Shiraz E-Medical Journal
Year:2021 | Volume:22 | Issue:2|Papers Count:8

Background: Physicians and health professionals are the cornerstone of health systems and play an indelible role in promoting the health of each community. As mentioned by the World Bank, human capital, particularly elites and highly skilled human resources, is the wealth of countries. Maintaining and preserving them is the prerequisite of sustainable development of the health sector, availability, and quality of health services. Objectives: The main purpose of this study was to identify the eff ective key variables in the retention of native Iranian physicians and preventing their migration abroad. Methods: This study was conducted using a mixed-method approach based on a sequential exploratory strategy in 2018. In the qualitative section, semi-structured interviews were conducted with 36 faculty members of Shiraz University of Medical Sciences (SUMS). The theoretical saturation was reached via a purposeful sampling and maximum variation by applying conventional thematic analysis method processes. In the quantitative section, a questionnaire was developed, and its validity and reliability were tested and verifi ed. The questionnaire was distributed among a random sample of 158 physicians out of a target population of 283 fi rst-year medical assistants at SUMS. In addition, the data were reviewed by applying a descriptive-survey method, and thematic analysis was used to analyze the data. Results: In total, 60 basic themes, 9 organizing themes, and one global theme were extracted. The strong educational management base for the educational support theme with a factor of 0. 91 (P < 0. 001) was the best descriptor in the physicians’ preservation model. Conclusions: The following critical variables aff ect the native physicians’ retention: eff ective and strong medical education administration as educational support, fl exible working hours, availability of complete labor market information, emphasis and attention to creativity and scientifi c, and research innovations in the medical profession.

Background: Acquired immunodefi ciency syndrome is a behavioral disorder that can be detected via two methods, including active and passive screening. Objectives: This study aimed to evaluate the cost-eff ectiveness of screening strategies of HIV/AIDS among injection drug users (IDUs) referring to the voluntary counseling and testing (VCT) center and drop-in center (DIC) of Shiraz University of Medical Sciences. Methods: This was a cross-sectional cost-eff ectiveness analysis to compare the cost-eff ectiveness of the two active and passive screening methods in 2015. The decision tree model, along with the TreeAge11 software, was used to analyze the data. Results: The averages of cost and eff ectiveness were $989 and 987 subjects in the active screening method while they were $1, 767 and 209 subjects in the passive screening method, respectively. The incremental cost-eff ectiveness ratio (ICER) to early-diagnosed and averted cases was $855/39 for the active screening method and $1528/90 for the passive screening method. According to the fi ndings of the study, the active screening method is more cost-eff ective than its passive counterpart. Conclusions: According to the fi ndings of the study, the active screening method is more cost-eff ective than its passive counterpart, and it is recommended to be used in these cases.

Self-medication is a serious health problem in Iran. In this quasi-experimental study with a control group, four healthcare facilities were selected and divided into intervention and control groups. Based on the health fi les of women in healthcare facilities, 192 women were selected randomly and completed a self-reported questionnaire to measure Health Belief Model constructs and selfmedication. After analyzing the data, perceived susceptibility was found as the main predictive factor for self-medication, and an intervention was developed to increase it. The intervention consisted of lectures and group discussions, along with distributing pamphlets and sending short messages for four weeks. Three months later, the data was collected again and analyzed. Perceived susceptibility was improved, and self-reported behavior was reduced signifi cantly in intervention groups compared to the control groups.

Context: The operating room is a unique environment in which learning happens through interactions with others and facing complex situations. The results of studies show that non-technical skills play a key role in successful technical performance in critical situations. Therefore, the identifi cation and assessment of them are very valuable. This review study was performed to identify and critique non-technical skill assessment tools for surgical team members. Evidence Acquisition: The Carnwell and Daly critical review method was used for the study design. Articles and documents were searched in databases of PubMed, Google Scholar, Scopus, and ScienceDirect from 1999 to 2019. Results: This literature review yielded 13 assessment tools of non-technical skills in the operating room, including ANTS, AS-NTS, N-ANTS, ANTS-AP for the anesthesia team, OTAS, Oxford NOTEHS, Oxford NOTECHS II, and Revised NOTECHS for the surgical team, SPINTS for scrub nurses, and OSANTS, NOTSS, SDM-RS, and SLI for surgeons. Conclusions: Since the development of the tools depends entirely on the context and task analysis of any member of the surgical team, all countries must customize the available tools and develop similar tools for other members of surgical teams.

Background: Pulmonary thromboembolism (PTE) is a leading cause of maternal mortality. However, diagnosis of PTE can be challenging during pregnancy, and there is no consensus regarding the best diagnostic approach. Objectives: The current study aimed to evaluate the applicability of clinical symptoms and diagnostic tests in ruling in or ruling out PTE during pregnancy. Methods: In this one-year, cross-sectional, descriptive study, we evaluated pregnant or postpartum (six weeks postpartum) women suspected of PTE, who were admitted to the internal medicine intensive care units (ICUs) of hospitals (Namazi and Shahid Faghihi hospitals), affi liated with Shiraz University, Shiraz, Iran, during August 2016-July 2017. The participants underwent electrocardiography (ECG), serum troponin-I and D-dimer measurements, chest X-ray, color-doppler sonography (CDS) of the lower extremity venous system, transthoracic echocardiography, pulmonary perfusion scan, or pulmonary computed tomography angiography (CTA). The participants’ clinical manifestations were also assessed. Results: A total of 103 women, with the mean age of 30. 37  5. 35 years, were included in this study. Seventy-seven women underwent pulmonary CTA or pulmonary perfusion scan. PTE was documented in nine cases. Dyspnea was the most common symptom. The respiratory rate, cough, dizziness, and fever on admission had signifi cant correlations with the fi nal diagnosis of PTE (P = 0. 01, 0. 03, 0. 007, and 0. 04, respectively). The ECG study of one case with PTE showed right axis deviation, while the ECG fi ndings of the other eight cases showed no specifi c pattern. The chest X-ray fi ndings had no signifi cant correlation with the fi nal diagnosis of PTE. Overall, 38 women underwent CDS, one of whom presented with deep vein thrombosis. The serum D-dimer level was positive in three cases with documented PTE (normal in one patient with PTE), and the serum troponin-I level was positive in one case with the fi nal diagnosis of PTE (normal level in two patients with PTE). Conclusions: Based on the fi ndings, clinical symptoms and biochemical tests alone are not reliable for ruling in or ruling out PTE during pregnancy, and CTA and pulmonary ventilation/perfusion scan should be performed for these cases.

Background: Quality of life among cancer patients after diagnosis and treatment steps is an important factor in preventing further cancer complications. Thus, appropriate tools to evaluate the quality of life among this group are required. Quality of life in Adult Cancer Survivors (QLACS) questionnaire is a suitable tool which evaluates diff erent aspects of life among cancer survivors. Objectives: This study evaluated the Persian version of the QLACS questionnaire among Iranian short-survivors of breast cancer by assessing its validity and reliability. Methods: The QLACS was translated to Persian for this study. The questionnaire’ s face and content validity were assessed by a panel of experts by the impact score, content validity ratio, and index methods. In the next step, the questionnaire was fi lled out by 150 women with breast cancer who were diagnosed 1. 5-5 years before this study. Explanatory factor analysis was performed to assess factors. Reliability was evaluated using Cronbach’ s alpha. Results: Overall, 37 items were selected for explanatory factor analysis that had an impact score of more than 1. 5, content validity ratio (CVR) more than 0. 99, and a suitable content validity index (CVI). In factor analysis, 10 factors were extracted via varimax rotation, accounting for 75. 8% of the total variance. Cronbach’ s alpha of all the factors was more than 0. 7, that was similar to the original questionnaire. Conclusions: We conclude that the Persian version of the QLACS questionnaire has optimal properties for the assessment of quality of life among Iranian short-survivors of breast cancer.

Background: Infl uenza vaccination is the most eff ective strategy to prevent comorbidity and mortality of this infection in pregnant women. Objectives: The current study aimed at evaluating the infl uenza vaccination rate and its related factors among pregnant women. Methods: The current cross-sectional study was conducted on 520 pregnant women referring to antenatal clinics of tertiary hospitals affi liated to Kerman University of Medical Sciences from January to April 2019 in Kerman city, Iran. The collected data through a form distributed among the subjects were analyzed using SPSS version 22. Results: The infl uenza vaccination coverage rate was 30. 0% (95% confi dence interval (CI): 26. 1-34. 1) among the pregnant women. Age older than 30 years (AOR = 3. 79; 95%CI: 1. 55-9. 24), being employed (AOR = 2. 44; 95%CI: 1. 01-5. 88), having an underlying chronic disease (AOR = 4. 39; 95%CI: 1. 33-14. 51), receiving recommendation to undergo infl uenza vaccination (AOR = 65. 76; 95%CI: 11. 04-391. 48), and having good knowledge of infl uenza vaccine (AOR = 9. 64; 95%CI: 3. 87-24. 02) increased the likelihood of receiving infl uenza vaccine. Conclusions: The current study highlighted that the infl uenza vaccination coverage rate was suboptimal. Also, fi ndings of the current study suggested that infl uenza vaccination, as an important component of antenatal care services, should be considered by health policymakers. Furthermore, educating pregnant women and healthcare providers can improve compliance with infl uenza vaccination.

Background: Uterine leiomyomas are considered as a major source of complications and the most common cause of hysterectomy. Objectives: The aim of this study was to compare the quality of life in women with and without uterine leiomyoma referred to gynecology clinics of Shiraz University of Medical Sciences in 2018. Methods: In this cross-sectional study, a total of 126 patients who referred to the clinics of Shiraz University of Medical Sciences were selected and divided into equal groups according to uterine leiomyoma, 1-7 cm uterine leiomyoma group and non-uterine leiomyoma group by convenience sampling. The World Health Organization Quality of Life and Healthy Lifestyle questionnaires were used for data collection. Independent t-test was used to analyze the data. Results: The mean quality of life of women with uterine leiomyoma was 47. 20  12. 41 and women without uterine leiomyoma had a signifi cant diff erence (51. 11  11. 23, t = 3. 93, P = 0. 041). The mean lifestyle of women with uterine leiomyoma was 114. 18  25. 48 and women without uterine leiomyoma had 149. 11  23. 81 (t = 4. 01, P = 0. 029). Conclusions: The mean score of quality of life and lifestyle were signifi cantly diff erent in women with and without uterine leiomyoma. Therefore, it is necessary to improve the quality of life of women by improving their lifestyle and providing psychological counseling.