Quality of in-hospital care in traumatic spinal column and cord injuries (TSC/SCI) in I.R Iran.

PURPOSE: This study aimed to implement the Quality of Care (QoC) Assessment Tool from the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to map the current state of in-hospital QoC of individuals with Traumatic Spinal Column and Cord Injuries (TSCCI). METHODS: The QoC Assessment Tool, developed from a scoping review of the literature, was implemented in NSCIR-IR. We collected the required data from two primary sources. Questions regarding health system structures and care processes were completed by the registrar nurse reviewing the hospital records. Questions regarding patient outcomes were gathered through patient interviews. RESULTS: We registered 2812 patients with TSCCI over six years from eight referral hospitals in NSCIR-IR. The median length of stay in the general hospital and intensive care unit was four and five days, respectively. During hospitalization 4.2% of patients developed pressure ulcers, 83.5% of patients reported satisfactory pain control and none had symptomatic urinary tract infections. 100%, 80%, and 90% of SCI registration centers had 24/7 access to CT scans, MRI scans, and operating rooms, respectively. Only 18.8% of patients who needed surgery underwent a surgical operation in the first 24 h after admission. In-hospital mortality rate for patients with SCI was 19.3%. CONCLUSION: Our study showed that the current in-hospital care of our patients with TSCCI is acceptable in terms of pain control, structure and length of stay and poor regarding in-hospital mortality rate and timeliness. We must continue to work on lowering rates of pressure sores, as well as delays in decompression surgery and fatalities.

Post-discharge follow-up of patients with spine trauma in the National Spinal Cord Injury Registry of Iran during the COVID-19 pandemic: Challenges and lessons learned.

PURPOSE: The purpose of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) is to create an infrastructure to assess the quality of care for spine trauma and in this study, we aim to investigate whether the NSCIR-IR successfully provides necessary post-discharge follow-up data for these patients. METHODS: An observational prospective study was conducted from April 11, 2021 to April 22, 2022 in 8 centers enrolled in NSCIR-IR, respectively Arak, Rasht, Urmia, Shahroud, Yazd, Kashan, Tabriz, and Tehran. Patients were classified into three groups based on their need for care resources, respectively: (1) non-spinal cord injury (SCI) patients without surgery (group 1), (2) non-SCI patients with surgery (group 2), and (3) SCI patients (group 3). The assessment tool was a self-designed questionnaire to evaluate the care quality in 3 phases: pre-hospital, in-hospital, and post-hospital. The data from the first 2 phases were collected through the registry. The post-hospital data were collected by conducting follow-up assessments. Telephone follow-ups were conducted for groups 1 and 2 (non-SCI patients), while group 3 (SCI patients) had a face-to-face visit. This study took place during the COVID-19 pandemic. Data on age and time interval from injury to follow-up were expressed as mean ± standard deviation (SD) and response rate and follow-up loss as a percentage. RESULTS: Altogether 1538 telephone follow-up records related to 1292 patients were registered in the NSCIR-IR. Of the total calls, 918 (71.05%) were related to successful follow-ups, but 38 cases died and thus were excluded from data analysis. In the end, post-hospital data from 880 patients alive were gathered. The success rate of follow-ups by telephone for groups 1 and 2 was 73.38% and 67.05% respectively, compared to 66.67% by face-to-face visits for group 3, which was very hard during the COVID-19 pandemic. The data completion rate after discharge ranged from 48% to 100%, 22%-100% and 29%-100% for groups 1 - 3. CONCLUSIONS: To improve patient accessibility, NSCIR-IR should take measures during data gathering to increase the accuracy of registered contact information. Regarding the loss to follow-ups of SCI patients, NSCIR-IR should find strategies for remote assessment or motivate them to participate in follow-ups through, for example, providing transportation facilities or financial support.

Validation and psychometric properties of the Persian version of the MISSCARE survey.

AIM: To conduct, translate, and psychometric evaluation of the MISSCARE-Persian Survey. DESIGN: A cross-sectional study was conducted in Iran in February-June 2021. METHODS: The translation of the MISSCARE Survey was accomplished according to World Health Organization (WHO) guidelines. Construct validity was performed by (N = 300) exploratory factor analysis and confirmation. To assess the reliability, internal consistency was assessed using Cronbach's alpha coefficient, and relative stability was assessed using the interclass correlation coefficient (ICC). The study adhered to COSMIN guidelines. RESULTS: The exploratory factor analysis, which resulted in the identification of three factors in the second part of the tool, explained 79.6% of the total variance. Confirmatory factor analysis indicated the model's good fit of information. The reliability of the first and second parts of the tool was 0.912 and 0.901, respectively. Additionally, the ICC was found to be 0.687 for the first and 0.706 for the second part of the tool.

Facilitators and barriers for families caring for adults living with Alzheimer's dementia: A qualitative study.

This study investigates the barriers and promoters of caring for older adults living with Alzheimer's Dementia (AD) in families. This was a qualitative study through content analysis (based on the Granheim and Lundman method), and the participants were selected using purposive sampling from the families of older adults living with AD who were receiving care in the community. We used semi-structured interviews to collect data from 32 family members. The validity and reliability of the data were assessed using the Lincoln and Guba criteria. In this study, 70.58% of primary caregivers were women. Caregiving facilitators included "Efficient family," "Capable caregiver," and "Motivated caregiver." Caregiving barriers included "Lacking awareness and knowledge," "Vulnerable family," "Older person with complex/multiple needs," and "Lack of care infrastructures." Training families and caregivers and developing care infrastructures for older adults with AD can help reduce caring barriers in older adults.

Development and validation of the Iranian version of the Patient Privacy and Confidentiality Scale.

The aim of this study was to develop and psychometrically validate the Iranian scale of patient privacy and confidentiality. This methodological study was conducted in two stages: first, a conventional content analysis was used to qualitatively identify concepts of privacy and confidentiality. Then, the face validity, content validity, and construct validity were assessed. Internal consistency coefficient and total consistency were checked. KMO and Bartlett's test were used to examine thequestionnaire for factor analysis. EFA identified seven factors that accounted for 55.25% of the total variance in the questionnaire score. The total Cronbach's α coefficient was 0.84 for the whole instrument. The Spearman reliability coefficient of the instrument was 0.91 using the test-retest method.The final Iranian version of the Patient Privacy and Confidentiality Scale can be used as a valid and reliable instrument to measure the rate of observation of patient privacy and confidentiality.

Psychometric Properties of the Persian Version of the 11-Item de Jong Gierveld Loneliness Scale in Iranian Older Adults.

Loneliness is usually a chronic condition which may lead to physical and psychological undesirable consequences, and requires measurement and intervention. This study was conducted with the aim of preparing a Persian version of the 11-item de Jong Gierveld Loneliness Scale and evaluating its psychometric properties among the Iranian older adults. After applying the translation-back translation method, the prepared script was subjected to the face and content validity evaluations and a Persian version of the scale was prepared. Factor analysis, concurrent validity, internal consistency, and test-retest methods were used to validate the scale. The Persian version of the 11-item de Jong Gierveld Loneliness Scale showed acceptable content validity. The negative and significant correlations between the loneliness scores and the Philadelphia Geriatric Center Morale Scale indicated that the questionnaire had acceptable concurrent validity. The results of confirmatory factor analysis confirmed two factors for the scale. Also, the results of the intra-class correlation coefficient and Cronbach's alpha coefficient demonstrated that the scale had acceptable reliability. The Persian version of the 11-item de Jong Gierveld Loneliness Scale is an appropriate tool for measuring loneliness in the Iranian older adults.

The effect of occupational stress on marital satisfaction and mental health in Iranian nurses.

BACKGROUND: Work and family life are the two basic components of the individuals' life and each one affects the other. OBJECTIVE: This study aimed to investigate the relationship between occupational stress, mental health and marital satisfaction among Iranian nurses. METHODS: A cross-sectional study was conducted on 200 randomly selected nurses. The 35 items hospital stress scale, Enrich Marital Satisfaction questionnaire and Scl-25 mental health questionnaire were used. Descriptive statistics, Pearson correlation coefficient, independent sample t-test and analysis of variance and regression analysis were used. RESULTS: Inverse correlations were observed between the scores of job stress and mental health (r = -0.468, p = 0.001) and marital satisfaction (r = -0.517, p = 0.001). More than 0.74% of variation in marital satisfaction is explained by the components of occupational stress. CONCLUSION: The results revealed that occupational stress plays a decisive role in nurses' marital satisfaction and mental health. Due to the destructive effects of occupational stress on the people's mental health, interpersonal relationships and on their efficacy in their job, establishment of some counseling services for nurses to be used by them periodically or by need, can help them to manage their stress level and better management of their family life problems. Moreover, in-service courses or workshops on stress management may help nurses to possess appropriate knowledge and skills on stress management.

Diagnostic accuracy of the Tilburg Frailty Indicator (TFI) for early frailty detection in elderly people in Iran.

AIM: Screening is one of the most important ways for early frailty detection that contributes to its prevention and timely treatment. The aim of this study was to determine the diagnostic value of the Persian version of the Tilburg Frailty Indicator (P-TFI) in the frailty screening. METHOD: This is a diagnostic test accuracy study that uses known group method. It was designed based on a STARD statement and performed on 175 elderly people in the City of Kashan, Iran. The subjects were selected among older people available in health centers affiliated to Kashan University of Medical Sciences using purposive sampling. Data analysis was carried out using SPSS v16. Descriptive statistics were used to describe the characteristics of the research subjects. Independent t-test was used to determine the ability of the P-TFI to discriminate frail and non-frail individuals, and to evaluate the cut-off point and instrument accuracy, the receiver operating characteristic (ROC) curve was used. The best cut-off point was determined among the proposed points using Youden index. At the determined cut-off point, the diagnostic value parameters of the P-TFI (sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, accuracy, and diagnostic odds ratio) were calculated and their range was estimated with 95 % confidence interval. FINDINGS: A total of 74.3 % of the sample was male and their mean age was 68.6 ± 54.44 years. The area under the ROC curve was calculated 0.922, indicating high accuracy of the instrument. The sensitivity and specificity of this instrument at the cut-off point of 4.5 were 0.95 and 0.86, respectively. Positive and negative predictive values were calculated 0.68 and 0.98, respectively, and the accuracy of the instrument was reported to be 0.88. CONCLUSION: The P-TFI can be used as a sensitive and accurate instrument, which is highly applicable to screen frailty in older people.

Development and psychometric evaluation of the Treatment Adherence Questionnaire for Patients with Combat Post-traumatic Stress Disorder.

PURPOSE: Treatment adherence is one of the major strategies in treating post-traumatic stress disorder (PTSD) in combat veterans. This study developed and psychometrically assessed the Treatment Adherence Questionnaire for Patients with Combat Post-Traumatic Stress Disorder. PARTICIPANTS AND METHODS: This methodological study was conducted in Tehran, Iran, during 2016-2017 in two phases. First, the concept of treatment adherence in combatants with PTSD was analyzed using a hybrid model. This model consisted of three phases: literature review phase, fieldwork phase, and final analysis phase. The consequences and attributes of the concept of treatment adherence in combatants with PTSD were identified, and based on the findings, the Treatment Adherence Questionnaire for PTSD veterans was developed. In the second stage, the face and content validities of the questionnaire were investigated both quantitatively and qualitatively. Exploratory factor analysis and confirmatory factor analysis were used to determine the questionnaire's validity. Internal consistency correlation coefficient of the questionnaire was estimated with Cronbach's alpha coefficient, while the reliability of the questionnaire was established using intra-class test-retest correlation coefficient. Study participants were selected from inpatients and outpatients referred to a hospital, clinic, and health center in Tehran and Kashan, Iran. All patients were diagnosed with combat PTSD by a psychiatrist, based on psychiatric interview and other clinical findings. RESULTS: The Persian version of the Treatment Adherence Questionnaire for Patients with Combat Post-Traumatic Stress Disorder included 17 items. Exploratory factor analysis identified three factors which accounted for a total of 87.57% of the total variance of treatment adherence score. The identified factors were labeled as "maintenance of treatment", "follow-up and treatment contribution", and "purposefulness and responsibility". The Cronbach's alpha correlation coefficient was 0.92 and the intra-class correlation coefficient of the questionnaire's reliability was estimated at 0.92 (P<0.001). CONCLUSION: The data obtained confirmed the hypothesis of the factor structure model with a latent second-order variable. The final version of the Treatment Adherence Questionnaire for Iranian combatants with PTSD can be applied as a valid and reliable questionnaire for measuring treatment adherence in these patients.

Psychometric Evaluation of the Cognitive State Test (COST) in a Sample of Iranian Elderly People.

BACKGROUND: An absolute prerequisite to the effective management of dementia is its early diagnosis. Successful dementia screening requires precise and sensitive instruments that can be completed even by illiterate elderly people. OBJECTIVES: The aim of this study was to evaluate the psychometric properties of the Persian version of the cognitive state test (COST). MATERIALS AND METHODS: This methodologic study was conducted in Kashan, Iran, during 2013 - 2014. A purposeful sample of 150 healthy elderly people and 50 elderly patients with dementia was recruited. After translating the instrument by using the standard forward-backward technique, we assessed its qualitative and quantitative face and content validity. The validity of the test was assessed by using the concurrent validity and the exploratory factor analysis. We also calculated Cronbach's alpha and employed the test-retest method for evaluating the internal consistency and the stability of the test, respectively. Study data were analyzed by using the SPSS v16.0, the Spearman-Brown, and the intraclass correlation coefficient tests and the principal components factor analysis with varimax rotation. RESULTS: The Persian COST consists of nineteen items. The impact scores, the content validity ratios and the content validity indices of all test items were greater than 4.5, 0.69, and 0.84, respectively. The COST had a significant correlation with the clinical dementia rating (rS = -0.76, P value < 0.001), indicating an acceptable concurrent validity for the test. The exploratory factor analysis revealed a five-factor structure that explained 60.59% of the total variance of the total cognitive state score. The Cronbach's alpha, Spearman-Brown, and interclass correlation coefficients were 0.82, 0.95, and 0.88, respectively (P value < 0.001). CONCLUSIONS: The Persian version of the COST can be used as a valid and reliable instrument for assessing cognitive state and screening dementia in literate and illiterate elderly people.

Diagnostic Accuracy of the Cognitive State Test in the Detection of Dementia Among Iranian Older Adults.

Dementia screening tests need to have acceptable sensitivity and specificity. The current study aimed to determine the cutoff point of the Persian Cognitive State Test (P-COST) and test its diagnostic accuracy. The study was conducted using the known-groups method. A purposive sample of 50 patients with dementia and 150 older adults without dementia was recruited in Kashan, Iran. The reference standard included clinical interviewing and findings of a computerized tomography scan. The P-COST was the index test. Mean P-COST scores of the two groups differed significantly (p < 0.001). The P-COST is a sensitive and precise test for assessing cognitive state and thus can be used for dementia screening and monitoring of older adults' health.

The Correlation of Social Support and Social Participation of Older Adults in Bandar Abbas, Iran.

Social participation is a criterion for successful aging. Research has shown that social participation decreases in older adults. However, the role of social support on older adults' social participation has received little attention, especially in eastern countries, such as Iran. Using the Social Participation Questionnaire, the relationship between social support and social participation was investigated in 525 Iranian older adults. A correlation was found between social support and social participation of older adults. Older adult women were found to have less social support and social participation compared with men.

The incidence of hypertension and the follow-up rate in a sample of population over 30 years old in kashan 2013.

INTRODUCTION: Studies indicate that hypertension is prevalent in Iran, however, the reports are heterogeneous. The aim of this study was to estimate the incidence of hypertension and the rate of follow-up in a sample of population over 30 years old in Kashan city. METHODS: A descriptive study was conducted on people screened for hypertension in the project of "monitoring the health of Iranian population" in Kashan city at April 2013. Among all completed screening forms, 5000 forms were selected randomly. Required data were extracted from these forms and were recorded on a checklist that was consisted of 9 questions on demographics characteristics and 10 questions about follow-up. Descriptive statistics, independent sample t-test, paired t-test and pearson correlation coefficient was used to analyze the data. RESULTS: Totally, 5% of the enrolled people had a systolic blood pressure over 140 mmHg and a diastolic pressure over 90 mmHg. Only 92 subjects with high blood pressure were available via telephone. Also, 42.42% of cases refused to answer. From all subjects who were available and answered the study questions, 50% had been referred to a physician after 5.17 (6.05) days. Of these, 52.2% were diagnosed as being hypertensive. Lacking time was the main reason for non-referral. CONCLUSION: The incidence of hypertension was less than other studies but the rate of follow-up was low. Nurses and Iranian nursing organization are suggested to conduct a nationwide screening and follow-up project to improve the rate of early diagnosis and help people in better management of hypertension.

Behavior of healthcare workers after injuries from sharp instruments.

BACKGROUND: Injuries with sharps are common occupational hazards for healthcare workers. Such injuries predispose the staff to dangerous infections such as hepatitis B, C and HIV. OBJECTIVES: The present study was conducted to investigate the behaviors of healthcare workers in Kashan healthcare centers after needle sticks and injuries with sharps in 2012. MATERIALS AND METHODS: A cross-sectional study was conducted on 298 healthcare workers of medical centers governed by Kashan University of Medical Sciences. A questionnaire was used in this study. The first part included questions about demographic characteristics. The second part of the questionnaire consisted of 16 items related to the sharp instrument injuries. For data analysis, descriptive and analytical statistics (chi-square, ANOVA and Pearson correlation coefficient) SPSS version 16.0 software was used. RESULTS: From a total of 298 healthcare workers, 114 (38.3%) had a history of injury from needles and sharp instruments in the last six months. Most needle stick and sharp instrument injuries had occurred among the operating room nurses and midwifes; 32.5% of injuries from sharp instruments occurred in the morning shift. Needles were responsible for 46.5% of injuries. The most common actions taken after needle stick injuries were compression (27.2%) and washing the area with soap and water (15.8%). Only 44.6% of the injured personnel pursued follow-up measures after a needle stick or sharp instrument injury. CONCLUSIONS: More than a half of the healthcare workers with needle stick or sharp instrument injury had refused follow-up for various reasons. The authorities should implement education programs along with protocols to be implemented after needle stick injuries or sharps.