Tehran University Medical Journal

Background: Infant mortality is important as a standard indicator for the development of health, educational and social health systems in each country. Considering the fact that in different studies of the country there are different statistics on the prevalence of infant mortality in the intensive care unit and the general statistics on the prevalence of mortality in neonates in the country are unclear and unclear, the aim of this study was systematic review and meta-analysis for determine the prevalence of mortality in infants admitted to the intensive care unit (ICU) of hospitals in Iran.
Methods: A meta-analysis was performed for relevant articles in scientific databases including scientific information database (SID) and Magiran, ScienceDirect, Scopus, Medline (PubMed) and Google Scholar. Entrance criteria included cross-sectional studies between March 2000 to September 2018. The search process in these databases was performed using keywords: Neonatal, Intensive Care Unit, Mortality, and Iran. Non-relevant articles included review articles, interventions, cohorts and case-control studies, excluded from the study list. Heterogeneity of study was checked using I2 index and the possibility of publication bias by funnel plot and Egger test. Data were analyzed using the comprehensive meta-analysis software, version 3 (Biostat, Englewood, NJ, USA).
Results: The overall prevalence of infant mortality in ICU hospitals was 21.8% (95% CI 14.4-31.6%), the highest prevalence of infant mortality in Isfahan was 64.4% percentage (95% CI 57.5-70.9%) and the lowest mortality rate in babies in Babol's intensive care unit with 5.1% (95% CI 3.8-6.7%). The results of the study showed that the prevalence of infant mortality was significantly reduced with increasing sample size (P<0.05). Also, with an increase in years of research, the frequency of infant mortality in the intensive care unit increases, which is also statistically significant respectively (P<0.05).
Conclusion: Considering the high prevalence of infant mortality in ICU hospitals in Iran, health policy makers need to take effective measures to raise awareness of parents as well as effective measures to reduce infant mortality.

Background: Medical errors are those errors or mistakes committed by healthcare professionals due to errors of omission, errors in planning, and errors of execution of a planned healthcare action whether or not it is harmful to the patient. Medical error in hospitals increases morbidity and mortality and decreases patient satisfaction and hospital productivity. This study aimed to determine the prevalence of medical errors in Iranian hospitals.
Methods: This study was conducted using systematic review and meta-analysis approaches. All articles written in English and Persian on the prevalence of medical errors in Iranian hospitals up to March 2019 were searched in Web of Science, PubMed, Elsevier, Scopus, Magiran, IranMedex and Scientific Information Database (SID) databases, and Google and Google Scholar search engines. In addition, reference lists of the retrieved papers were hand-searched. A total of 9 studies matching the inclusion criteria were identified, reviewed, and analyzed using comprehensive meta-analysis software.

Background: The Electronic Health Record contains personalized health care information. Several factors affect the quality of SEPAS (Iranian electronic health record) data, disregarding the types of hospital information system set-up in hospitals. The purpose of this study was to investigate users' views on the factors affecting the data quality of Iranian Electronic Health Record (SEPAS) in hospitals affiliated to Mashhad University of Medical Sciences.
Methods: This descriptive cross-sectional study was conducted in 2018. In this study, the views of supervisors of the SEPAS system, HIS chief officers, and head of health information technology departments of hospitals were evaluated through a valid and reliable researcher-made questionnaire. Content validity ratio and content validity index of the questionnaire were validated as 0.82 and 0.94, respectively. Furthermore, the internal questionnaire reliability was affirmed by Cronbach's alpha of 0.96. Data analysis was conducted using descriptive statistics in the SPSS v.16 software.

Background: Currently many hospitals around the country face increasing demands of their patients and readmission.The rate of readmission is a useful indicator for determining the performance of healthcare system and it shows the quality of services in the medical institutions. Readmissions have high economic, social and financial impact and studying the related factors seems to be high priority for healthcare systems.
Methods: This qualitative study performed by phenomenological method in three educational hospitals in Kerman from April to September of 2017. Data collection was performed through semi-structured interviews using targeted sampling among all patients who were hospitalized at internal medicine wards, nurses who were working in those wards, and in charge physicians. In total twenty patients, fifteen nurses, and five physicians were selected for interviews. The including criteria were for patients, the history of hospitalization at least once, during one month after the initial hospitalization, and for service providers, familiarity with the subject, work experience in the relevant department of at least three years for nurses and five years for physicians. A seven-step clustering method was used to analyze the data.
Results: The analysis of the interviews led to the identification of three main themes and 11 sub-themes. The main themes included patients' characteristics, manpower and clinical factors, hospital, and environmental factors. Some of the sub-codes included economic and living conditions, marriage status, insurance coverage, patients' beliefs and expectations, the presence or absence of underlying disease, education, lifestyle habits, dietary beliefs of hospitalized patients, lack of trust in medical staff, communication and cultural barriers, ignorance of service providers in treatment, lack of facilities, lack of motivation in medical staff, stressors and finally lack of hospital equipment.

Background: Hospital accreditation is a systematic external evaluation of a hospital's structures, processes, and outcomes by an independent professional accreditation body using published optimum, evidence‐based, and achievable standards. Accreditation is a strategy for ensuring the quality, safety, and productivity of hospital services. Implementing accreditation standards imposes a high cost on hospitals. Therefore, this cost should be offset by increased hospital efficiency. Hence, this study aimed to examine the relationship between the Iranian public hospitals’ efficiency and their accreditation status.
Methods: This descriptive and cross-sectional study was conducted in May 2019. The efficiency of general hospitals in Iran was assessed using the Pabon Lasso chart and three performance indicators of bed occupancy rate, average patient length of stay and hospital bed turnover. Then, the relationship between the efficiency of hospitals and their accreditation grade was examined. Descriptive statistics and ANOVA tests were used for data analysis using SPSS software.

Background: The preparedness and safety of hospitals in disasters are essential to maintain the health and survival of the community. Numerous studies have shown that the level of preparedness of Iranian hospitals is moderate and low. Lack of comprehensive hospital standards for disaster preparedness is one of the reasons. This study aimed to develop hospital accreditation standards for hospital disaster risk management.
Methods: This comparative study was conducted between April and September 2016. Hospital disaster risk management accreditation standards were extracted from the hospital accreditation standards of 11 countries including the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, Denmark and Iran. Overall, 27 hospital disaster risk management accreditation standards were introduced. The opinions of 22 disaster risk management experts were used to assess the content validity of the proposed disaster risk management accreditation standards.
Results: Differences were observed in the quality and quantity of those countries’ disaster risk management standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. Finally, 27 standards were proposed for developing Iranian hospitals’ disaster risk management accreditation standards. The CVI & CVR validity of the proposed standards were acceptable.
There were significant differences in the quantity and quality of hospital disaster risk management accreditation standards in selected countries. The most comprehensive standards belonged to the US National Standards (12 standards and 113 sub-standards), followed by the Australian and Canadian accreditation standards. The accreditation standards of the developing countries and Iran were not comprehensive and did not meet the international goals of disaster risk management. The proposed hospital disaster risk management accreditation standards had high content validity.
Conclusion: Disaster risk management accreditation standards in Iran and developing countries need to be revised and upgraded. Comprehensive standards based on international experiences and expert opinions were introduced in this study that can be used to develop hospital accreditation standards in Iran and other countries.

Background: The prevalence of emerging and re-emerging diseases has made the need for basic preparations for all health care organizations more crucial. Strengthening preparedness and formulating crisis strategies will have a great impact on reducing casualties. Given the importance of preparing hospitals to deal with such an outbreak and reduce the resulting mortality, the present study was conducted to assess their readiness against Covid-19.
Methods: The present study is a quantitative and descriptive cross-sectional research conducted from October to March 2019. Data collection used the standard checklists prepared by the European Center for the Prevention and Control of Coronavirus and the Centers for Disease Control and Prevention, consisting of eight domains and 21 components. The minimum score that each hospital could get in this checklist was 143 and the maximum was 429. The sampling method in the present study was a census, and nine reference hospitals for Corona were included in the study. All hospitals’ directors, managers, quality officers and crisis secretaries and others related to hospital readiness during Covid-19 were recruited by the census.

Results: On average, the hospitals scored 391 out of 429, indicating a fairly "high readiness" in dealing with Covid-19. The highest score obtained by the hospitals was 425 and the lowest score was 349. In terms of preparation areas, the hospitals’ readiness was higher than 80% in all areas. The highest readiness of hospitals was in the fifth  domain, i.e. Hand hygiene, personal protective equipment and hospital waste management. The 7th domain namely, patient placement and relocation, and patient visitor access was of the lowest preparation. Conclusion: The hospitals were of fairly appropriate readiness to deal with Covid-19. This level of preparedness, despite being desirable, might not reflect the real capacity of hospitals to deal with this disease. Regular evaluation of the Covid referral hospitals could help make these hospitals more prepared. Also, the experiences of hospitals that were more prepared should be used to improve the condition of other hospitals.

Background: Fetal health diagnostic tests are tools to reduce the incidence of adverse outcomes and neonatal death. However, their diagnostic value is still debated in relation to various outcomes. The aim of this study was to evaluate the value of biophysical profile and sonographic cerebroplacental ratio in predicting childbirth mode and adverse neonatal outcomes.
Methods: In this cross-sectional study, 70 pregnant women (37-41 weeks) who were candidates for termination of pregnancy who were referred to Ayatollah Mousavi Hospital in Zanjan from October 2020 to May 2021 were studied. After selecting the mothers based on inclusion criteria, biophysical profile test (BPP) and CPR sonographic index were performed. Then delivery method, infant weight, fifth minute Apgar score, need for resuscitation and hospitalization of infants in NICU were recorded in each case. T-test, Mann-Whitney test and ROC curve in SPSS 22 software were used for statistical analysis. (P≤0.05).

Results: In this study, the mean (SD) gestational age of participants was 38.56±1.11 weeks. Based on the data, there was a statistically significant relationship between CPR and the infant's need for resuscitation and hospitalization in the NICU (P=0.021) and Apgar score (P=0.042). However, there was no statistically significant relationship between CPR and delivery method, gestational age and birth weight. BPP score was not significantly associated with any of the consequences. Based on the results of the ROC curve, CPR with a cut point of 1.59 with a sensitivity of 88.9% and a specificity of 75% is able to predict the need for resuscitation and hospitalization in the NICU, and with a sensitivity of 83% and a specificity of 54.5%, it is able to predict a low Apgar score. However, BPP score did not have a predictive role in any of the studied parameters. Conclusion: It seems that CPR examination around delivery can be useful in predicting the condition of the baby immediately after birth and preparing the treatment staff for immediate action.

Background: Preventing the cancellation of surgeries is an important and devastating challenge in operating room management. Cancellation of pre-scheduled surgeries at the last moment in the operation room leads to increased length of stay, patient dissatisfaction, human resource consumption and financial burden for patients and the health care system. In this study, we have investigated the effect of recording the causes of surgery cancellations in the operation room on the incidence of surgery cancellations in patients who have been candidates for non-emergent surgeries.
Methods: A total of 545 surgeries which had been canceled in different types of surgery between March 2014 and March 2015 were recorded according to the reasons for cancellation in predetermined forms and the information was analyzed. The most common reasons for cancellation included changing the plan of treatment from surgery, a high-risk comorbidity with a high probability of mortality, patient’s refusal from surgery, an unanticipated duration of previous surgery longer than anticipated, the unavailability of an ICU bed in the hospital, requested laboratory data not being ready, failing to prepare requested packed RBCs and other hospital or patient-related problems.

Results: The percentage of surgery cancellations in most groups including orthopedics, urology, cardiac surgery, general surgery, gynecology and maxillofacial surgery, decreased during the course of this study. According to our findings the most relevant cause of non-emergent surgery cancellation was the unpredictable increased duration of previous surgery. The maxillofacial surgery group reached the highest surgery cancellation reduction rate and the cardiovascular surgery group experienced the lowest cancellation reduction rate. Also, the percentage of surgery cancellations in the field of neurosurgery increased during the study period. Conclusion: Recording the reasons mentioned by the surgical team as the reason for canceling surgeries and reducing the rate of their occurrence during the study and providing appropriate feedback and dialogue in this case had a positive effect on reducing the rate of cancellation of the surgeries and reducing the mentioned reasons.

Methods: This descriptive-analytical study was carried out cross-sectionally from March 21, 2019 to March 19, 2020, using a simple random sampling method in patients referred to the emergency department of Imam Khomeini Hospital in Urmia. Which was used to collect information from the demographic information checklist and the EDWIN index was calculated. Then the information was entered into SPSS18 software and analyzed with the help of descriptive and analytical statistics. Results: In this study, the results showed that in terms of the frequency of triage level, 5.4% was level one, 65.6% was level two, 26.3% was level three, 2.7% was level four and there was no disease in level five. In terms of shift, 22.5% visited the hospital in the morning shift, 27.6% in the evening shift and 49.9% in the night shift. The average EDWIN index was 2.7±0.75 on holidays and 5.9±4.6 on non-holiday days. Although emergency room congestion was more on non-holiday days, this difference was not statistically significant (P=0.15). Also, the average of EDWIN in the morning shift was 2.5±2.3, in the evening shift it was 0.71±2.16 and in the night shift it was 9.7±5.8 and even though the average of EDWIN in the night shift was higher than in the evening and night shifts, this difference was not statistically significant (P=0.06). Conclusion: The results of the present study indicated that on most of the investigated days, the emergency room was evaluated as crowded based on the EDWIN criteria. Also, there is no significant difference between the busyness of the emergency room according to the holiday or working day, as well as the morning, evening and night shift.

Background: Medical errors are one of the biggest problems of the health system in countries. Identifying the factors responsible for these errors is crucial to designing optimal strategies to reduce such occurrences. The aim of this study was to investigate the type and nature of medical errors.
Methods: In this cross-sectional descriptive study, all documented medical errors that occurred between March 2021 and February 2022 at Firoozgar Educational and Medical Center were thoroughly examined. The data collection involved reviewing records from various departments within the center to ensure a comprehensive analysis of error types. The extracted data were processed and analyzed using SPSS v.22 software, allowing for statistical evaluation and identification of potential patterns or trends in medical errors over the specified period.

Results: A total of 214 cases were reviewed. 45.3% of the recorded medical errors occurred in the morning shift, 20.6% in the evening shift and 34.1% in the night shift. The highest number of medical errors was reported by nurses (40.7%), followed by physicians (16.8%) and paramedics (11.7%). The etiology of most medical errors was systemic errors (63.6%) followed by pharmacological errors (15.4%) and technical errors (13.1%) and the most reported systemic errors were of insufficient supervision. Most of the patients who had medical errors were admitted to the inpatient wards (40.7%) and later to the surgical wards (17.3%) and ICU (12.6%). 62.1% of medical errors did not cause any specific complication and in 33.2% of cases, mild complication, 10.7% moderate complication and 3.3% severe complication occurred for patients. 62.1% of medical errors had no consequences for anyone, and in 36.9% of cases, the consequences of errors were to the patient and 1% of the consequences of errors were to the organization and employees. Conclusion: Most of the reported medical errors were performed by nurses and were uncomplicated errors. Establishing transparent and accurate self-reporting systems is essential to identify medical errors of all employees.

Results: In this study, the results showed that out of 1901 studied patients, 1101(57.9) were male and the rest were female 801(42.1), And the average age of the patients was 61.67±17.13 years, and 1160(60.9) patients did not have drug interactions and 724(39.01) had drug interactions, and the most common type of drug interaction was the moderate type, which was present in 75.1% of cases; And the final clinical outcome of the patients was 1088(57.2) discharge, 296(15.5) personal consent discharge and 506(26.6) death. Also, the most common drug interactions were serotide/salbutamol, azithromycin/ondansetron, and aspirin/nitroglycerin, respectively. And there was no significant relationship between the occurrence of drug interactions and the gender of patients (P=0.27) and finally, the average age of patients with drug interactions was 17.7±61.2 years and in patients without drug interactions was 16.7±61.9 years. Conclusion: The overall incidence of drug interactions in the studied patients was equal to 39.01, and the most common drug interactions in patients were of moderate and mild type; and there was no statistically significant relationship between the age of the patients and the gender of the patients and the incidence of drug interactions.

 

Background: Although the respiratory system is the main element involved in the disease of COVID-19, nevertheless, there are reports of the involvement of other organs and their lesser symptoms. This study was conducted with the aim of investigating the frequency of gastrointestinal symptoms in patients with COVID-19.
Methods: This cross-sectional descriptive study was conducted on all patients diagnosed with COVID-19 hospitalized in Imam Khomeini Hospital from April to September 2021 by census method. The data was collected using a checklist that included demographic information. After the data was collected, it was entered into SPSS software, version 18 (IBM SPSS, Armonk, NY, USA) and analyzed with the help of descriptive statistics.

Results: In this study, the results showed that out of 2580 hospitalized patients, 54% were women and 46% were men. And the average age of the patients was 58.67±17.68. The highest frequency of people was in the age range of 40-59 years (925 people). 64% of patients had at least one gastrointestinal symptom, Each of the symptoms had a different prevalence, Anorexia 40% with a preference for men (57%) and the highest frequency in the age range of 40-59 years (430 people), gastrointestinal bleeding 10% with a preference for men (80%), And the highest frequency in the age range of 60-79 years (112 people), abdominal pain 8% with preference for women (65%) with preference for frequency in the age range of 40-59 years (65 people), vomiting 3% with preference for women (51%) with abundance in the age range of 80-99 years (58 people), diarrhea 1.5% with preference in men (51%) with abundance in the age range of 60-79 years (18 people) and constipation in 0.2% with preference Women (67%), all of whom were over 60 years old. Conclusion: The findings of this study showed that the COVID-19 disease can not only involve the respiratory system but also the digestive system in the course or beginning of the disease.