Predicting Length of Stay in Intensive Care Units after Cardiac Surgery: Comparison of Artificial Neural Networks and Adaptive Neuro-fuzzy System / 대한의료정보학회지

OBJECTIVES: Accurate prediction of patients' length of stay is highly important. This study compared the performance of artificial neural network and adaptive neuro-fuzzy system algorithms to predict patients' length of stay in intensive care units (ICU) after cardiac surgery. METHODS: A cross-sectional, analytical, and applied study was conducted. The required data were collected from 311 cardiac patients admitted to intensive care units after surgery at three hospitals of Shiraz, Iran, through a non-random convenience sampling method during the second quarter of 2016. Following the initial processing of influential factors, models were created and evaluated. RESULTS: The results showed that the adaptive neuro-fuzzy algorithm (with mean squared error [MSE] = 7 and R = 0.88) resulted in the creation of a more precise model than the artificial neural network (with MSE = 21 and R = 0.60). CONCLUSIONS: The adaptive neuro-fuzzy algorithm produces a more accurate model as it applies both the capabilities of a neural network architecture and experts' knowledge as a hybrid algorithm. It identifies nonlinear components, yielding remarkable results for prediction the length of stay, which is a useful calculation output to support ICU management, enabling higher quality of administration and cost reduction.

Characteristics of occupational injuries in a pharmaceutical company in Iran

Objective: To prioritize occupational hazards in a Pharmaceutical Company in Iran using the analytical hierarchy process [AHP]

Methods: This was a cross-sectional study conducted in a Pharmaceutical Company in Iran in 2017. All employees working in the administrative, production, installations and facilities, and laboratory units were studied using the consensus method [N=n=130 employees]. A data collection form was designed for identifying the hazards using the Nominal Group Technique [NGT] method, as well as a pair-wise questionnaire was used for collecting required data in the quantitative phase. The collected data were analyzed using Expert Choice 10.0 and SPSS 23.0

Results: The results showed that among hazards detected in the studied units, the highest and lowest weights and priorities were, respectively, related to "inhalation of toxic gases" [W=0.253] and "being exposed to radiation" [W=0.022] in the laboratory unit, "skin injuries" [W=0.205] and "bending and straightening for a long time" [W= 0.032] in the production unit, "falling down" [W=0.271] and "standing and sitting for a long time " [W=0.037] in the installations and facilities unit, and "hand joint failure" [W=0.295] and "working in a low-light environment" [W=0.092] in the administrative unit

Conclusion: The results of the present study showed that there were hazards in all of the studied units. These results indicated a high level of hazards in the pharmaceutical company's units. Due to the increased medication diversification and increased workload for these companies, paying attention to the preventive and corrective measures in order to reduce the risk of emerging hazards is essential

Factors affecting the location of road emergency bases in Iran using analytical hierarchy process [AHP]

Objective: to identify and prioritize factors affecting the location of road emergency bases in Iran using Analytical Hierarchy Process [AHP]

Methods: this was a mixed method [quantitative-qualitative] study conducted in 2016. The participants in this study included the professionals and experts in the field of pre-hospital and road emergency services issues working in the Health Deputy of Iran Ministry of Health and Medical Education, which were selected using purposive sampling method. In this study at first, the factors affecting the location of road emergency bases in Iran were identified using literature review and conducting interviews with the experts. Then, the identified factors were scored and prioritized using the studied professionals and experts' viewpoints through using the analytic hierarchy process [AHP] technique and its related pair-wise questionnaire. The collected data were analyzed using MAXQDA 10.0 software to analyze the answers given to the open question and Expert Choice 10.0 software to determine the weights and priorities of the identified factors

Results: the results showed that eight factors were effective in locating the road emergency bases in Iran from the viewpoints of the studied professionals and experts in the field of pre-hospital and road emergency services issues, including respectively distance from the next base, region population, topography and geographical situation of the region, the volume of road traffic, the existence of amenities such as water, electricity, gas, etc. and proximity to the village, accident-prone sites, University ownership of the base site, and proximity to toll-house

Conclusion: among the eight factors which were effective in locating the road emergency bases from the studied professionals and experts' perspectives, "distance from the next base" and "region population" were respectively the most important ones which had great differences with other factors

Medical Errors and Barriers to Reporting in Ten Hospitals in Southern Iran

Background: International research shows that medical errors (MEs) are a major threat to patient safety. The present study aimed to describe MEs and barriers to reporting them in Shiraz public hospitals, Iran. Methods: A cross-sectional, retrospective study was conducted in 10 Shiraz public hospitals in the south of Iran, 2013. Using the standardised checklist of Shiraz University of Medical Sciences (referred to the Clinical Governance Department and recorded documentations) and Uribe questionnaire, we gathered the data in the hospitals. Results: A total of 4379 MEs were recorded in 10 hospitals. The highest frequency (27.1%) was related to systematic errors. Besides, most of the errors had occurred in the largest hospital (54.9%), internal wards (36.3%), and morning shifts (55.0%). The results revealed a significant association between the MEs and wards and hospitals (p < 0.001). Moreover, individual and organisational factors were the barriers to reporting ME in the studied hospitals. Also, a significant correlation was observed between the ME reporting barriers and the participants’ job experiences (p < 0.001). Conclusion: The medical errors were highly frequent in the studied hospitals especially in the larger hospitals, morning shift and in the nursing practice. Moreover, individual and organisational factors were considered as the barriers to reporting MEs.

Factors affecting the nurses' motivation for participating in the in-service training courses: a case study

Introduction: Due to the vital role of nurses and the effects of scientific advances on nursing care, providing high quality nursing services is not possible without participating in the in-service training programs and becoming familiar with the new techniques. This study aimed to determine the motivational factors influencing the participation in the in-service training courses among nurses working in the teaching hospitals affiliated to Shiraz University of Medical Sciences in 2013

Method: This was an applied, cross-sectional and descriptive-analytical study. A sample of 216 nurses working in the teaching hospitals affiliated to Shiraz University of Medical Sciences was selected using stratified sampling proportional to size and simple random sampling methods. The required data were collected using a questionnaire determining the motivational factors influencing the nurses' participation in the in-service training courses, including personal factors, organizational factors, and those related to the profession and the training courses planning. SPSS 18.0 and some statistical tests including ANOVA, Independent-Samples T-Test, as well as Pearson Correlation Coefficient were used to analyze the collected data

Results: The results showed that the mean score of nurses' motivation for participating in the in-service training programs was 3.41 +/- 0.5. Also, the highest and lowest means of motivational factors affecting the studied nurses' participation in the in-service courses were associated with the factors related to the profession [3.75 +/- 0.71], and those related to the training courses planning [3.20 +/- 0.59], respectively. In addition, there were significant associations between the personal factors [p=0.037] and factors related to the profession [p=0.047] and the studied nurses' positions, between the organizational factors and their employment status [p=0.007], and between the factors related to the training courses planning and the nurses' service unit [p=0.014]. Furthermore, there was a significant and negative correlation between their nursing job experience and organizational factors [r= -0.21, P= 0.004]

Conclusion:: According to the results and in order to increase the studied nurses' motivation for participating in the in-service training courses, the following suggestions can be offered: making a proper educational needs assessment, paying careful attention to the nurses' educational needs, determining the suitable time and place for providing training courses, and encouraging the nurses' participating in the in-service training courses, etc.

Shift work and related health problems among medical and diagnostic staff of the general teaching hospitals affiliated to Shiraz University of Medical Sciences, 2012

Introduction: Today, shift work is considered as a necessity in many jobs and for some 24-hour services the use of shift-work is growing. However, shift work can lead to physiological and psycho-social problems for shift workers. This study aimed to determine the effects of shift work on the associated health problems, together with the demographic and job characteristics underlying the problems, among the medical and diagnostic staff of the general teaching hospitals affiliated to Shiraz University of Medical Sciences in 2012

Method: This study was an applied, cross-sectional and descriptive-analytical one. The study employed a sample of 205 employees from the medical and diagnostic staff using stratified sampling proportional to the size and simple random sampling methods. Data were collected using the Survey of Shift workers [SOS] questionnaire, validity and reliability of which have already been confirmed. Finally, the collected data were analyzed using SPSS 16.0 software through ANOVA, Chi-square, Independent-Samples T-Test, as well as Pearson Correlation Coefficient. A P<0.05 was considered statistically significant

Results: The results showed that among the demographic and job characteristics studied, the individual, family and social problems had significant associations with work schedules, shift work and job satisfaction. In addition, there were significant associations between musculoskeletal disorders and the satisfaction of shift work; cardiovascular disorders and marital status and occupation; digestive disorders and the work schedules; sleep disorders and the satisfaction of shift work; musculoskeletal disorders, cardiovascular disorders and sleep disorders and age, job experience and shift work experience. And finally, there were significant associations among sleep disorders and age, job experience and the shift work experience

Conclusion: Based on the findings of this study, demographic characteristics such as age, marital status, as well as job characteristics can increase the individual, family and social problems, and cardiovascular, musculoskeletal, digestive and sleep disorders. Therefore, in order to reduce these problems and disorders, the following suggestions are made: allowing voluntary shifts for the staff, shortening the hours of night work, limiting the employment of older people in the shift work systems, etc.

Analysis of the systematic relationships among social determinants of health [SDH] and identification of their prioritization in Iran using DEMATEL technique

Social determinants, similar to equity, have been considered by policymakers in many countries .However, there is not a correct and complete understanding of them. This study aimed to analyze the systematic relationships among social determinants of health [SDH] and identify their prioritization in Iran. This cross-sectional descriptive-analytical study was conducted in 2012. The target population consisted of 30 experts on SDH. Required data was collected using a questionnaire, as well as, nominal group technique [NGT]. Then collected data were analyzed using MATLAB 7.9.0 and SPSS 18.0. Determinants of early life [EL], social gradient [SG], unemployment [U], stress [S] and addiction [A] were certainly affecting determinants on the system, which were placed in the cause group and ranked as the first to fifth priorities, respectively. While social exclusion [SE], food [F], social support [SS], work [W] and transport [T] were partially affected determinants and were placed in the effect group and ranked as the sixth to tenth priorities, respectively. Early life and transport were identified as the most affecting and affected determinants with the coordinates [2.16 and 0.75] and [1.68 and -0.47] on the SDH diagram, respectively. Improving the social and economic status, considering the early life, increasing the quality of education, and reducing unemployment and stress have effects on the other social determinants of health and provide opportunities for increasing equity

Comparison of the results of Cox proportional hazards model and parametric models in the study of length of stay in a tertiary teaching hospital in Tehran, Iran

Survival analysis is a set of methods used for analysis of the data which exist until the occurrence of an event. This study aimed to compare the results of the use of the semi-parametric Cox model with parametric models to determine the factors influencing the length of stay of patients in the inpatient units of Women Hospital in Tehran, Iran. In this historical cohort study all 3421 charts of the patients admitted to Obstetrics, Surgery and Oncology units in 2008 were reviewed and the required patient data such as medical insurance coverage types, admission months, days and times, inpatient units, final diagnoses, the number of diagnostic tests, admission types were collected. The patient length of stay in hospital 'leading to recovery' was considered as a survival variable. To compare the semi-parametric Cox model and parametric [including exponential, Weibull, Gompertz, log-normal, log-logistic and gamma] models and find the best model fitted to studied data, Akaike's Information Criterion [AIC] and Cox-Snell residual were used. P<0.05 was considered as statistically significant. AIC and Cox-Snell residual graph showed that the gamma model had the lowest AIC [4288.598] and the closest graph to the bisector. The results of the gamma model showed that factors affecting the patient length of stay were admission day, inpatient unit, related physician specialty, emergent admission, final diagnosis and the number of laboratory tests, radiographies and sonographies [P<0.05]. The results showed that the gamma model provided a better fit to the studied data than the Cox proportional hazards model. Therefore, it is better for researchers of healthcare field to consider this model in their researches about the patient length of stay [LOS] if the assumption of proportional hazards is not fulfilled