Investigating the implementation challenges of the research doctoral program and providing related solutions: a qualitative study.

BACKGROUND: Doctoral programs have consistently garnered the attention of policymakers in medical education systems due to their significant impact on the socio-economic advancement of countries. Therefore, various doctoral programs have been implemented with diverse goals. In Iran, a research doctorate program, known as PhD by Research, was introduced primarily to engage in applied research related to healthcare needs. Nevertheless, the achievement of the program's goals has been questioned. This study aimed to identify the implementation challenges of the Research Doctorate Program and its solutions in Iran. METHOD: This descriptive qualitative study followed the Standards for Reporting Qualitative Research: A Synthesis of Recommendations and was conducted in two steps. Firstly, the challenges of the Iranian Ph.D. by research program were identified through the perspectives of the program's students and graduates. In the second step, relevant solutions to these challenges were determined by focus groups of key informant experts. The transcripts were analyzed using qualitative content analysis. RESULTS: Five students and six graduates were interviewed in the first step and seven experts participated in the second one. The challenges and related solutions are explored in four main themes, including: (1) admission criteria, (2) program goals and expected outcomes, (3) curricula, and (4) financial and human resources. The study showed that various dimensions of the doctoral program are not aligned with each other and how to adapt the program in these dimensions. CONCLUSION: The study revealed the importance of a systematic approach in defining various dimensions of doctoral programs according to program goals and provided specific solutions for defining a research doctorate program in the context of a low- and middle-income country.

A survey on road hazardous material transportation accidents in Iran.

Hazardous material road transportation is one of the most challenging procedures performed by large trucks and trailers. In this study, after examining and analyzing road hazardous material transportation accidents, occurred over 5 years in Iran, the contributing factors of road hazardous material transportation accidents were determined. Subsequently, the introduced factors were prioritized using fault tree analysis and the Dempster-Shafer evidence theory. The results revealed that the frequency of accidents has significantly increased in recent years. It is shown that the three pivotal factors in road hazardous material transportation accidents were transport vehicle, packaging and loading of hazardous materials, and human factors. These findings provide an empirically supported theoretical basis for transportation corporations to take corrective and preventative measures to reduce the accident risks. A novel technique has been introduced for analyzing the causes of road hazardous material transportation accidents. Finally, the absence of hazardous material transportation companies in Iran is introduced as a critical reason for the higher frequency of such accidents in Iran compared to other countries.

Risk characterisation and methods of improving practice for municipal waste management in disaster situations: A case study in Qom Province, Iran.

Developing strategies to control environmental challenges and various aspects of health consequences of waste management is one of the major programs in metropolitan management. The main purpose of this study is to examine the level of preparedness, having a contingency plan and the emergency response ability to waste management in disaster situations. A descriptive study was designed in two phases: in the first phase of the study, composition, quantity and characteristics of municipal solid waste in the disaster were estimated, and by using DotMapper software, temporary waste sites for disaster situations (map waste) were determined. In the second phase of the study, the preliminary hazard analysis (PHA) to identify the initial events and risk analysis in the municipal waste management system was considered. Results show that more than 50% of the generated waste in the disaster is allocated to construction waste resulting from the destruction and more than 30% to recyclable items (metals, glass, plastic), and a very small part of about 1% of biodegradable waste was determined. Twenty points were designated as temporary sites for municipal waste in a disaster situation. Results of risk analysis in the disaster were described that for three events containing lack of temporary waste storage sites, lack of identification and determination of hazardous waste production centres and lack of waste management training programme in emergency situations were in the red range. Developing the necessary strategies to control environmental challenges and various aspects of health outcomes in waste management is one of the basic programmes in metropolitan management.

The Experiences of Intensive Care Nurses in Advocacy of COVID-19 Patients.

The lack of face-to-face interactions with families, the increase in the number of patients admitted to the ICU, nursing staff shortages, and inadequate personal protective equipment has created many challenges for nurses in advocacy of the COVID-19 patient with life-threatening conditions. This study aimed to explore the experiences of intensive care nurses in the advocacy of COVID-19 patients. This study was performed using a qualitative content analysis method with Graneheim and Lundman approach, Iran, 2020. Data were collected through semi-structured interviews with eighteen clinical nurses from the intensive care units of three hospitals. Themes extracted from the nurses' statements were promoting patient safety (informing physicians about the complications and consequences of treatment, preventing medical errors, protecting patients from threats), respecting the patients' values (providing comfort at the end of life, providing a comfortable environment, commitment to confidentiality, cultural observance, respect for individualism, fair care), and informing (clarifying clinical conditions, describing available services, and being the patients' voice). ICU nurses in health crises such as COVID-19 as patient advocates should promote patient safety, respect patients' values, and inform them. The results of this study could help enhance the active role of intensive care nurses in the advocacy of COVID-19 patients.

Mapping and Spatial Pattern Analysis of COVID-19 in Central Iran Using the Local Indicators of Spatial Association (LISA).

BACKGROUND: Using geographical analysis to identify geographical factors related to the prevalence of COVID-19 infection can affect public health policies aiming at controlling the virus. This study aimed to determine the spatial analysis of COVID-19 in Qom Province, using the local indicators of spatial association (LISA). METHODS: In a primary descriptive-analytical study, all individuals infected with COVID-19 in Qom Province from February 19th, 2020 to September 30th, 2020 were identified and included in the study. The spatial distribution in urban areas was determined using the Moran coefficient in geographic information systems (GIS); in addition, the spatial autocorrelation of the coronavirus in different urban districts of the province was calculated using the LISA method. RESULTS: The prevalence of COVID-19 in Qom Province was estimated to be 356.75 per 100,000 populations. The pattern of spatial distribution of the prevalence of COVID-19 in Qom was clustered. District 3 (Imam Khomeini St.) and District 6 (Imamzadeh Ebrahim St.) were set in the High-High category of LISA: a high-value area surrounded by high-value areas as the two foci of COVID-19 in Qom Province. District 1 (Bajak) of urban districts was set in the Low-High category: a low-value area surrounded by high values. This district is located in a low-value area surrounded by high values. CONCLUSIONS: According to the results, district 3 (Imam Khomeini St.) and district 6 (Imamzadeh Ebrahim St.) areas are key areas for preventing and controlling interventional measures. In addition, considering the location of District 1 (Bajak) as an urban district in the Low-High category surrounded by high values, it seems that distance and spatial proximity play a major role in the spread of the disease.

Identification and assessment of nursing task errors in emergency department using SHERPA technique and offering remedial strategies.

BACKGROUND: Improving health care quality is a global concern, and providing patients with safe healthcare is a WHO Patient Safety priority. The technological revolution in health services has highlighted the role of human factors in committing such errors, and since the number of medical errors, including nursing errors, increases on a daily basis. OBJECTIVES: This research aimed to identify the causes of Nursing Task Errors in Emergency Department Using SHERPA Technique and adopt strategies to prevent and reduce them. Participants were 47 nurses (24 women and 23 men), who worked morning, evening and night shifts. The nurses were taught the methodology and talked about the objective of the study; they were then interviewed and observed for six months while working. This way, their tasks and subtasks were demarcated and the Hierarchical Task Analysis (HTA) was performed. SHERPA Error Mode Checklist was used to identify errors and their various types and then risk assessment was conducted. RESULTS: A total of 45 tasks, 234 subtasks, and 326 errors in regard to nursing activities were identified in the emergency department, with the highest frequency for action errors (61.34%) and the lowest for communication errors (1.84%). Also, there were 7.24 errors per task. The highest and lowest number of errors were at the 'unfavorable' (19.07%) and,'acceptable (safe)' (6.15%) risk levels, respectively. Based on the finding staff training, workload elimination,work process modification and updating guidelines are recommended. CONCLUSION: The results of present study were also submitted to the University Medical Executive management Committee to make individual, educational and organizational reforms (guidelines and instructions) in order to optimize the situation.

Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study.

This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.

Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU.

BACKGROUND: COVID-19 is known as a new viral infection. Viral-bacterial co-infections are one of the biggest medical concerns, resulting in increased mortality rates. To date, few studies have investigated bacterial superinfections in COVID-19 patients. Hence, we designed the current study on COVID-19 patients admitted to ICUs. METHODS: Nineteen patients admitted to our ICUs were enrolled in this study. To detect COVID-19, reverse transcription real-time polymerase chain reaction was performed. Endotracheal aspirate samples were also collected and cultured on different media to support the growth of the bacteria. After incubation, formed colonies on the media were identified using Gram staining and other biochemical tests. Antimicrobial susceptibility testing was carried out based on the CLSI recommendations. RESULTS: Of nineteen COVID-19 patients, 11 (58%) patients were male and 8 (42%) were female, with a mean age of ~ 67 years old. The average ICU length of stay was ~ 15 days and at the end of the study, 18 cases (95%) expired and only was 1 case (5%) discharged. In total, all patients were found positive for bacterial infections, including seventeen Acinetobacter baumannii (90%) and two Staphylococcus aureus (10%) strains. There was no difference in the bacteria species detected in any of the sampling points. Seventeen of 17 strains of Acinetobacter baumannii were resistant to the evaluated antibiotics. No metallo-beta-lactamases -producing Acinetobacter baumannii strain was found. One of the Staphylococcus aureus isolates was detected as methicillin-resistant Staphylococcus aureus and isolated from the patient who died, while another Staphylococcus aureus strain was susceptible to tested drugs and identified as methicillin-sensitive Staphylococcus aureus. CONCLUSIONS: Our findings emphasize the concern of superinfection in COVID-19 patients due to Acinetobacter baumannii and Staphylococcus aureus. Consequently, it is important to pay attention to bacterial co-infections in critical patients positive for COVID-19.

The COVID-19 Outbreak in Iran; The First Patient with a Definite Diagnosis.

The novel coronavirus, formerly named as 2019 novel coronavirus (2019-nCov) caused a rapidly spreading epidemic of severe acute respiratory syndrome (SARS) in Wuhan, China and thereafter, progressed globally to form a pandemic of coronavirus disease 2019 (COVID-19) in numerous countries; and now confirmed cases are reported from several provinces of Iran. Now various medical centers, clinicians and researchers around the world share their data and experiences about COVID-19 in order to participate in the global attempt of controlling the pandemic. The current report investigates the clinical presentations and paraclinical findings of the first confirmed cases and mortalities in the initiation of the outbreak of COVID-19 in Iran.

Integrating the Ergonomics Techniques with Multi Criteria Decision Making as a New Approach for Risk Management: An Assessment of Repetitive Tasks -Entropy Case Study.

BACKGROUND: Nowadays, the health work decision makers need to analyze a huge amount of data and consider many conflicting evaluation criteria and sub-criteria. Therefore, an ergonomic evaluation in the work environment in order to the control occupational disorders is considered as the Multi Criteria Decision Making (MCDM) problem. In this study, the ergonomic risks factors, which may influence health, were evaluated in a manufacturing company in 2014. Then entropy method was applied to prioritize the different risk factors. METHODS: This study was done with a descriptive-analytical approach and 13 tasks were included from total number of employees who were working in the seven halls of an ark opal manufacturing (240). Required information was gathered by the demographic questionnaire and Assessment of Repetitive Tasks (ART) method for repetitive task assessment. In addition, entropy was used to prioritize the risk factors based on the ergonomic control needs. RESULTS: The total exposure score based on the ART method calculated was equal to 30.07 ±12.43. Data analysis illustrated that 179 cases (74.6% of tasks) were in the high level of risk area and 13.8% were in the medium level of risk. ART- entropy results revealed that based on the weighted factors, higher value belongs to grip factor and the lowest value was related to neck and hand posture and duration. CONCLUSIONS: Based on the limited financial resources, it seems that MCDM in many challenging situations such as control procedures and priority approaches could be used successfully. Other MCDM methods for evaluating and prioritizing the ergonomic problems are recommended.

General Health status of workers among different workplaces in Qom Province, Iran.

INTRODUCTION: In a healthy organization, psychological health and physical health are as important as production and productivity; and healthy workers have higher productivity. Regarding lack of information about workers' general health profile in Qom Province, this study aimed to assess and compare the staffs' general health and its components among different workplaces in 2014. METHODS: In a cross-sectional study, 2,276 employees working at 46 industries and organizations completed a standardized General Health Questionnaire (GHQ 28) and a demographic questionnaire. Data were analyzed using t-test, ANOVA, and Pearson product-moment correlation coefficient by IBM SPSS version 20. RESULTS: The mean age of the participants was 32.22 (±7.55) years. Seventy-nine point four percent of participants were married and the rest were single. Highest and lowest scores belonged to social dysfunction and depression, respectively. Also, total score of staffs' general health was 17.87 ± 10.93. The results showed that, in spite of the non-relationship between general health score difference among married and single personnel (p > 0.05), there was a significant difference between men and women and among organizations and industries with regards to general health score (p < 0.05), and drivers had the most difference with others. The relationship between workers' ages and GH was significant (p < 0.05, Pearson's bivariate correlation coefficient = -0.05). CONCLUSION: The findings of this study collectively indicated that participants had an acceptable condition for mental factors, such as depression, but not in viewpoints of social dysfunction. In other words, staffs' interfaces with circumstances and personal innovation/creativity in the workplaces are at risk. Altogether, the general health score in the studied population was suitable in its entirety.

Single-Walled Carbon Nanotubes (SWCNTs), as a Novel Sorbent for Determination of Mercury in Air.

BACKGROUND: Based on the noticeable toxicity and numerous application of mercury in industries, removal of mercury vapor through sorbent is an important environmental challenge. PURPOSE OF THE STUDY: Due to their highly porous and hollow structure, large specific surface area, light mass density and strong interaction, Single-Walled Carbon Nanotubes (SWCNTs) sorbent were selected for this investigation. METHODS: In this study, instrumental conditions, method procedure and different effective parameters such as adsorption efficiency, desorption capacity, time, temperature and repeatability as well as retention time of adsorbed mercury were studied and optimized. Also, mercury vapor was determined by cold vapor atomic absorption spectrometry (CV-AAS).Obtained data were analyzed by Independent T- test, Multivariate linear regression and one way-ANOVA finally. RESULTS: For 80 mg nanotubes, working range of SWCNT were achieved 0.02-0.7 mg with linear range (R2=0.994).Our data revealed that maximum absorption capacity was 0.5 mg g-1 as well as limit of detection (LOD) for studied sorbent was 0.006 mg. Also, optimum time and temperature were reported, 10 min and 250 °C respectively. Retention time of mercury on CNTs for three weeks was over 90%. Results of repeated trials indicated that the CNTs had long life, so that after 30 cycles of experiments, efficiency was determined without performance loss. CONCLUSION: Results showed that carbon nanotubes have high potential for efficient extraction of mercury from air and can be used for occupational and environmental purposes. The study of adsorption properties of CNTs is recommended.