Farid Zand - Academia.edu (original) (raw)

Papers by Farid Zand

BMC Health Services Research, 2022

Background One of the challenging decision-making tasks in healthcare centers is the interpretati... more Background One of the challenging decision-making tasks in healthcare centers is the interpretation of blood gas tests. One of the most effective assisting approaches for the interpretation of blood gas analysis (BGA) can be artificial intelligence (AI)-based decision support systems. A primary step to develop intelligent systems is to determine information requirements and automated data input for the secondary analyses. Datasets can help the automated data input from dispersed information systems. Therefore, the current study aimed to identify the data elements required for supporting BGA as a dataset. Materials and methods This cross-sectional descriptive study was conducted in Nemazee Hospital, Shiraz, Iran. A combination of literature review, experts’ consensus, and the Delphi technique was used to develop the dataset. A review of the literature was performed on electronic databases to find the dataset for BGA. An expert panel was formed to discuss on, add, or remove the data e...

Studies in Health Technology and Informatics, 2022

Poor usability of clinical decision support system impact negative on healthcare professionals, d... more Poor usability of clinical decision support system impact negative on healthcare professionals, decrease usage and quality of clinical decision support system and result in a negative effect on patient outcome. Therefore, the objective of this study was the usability evaluation of the venous thromboembolism prophylaxis recommendation system. This study design is a pilot study. Totally seven individuals participate in the study that 4 out of 7 were ICU attending and 3 out of 7 were Residents in ICUs setting. System Usability Scale (SUS) was used to assess the usability of the clinical decision support system (venous thromboembolism prophylaxis recommendation system) integrated into the medication order entry system in the ICU setting. This study has shown that the mean System Usability Scale (SUS) score was 74.64. Summing up the results, it can be concluded that the usability quality of the venous thromboembolism prophylaxis recommendations system is good. Further research requires t...

Indian Journal of Surgery, 2022

There is a considerable gap between standard care and routine practice for venous thromboembolism... more There is a considerable gap between standard care and routine practice for venous thromboembolism (VTE) prophylaxis in hospitalized surgical patients. In this case series study, we aimed to determine the appropriate use of VTE prophylaxis in surgical patients admitted to three ICUs of the largest referral hospital in Shiraz, Iran. Appropriate VTE prophylaxis rates in surgical patients admitted to the ICUs were investigated from April 20 to November 21, 2020. Totally 151 surgical patients met the inclusion criteria. Fifty-three percent of surgical patients admitted to the ICUs received appropriate VTE prophylaxis. The median VTE risk score according to the Caprini model was 8 (interquartile range: 4). According to the Caprini risk stratification model, 140 patients were at high risk for VTE (92.7%). The most significant percentage of patients (37.1%) received unfractionated heparin 5000 units twice a day. Here, we conclude that VTE prophylaxis in the postsurgical period and ICU admission was underutilization.

Background: An important application in health care system is computerized physician order entry ... more Background: An important application in health care system is computerized physician order entry system (CPOE) which improves the quality of patient’s care. Given that the users’ satisfaction is necessary in predicting the success of a system, this study aimed to evaluate the satisfaction of CPOE users in Namazi Hospital. Methods: This cross-sectional study was conducted as a descriptive-analytical research three months after CPOE implementation in Namazi Hospital. The study population consisted of all physicians and nurses in General Intensive care Unit (ICU), which included 14 physicians and 26 nurses who had been working with CPOE system. A standard questionnaire was applied for data gathering; its validity and reliability was confirmed in the study (α=0.84). The data were processed by SPSS 21 software and appropriate statistical tests including T test, One-way Anova and Chi-square tests were used. Results: Overall, the satisfaction of physicians and nurses about the CPOE systems...

Health Scope, 2021

Background: Clinical decision support (CDS) functionalities in Computerized Provider Order Entry ... more Background: Clinical decision support (CDS) functionalities in Computerized Provider Order Entry system (CPOE) need to be identified by the institutional healthcare providers in developing countries. In this regard, CDS functionalities should be a priority for the execution in CPOE. Objectives: Thus, our study was done to identify and prioritize the CDS functionalities in CPOE. Methods: A Two-round Modified Delphi process was used. Firstly, a systematic search was conducted in electronic databases from the date of database inception to February 2019 for identifying CDS functionalities integrated into CPOE. Studies were retrieved from databases, including PubMed, Embase, ProQuest, Scopus, Web of Science, Cochrane, Science Direct, ACM digital library, and IEEE Xplore Digital Library. Secondly, the Modified Delphi method was carried out in 2019 to provide contextual priorities regarding CDS functionalities in CPOE in two iterative rounds. A total of 12 experts working in the three Inte...

Background and objective: There is a gap between expert recommendations and clinical practice in ... more Background and objective: There is a gap between expert recommendations and clinical practice in (Venous Thromboembolism) VTE prophylaxis among nonsurgical patients worldwide. Rate of adherence to evidence-based practice is inadequate in the nonsurgical population. Therefore, this study aimed to determine The effect of Clinical Decision Support Systems(CDSS) on the use of the appropriate VTE Prophylaxis in Nonsurgical Patients in the Intensive Care Unit (ICU).Method: We conducted a cross-sectional study (pre and post-implementation CDSS for recommendation VTE prophylaxis order set) to analyze the effect of the CDSS within CPOE on the appropriate VTE prophylaxis in three ICUs of the Nemazee hospital (before intervention from 20 April 2020, to 21 November 2020 and post-intervention duration form 7 April 2021, to 9 July 2021). The pre-intervention and post-intervention phase samples comprised 175 and 27 patients, respectively. P-value is less than 0.05 was considered a significant leve...

Shiraz E-Medical Journal, 2017

Background: The effectiveness of the educational message for motivating to change behavior may be... more Background: The effectiveness of the educational message for motivating to change behavior may be greater than the actual content of a message, depending on how the message is designed. Objective: The purpose of this study was to compare the effectiveness of gain and loss framed messages on increased physical activity in women with type 2 diabetes attending a diabetes clinic in Ahvaz city. Methods: This randomized clinical trial study was performed among 119 patients with type 2 diabetes who were referred to the diabetes clinic in Ahvaz in 2014. Patients were selected by convenience sampling and then randomly divided into gain (59 cases) and loss (60 cases) groups by use of random numbers table. Two groups received physical activity educational messages in a different context via short message service for 2 months. The data in this study were collected by using a standard 3-part questionnaire as well as interviews before and 1 month after intervention. Data were analyzed by using SPSS version 16 by descriptive statistics, independent t-test, and Chi-square. Results: Based on the finding before the intervention, 2 groups were similar of individual variables, the mean score of physical activity, and disease characteristics. After the intervention, the mean score of physical activity in both groups showed a significant increase (P < 0.05). The results showed that patients who were faced with the loss framed messages compared to patients who were confronted to gain framed messages have more motivation for physical activity (P < 0.05). Conclusion: The present study indicates that loss framed messages are effective in increasing physical activity behaviors in women with type 2 diabetes.

World Family Medicine Journal/Middle East Journal of Family Medicine, 2018

Introduction: To improve accessibility, central vein catheterization in the upper body region is ... more Introduction: To improve accessibility, central vein catheterization in the upper body region is classically done in Trendelenburg position but it may impose potential disadvantages to respiratory system and disturb physiologic status of many other organs. Passive leg raising (PLR), a simple maneuver, widely used to improve cardiac preload and to predict patients' volume responsiveness could be an alternative.

Electronic Journal of General Medicine, 2019

Background and Objective: Catheter Associated Urinary Tract infection (CAUTI) is one of the most ... more Background and Objective: Catheter Associated Urinary Tract infection (CAUTI) is one of the most prevalent hospital acquired infections which causes increased medical costs, hospital stay and mortality. Patients in critical care units are in a higher risk. The main purpose of the present study is the Identification of the effect of instruction and implementation of a preventive urinary tract infection bundle on the incidence of CAUTI. Materials and Methods: This was a before-after quasi-experimental study. 330 patients were included (185 patients in before and 145 in after the intervention). In both phases, the incidence of CAUTI, compliance with principles of CAUTI prevention, urinary catheter utilization and indications of catheter insertion were evaluated. CAUTI was identified based on the Center for Disease Control and Prevention/ National Healthcare Safety Network (CDC/NHSN) criteria with the online INICC software. Interventions included the instruction of the bundle to all health care workers in selected intensive care units and implementing interventions to improve facilities required for the implementation of the bundle. Results: No significant decrease was seen in the incidence of the CAUTI after the intervention (3.2 v/s 1.36 in 1000 catheter-day, p<0.388). The most prevalent indication for urinary catheter utilization in both phases, were critical monitoring of urine output (80.16% and 72.26%, respectively). Before the intervention, 1.6 % of catheterized cases were labeled inappropriate by the physicians. This increased significantly to 5.5% after intervention (P<0.001). Before the intervention, 37.5% of the catheters which were labeled inappropriate were removed which increased to 42/4% after the intervention insignificantly (P<0/709). From the 88 hours of compliance monitoring. The number of observed noncompliance cases before the intervention, which was 1941, decreased significantly after the intervention (P<.001). Conclusion: This study revealed that although instruction and implementation of the preventive bundle reduced CAUTI, this reduction was not significant. Future studies should be conducted with larger sample sizes and in longer periods. The most prevalent criterion for urinary catheter utilization was the need for critical monitoring of urine output. Instruction of the bundle reduced noncompliance with principles of urinary tract infection control.

International Archives of Health Sciences, 2019

Nowadays, hospital-acquired infections are the most widespread phenomena among the critically ill... more Nowadays, hospital-acquired infections are the most widespread phenomena among the critically ill patients. [1,2] Comparing to the patients who are not admitted to the intensive care unit (ICU), pneumonia is one of the most lethal hospital-acquired infections which is 5-10 times higher among the ICU patients and twenty times higher among those under mechanical ventilation. [1] Based on morbidity and the consequences cost rise due to hospital-acquired pneumonia, the recommended clinical guidelines have been established to avoid the related risk factors. [3-5] Ventilator-associated pneumonia (VAP) is a pneumonia which develops under mechanical ventilation condition for longer than 48 h with no clinical evidence of presence or possibility of pneumonia since the early intubation. [6,7] The mortality rates of VAP were evaluated about 20%-75% [8] which is mainly due to the multidrug-resistance bacteria. [9-11] VAP is spread by microorganisms entering the sterilized lower respiratory system through oral-aspiratory secretions, including endemic or external bacteria of the digestive system produced by the contamination of health-care instruments or personnel. [12,13] Prophylaxis of gastric stress ulcer with acid-suppressive therapy increases the risk of VAP in critically ill patients. Gastrointestinal PH rise could lead to overgrowth

F1000Research, 2017

Clinical assessment of disease severity is an important part of medical practice for prediction o... more Clinical assessment of disease severity is an important part of medical practice for prediction of mortality and morbidity in Intensive Care Unit (ICU). A disease severity scoring system can be used as guidance for clinicians for objective assessment of disease outcomes and estimation of the chance of recovery. This study aimed to evaluate the hypothesis that the mortality and length of stay in emergency ICUs predicted by APACHE-IV is different to the real rates of mortality and length of stay observed in our emergency ICU in Iran. This was a retrospective cohort study conducted on the data of 839 consecutive patients admitted to the emergency ICU of Nemazi Hospital, Shiraz, Iran, during 2012-2015. The relevant variables were used to calculate APACHE-IV. Length of stay and death or discharge, Glasgow coma score, and acute physiology score were also evaluated. Moreover, the accuracy of APACHE-IV for mortality was assessed using area under the Receiver Operator Characteristic (ROC) c...

Iranian journal of medical sciences, 2016

Malnutrition is an important factor in the survival of critically ill patients. The purpose of th... more Malnutrition is an important factor in the survival of critically ill patients. The purpose of the present study was to assess the nutritional status of patients in the intensive care unit (ICU) on the days of admission and discharge via a detailed nutritional assessment. Totally, 125 patients were followed up from admission to discharge at 8ICUs in Shiraz, Iran. The patients' nutritional status was assessed using subjective global assessment (SGA), anthropometric measurements, biochemical indices, and body composition indicators. Diet prescription and intake was also evaluated. Malnutrition prevalence significantly increased on the day of discharge (58.62%) compared to the day of admission (28.8%) according to SGA (P<0.001). The patients' weight, mid-upper-arm circumference, mid-arm muscle circumference, triceps skinfold thickness, and calf circumference decreased significantly as well (P<0.001). Lean mass weight and body cell mass also decreased significantly (P<0...

Computers, informatics, nursing : CIN, Jan 4, 2016

This study aimed to identify the functional requirements of computerized provider order entry sof... more This study aimed to identify the functional requirements of computerized provider order entry software and design this software in Iran. This study was conducted using review documentation, interview, and focus group discussions in Shiraz University of Medical Sciences, as the medical pole in Iran, in 2013-2015. The study sample consisted of physicians (n = 12) and nurses (n = 2) in the largest hospital in the southern part of Iran and information technology experts (n = 5) in Shiraz University of Medical Sciences. Functional requirements of the computerized provider order entry system were examined in three phases. Finally, the functional requirements were distributed in four levels, and accordingly, the computerized provider order entry software was designed. The software had seven main dimensions: (1) data entry, (2) drug interaction management system, (3) warning system, (4) treatment services, (5) ability to write in software, (6) reporting from all sections of the software, an...

International Journal of Preventive Medicine, 2015

Background: Most medical errors are preventable. The aim of this study was to compare the current... more Background: Most medical errors are preventable. The aim of this study was to compare the current execution of the 3 patient safety solutions with WHO suggested actions and standards. Methods: Data collection forms and direct observation were used to determine the status of implementation of existing protocols, resources, and tools. Results: In the field of patient handover , there was no standardized approach. In the field of the performance of correct procedure at the correct body site, there were no safety checklists, guideline, and educational content for informing the patients and their families about the procedure. In the field of hand hygiene (HH), although availability of necessary resources was acceptable, availability of promotional HH posters and reminders was substandard. Conclusions: There are some limitations of resources, protocols, and standard checklists in all three areas. We designed some tools that will help both wards to improve patient safety by the implementation of adapted WHO suggested actions.

Background & Objective: Journal club is one of the classical methods of medical education dating ... more Background & Objective: Journal club is one of the classical methods of medical education dating back to 100 years ago. This method can be used for teaching critical evaluation, evidence-based medicine, research design, statistics, and educational concepts to medical residents. The purpose of this study was to investigate the anesthesiology residents’ attitude toward a new method of presenting journal club (with the presence of specialists in community medicine and/or statistics). Methods: This was a cross-sectional, interventional study performed in the adult intensive care unit of Namazi Hospital, Shiraz, Iran. From among 50 faculty members and second year anesthesiology residents participating in the journal club through both the new and traditional methods, 36 returned their viewpoints. A questionnaire with 19 items was designed by the researcher with the collaboration of the Medical Education Development Office and the Anesthesiology Department of Shiraz University of Medical S...

Background: Several formulas are available for enteral nutrition (EN). We tried to find if the am... more Background: Several formulas are available for enteral nutrition (EN). We tried to find if the amount of energy intake (I) and amount of GRV( Gastric Residual Value) is affected by the type of formula during the first week of start of enteral feeding. Methods: 128 patients were assigned to 4 groups of formulas randomly. Formulas which were used were Entera meal Standard, Entera meal High Fiber, Ensure and Nutricomp Standard. Amount of formula was advanced according to ICU protocol. Results: Median goal of (I) was 2294kcal/day. Only 0.8% of patients achieved goal of energy at seventh day. There was no significant differences between formula`s type (p<0.344) however according to GRV there was significant differences between formulas(p<0.0001)( Ensure13.8± 2.9 , Entera meal standard 18.4± 11 , Entera meal high fiber 23.33; ±17, Nutricomp18.09± 11 ) Discussion: There was no difference in amount of energy intake according to type of formula. Attention to total amount of energy inta...

Acta medica Iranica, 2014

Recent studies in animal models indicate that recombinant human erythropoietin (rhEPO) is very ef... more Recent studies in animal models indicate that recombinant human erythropoietin (rhEPO) is very effective in enhancing neurological recovery after spinal cord injury (SCI). We aimed to evaluate the effect of rhEPO plus methylprednisolone sodium succinate (MPSS) compared to MPSS alone to improve neurological function of patients after SCI in a randomized clinical trial. During a 15-month period 30 patients presenting to emergency departments of two university affiliated hospitals within less than 6 hours after acute SCI were randomized to two groups. Both groups received MPSS 30 mg/kg initially and 5.4 mg/kg every hour till 23 hours if admitted within 3 hours and till 47 hours if recruited within 3-6 hours after injury. Group EPO also received 500 unit/kg rhEPO on admission and another 500 unit/kg 24 hours later instead of placebo in group MPSS. Neurologic evaluation was performed on admission, 24, 48, 72 hours and one and 6 months later. Range of patients' age was 18-65 years. Th...

Iranian Red Crescent medical journal, 2011

Digoxin, as a cardiac glycoside extracted from the Digitalis lanata 1 is widely used in the treat... more Digoxin, as a cardiac glycoside extracted from the Digitalis lanata 1 is widely used in the treatment of different heart diseases, such as atrial fibrillation, atrial flutter and heart failure. 2 Its effect is to increase myocardial contractility while mildly prolonging the duration of contraction. The result is decreased heart rate, increased blood pressure and stroke volume, leading to increased tissue perfusion, improved myocardial function and hemodynamics. 2 Digoxin interacts with verapamil, amiodarone, and erythromycin, leading to increase in its plasma level. 3 Arrhythmogenesis and atrio-ventricular conduction arrhythmias such as paroxysmal atrial tachycardia with A-V block are diagnostic for digoxin toxicity. 4 Without the use of digoxin-specific Fab fragments, in a recent review, mortality after digoxin toxicity have been reported to be zero in patients with acute digoxin toxicity and potassium levels less than 5.0 meq/dl, 50% in potassium levels between 5.0 and 5.5, and 100 percent in those with potassium levels above 5.5 meq/dl. 5 Serum potassium levels above 5.0 meq/dl in patients with acute cardiac digoxin toxicity has been proposed as an absolute indication for digoxin-specific Fab fragments. 5 We present a case of acute digoxin toxicity with high potassium level and good outcome despite unavailability of digoxin-specific Fab fragments. The patient was a 75 year-old lady, who was admitted in intensive care unit (ICU) for management of respiratory failure after pulmonary emboli and pulmonary arterial hypertension. She had tracheostomy tube due to prolonged mechanical ventilation and her

Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists, 2008

One of the hazards of general anesthesia for cesarean section (C/S) is the risk of intraoperative... more One of the hazards of general anesthesia for cesarean section (C/S) is the risk of intraoperative awareness with or without recall of the event. We examined the relationship between auditory evoked potential index (AAI), end-tidal isoflurane concentration and hemodynamic parameters to evaluate the adequacy of our routine general anesthetic technique in C/S. This study was carried out in 70 parturients undergoing elective C/S. A standardized anesthetic technique was applied, including thiopentone and suxamethonium for induction, and O2, N2O and isoflurane for maintenance of anesthesia. AAI, heart rate, blood pressure, end-tidal isoflurane concentration and any clinical signs of inadequate depth of anesthesia such as movement, lacrimation and coughing or jerking were continuously monitored and recorded at 17 fixed time points during surgery and anesthesia. Mean arterial pressure and heart rate increased at intubation, but did not show a positive correlation with the AAI values during ...

Revista Brasileira de Anestesiologia, 2010