مهرداد عسکریان

Journal club is one of the classical methods of medical education dating back to 100 years ago. This method can be used for teaching critical evaluation, evidence-based medicine, research design, statistics, and educational concepts to medical residents. The purpose of this study was to investigate the anesthesiology residents’ attitude toward a new method of presenting journal club (with the presence of specialists in community medicine and/or statistics). This was a cross-sectional, interventional study performed in the adult intensive care unit of Namazi Hospital, Shiraz, Iran. From among 50 faculty members and second year anesthesiology residents participating in the journal club through both the new and traditional methods, 36 returned their viewpoints. A questionnaire with 19 items was designed by the researcher with the collaboration of the Medical Education Development Office and the Anesthesiology Department of Shiraz University of Medical Sciences, Iran. The validity of the questionnaire was confirmed by educational experts and its reliability was reported as over 90% using Cronbach's alpha coefficient. The intervention group (journal club sessions with the presence of community medicine or statistics professionals) scored significantly higher than the control group on all items of the questionnaire. The participants in the experimental group reported that the most important effects of the new approach was their better understanding of statistical terms and research methodology, a positive attitude toward the usefulness of interdisciplinary communication, article reviews and the application of results in clinical practice, development of article assessment skills, creating motivation for further research, causing desire to participate in other journal clubs, and recommending colleagues to participate in such clubs. Moreover, Spearman's rank correlation coefficient showed that with the increase in the number of journal club sessions participated in, the rate of knowledge and desire to participate in more sessions also increased. Participants admitted that they had improved academically and were generally satisfied with this new approach. Regarding the generalizability and implementation in other training centers, this new approach can be exploited in other departments of specialized medical fields. In case of achieving valid and reliable results, the approach can be proposed as a national model.

Congenital anomalies are of main reasons of neonatal mortalities. Although most of the symptoms can be detected immediately after birth، some are mild enough to be ignored. Failure to diagnose of the disease may result in irreversible physical and mental problems in neonates. In most of the countries، there are screening programs for detection of the Phenylketonuria. This study aimed to assess cost- effectiveness of neonatal screening program for Phenylketonuria in Fars province. Implementation costs of the screening program and the cost of the disease management were calculated and compared using Decision Tree model. The health related quality of life of the two mentioned groups and incremental cost-effectiveness were also estimated. Results showed that the Phenylketonuria screening cost was about 34727047 Rials for every individual. The screening program was cost-effective. The Phenylketonuria screening program was beneficial for both patients and society. It increased quality of life of the patients and might have long-term financial gain for the society.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. The aim of this study was to determine the risk factors of nasal carriage of MRSA and its antibiotic susceptibility pattern among healthcare workers at Namazi Hospital (Shiraz-Iran) In a cross-sectional study from July to November 2006, nasal swabs were taken from 600 stratified randomly selected health care workers. The isolates were identified as S. aureus based on morphology, gram stains, catalase test, coauglase test and DNase Agar. To differentiate Methicillinsusceptible S. aureus (MSSA) and Methicillin Resistant S. aureus (MRSA), agar screen plate was used. All methicillin-resistant isolates were examined for mecA genes existence by PCR performance. The sensitivity patterns of S.aureus isolates were determined by disc diffusion and E-test method. Nasal screening identified 186 (31%) S. aureus carriers of whom, 154 ones (82.8%) were MSSA and 32 ones (17.2%) were MRSA._There was no significant association between related risk factors and gender, age, years of healthcare service and level of education. In the univariate analysis, a statistically significant difference was found only based on occupation (P=0.032) between carriers of MSSA and MRSA. In multivariate analysis(logistic regression), having nursing occupation (p=0.012, OR=3.6, 95%CI=1.3-9.7) was independently associated with MRSA carriage. All of the MRSA strains were sensitive to mupirocin. This study revealed that having nursing occupation is independently associated with MRSA carriage since all S.aureus isolates were susceptible to mupirocin, topical mupirocin could be used successfully to eradicate nasal staphylococcal colonization and carriers.

Increasing hospital costs in recent years and also the implementation of privatization and managing the hospitals with their own private revenues, cause hospitals to confront with a lot of monetary problems. On the other hand, many resources in hospitals become useless because of the wrong and inappropriate financial management. The aim of this study was decreasing the deficits resulting from not recording these procedures in patient's medical records and also in patient's bills using a 9 step quality- improved module on hospital revenues. This wsa an interventional and longitudinal study on 350 patient's medical records in male and female internal ward in Nemazi hospital in Shiraz in early months of 2006. The randomly selected records were compared with patient's bills. Then a medical procedure form was designed and the nurses were instructed on how to fill this form and were made aware about the importance of this form. The intervention last about 4 months. After intervention in post test the impact of intervention on 215 medical records was examined. In the pretes,t 56% of the costs of medical procedures have not been recorded and after intervention these lost revenues decreased to 31% and totally caused 25% increase in the revenues of this hospital. Nemazi hospital does not have any acceptable method for recording the medical procedures. This hospital can significantly increase its revenues, if patient's bills be compromised with their medical processes records and a correct and appropriate financial management module correctly be used.

Increasing hospital costs in recent years and also the implementation of privatization and managing the hospitals with their own private revenues, cause hospitals to confront with a lot of monetary problems. On the other hand, many resources in hospitals become useless because of the wrong and inappropriate financial management. The aim of this study was decreasing the deficits resulting from not recording these procedures in patient's medical records and also in patient's bills using a 9 step quality- improved module on hospital revenues. This wsa an interventional and longitudinal study on 350 patient's medical records in male and female internal ward in Nemazi hospital in Shiraz in early months of 2006. The randomly selected records were compared with patient's bills. Then a medical procedure form was designed and the nurses were instructed on how to fill this form and were made aware about the importance of this form. The intervention last about 4 months. After intervention in post test the impact of intervention on 215 medical records was examined. In the pretes,t 56% of the costs of medical procedures have not been recorded and after intervention these lost revenues decreased to 31% and totally caused 25% increase in the revenues of this hospital. Nemazi hospital does not have any acceptable method for recording the medical procedures. This hospital can significantly increase its revenues, if patient's bills be compromised with their medical processes records and a correct and appropriate financial management module correctly be used.

Enterococci were the first organisms which developed resistance to vancomycin. In the recent years, they have shown resistance to many antibiotics and vancomycin is one of such antibiotics. Risk factors for rectal colonization with vancomycin-resistant enterococci include patient related factors such as underlying diseases and hospital related factors such as duration of hospitalization, treatment procedures and antibiotic use. In this study the prevalence and risk factors for rectal colonization with vancomycin-resistant enterococci (VRE) in the medical and surgical wards were assessed and the results of the study in the 2 above mentioned wards were compared with each other. Serial rectal swabs were obtained from 370 hospitalized patients in seven medical wards and 143 patients in five surgical wards every five days. Sampling method was stratified random sampling. During the study 750 samples of rectal swab were taken under sterile conditions. Enterococci were detected by disk diffusion method and their resistance to vancomycin was verified by minimum inhibitory concentration dilution method. Chi square and T tests were used for data analysis. Among 513 patients, 76 (15%) were colonized with VRE (cases) and 40 patients with vancomycin-sensitive strains (VSE). Medical wards showed a higher rate of colonization (18.1%) in comparison to surgical wards (6.3%). In surgical wards, prevalence of VRE was related to clinical outcome (p=0.04) and major surgery (p=0.000), but in medical wards, VRE colonization showed a significant relationship with duration of hospitalization (p=0.03), underlying disease (p=0.04), the number of antibiotics (p=0.02), renal failure, history of dialysis (p=0.01) and duration of antibiotic use. Our study demonstrates that VRE prevalence in medical wards is three times as those of surgical wards. Considering longer period of hospitalization, use of more drugs for longer periods and also presence of underlying diseases in medical ward patients, performance of infection control strategy in regard to VRE seems necessary.

The present research has been conducted to design the HIV/AIDS Surveillance system for Iran applying WHO recommendations, using the experiences of the countries having the lead in the design and implementation of the system. In this descriptive study of applied kind, we initially investigated the existing circumstances governing Iran's HIV/AIDS information system from the Ministry of Health using a checklist. Subsequently, the HIV/AIDS surveillance system of selected countries (USA, United Kingdom and Australia) were studied and based on the country's requirements, a model was proposed and designed for Iran. The Delphi technique was utilized to find the views of 24 experts in infectious diseases and Health Information Management. The validity of research instruments was measured using content validity and the reliability was obtained using attest-retest method. A model for HIV/AIDS surveillance system was presented based on WHO recommendations and using the experiences of selected countries. This was presented in six axes: general specifications of the system, minimum data set, data collection and reporting, data processing, data processing rules, and data distribution. Using Delphi technique, the results were approved obtaining the score of 36.3 out of 44 (82.5 percent). The design and implementation of HIV/AIDS surveillance system at the nation level in Iran is proposed for a better understanding of the epidemic procedure and spreading behaviors as well as focusing on the at high risk subpopulations and designing a prevention and care system using high quality data.

Surgical site infection is the most common complication of surgery and can be prevented with the appropriate use of prophylactic antibiotics. In fact, some complications may occur such as emergence of resistant bacteria and increased costs are due to inappropriate use of antibiotics. We have designed this descriptive study to recognize the current status of surgical antibiotic prophylaxis comparing with the National Iranian Guideline (NIG). 760 patients in 7 different surgical wards from 6 university hospitals in Shiraz enrolled to the study. Using the NIG as reference, we considered indices like the decision making toward the prescription of prophylactic antibiotics, antimicrobial agents, starting time, duration, route of administration of prophylactic antibiotics and total adherence to the guideline for each patient. It was found that 82.1% of decision making regarding prescriptions were on the base of the guidelines. Comparing with the guideline, drug selection, initiation time, duration, and route of prophylaxis was appropriate in 2.9%, 55%, 0%, and 30.7% of patients, respectively. However the total adherence was 0%. This study showed significant discrepancies between the NIG recommendations and the current prophylactic practice. An interventional study is essential in order to improve prophylactic antibiotic prescription, patient safety, infection control and to decrease complications.

Urban growth with increase in population has resulted in an increase in amount of waste. Today getting rid of this waste especially in hospitals has known as one of the most significant environment challenges in all developed and developing countries. Improper hospital waste management in many of countries like Iran causes disposal of hospital waste without considering environmental and technical issues causes harmful effects on human and the environment. Therefore managing of hospital waste is one of the most complicated problems for government in all countries that involves many expenses. The study aimed at decreasing the amount of infectious waste by using a quality model. In this study, we performed a quality improvement model to interfere generation of waste in a public university affiliated hospital in shiraz- Iran. In this study, we tried to decrease the amount of infectious waste by using this model. Hospital waste was weighted in two stages, before and after performing model. The descriptive statistics was used to compare the results of two phases. Prior to accomplishing this model, the daily average of waste production was 813 kg for infectious waste and 83 kg for non-infectious wastes that contains kitchen wastes only. Total amount of daily medical wastes in inpatient wards was 594kg (3.4 kg per occupancy bed-day). Therefore, infectious waste was 90.7% of the total amount of hospital waste. After accomplishing the model, it decreased to 57.6%. Using the quality improvement model, infectious waste production has been decreased by 33.1%. Therefore, hospital can use the quality model to decrease their infectious waste production.

The aim of this cross sectional study was to determine the prevalence of intestinal colonization by vancomaycin-resistant enterococci (VRE) in Namazi Hospital in Shiraz. Serial rectal swabs were obtained every 5 days from all the 700 hospitalized patients, (from December 2003 through July 2004), and VRE (Vancomycin-resistant Enterococci) were detected by disk diffusion method and then confirmed with Minimum Inhibitory Concentration dilution Method. The data collected out of interviews and patients` records, were analyzed by means of chi-square test. 99 (%14) out of 700 patients were colonized by VRE. 3% of 23 patients who had negative tests for VRE, at the time of hospitalization, were colonized by resistant enterococci. In this study the prevalence of VRE showed a significant relationship with variables of age, ward, history of previous admissions, history of previous antibiotic use, duration of hospitalization, underlying disease, neutropenia, renal failure, dialysis and major surgery (p<0/05). But association between prevalence of VRE and sex, clinical outcome or conditions such as immunosuppression, cancer and diabetes were not statistically significant (p>0.05). This study that was the first on VRE in Iran and revealed that colonizeation with VRE has a high prevalence in Namazi Hospital and this organism might be endemic in large hospitals. Interventional strategies are required to control this emerging nosocomial infection.