages 10 to 25 years, is the first step toward developing a clinical decision support system for screening individuals for major depression.
Mostafa Shanbehzadeh, Hadi Kazemi-Arpanahi, Raoof Nopour,
Volume 16, Issue 2 (5-2022)
Volume 16, Issue 2 (5-2022)
Abstract
Background and Aim: Breast cancer is one of the most common and aggressive malignancies in women. Timely diagnosis of breast cancer plays an important role in preventing the progression of this disease, timely treatment measures, and aftermath reducing the mortality rate of these patients. Machine learning has the potential ability to diagnose diseases quickly and cost-effectively. This study aims to design a CDSS based on the rules extracted from the decision tree algorithm with the best performance to diagnose breast cancer in a timely and effective manner.
Materials and Methods: The data of 597 suspected people with breast cancer (255 patients and 342 healthy people) were retrospectively extracted from the electronic database of Ayatollah Taleghani Hospital in Abadan city with 24 characteristics, mainly pertained to lifestyle and medical histories. After selecting the most important variables by using the Chi-square Pearson and one-way analysis of variance (P<0.05), the performance of selected data mining algorithms including RF, J-48, DS, RT and XG -Boost was evaluated for breast cancer diagnosis in Weka 3.4 software. Finally, the breast cancer diagnostic system was designed based on the best model and through C# programming language and Dot Net Framework V3.5.4.
Results: Fourteen variables including personal history of breast cancer, breast sampling, and chest X-ray, high blood pressure, increased LDL blood cholesterol, presence of mass in upper inner quadrant of the breast, hormone therapy with estrogen, hormone therapy with Estrogen-progesterone, family history of breast cancer, age, history of other cancers, waist-to-hip ratio and fruit and vegetable consumption showed a significant relationship with the output class at the P<0.05. Based on the results of the performance evaluation of selected algorithms, the RF model with sensitivity, specificity, accuracy, and F- measure equal to 0.97, 0.99, 0.98, 0.974, respectively, AUC=0.936 had higher performance than other selected algorithms and was suggested as the best model for breast cancer diagnosis.
Conclusion: It seems that using modifiable variables such as lifestyle and reproductive-hormonal characteristics as input to the RF algorithm to design the CDSS, can detect breast cancer cases with optimal accuracy. In addition, the proposed system can be effectively adapted in real clinical environments for quick and effective disease diagnosis.
Materials and Methods: The data of 597 suspected people with breast cancer (255 patients and 342 healthy people) were retrospectively extracted from the electronic database of Ayatollah Taleghani Hospital in Abadan city with 24 characteristics, mainly pertained to lifestyle and medical histories. After selecting the most important variables by using the Chi-square Pearson and one-way analysis of variance (P<0.05), the performance of selected data mining algorithms including RF, J-48, DS, RT and XG -Boost was evaluated for breast cancer diagnosis in Weka 3.4 software. Finally, the breast cancer diagnostic system was designed based on the best model and through C# programming language and Dot Net Framework V3.5.4.
Results: Fourteen variables including personal history of breast cancer, breast sampling, and chest X-ray, high blood pressure, increased LDL blood cholesterol, presence of mass in upper inner quadrant of the breast, hormone therapy with estrogen, hormone therapy with Estrogen-progesterone, family history of breast cancer, age, history of other cancers, waist-to-hip ratio and fruit and vegetable consumption showed a significant relationship with the output class at the P<0.05. Based on the results of the performance evaluation of selected algorithms, the RF model with sensitivity, specificity, accuracy, and F- measure equal to 0.97, 0.99, 0.98, 0.974, respectively, AUC=0.936 had higher performance than other selected algorithms and was suggested as the best model for breast cancer diagnosis.
Conclusion: It seems that using modifiable variables such as lifestyle and reproductive-hormonal characteristics as input to the RF algorithm to design the CDSS, can detect breast cancer cases with optimal accuracy. In addition, the proposed system can be effectively adapted in real clinical environments for quick and effective disease diagnosis.
Mostafa Roshanzadeh, Mina Shirvani, Ali Tajabadi, Mohammad Hossein Khalilzadeh, Somayeh Mohammadi,
Volume 16, Issue 2 (5-2022)
Volume 16, Issue 2 (5-2022)
Abstract
Background and Aim: Clinical learning is an important part of the health field, where the student interacts with the environment and applies the learned concepts in practice. Clinical environments such as operating rooms are challenging for students due to their special complexity and can have a negative impact on their learning process. In order to identify students ‘learning challenges in the operating room environment, the present study was conducted to explain students’ experiences in the field of clinical learning challenges.
Materials and Methods: The present qualitative study was performed by contract content analysis method in 2022 in Shahrekord University of Medical Sciences. Fourteen surgical technology students were purposefully selected and data were collected using in-depth semi-structured individual and group interviews and analyzed using the Granheim and Landman approaches.
Results: The participants were interviewed over a period of 5 months. 9 face-to-face interviews were conducted with 14 participants. There were 6 individual interviews and 3 group interviews. The average duration of the interview was 30 minutes. The interviews continued until data saturation and when no new themes or categories were obtained from the interviews. The findings included a theme of “unfavorable learning environment” and three categories of “confusion in learning educational content, improper professional behavior of staff and insufficient self-confidence”. The main challenge that students faced in the field of clinical learning was the unfavorable learning environment. Conditions such as confusion in learning educational content, improper professional behavior of staff and insufficient self-confidence experienced by the students in the operating room, cause the students to find the learning atmosphere in the operating room unfavorable.
Conclusion: Improving the behavior and performance of staff and physicians in accordance with the standards of professional and ethical behavior and its regular evaluation from the perspective of students and other colleagues can play an effective role in maintaining professional conditions. Also, using experienced instructors who have the role of facilitating communication and learning of students in the operating room environment will play an effective role in reducing fear and controlling inappropriate behaviors of staff towards students. Educational officials are advised to solve the existing problems in order to improve the educational atmosphere of the operating room.
Materials and Methods: The present qualitative study was performed by contract content analysis method in 2022 in Shahrekord University of Medical Sciences. Fourteen surgical technology students were purposefully selected and data were collected using in-depth semi-structured individual and group interviews and analyzed using the Granheim and Landman approaches.
Results: The participants were interviewed over a period of 5 months. 9 face-to-face interviews were conducted with 14 participants. There were 6 individual interviews and 3 group interviews. The average duration of the interview was 30 minutes. The interviews continued until data saturation and when no new themes or categories were obtained from the interviews. The findings included a theme of “unfavorable learning environment” and three categories of “confusion in learning educational content, improper professional behavior of staff and insufficient self-confidence”. The main challenge that students faced in the field of clinical learning was the unfavorable learning environment. Conditions such as confusion in learning educational content, improper professional behavior of staff and insufficient self-confidence experienced by the students in the operating room, cause the students to find the learning atmosphere in the operating room unfavorable.
Conclusion: Improving the behavior and performance of staff and physicians in accordance with the standards of professional and ethical behavior and its regular evaluation from the perspective of students and other colleagues can play an effective role in maintaining professional conditions. Also, using experienced instructors who have the role of facilitating communication and learning of students in the operating room environment will play an effective role in reducing fear and controlling inappropriate behaviors of staff towards students. Educational officials are advised to solve the existing problems in order to improve the educational atmosphere of the operating room.
Saman Mohammadpour, Reza Rabiei, Elham Shabahrami, Kamyar Fathisalari, Maryam Khakzad, Mostafa Langarizadeh,
Volume 16, Issue 2 (5-2022)
Volume 16, Issue 2 (5-2022)
Abstract
Background and Aim: Cancer is the second leading cause of death in the world, which leads to the death of more than 10 million people in the world every year. Its early diagnosis, management and proper treatment play an important role in reducing complications and mortality. One of the support tools in early diagnosis, treatment and management of this disease are Clinical Decision Support System (CDSS), which are divided into two groups, rule-based and non-rule-based. Rule-based decision support systems are created based on clinical guidelines, while non-rule-based decision support systems use machine learning. In this research, the effects of decision support systems, rule-based and non-rule-based, on cancer diagnosis, treatment and management were measured.
Materials and Methods: The present study was conducted using a systematic review method, which was conducted by searching the Web of Science, Scopus, IEEE and PubMED databases until 12/31/2021. After removing duplicates and evaluating the characteristics of the inclusion and exclusion criteria, studies related to the goal were selected. The selection of articles was based on the title, abstract and full text The data collection tool was the data extraction form, which included year of study, type of study, system of body, organ of body, the service provided by the decision support system, type of decision support system, effect, effect index and the score of effect index. Narrative synthesis were used for data analysis.
Results: Out of 768 articles, 16 articles related to the objectives of the study were identified. Studies were presented in two categories of clinical decision-support systems: Rule-based and non-Rule based. The effects evaluated in the clinical decision support systems were Rule-based, dose adjustment, symptoms, adherence to treatment guidelines, care time, smoking, need for chemotherapy and pain management, all of which except pain management were significant and positive. The effects evaluated were in the category of non-Rule based clinical decision support systems, diagnostic and therapeutic decisions, controlling neutropenia, all of which were significant and positive except controlling neutropenia.
Conclusion: The results obtained for the effectiveness of both Rule-based and non-Rule-based decision support systems indicated different benefits of these two categories. Therefore, using their combination in the field of cancer can bring very useful results.
Materials and Methods: The present study was conducted using a systematic review method, which was conducted by searching the Web of Science, Scopus, IEEE and PubMED databases until 12/31/2021. After removing duplicates and evaluating the characteristics of the inclusion and exclusion criteria, studies related to the goal were selected. The selection of articles was based on the title, abstract and full text The data collection tool was the data extraction form, which included year of study, type of study, system of body, organ of body, the service provided by the decision support system, type of decision support system, effect, effect index and the score of effect index. Narrative synthesis were used for data analysis.
Results: Out of 768 articles, 16 articles related to the objectives of the study were identified. Studies were presented in two categories of clinical decision-support systems: Rule-based and non-Rule based. The effects evaluated in the clinical decision support systems were Rule-based, dose adjustment, symptoms, adherence to treatment guidelines, care time, smoking, need for chemotherapy and pain management, all of which except pain management were significant and positive. The effects evaluated were in the category of non-Rule based clinical decision support systems, diagnostic and therapeutic decisions, controlling neutropenia, all of which were significant and positive except controlling neutropenia.
Conclusion: The results obtained for the effectiveness of both Rule-based and non-Rule-based decision support systems indicated different benefits of these two categories. Therefore, using their combination in the field of cancer can bring very useful results.
Sedighe Hannani, Nazanin Sarraf Shahri, Asma Feizy Dehkharghani, Najme Samii, Azar Arab Khazaie, Azin Arab Khazaie, Kiarash Kamboozia,
Volume 17, Issue 3 (8-2023)
Volume 17, Issue 3 (8-2023)
Abstract
Background and Aim: Virtual networks have become one of the most influential tools in people’s lives, affecting various aspects of life. In medical sciences, with numerous advancements, the use of virtual networks is increasing. However, virtual networks can lead to wastage of students’ time and a reduction in study hours, which negatively impacts their knowledge and practical skills. Therefore, this study aimed to investigate the impact of using virtual networks on the knowledge and practical skills of surgical technologist students.
Materials and Methods: This descriptive-analytical study was conducted on 60 students in the 6th and 8th semester of operating room technology at Iran University of Medical Sciences in 2020-2021. At the end of the semester, the students underwent a comprehensive 40-question theoretical exam to assess their theoretical knowledge. To evaluate the level of virtual network usage, the students filled out a researcher-designed questionnaire. The practical skills of the students were measured based on their internship grades. Normality of the data was assessed using the Kolmogorov-Smirnov, and Pearson correlation coefficient test. Data analysis was performed using SPSS software.
Results: According to the findings of this study, there was a significant negative relationship between the level of virtual network usage and theoretical knowledge (P<0.05). This means that with an increase in virtual network usage, the level of students’ knowledge decreased. On the other hand, there was a significant positive relationship between theoretical knowledge and practical skills. This means that as the scores of the comprehensive exam increased, the scores of practical skills (internship) also increased. However, no significant relationship was found between the level of virtual network usage and students’ practical skills (P>0.21).
Conclusion: Based on the findings of this study, virtual networks lead to a weakening of students’ theoretical knowledge, as evidenced by the decrease in scores on the researcher-designed questionnaire (level of virtual network usage) and the comprehensive exam scores. Another result of the study was the significant positive relationship between theoretical knowledge and practical skills, indicating that as the comprehensive exam scores increased, the scores obtained in internships also increased.
Materials and Methods: This descriptive-analytical study was conducted on 60 students in the 6th and 8th semester of operating room technology at Iran University of Medical Sciences in 2020-2021. At the end of the semester, the students underwent a comprehensive 40-question theoretical exam to assess their theoretical knowledge. To evaluate the level of virtual network usage, the students filled out a researcher-designed questionnaire. The practical skills of the students were measured based on their internship grades. Normality of the data was assessed using the Kolmogorov-Smirnov, and Pearson correlation coefficient test. Data analysis was performed using SPSS software.
Results: According to the findings of this study, there was a significant negative relationship between the level of virtual network usage and theoretical knowledge (P<0.05). This means that with an increase in virtual network usage, the level of students’ knowledge decreased. On the other hand, there was a significant positive relationship between theoretical knowledge and practical skills. This means that as the scores of the comprehensive exam increased, the scores of practical skills (internship) also increased. However, no significant relationship was found between the level of virtual network usage and students’ practical skills (P>0.21).
Conclusion: Based on the findings of this study, virtual networks lead to a weakening of students’ theoretical knowledge, as evidenced by the decrease in scores on the researcher-designed questionnaire (level of virtual network usage) and the comprehensive exam scores. Another result of the study was the significant positive relationship between theoretical knowledge and practical skills, indicating that as the comprehensive exam scores increased, the scores obtained in internships also increased.
Mohamad Jebraeily, Shima Touraj, Farid Khorrami,
Volume 17, Issue 3 (8-2023)
Volume 17, Issue 3 (8-2023)
Abstract
Background and Aim: In the health system, reimbursement methods are an important criterion for the allocation of resources and the performance of service providers. The use of diagnosis-related groups (DRG) system reduces the length of stay and additional costs of the patient, prevents unnecessary treatment, increases resource efficiency and transparency of health care services. The development of the DRG system focuses on the accurate documentation of medical records and the correct coding of diagnoses and procedures. The purpose of this research is to evaluate the documentation and coding requirements of medical records in the implementation of a payment system based on diagnosis-related groups in Iran.
Materials and Methods: This research was descriptive-cross-sectional and was conducted in 2022. The data collection tool was a researcher-made checklist, the validity of which was confirmed based on the opinion of experts (health information management health economics) and its reliability was obtained by calculating Cronbach’s alpha (0.83). The research population consisted of 418 medical records in five medical training centers affiliated to Urmia University of Medical Sciences, which were selected through stratified-proportional sampling. Data were analyzed using SPSS software.
Results: The results of the evaluation of the documentation and coding requirements of medical records for the implementation of the DRG system showed that the demographic/administrative variables including age, sex, type of admission, length of stay, health insurance, and doctor’s expertise were completely recorded. Evaluation of clinical variables also showed that the main diagnosis, main procedure, secondary diagnosis and other procedures were documented in medical records in 98%, 97%, 88% and 75% respectively. Regarding the coding of the main diagnosis and the main procedure, 100%, secondary diagnosis 68% and other procedures 80% have been done.
Conclusion: Considering that some essential clinical variables for the implementation of DRG, especially co-morbidities, complications and other procedures are not recorded separately and completely, therefore it is necessary to define separate information elements in medical records and HIS for accurate recording of these variables and proper interaction between coders and doctors is established to increase the possibility of correct coding. It is also suggested that the DRG system be implemented in our country in a phased and gradual approach so that necessary changes are made in the documentation process and hospital information systems.
Materials and Methods: This research was descriptive-cross-sectional and was conducted in 2022. The data collection tool was a researcher-made checklist, the validity of which was confirmed based on the opinion of experts (health information management health economics) and its reliability was obtained by calculating Cronbach’s alpha (0.83). The research population consisted of 418 medical records in five medical training centers affiliated to Urmia University of Medical Sciences, which were selected through stratified-proportional sampling. Data were analyzed using SPSS software.
Results: The results of the evaluation of the documentation and coding requirements of medical records for the implementation of the DRG system showed that the demographic/administrative variables including age, sex, type of admission, length of stay, health insurance, and doctor’s expertise were completely recorded. Evaluation of clinical variables also showed that the main diagnosis, main procedure, secondary diagnosis and other procedures were documented in medical records in 98%, 97%, 88% and 75% respectively. Regarding the coding of the main diagnosis and the main procedure, 100%, secondary diagnosis 68% and other procedures 80% have been done.
Conclusion: Considering that some essential clinical variables for the implementation of DRG, especially co-morbidities, complications and other procedures are not recorded separately and completely, therefore it is necessary to define separate information elements in medical records and HIS for accurate recording of these variables and proper interaction between coders and doctors is established to increase the possibility of correct coding. It is also suggested that the DRG system be implemented in our country in a phased and gradual approach so that necessary changes are made in the documentation process and hospital information systems.
Sedigheh Hannani, Parsa Farmahin Farahany, Fardin Amiri,
Volume 18, Issue 3 (7-2024)
Volume 18, Issue 3 (7-2024)
Abstract
Background and Aim: The usual trainings are not enough to acquire the knowledge and skills of operating room students to play the role of scrub and mobile person, especially in complex and specialized surgeries. This research was conducted with the aim of determining the effect of designing, implementing and evaluating the protocol before, during and after Whipple surgery and its effect on the knowledge, attitude and clinical skills of surgical technology students of Iran University of Medical Sciences.
Materials and Methods: This research was a semi-experimental study of pre- and post-intervention type, during which 50, fifth and seventh semester undergraduate students of surgical technology were selected and trained using the designed protocol. The content of the protocol included the latest principles of Whipple surgery technology in the field of surgical anatomy, pathology of the digestive system and pancreas, diagnostic procedures and preparations before Whipple surgery, the procedure of Whipple surgery and the post-surgery phase and the recovery period of Whipple surgery. Before and after the training, the amount of knowledge, attitude and clinical skills of the students were evaluated and compared using a questionnaire and an observational checklist. The data were analyzed using paired t-test, non-parametric Wilcoxon test and analysis of covariance test in SPSS software.
Results: The results of this study showed that after using the designed educational protocol, the knowledge, attitude and clinical skills of surgical technology students increased. That is, the use of the designed educational protocol was effective on the level of knowledge, attitude and especially the clinical skills of the students. So that a statistically significant difference was observed in the average scores of the knowledge, attitude and clinical skill test of the students before and after training (P<0.05).
Conclusion: Based on the results of this study, designing and using educational protocols is an effective method in the process of teaching and evaluating the level of knowledge, attitude and clinical skills of students in complex and specialized surgeries such as Whipple surgery. Therefore, the use of educational protocols designed in the process of teaching students is recommended to all professors and educational officials of surgical technology.
Materials and Methods: This research was a semi-experimental study of pre- and post-intervention type, during which 50, fifth and seventh semester undergraduate students of surgical technology were selected and trained using the designed protocol. The content of the protocol included the latest principles of Whipple surgery technology in the field of surgical anatomy, pathology of the digestive system and pancreas, diagnostic procedures and preparations before Whipple surgery, the procedure of Whipple surgery and the post-surgery phase and the recovery period of Whipple surgery. Before and after the training, the amount of knowledge, attitude and clinical skills of the students were evaluated and compared using a questionnaire and an observational checklist. The data were analyzed using paired t-test, non-parametric Wilcoxon test and analysis of covariance test in SPSS software.
Results: The results of this study showed that after using the designed educational protocol, the knowledge, attitude and clinical skills of surgical technology students increased. That is, the use of the designed educational protocol was effective on the level of knowledge, attitude and especially the clinical skills of the students. So that a statistically significant difference was observed in the average scores of the knowledge, attitude and clinical skill test of the students before and after training (P<0.05).
Conclusion: Based on the results of this study, designing and using educational protocols is an effective method in the process of teaching and evaluating the level of knowledge, attitude and clinical skills of students in complex and specialized surgeries such as Whipple surgery. Therefore, the use of educational protocols designed in the process of teaching students is recommended to all professors and educational officials of surgical technology.
Leila Keikha, Fatemeh Sheikhshoaei, Abdolahad Nabiolahi, Mahnaz Khosravi,
Volume 18, Issue 4 (10-2024)
Volume 18, Issue 4 (10-2024)
Abstract
Background and Aim: Health librarians can play an important role in meeting the information needs of the clinical team and improving the quality of medical cares. Increasing clinical health literacy and use of Evidence-based medicine among ophthalmology residents is of great importance due to the importance of patients’ health in this field and appropriate decision-making about the individual’s health status. The present study aimed to evaluate the effect of an educational intervention by clinical librarians on the skills of ophthalmology residents in using of evidence-based information at Zahedan University of Medical Sciences.
Materials and Methods: This was a semi-experimental applied study. The research population was ophthalmology residents of Al-Zahra Eye Hospital, Zahedan University of Medical Sciences during the years 2020-2023, who were selected through a census. During a three-month period, 17 combined training sessions (face-to-face and virtual using the Navid system) were held for 18 ophthalmology residents regarding correct search methods from different databases and appropriate use of evidence-based information. To collect data before and after training, a clinical information literacy questionnaire derived from previous studies was used, and data analysis was performed using SPSS software and ANOVA and ANCOVA statistical tests to compare scores before and after training in the intervention group.
Results: The majority of participating residents (55.6%) were female. Before the intervention, 33.3% of the study population had moderate to high levels of knowledge about evidence-based medicine. There was a statistically significant relationship between the total level of knowledge of residents after training and gender (P-value<0.05). Clinical librarian training was effective on the level of basic knowledge of evidence-based medicine, designing clinical questions, searching for clinical evidence, critical evaluation of clinical evidence, and dissemination of evidence-based medical information of residents (P-value<0.05).
Conclusion: Considering the positive impact of clinical librarians’ intervention in improving the level of clinical decision-making knowledge of ophthalmology residents, it is suggested that evidence-based medicine training workshops or courses be held for residents of different disciplines using a variety of educational methods. In addition, it is suggested that evidence-based units be included in the residents’ curriculum and that training be conducted as a team consisting of medical librarians and specialists and ophthalmologist.
Materials and Methods: This was a semi-experimental applied study. The research population was ophthalmology residents of Al-Zahra Eye Hospital, Zahedan University of Medical Sciences during the years 2020-2023, who were selected through a census. During a three-month period, 17 combined training sessions (face-to-face and virtual using the Navid system) were held for 18 ophthalmology residents regarding correct search methods from different databases and appropriate use of evidence-based information. To collect data before and after training, a clinical information literacy questionnaire derived from previous studies was used, and data analysis was performed using SPSS software and ANOVA and ANCOVA statistical tests to compare scores before and after training in the intervention group.
Results: The majority of participating residents (55.6%) were female. Before the intervention, 33.3% of the study population had moderate to high levels of knowledge about evidence-based medicine. There was a statistically significant relationship between the total level of knowledge of residents after training and gender (P-value<0.05). Clinical librarian training was effective on the level of basic knowledge of evidence-based medicine, designing clinical questions, searching for clinical evidence, critical evaluation of clinical evidence, and dissemination of evidence-based medical information of residents (P-value<0.05).
Conclusion: Considering the positive impact of clinical librarians’ intervention in improving the level of clinical decision-making knowledge of ophthalmology residents, it is suggested that evidence-based medicine training workshops or courses be held for residents of different disciplines using a variety of educational methods. In addition, it is suggested that evidence-based units be included in the residents’ curriculum and that training be conducted as a team consisting of medical librarians and specialists and ophthalmologist.
Parsa Farmahin Farahany, Maryam Amirshekari, Mohsen Yaghmaie,
Volume 19, Issue 5 (12-2025)
Volume 19, Issue 5 (12-2025)
Abstract
Background and Aim: Designing a standard surgical preference card and implementing it in the operating room environment can partially solve the problems related to the variety of surgical procedures and the preparation of tools and equipment required for each surgical procedure. The present study aimed to determine the effect of designing and implementing surgical preference card software on the clinical skills of operating room students at Jiroft University of Medical Sciences.
Materials and Methods: This study was a semi-experimental intervention study in which 70 operating room students from the 4th, 6th, and 8th semesters of the undergraduate operating room program were selected through a census method and were trained using educational software designed by the researcher. Before and after the training, their clinical skills were assessed using a researcher-made questionnaire and checklist. To confirm the validity of the questionnaires and the researcher-made checklist, the opinion of an expert panel (12 expert faculty members) and the consensus of peer reviewers were used. Then, the data were analyzed in SPSS software using descriptive statistics, paired t-test, nonparametric Wilcoxon test, and analysis of covariance test.
Results: According to the research findings, the use of the designed software was effective on the clinical skills of operating room students. Based on the results of the Willcocson tests, a significant difference was observed in the mean scores of the students’ clinical skills test before and after implementing the designed software. The results of the study showed that the clinical skill scores of the students increased after using the software. The maximum scores of the samples are calculated from 100 points. The average clinical skill score of the subjects in the study increased from 40.98 before the educational intervention to 92.36 after the intervention, and the students had a higher level of skill in preparing the items and tools needed by the surgical team in all three stages before, during, and after surgery. Also, in the study, no relationship was found between any of the demographic variables studied, such as age, gender, and academic semester, and the clinical skills of the study members (P<0/05).
Conclusion: Based on the results of the present study, the design and use of surgical preference card software in training procedure of operating room students has had an impact on improve their clinical skills. Therefore, the design and use of educational software in the field of anticipating the needs and preparing the requirements of each surgical procedure is recommended to all professors and officials in the operating room field.
Materials and Methods: This study was a semi-experimental intervention study in which 70 operating room students from the 4th, 6th, and 8th semesters of the undergraduate operating room program were selected through a census method and were trained using educational software designed by the researcher. Before and after the training, their clinical skills were assessed using a researcher-made questionnaire and checklist. To confirm the validity of the questionnaires and the researcher-made checklist, the opinion of an expert panel (12 expert faculty members) and the consensus of peer reviewers were used. Then, the data were analyzed in SPSS software using descriptive statistics, paired t-test, nonparametric Wilcoxon test, and analysis of covariance test.
Results: According to the research findings, the use of the designed software was effective on the clinical skills of operating room students. Based on the results of the Willcocson tests, a significant difference was observed in the mean scores of the students’ clinical skills test before and after implementing the designed software. The results of the study showed that the clinical skill scores of the students increased after using the software. The maximum scores of the samples are calculated from 100 points. The average clinical skill score of the subjects in the study increased from 40.98 before the educational intervention to 92.36 after the intervention, and the students had a higher level of skill in preparing the items and tools needed by the surgical team in all three stages before, during, and after surgery. Also, in the study, no relationship was found between any of the demographic variables studied, such as age, gender, and academic semester, and the clinical skills of the study members (P<0/05).
Conclusion: Based on the results of the present study, the design and use of surgical preference card software in training procedure of operating room students has had an impact on improve their clinical skills. Therefore, the design and use of educational software in the field of anticipating the needs and preparing the requirements of each surgical procedure is recommended to all professors and officials in the operating room field.
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