A novel framework for human factors analysis and classification system for medical errors (HFACS-MES)-A Delphi study and causality analysis.

The healthcare system (HCS) is one of the most crucial and essential systems for humanity. Currently, supplying the patients' safety and preventing the medical adverse events (MAEs) in HCS is a global issue. Human and organizational factors (HOFs) are the primary causes of MAEs. However, there are limited analytical methods to investigate the role of these factors in medical errors (MEs). The aim of present study was to introduce a new and applicable framework for the causation of MAEs based on the original HFACS. In this descriptive-analytical study, HOFs related to MEs were initially extracted through a comprehensive literature review. Subsequently, a Delphi study was employed to develop a new human factors analysis and classification system for medical errors (HFACS-MEs) framework. To validate this framework in the causation and analysis of MEs, 180 MAEs were analyzed by using HFACS-MEs. The results showed that the new HFACS-MEs model comprised 5 causal levels and 25 causal categories. The most significant changes in HFACS-MEs compared to the original HFACS included adding a fifth causal level, named "extra-organizational issues", adding the causal categories "management of change" (MOC) and "patient safety culture" (PSC) to fourth causal level", adding "patient-related factors (PRF)" and "task elements" to second causal level and finally, appending "situational violations" to first causal level. Causality analyses among categories in the HFACS-MEs framework showed that the new added causal level (extra-organizational issues) have statistically significant relationships with causal factors of lower levels (Φc≤0.41, p-value≤0.038). Other new causal category including MOC, PSC, PRF and situational violations significantly influenced by the causal categories of higher levels and had an statistically significant effect on the lower-level causal categories (Φc>0.2, p-value<0.05). The framework developed in this study serves as a valuable tool in identifying the causes and causal pathways of MAEs, facilitating a comprehensive analysis of the human factors that significantly impact patient safety within HCS.

Effectiveness of physiotherapy plus acupuncture compared with physiotherapy alone on pain, disability and grip strength in people with carpal tunnel syndrome: A randomized clinical trial.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment syndrome in the upper extremities. Acupuncture is often used as a treatment method in CTS and numerous studies consider it effective. However, no study has yet compared the efficacy of physical therapy including bone and neural mobilization, exercise and electrotherapy with and without acupuncture in CTS patients. PURPOSE: comparing the effect of physiotherapy plus acupuncture with physiotherapy alone on pain, disability and grip strength in CTS patients. METHOD: Forty patients with mild to moderate CTS were randomly divided into two equal groups. Both groups received exercise and manual techniques for 10 sessions. Patients in the physiotherapy plus acupuncture group also received 30 min of acupuncture in every session. The visual analog scale (VAS) score, the score on the Boston carpal tunnel questionnaire for functional status and symptom severity, shortened disability of arm, shoulder, hand (Quick-DASH) score and grip strength were evaluated at pre-test and post-test. RESULTS: According to ANOVA results, there is a significant interaction between group and time for VAS, BCTQ and Quick-DASH parameters. At the post-test, while the parameters of VAS, BCTQ and Quick-DASH in the physiotherapy plus acupuncture group had a statistically significant difference compared to the physiotherapy group, no significant difference was observed between the two groups in the pre-test. Moreover, there is no significant difference between groups in grip strength improvement. CONCLUSION: This study shows preliminary evidence that physiotherapy plus acupuncture, was more effective than physiotherapy alone in pain relief and improving disability of patients suffering from CTS.

Diagnostic and Therapeutic Costs of Patients With a Diagnosis of or Suspected Coronavirus Disease in Iran.

OBJECTIVES: To understand the social and individual effects of the disease and make decisions on the allocation of health resources, it is necessary to understand the economic burden of coronavirus disease (COVID-19); however, there are limited data in this field. This study aimed to estimate diagnostic and therapeutic costs of patients with a diagnosis of or suspected of COVID-19 disease admitted to hospitals in northeast Iran. METHODS: This descriptive and analytical research was conducted as a retrospective study using the data collected from 2980 patients admitted to 30 hospitals from February to April 2020 in Iran. For data collection, an appropriate data capture tool was designed to record detailed resource use. A multivariate regression analysis was performed to examine the association between the treatment costs and sociodemographic, disease severity, and underlying diseases. Data were analyzed using Excel 2017 (Microsoft, Redmond, WA) and SPSS version 21 software (SPSS Inc., Chicago, IL). RESULTS: The inpatient costs per patient were Int$416, of which 74% were paid by social health insurance systems, 19% by the government, and 7% by the patients. The largest cost components were hoteling (37%) and medicine (36%). The 4 subscales of age, sex, underlying disease, and severity predicted 48.6% of the cost variance. CONCLUSION: Understanding the economic consequences of diseases can help policymakers to make plans to reduce out-of-pocket payments and make plans for funding. Since COVID-19 is a newly emerging disease and there is no definitive cure for the disease, the discovery of an effective medicine may alter medical costs and reduce the hospital length of stay, therefore significantly reducing treatment costs.

Challenges faced by nurses while caring for COVID-19 patients: A qualitative study.

INTRODUCTION: In the COVID-19 crisis, nurses are directly involved in patient care, so they face many challenges. This study was performed to determine the challenges faced by nurses while caring for COVID-19 patients in Iran in 2020. MATERIALS AND METHODS: This qualitative, content analysis was conducted in Iran on ten nurses directly involved in the fight against the corona epidemic, selected through a purposeful sampling strategy. Data were collected through deep interviews consisting of open questions. All the interviews were recorded, and immediately after each interview, it was transcribed into written form. The data were analyzed using MAXQDA software. RESULTS: All the challenges could be classified into three main categories and 17 subcategories. The main categories were miss-management in controlling corona conditions, mental and physical complications and challenges in corona work conditions, and lack of sufficient workforce. CONCLUSION: Hospital managers and authorities play a significant role in meeting the financial needs and requirements of nurses, and can minimize the job discrimination prevalent at medical centers through providing financial and nonfinancial incentives for nurses. Moreover, the findings of the present study can help hospital managers and authorities to gain a better understanding of the experiences of nurses, and to take the necessary measures to obviate the challenges faced by nurses in public health emergencies.

Evaluation of acupressure effects on self-efficacy and pregnancy rate in infertile women under in vitro fertilization/intracytoplasmic sperm injection treatment: A randomized controlled trial.

CONTEXT: Infertility is one of the major stressful events in individual life, especially women. Self-efficacy means a person can perceive a potentially threatening and stressful situation as being amenable to influences of personal control. AIMS: This study was conducted to determine the acupressure effects on self-efficacy and pregnancy rate in infertile women under in vitro fertilization (IVF)/intracytoplasmic sperm injection treatment. SETTINGS AND DESIGN: This study was a randomized controlled trial in infertile women. It performed at Milad IVF Center, Mashhad, Iran, from September 2015 to August 2016. MATERIALS AND METHODS: The sample size was 144 participants. The participants were randomly divided into three groups: real and sham acupressure and control groups. Acupressure performed on the H7 and P6 acupoints on both the hands. The infertility self-efficacy scale was completed before and after intervention. Beta-human chorionic gonadotropin hormone assay was measured to determine pregnancy. Data analysis was done by Chi-square, Fisher's exact, paired sample t, Kruskal-Wallis, and ANOVA test and general linear model and multinomial logistic. Levels of significance were reported at P < 0.05. RESULTS: The mean age of women was 30.84 ± 5.34 years. The ovulation factor (P = 0.02) and spouse's job (P = 0.05) were statistically significant difference between the groups. The score of self-efficacy and frequency of clinical pregnancy were no significant difference among three groups. Using linear regression, only the score of primary self-efficacy (before intervention) was in a significant relationship with self-efficacy after the intervention (P < 0.001). CONCLUSION: To our results, we recommend more research for assessing acupressure effects on self-efficacy and clinical pregnancy rate in infertile women.

Challenges of OSCE national board exam in Iran from participants' perspective.

BACKGROUND: The national board exam for residents in Iran is held in two parts: Multiple-choice and Objective Structured Clinical Examination (OSCE). The OSCE is a suitable method for evaluation of residents' clinical qualifications. However, it requires experienced human resources, accurate planning, facilities and reliable evaluation tools. OBJECTIVE: To determine the challenges of the OSCE National Board Exam in Iran. METHODS: This cross-sectional study was conducted on all the final-year pediatrics and gynecology residents of Mashhad University of Medical Science, who participated in the board exam in September 2014. A questionnaire was designed to evaluate the residents' opinion on challenges of the OSCE. Data was analyzed with SPSS16. We used U Mann-Whitney test independent t-test, and Pearson correlation coefficient. RESULTS: Fourteen pediatrics and eleven gynecology residents participated. In the gynecology group, there was no significant statistical correlation between the individual marks and questionnaire scores. However, in the pediatrics group, there was a significant correlation (p=0.046, r=-0.763). Based on pediatrics residents' perspective, the main challenge of the OSCE part of the exam was the imbalance and disproportion between the allowed time and the task load in each exam stage. In other words, they believed that the tasks could not be fulfilled in the given time. In the gynecology group, the main challenge reported was the delay in announcing the exam results. In the pediatrics group, the main complaint was the disproportion of the allowed time and the task load in the exam stages. CONCLUSION: Some of the challenges of the board exam were associated with the examiners and the exam environment, and some of them were related to the home university where the candidates had studied. To solve the problems, both aspects should be considered.