Background: Patients' escape from hospital imposes a significant cost to patients as well as the health system. Besides, for these patients, exposure to adverse events (such as suicide, self-harm, violence and harm to hospital reputation) are more likely to occur compared to others. The present study aimed to determine the characteristics of the absconding patients in a general hospital through a case-control design in Shiraz, Iran. Methods: This case-control study was conducted on 413 absconded patients as case and 413 patients as control in a large general hospital in Shiraz, southern Iran. In this study, data on the case and control patients was collected from the medical records using a standard checklist in the period of 2011-3. Then, the data were analyzed using descriptive and analytical statistics, through SPSS 16. Results: The finding showed that 413 patients absconded (0.50%) and mean of age in case group was 40.98 ± 16.31 years. In univariate analysis, variables of gender [Odds Ratio (OR)= 2], ward (OR= 1.22), insurance status (OR= 0.41), job status (OR= 0.34) and residence expenditure were significant. However, in multivariate analysis significant variables were age (OR adj = 0.13), gender (OR adj = 2.15), self-employment/unemployed (OR adj = 0.47), emergency/admission (OR adj = 2.14), internal/admission (OR adj = 3.16), insurance status (OR adj = 4.49) and residence expenditure (OR adj = 1.15). Conclusion: Characteristics such as middle age, male gender, no insurance coverage, inability to afford hospital expenditures and admission in emergency department make patients more likely abscond from the hospital. Therefore, it may be necessary to focus efforts on high-risk groups and increase insurance coverage in the country to prevent absconding from hospital.
Background: Training of human resources, especially nurses, is a profitable investment for hospitals with major economic return if properly planned and implemented. Objectives: The present study aimed to evaluate the effectiveness of a cardiopulmonary resuscitation (CPR) course as an in-service training program, based on the Kirkpatrick model. Methods: This interventional study was conducted at Afzalipour Hospital of Kerman, Iran from October 2014 to May 2015. The study sample consisted of 45 nurses, including 20 nurses in the case group and 25 nurses in the control group. The case group participated in a four-hour CPR training workshop. The Kirkpatrick model was used to determine the effectiveness of the CPR course. Data were collected using three questionnaires and hospital records. Results: The participants were satisfied with the training course, and a significant difference was observed in the mean score of three intervals of learning levels evaluation (P < 0.0001). Based on the findings, CPR training affected the learning level of nurses from the case group; however, the average learning score was not significantly different between the two groups (P = 0.26). In addition, the difference in the mean score of behavior level was not significant before and after training (P = 0.91). The results of Chi-square test also showed that CPR training did not affect the forth level (P = 0.54). Finally, the overall effectiveness of the CPR training course was estimated at 32.51%. Conclusions: This study indicated that effectiveness of in-service training is not at a desirable level. Since organizations allocate a lot of their resources to such training courses every year, it is essential to reconsider planning and implementation processes.
Context: Patients with hemophilia receive coagulation factor replacement for a lifetime. In Iran, on-demand treatment method is used as a standard. Clinical studies have shown significant improvements in clinical and economic outcomes as a result of the use of prophylaxis compared with other therapies. The aim of this study was to evaluate the safety and efficacy of prophylaxis in patients with severe hemophilia type A and B. Evidence Acquisition: This is a systematic review and meta-analysis in order to evaluate the safety and efficacy of prophylaxis treatment in patients with severe hemophilia. To this response, all clinical trials, cohorts, and case-control studies, which have been investigated, were published between 1970 to Sep of 2017. STROBE and CONSORT checklists have been used according to the type of study to assess the quality of the study reports, and the results have been analyzed in STATA by meta-analysis methods. Results: A total of 1439 studies were found in primary search and 17 of them had an inclusion criteria. The mean annual bleeding rate in prophylays treatment was 2.8 times per person/year. This study also showed that in prophylaxis, the average incidence of adverse effects was 0.13 cases, and the severe adverse effects was 0.06 cases per person/year. Conclusions: The analysis of the studies entered in this evaluation showed that the adverse effects were significantly lower in patients treated with prophylaxis than in patients treated with on-demand treatment. This difference was observed in severe adverse effect, however, it was not statistically significant; this shows that prophilaxis is safer than the on-demand method. The lower annual bleeding rate in prophylaxis compared with the on-demand treatment method is also a sign of the effectiveness of prophilaxis.
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