Incidence and Risk Factors of Surgical Site Infection in Abdominal Surgeries: A Scoping Review of Cohort and Case-Control Studies.

Background: Abdominal surgery is considered a high-risk procedure for the development of surgical site infection (SSI). Few studies have evaluated the relative importance of surgical site infection risk factors in terms of consistency in abdominal surgery. Therefore, this comprehensive review article mapped and summarized the evidence aimed to determine the relative importance of the risk factors and incidence of SSIs in abdominal surgery. Methods: A literature review was conducted using electronic databases and search engines such as Scopus, PubMed, and Web of Science up to March 16, 2023. There was no language restriction for the papers to be included in the study. The relative consistency of the risk factors was measured and evaluated using the methodology of the Joanna Briggs Institute. Original peer-reviewed cohort and case-control studies were included if all types of SSIs were included. Meta-analysis was performed to determine the pooled estimates of SSI incidences. Results: Of 14,237 identified records, 107 articles were included in the review. The pooled incidence of SSI was 10.6% (95% CI: 9.02-12.55%, χ2=12986.44, P<0.001). Operative time and higher wound class were both significant consistent risk factors for SSI incidence. Patients' educational status, malnutrition, functional status, and history of neurological/psychiatric disorders were all candidates for consistent risk factors, with insufficient evidence. Conclusion: The findings of the present study indicated that SSI in abdominal surgery was a multifactorial phenomenon with a considerable risk and had different risk factors with various relative importance. Determining the relative importance of the risk factors for the prevention and control of SSI is strongly recommended.This manuscript has been released as a preprint at the research square: (https://doi.org/10.21203/rs.3.rs-3219597/v1).

The feedback dilemma in medical education: insights from medical residents' perspectives.

BACKGROUND: Feedback is a critical component of the learning process in a clinical setting. This study aims to explore medical residents' perspectives on feedback delivery and identify potential barriers to feedback-seeking in clinical training. METHODS: This cross-sectional study involved 180 medical residents across seventeen specialties. We employed the validated Residency Education Feedback Level Evaluation in Clinical Training (REFLECT) tool to assess residents' perspectives on their attitude toward feedback, quality of feedback, perceived importance, and reaction to feedback. Additionally, we explored barriers to feedback-seeking behavior among medical residents. RESULTS: The majority of medical residents held positive attitudes toward feedback. They agreed that feedback improves their clinical performance (77.7%), professional behavior (67.2%), and academic motivation (56.7%), while also influencing them to become a better specialist in their future career (72.8%). However, the study revealed critical deficiencies in the feedback process. Only 25.6% of residents reported receiving regular feedback and less than half reported that feedback was consistently delivered at suitable times and locations, was sufficiently clear or included actionable plans for improvement. A minority (32.2%) agreed that faculty had sufficient skills to deliver feedback effectively. Moreover, peer-to-peer feedback appeared to be a primary source of feedback among residents. Negative feedback, though necessary, often triggered feelings of stress, embarrassment, or humiliation. Notably, there were no significant differences in feedback perceptions among different specialties. The absence of a feedback-seeking culture emerged as a central barrier to feedback-seeking behavior in the clinical setting. CONCLUSIONS: Establishing shared expectations and promoting a culture of feedback-seeking could bridge the gap between residents' perceptions and faculty feedback delivery. Furthermore, recognizing the role of senior and peer residents as valuable feedback sources can contribute to more effective feedback processes in clinical training, ultimately benefiting resident development and patient care.

Explaining the challenges of resources management and its underlying factors in COVID-19 era in Iran: a qualitative study.

BACKGROUND: Identifying factors affecting health costs can contribute to formulating the best policies for controlling and managing health costs. To this end, the present study aimed to analyze resource wastage and identify the factors underlying it in COVID-19 management in Iran's health sector. METHOD: This qualitative content analysis study was conducted in Iran's health sector. The participants were 23 senior, middle, and operational managers in the health sector. The data were collected through semistructured interviews with the managers. The participants were selected using purposive, quota, and snowball sampling techniques. The interviews continued until the data were saturated. The collected data were analyzed using MAXQDA software (version 10). RESULTS: Following the data analysis, the factors affecting the wastage of health resources were divided into 4 themes and 13 main themes. Vaccines, diagnostic kits, medicines, and human resources were the main factors underlying resource wastage. The identified main themes were open and unused vials, nonuse of distributed vaccines and their expiration, excess supply and decreased demand for vaccines, expiration of diagnostic and laboratory kits and their quantitative and qualitative defects, and the large number of tests. Inefficiency and the expiration of COVID-19 drugs, poor drug supply and consumption chain management, inaccuracy in inventory control and expiration dates, disorganization and inconsistency in the distribution of healthcare staff, low productivity of the staff, and failure to match the staff's skills with assigned tasks in selected centers were identified as the most important causes of resource wastage. CONCLUSION: Given the limited health funds and the increased healthcare costs, effective preparation and planning and making reasonable decisions for unexpected events can minimize unnecessary costs and resource wastage, which requires some revisions in attitudes toward COVID-19 management in the healthcare sector.

Reconstructing feedback in graduate medical education: development of the REFLECT scale to measure feedback delivery in medical residency training.

BACKGROUND: Feedback plays a pivotal role in graduate medical education, where medical residents are expected to acquire a wide range of practical and professional competencies. Assessing the feedback delivery status is a preliminary step for educators to enhance the quality of feedback provided. This study aims to develop an instrument to assess the various aspects of feedback delivery in medical residency training. METHODS: The fifteen-item REFLECT (Residency Education Feedback Level Evaluation in Clinical Training) questionnaire was developed. The content validity was evaluated according to a panel member consisting of fourteen clinical professors and medical education instructors. After evaluating the test-retest reliability, the questionnaire was distributed to a sample of 154 medical residents and was further assessed in terms of internal consistency and factor analysis. RESULTS: Content validity analysis resulted in an appropriate content validity ratio and content validity index for the final 15 items. The test-retest reliability resulted in an ICC of 0.949 (95% C.I. 0.870-0.980), indicating excellent reliability. The Cronbach's alpha for the 15-item questionnaire was α = 0.85, demonstrating good internal consistency. The factor analysis resulted in a four-factor structure: "attitude towards feedback", "quality of feedback", "perceived importance of feedback", and "reaction to feedback". CONCLUSIONS: REFLECT proved to a reliable tool that could be utilized as a quick assessment method of feedback delivery, making it a suitable aid for educational managers and faculties to design necessary interventions aiming to enhance the quantity and quality of feedback provided.

Physician-directed information prescription service. A scoping review.

OBJECTIVE: This scoping review aims to identify and map the characteristics of research studies, types, delivery methods, and team members of physician-directed information prescription services. METHODS: Following the PRISMA-ScR checklist, a systematic search was performed on Web of Science, Scopus, Library, Information Science & Technology Abstracts (LISTA), and PubMed/Medline from 1990 to 2021. RESULTS: 37 studies were included in the final analysis. Five types of providing information prescription were recognized: typical, oral, web-based, electronic, and mixed methods. Physicians, nurses, and librarians were the most agreed-upon professionals in information prescription delivery teams. The steps of prescribing information were needs assessment, content production, information evaluation, prescribing information, follow-up, and documentation. DISCUSSION: This review presents a synthesis of the process of information prescription. It is suggested to determine the effective information prescription type, provide methods and develop the service according to patients' preferences and characteristics. PRACTICE IMPLICATIONS: Results of this study can be used to identify the challenges, the competent individuals, roles, and steps of information prescription service, as well as design and develop the protocol, model, and flowchart of it.

Virtual reality-based medical education versus lecture-based method in teaching start triage lessons in emergency medical students: Virtual reality in medical education.

INTRODUCTION: Epidemics such as the recent one, COVID-19, have caused a change in education and its methods. Virtual simulation is one of the types of technology used in medical education and related sciences. Virtual simulation provides practical and clinical medical education in a safe, cost-effective, reproducible, and flexible learning environment where students can practice over and over in a standard environment. This study was conducted to compare the effect of virtual-based medical education versus lecture-based method in teaching start triage lessons in emergency medical students in educational and medical centers affiliated to Birjand University of Medical Sciences Ferdows, Paramedical School, in 2020. METHODS: This is a quasi-experimental study. َAll 44 students of emergency medicine registered for triage course participated in the study. They were divided into two homogenous groups which were matched based on their grade point average. The simple triage and rapid transport (START) triage course was taught in the traditional way- lecture based- from the beginning of the semester to the middle of the semester; then, the other group (simulation-based) was trained in the second half of the same semester using virtual simulation. RESULTS: The students' rate of learning was measured by their scores at the end of the course exam in both groups. The mean scores of virtual simulation-based education were slightly higher than those of the lecture-based education, but it was not statistically significant (P>0.05). The students were more satisfied with virtual simulation-based education than the lecture-based and the difference between the mean scores of satisfaction was statistically significant (P>0.05). CONCLUSION: The results of this study suggest that VR can effectively improve knowledge in undergraduate emergency student's education, but it was not more effective than traditional educational methods. More experimental studies with a larger sample size are needed to confirm that virtual simulation-based education can more effectively improve knowledge in teaching practical lessons such as triage.

Prevalence of Posttraumatic Stress Disorder Following the Earthquake in Iran and Pakistan: A Systematic Review and Meta-Analysis.

Posttraumatic stress disorder (PTSD) is a common mental disorder following traumatic events. The present study was conducted to understand the prevalence of PTSD after the earthquake in Iran and Pakistan. The review includes all articles published from inception to March 2019. The pooled prevalence for overall PTSD was 55.6% (95% CI: 49.9-61.3). It was 60.2% (95% CI: 54.1-66.3) and 49.2% (95% CI: 39.4-59) for Iranian and Pakistani survivors, respectively. Women experienced higher incidence of PTSD than men. The variation of PTSD based on the clinical interview was lower than the self-report approach. The interval time between the earthquakes and the assessment showed that the prevalence of PTSD decreased over time. The prevalence of PTSD in Iran and Pakistan was higher than the global average, and the rate of the disorder in Iran was higher than in Pakistan. Sex, method of assessment, and time lag between the occurrence of disaster and assessment of PTSD affect the prevalence.

COVID-19 research progress: Bibliometrics and visualization analysis.

Background: Coronavirus primarily targets the human respiratory system, COVID-19 (Coronavirus disease 2019) triggered in China in the late 2019. In March 2020, WHO announced the COVID-19 pandemic. This study aims to analyze and visualize the scientific structure of the COVID-19 publications using co-citation and co-authorship. Methods: This is a scientometric study. Web of Science Core Collection (WoSCC) was searched for all documents regarding COVID-19, MERS-Cov, and SARS-Cov from the beginning to 2020. An Excel spreadsheet was applied to gather and analyze the data and the CiteSpace was used to visualize and analyze the data. Results: A total of 5159 records were retrieved in WoSCC. The structure of the network indicated that the network mean silhouette was low (0.1444), implying that the network clusters' identity is not identifiable with high confidence. The network modularity was 0.7309. The cluster analysis of the co-citation network on documents from 2003 to 2020 provided 188 clusters. The largest cluster entitled, "the Middle East respiratory syndrome coronavirus" had 255 nodes. The coauthorship network illustrated that the most prolific countries, USA, China, and Saudi Arabia, have focused on a specific field and have formed separate clusters. Conclusion: The present study identified the important topics of research in the field of COVID-19 based on co-citation networks as well as the analysis of clusters of countries' collaborations. Despite the similarities in the production behavior in prolific countries, their thematic focus varies so that a country like China plays a role in "Quantitative Detection" cluster, while USA is the leading country in the "Biological Evaluation" cluster.

Posttraumatic growth after earthquake: A systematic review and meta-analysis.

BACKGROUND: Posttraumatic growth (PTG) represents a positive personal change after adverse events, such as natural disasters, including earthquake. However, the association between exposure to earthquake and level of PTG is still unknown. Thus, the aim of this systematic review and meta-analyses (MA) is to assess the level of PTG in people exposed to earthquake. METHODS: Studies were identified via Scopus, PsycInfo, Web of Science, PubMed, EMBASE, ProQuest, Cochran Library, Ovid, Google Scholar, OpenGrey, congress, and conferences research papers. The level of PTG was presented as mean and standard deviation. Subgroup analyses were conducted to control for the amount of time that had passed since stressor onset and age of the study population. The meta-regression was used to explore the sources of between-study heterogeneity, including sample size and age. RESULTS: The MA of all 21 studies using no restrictions related to age and time of the PTG measurement since traumatic event showed low level of PTG (41.71; 95%CI = 34.26; 49.16, I2: 62.44%, p: .000). Subgroup analyses controlled for the age demonstrated that level of PTG was higher in adults (49.47; 95% CI = 42.35; 56.58, I2: 0%, p = .466) when compared to children and adolescents (35.38; 95% CI = 23.65; 47.11, I2: 69.09%, p < .00). Moreover, the pooled weight mean of PTG measured 1 year and less than 1 year since the earthquake varied between medium (46.04; 95%CI = 34.45; 57.63, I2:51.2%, p: .037) and high (59.03; 95%CI = 41.46; 76.41, I2: 0%, p: .990) levels, respectively. CONCLUSION: The results of our MA showed low level of PTG in earthquake survivors. However, the mean value of PTG in adults was higher when compared to children and adolescents. In addition, the mean PTG was found to decrease over time since traumatic events.

Incidence of adverse reaction in blood donation: a systematic review.

There are a lot of reports related to adverse reactions post blood donation. The present study is designed to investigate the incidence of adverse reactions in blood donation around the world. This research was conducted through searching databases such as PubMed, Web of Science, Scopus, EmBase, Ovid, as well as the specialized journal of TRANSFUSION without any time limit by using the keywords including "Adverse Event", "Adverse Effect", "Adverse Reaction", "Complication", "Side Effect", "Vasovagal Reaction", "Local Reaction", "General Reaction", "Allergic Reaction", "Blood Donor", and "Blood Donation". In the initial search, 7054 documents were found, of which 2517 duplicates were excluded. After screening the remaining 4,537 documents, 97 one were reviewed for quality assessment, of which 30 with the appropriate quality were selected for the review process. The results of the study showed that the reactions caused by blood donation are very different. Most reactions were systemic, and ranged from 0.08 to 13 percent in different countries. The incidence of adverse reactions in blood donation differ across the countries which might be related to the donors' characteristics. The difference did even existed in studies conducted in the same country and the same year. This suggests that many factors can cause adverse reactions in blood donation, and that a wide range of them investigated in one study, most of which were systemic.

Can Internet Anxiety Affect Electronic Journals Usage? A Cross- Sectional Study with Iranian Postgraduate Dental Students

Objective: To investigate internet anxiety among the dentistry students at Kerman University of Medical Sciences and its relationship with electronic journals use. Material and Methods: In this cross-sectional study, all 72 postgraduate dental assistants at Dentistry School of Kerman University of Medical Sciences were considered. Internet anxiety questionnaire included demographic questions and questions measuring online journals use and the barriers of using. The data then analyzed using independent t-test and linear regression, with significance level set at 5%. Results: The use of printed books was reported by 78.2% of the sample while the use of electronic books was 45.8%. The use of atlas was 28.9%, while the use of indexes and abstracts was 57.2. The participants used online journals mostly for research (30.8%) and education (27.7%). The most important advantages of online journals were fast access (25.1%) and easy use (19.9%). To get informed about online journals contents, they mostly used search engines and online databases (79%). The most important criterion was indexing in Web of Science (20.8%). A significant relationship between Internet anxiety and academic year was detected (p<0.05) also increase in internet use significantly increased Internet anxiety (p=0.001). We suggested increasing the knowledge and skill of dental students with online resources toward decreasing the level of their Internet anxiety. Conclusion: A reverse relationship was observed between the academic year and internet anxiety, in other words, senior students were more anxious than the junior ones. This study did not ask about computer literacy, other studies have reported a negative relationship between computer literacy, Internet literacy and internet anxiety, so it is suggested to increase the knowledge and skill of students with computer, internet and online resources.

Do highly cited clinicians get more citations when being present at social networking sites?

BACKGROUND AND AIMS: The advent of social networking sites has facilitated the dissemination of scientific research. This article aims to investigate the presence of Iranian highly cited clinicians in social networking sites. MATERIALS AND METHODS: This is a scientometrics study. Essential Science Indicator (ESI) was searched for Iranian highly cited papers in clinical medicine during November-December 2015. Then, the authors of the papers were checked and a list of authors was obtained. In the second phase, the authors' names were searched in the selected social networking sites (ResearchGate [RG], Academia, Mendeley, LinkedIn). The total citations and h-index in Scopus were also gathered. RESULTS: Fifty-five highly cited papers were retrieved. A total of 107 authors participated in writing these papers. RG was the most popular (64.5%) and LinkedIn and Academia were in 2nd and 3rd places. None of the authors of highly cited papers were subscribed to Mendeley. A positive direct relationship was observed between visibility at social networking sites with citation and h-index rate. A significant relationship was observed between the RG score, citations, reads indicators in RG, and citation numbers and there was a significant relationship between the number of document indicator in Academia and the citation numbers. CONCLUSION: It seems putting the papers in social networking sites can influence the citation rate. We recommend all scientists to be present at social networking sites to have better chance of visibility and also citation.

Mapping the Iranian Research Literature in the Field of Traditional Medicine in Scopus Database 2010-2014.

BACKGROUND: The aim of this study was to provide research and collaboration overview of Iranian research efforts in the field of traditional medicine during 2010-2014. METHODS: This is a bibliometric study using the Scopus database as data source, using search affiliation address relevant to traditional medicine and Iran as the search strategy. Subject and geographical overlay maps were also applied to visualize the network activities of the Iranian authors. Highly cited articles (citations >10) were further explored to highlight the impact of research domains more specifically. RESULTS: About 3,683 articles were published by Iranian authors in Scopus database. The compound annual growth rate of Iranian publications was 0.14% during 2010-2014. Tehran University of Medical Sciences (932 articles), Shiraz University of Medical Sciences (404 articles) and Tabriz Islamic Medical University (391 articles), were the leading institutions in the field of traditional medicine. Medicinal plants (72%), digestive system's disease (21%), basics of traditional medicine (13%), mental disorders (8%) were the major research topics. United States (7%), Netherlands (3%), and Canada (2.6%) were the most important collaborators of Iranian authors. CONCLUSION: Iranian research efforts in the field of traditional medicine have been increased slightly over the last years. Yet, joint multi-disciplinary collaborations are needed to cover inadequately described areas of traditional medicine in the country.

Investigating Knowledge Management Status among Faculty Members of Kerman University of Medical Sciences based on the Nonaka Model in 2015.

INTRODUCTION: Education and research are two major functions of universities, which require proper and systematic exploitation of available knowledge and information. Therefore, it is necessary to investigate the knowledge management status in an education system by considering the function of faculty members in creation and dissemination of knowledge. This study was conducted to investigate the knowledge management status among faculty members of the Kerman University of Medical Sciences based on the Nonaka and Takeuchi models in 2015. METHODS: This was a descriptive-analytical and cross-sectional study. It was conducted on 165 faculty members at the Kerman University of Medical Sciences, who were selected from seven faculties as weighted using a random stratified sampling method. The Nonaka and Takeuchi knowledge management questionnaire consists of 26 questions in four dimensions of socialization, externalization, internalization, and combination. Scoring of questions was conducted using the five-point Likert scale. To analyze data, independent t-test, one-way ANOVA, Pearson correlation coefficients, and the Kruskal-Wallis test were employed. RESULTS: The four dimensions in the Nonaka and Takeuchi model are based on optimal indicators (3.5), dimensions of combination, and externalization with an average of 3.3 were found in higher ranks and internalization and socialization had averages of 3.1 and 3. According to the findings of this study, the average knowledge management among faculty members of the Kerman University of Medical Sciences was estimated to be 3.1, with a bit difference compared to the average. According to the results of t-tests, there was no significant relationship between gender and various dimensions of knowledge management (p>0.05). The findings of Kruskal-Wallis showed that there is no significant relationship between variables of age, academic rank, and type of faculty with regard to dimensions of knowledge management (p>0.05). In addition, according to the results of Pearson tests, there is no significant relation between employment history and dimensions of knowledge management (p>0.05). CONCLUSION: Considering the function and importance of knowledge management in education and research organizations including universities, it is recommended to pay comprehensive attention to establishment of knowledge management and knowledge sharing in universities and provide the required background to from research teams and communication networks inside and outside universities.

Variations in Ischemic Heart Disease Research by Country, Income, Development and Burden of Disease: A Scientometric Approach.

INTRODUCTION: Ischemic heart diseases (IHDs) are the leading cause of mortality worldwide. However the global burden of IHD has been concentrated on developing countries, where limited research efforts have been made to address these needs. This study aimed to understand the global distribution of IHD research activities by looking at the countries' burden of disease, income and development data. METHODS: As a scientometric study, Scopus database was searched for research publications indexed under the medical subject heading (MeSH) 'myocardial ischemia' including the following terms: coronary artery disease, coronary heart disease, and ischemic heart disease. The number of research publications in Scopus database was recorded for each individual year 2000-2012, and for each country. Data for estimated IHD disability-adjusted life-year's (DALY's), gross domestic product (GDP) per capita and human development index were also included for the analysis. RESULTS: IHD research publications were most likely produced by European and Western pacific countries. High-income countries produced the greatest share of about 81% of the global IHD research. However, no significant association observed between the countries' GDP and number of research publications worldwide (OR = 0.98, P = 0.939). Global IHD research found to be strongly associated with the burden of disease (P < 0.0001) and the countries' HDI values worldwide (OR = 16.8, P = 0.016). CONCLUSION: Our study suggested that global research on IHD were geographically distributed and highly concentrated among the world's richest countries. Estimated DALYs and HDI were found as important predictors of IHD research and the key drivers of health research disparities across the world.

Research Performance Measures and the Moderating Role of Faculty Characteristics in Epidemiology.

Several numeric measures have been proposed to evaluate the individual researchers' scientific performance. Among these measures, h-index is the most common and well recognized measure of research productivity and impact in scientific communities. However, empirical investigations and recent inspections revealed some shortcomings and limitations of this measure. In order to complement these limitations, several variants have been proposed in which g-index and ar-index were among the most discussed measures. The aim of this study was to examine h-index, g-index and ar-index across Iranian epidemiologists to identify the moderating characteristics as well as the distribution of these measures in the field. Using Web of Science Database, a list of Iranian epidemiologists was searched and total number of articles, total citations, and citations per paper, h-index, scientific age, g-index and ar-index were extracted and calculated for any epidemiologist. Descriptive statistics and multivariate linear regression models were used to examine research performance measures of Iranian epidemiologists. According to our findings, research performance measures found to be statistically associated with scientific age and academic ranking of Iranian Epidemiologists. Gender differences were not relevant to research performance across different measures.

Trends in Global Assisted Reproductive Technologies Research: a Scientometrics study.

INTRODUCTION: This study illustrated the global contribution to assisted reproductive technologies (ARTs) research in MEDLINE database from 1998 to 2014. METHODS: In March 2015, the MEDLINE database was searched for research publications indexed under 'reproductive techniques, assisted' (including the following MeSH headings: in vitro fertilization [IVF]; intracytoplasmic sperm injections; cryopreservation; and ovulation induction), with the following expressions in the fields of title or abstract: intrauterine insemination; sperm donation; embryo/egg donation and surrogate mothers. The number of publications in MEDLINE database was recorded for each individual year, 1998-2014, and for each country. The following countries were arbitrarily selected for data retrieval: United States, United Kingdom, France, Germany, Canada, Italy, Japan (G7 countries), Brazil, Russia, India, China (BRIC countries), Egypt, Turkey, Israel and Iran. RESULTS: The absolute number of publications for each country from 1998 to 2014 ranged from 75 to 16453, with a median of 2024. The top five countries were the US (16453 publications), the UK (5427 publications), Japan (4805), China (4660) and France (3795). ART (20277), cryopreservation (11623) and IVF (11209) were the most researched areas. CONCLUSION: Global research on ARTs were geographically distributed and highly concentrated among the world's richest countries. Cryopreservation and IVF were the most productive research domains among ARTs.