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A Heidary ,
Volume 56, Issue 5 (7-1998)
Volume 56, Issue 5 (7-1998)
Abstract
As fever is a sign of infection and also an unpleasant and unfavorable feeling for patients it is urgent to be treated as soon as possible. The treatment can be difficult because of critical situation. This paper is intended to propose a management program according to 6 months follow up in our (ICU). Results were considerable in decreasing about 60% mortality and morbidity.
M Zargar, Mr Zafarghandi, H Mdaghgh, K Abasi, H Rezai Shirazi,
Volume 56, Issue 5 (7-1998)
Volume 56, Issue 5 (7-1998)
Abstract
Nowadays, trauma is a major complex of industrial and developed countries. Integrated trauma systems have been used for many years to evaluate and minimize the severity of trauma outcomes (mortality and morbidity). We haven't had any trauma system or any comprehensive study, giving us proper information about our country trauma state. This article is based on comprehensive information of a descriptive prospective cohort study, performed in one year period in 3 major trauma centers in Tehran, evaluating 58005 Traumatic patients, referred to emergency rooms of these hospitals. In this article we have tried to represent a complete report of our patients' epidemiologic and demographic factors and trauma inducing mechanisms including traffic accidents, falls, gunshots, cutting objects ..., and their effect on the severity of injury and patients' outcome. Based on our study, traumatic patients are mainly young (age mode between 20-29) males (80%). The majority of patients were illiterate or had a low level of education. The most common mechanism of trauma was hitting of blunt objects (44.9%), however, it was car accidents in hospitalized and severely injured patients (39.9% and 53.7% respectively). The mechanism of trauma correlates significantly to the severity of injury, the need to hospitalization and the patients' outcome. In our study gunshots, car accidents and falls are the most important trauma inducing factors.
Ghaem Maghami F, Harirchi I, Moghimi R, Mazaheri H ,
Volume 60, Issue 2 (5-2002)
Volume 60, Issue 2 (5-2002)
Abstract
Background: The aim of study was to determine the frequency of delay referring and related factors in patients with advanced breast cancer, in Imam Khomeini Hospital in the 2000.
Materials and Methods: Successively 200 patients were entered the study if they were consentient. A questionnaire was constructed and information was obtained through interviewing.
Results: From the cases, 64 patients (32 percent) referred without delay and 136 patients (68 percent) referred tardily. The patients who were late in comparison with patients who didn’t late, had significantly higher mean age (P=0.004), lower education level (P=0.002), and lower economic status (P=0.001). The frequency rate of single were lower among them (P=0.001), fewer percent were residual of big cities (P=0.01) and they had less rate of available physician (P=0.004). 24.3 percent of delay referring patients and 53.1 percent of patients without delay has a positive family history of breast cancer (P=0.001). 62.5 percent of delay referring patients and 85 percent of patients without delay were aware about importance of Self Breast Examination (S.B.E) (P=0.002) and respectively 84.4 percent and 98.4 percent were award about symptoms of breast cancer (P=0.01). 23.5 percent and 33 percent of patients with and without delay Knew the method of B.S.E respectively. It wasn’t a significant difference.
Conclusion: Lack of awareness about necessity of medical consultation, fear, carelessly, unavailable physician and poverty were the major causes of delay in patients who referred late.
Mahdavi Mazdeh M, Moradiance V, Lesan Pezeshki M, Jahan Zad I,
Volume 61, Issue 3 (6-2003)
Volume 61, Issue 3 (6-2003)
Abstract
LP(a) level in uremic patients is high. It has recently considered that the effect of androgens on lipids vary widely. The aim of this study was to determine the effect of nandrolone decanoate on lipid profile in chronic hemodialysis patients.
Materials and Methods: thirty six stable male patients over 40 years who were under maintenance hemodialysis were randomized to receive nandrolone decanoate , 100 mg weekly for six month, by intramuscular injection on nondialysis day (Group A, N=18) or B complex (Group B, N=18). Between September 2001 and 2002, male hemodialysis patients more than 40 years old without history of high prostatic specific antigen (PAS) or sensitization to drug were started on treatment with androgen therapy. The evolution in the liquid profile was prospectively assessed immediately before the first dose of nandrolone decanoate (basal values) and at 2, 4 and 6 month of therapy. The evolution of lipids after withdrawal of androgens at 2 month after the last dose was also studied. The patients underwent hemodialysis 3 to 4 hours three times a week. The dialysis schedule was not modified during the period of study.
Results: Mean decrease of LP(a) level in group A was significantly lower then group B in second month (p<0.05). Surprisingly HP level decreased also in second month. Other lipid parameters did not show significant changes.
Conclusion: In this study we observed that nandrolone decanoate affects on LP(a) leveK but the changes of it did not correlate with those of hemoglobin or other lipid parameters< suggesting that the underlying mechanisms are unrelated. Our finding might be affected by low dose of the drug. Further studies with higher doses will be requied to clarify the beneficial or adverse effects of this type of therapy.
Katiraee F, Khosravi Ar, Khalaj V, Hajiabdolbaghi M, Khaksar Aa, Rasoulinejad M,
Volume 70, Issue 2 (5-2012)
Volume 70, Issue 2 (5-2012)
Abstract
Background: Oropharyngeal candidiasis and antifungal drug resistance are major problems in HIV positive patients. The increased reports of antifungal resistance and expanding therapeutic options prompted the determination of antifungal susceptibility profile of Candida species isolates in Iranian patients living with HIV/AIDS (PLWHA) in the present study.
Methods: One hundred fifty oral samples from Iranian HIV positive patients were obtained and cultured on CHROMagar and Sabouraud's dextrose agar. All isolates were identified according to assimilation profile, germ tube, colony color and other conventional methods. Disk diffusion testing and Broth Microdilution of six antifungal agents were performed according to the methods described in CLSI.
Results: Candida albicans (50.2%) was the most frequent isolated yeast, followed by C. glabrata (22%). Non-Candida albicans species were isolated from 71 (61%) positive cultures. 25.7% of Candida albicans isolates were resistant to fluconazole (MIC≥64 µg/ml) as were 21.9% and 16.4% to ketoconazole and clotrimazole (MIC>0.125 µg/ml), respectively. Resistance to polyene antifungals including amphotericin B and nystatin, and caspofungin were scarce. 57.7% of candida glabrata isolates were resistant to fluconazole, 31% to ketoconazole and 35% to clotrimazole.
Conclusion: Screening for antifungal resistant candida isolates by disk diffusion or broth dilution methods in clinical laboratories is an ideal surveillance measure in the management of oral thrush in patients with HIV/AIDS. Although nystatin is widely used in clinical practice for HIV positive patients, there was no evidence of enhanced resistance to it. Regarding no resistance to caspofungin, its administration is suggested.
Amirhooshang Ehsani , Yousef Fakour , Fatemeh Gholamali , Leila Mokhtari, Mahbobeh Sadat Hosseini , Najmeh Khosrovanmehr, Pedram Noormohammadpour ,
Volume 71, Issue 3 (6-2013)
Volume 71, Issue 3 (6-2013)
Abstract
Background: Body dysmorphic disorder (BDD) is characterized by a preoccupation with an imagined defect in ones appearance or an exaggeration of a slight physical anomaly. Any part of the appearance may be the focuse of BDD patients. Thus preoccupation with appearance leads to significant damages of social and job functioning. The aim of this study is to determine the prevalence of BDD in patients referred to cosmetic clinic of Razi hospital.
Methods: Patients visiting cosmetic clinic of Razi hospital were selected if they agreed to participate in the study. They were evaluated by Yale brown obsessive compulsive scale modified for body dysmorphic disorder (YBOCS-BDD) as well as questionnaires containing demographic characteristics of patients including gender, educational status, marital status, history of reference to psychiatrist or psychologist, other medication, history of cosmetic surgery and rate of satisfaction of cosmetic surgery. YBOCS-BDD questionnaires then processed by educated specialist to determine BDD score of patie-nts. Demographic questionnaires, also analysed to evaluate epidemiologic properties of patients visiting cosmetic clinic of Razi hospital.
Results: The prevalence of BDD in current sample was 33.3%. 70.7% of BDD patients were female while 29.3% were male. The commonest age range was 21-50 years (82.8%). 65.5% were educated to level of diploma or lower, while 34.5% had academic degrees. 51.7% were married. 20.7% had history of reference to psychiatrist or psycholo-gist. 17/2% had history of cosmetic surgery with satisfaction ranging from unsatisfied (20%) to relative satisfaction (80%). None were fully satisfied.
Conclusion: BDD had high prevalence in patients visiting cosmetic clinic of Razi skin hospital. This high rate of prevalence show the necessity of diagnosis of BDD in skin patients and it is critical for them to refer to psychiatrists or psychologists.
Hossein Mashhadinezhad , Babak Ganjeifar ,
Volume 73, Issue 3 (6-2015)
Volume 73, Issue 3 (6-2015)
Abstract
Background: Sciatic pain in association with lumbar disc herniation may require surgical intervention in the form of lumbar discectomy. Yet, the optimal time for this operation has not been specified in medical literature. Methods: In a Cross-sectional study, 147 patients (100 men and 47 women) with radiological and clinical signs of L4-L5 or L5-S1 disc herniation were entered to our registry prior to March 2009. They were all examined, diagnosed and operated on (lumbar discectomy) in Ghaem General Hospital, Mashhad, Iran. Patients were all subsequently followed for one year. The follow-up continued in a number of 126 cases, whose satisfaction was rated via phone interview for an extra year. The patients’ assessments were implemented employing three scaling systems, both before and following lumbar discectomy, to name the Modified Oswestry Disability Index (MODI), Visual Analogue Scale (VAS) and Prolo Functional Economic Outcome Rating Scale (PORS). The former two were used for pre-operative and post-operative assessments whereas the latter was applied during the first year of follow-up. The focus of the investigation during second year was on patients’ satisfaction. Results: Mean age of our cases were 34±7.4 years. According to the duration of the sciatica, patients were divided into 4 groups. <3 months, 3 to <6 month, 6 to <12 months and >12 months. Statistical analysis revealed a significant difference between patients having undergone lumber discectomy with a history of sciatica for less and more than three month before the operation in terms of pre-and post-operative visual Analogue Scale (P= 0.022). However, there could be found no such disparity in other clinical scores (P= 0.63 for MODI, P= 0.85 for Prolo scale and P= 0.73 for satisfaction). Conclusion: Patients with less than three months of sciatica may seem to enjoy a better clinical outcome after one year, there could be found no correlation between the duration of sciatica and the satisfaction after two years.
Mozhgan Tanhapour , Ali Asghar Safaei ,
Volume 73, Issue 6 (9-2015)
Volume 73, Issue 6 (9-2015)
Abstract
Background: Patient-centered care improves the quality of life and health care, and reduces the costs of care. The advent of new technologies such as health social networks, and personal health records (PHR), have significant impact on the patient-centered care. The aim of this article is to analyze and provide a set of features and requirements needed by the users of health social network serving as a PHR (Personal Health Record) system. The combination of capabilities offered by PHRs and social networks providing better delivery of patient-centered care. Methods: In this paper, after a brief study of capabilities and features of existing health social networks and based on a comparative study, a set of requirements which are necessary to create a comprehensive health social network as a PHR system are proposed. Identification of such a systems stakeholders and users e.g. healthcare professionals, patients, and healthcare organizations is important for categorizing the requirements. Also, classifying relatively vast range of existing systems is needed to have a better analyze and design. Results: The proposed health social network can be used by different user groups in healthcare e.g. healthcare professionals, patients, and healthcare organizations. According to the each user group’s requirements, it provides separate facilities for them. The users of this integrated health social network can optionally share some of their information with other users in their group or with users in the other groups and interact with them. Studies show that the proposal requirements and capabilities for health social network not only cover the capabilities of similar systems but also satisfactory provide the requirements of a PHR system to deliver the patient-centered care. Conclusion: The proposed set of requirements are qualitatively compared with the other similar systems. Using the proposed health social network that provides PHR capabilities for its users will have an irrefutable impact on quality and efficiency of patient-centered care, and play an important role in improving the health of society.
Ali Labaf , Rasoul Masoomi , Misaq Raeisi ,
Volume 73, Issue 8 (11-2015)
Volume 73, Issue 8 (11-2015)
Abstract
Background: There is a concern by some doctors that not interrupting the patients' initial statements of concerns can lead to too long medical visits. Therefore, in this study, the duration of the patients' initial statements of concerns was studied. Methods: This descriptive cross sectional study was conducted from August to October, 2011 in the Emergency Department of Imam Khomeini Hospital in Tehran. 100 patients entered the study through convenience sampling. Based on a 5 level triage system Emergency Severity Index (ESI), patients who were not life-threatening conditions (level 5) entered the study and critically ill patients and foreign patients were excluded from the study. Demographic data of the patients and durations the patients' initial statements of concerns were recorded and measured. Results: Fifty-six percent of patients were men. 79 percent of them had academic degree less than diploma and most of them have Persian ethnicity (60 percent). The mean age of the participants was 37.09 (SD, 1.68). The mean durations of patients' initial statements was 71.60±2.37 seconds. The minimum time was 22.51 seconds and the maximum time was 206.51 seconds. There was significant difference between age (P=0.001, r=0.382) and gender (P=0.032, df=98, t= -2.17) with the durations of patients' initial statements. But education level (P=0.996, F (2, 97)=0.004) and ethnicity (P=0.266, F (6, 93)=1.3) did not have a significant effect on the durations of patients' initial statements. Conclusion: According to the findings of this study, duration of patients' initial statements of concerns is less than what which leads to an increase the time of medical visits.
Razieh Akbari, Mehdi Aghili,
Volume 75, Issue 3 (6-2017)
Volume 75, Issue 3 (6-2017)
Abstract
Background: Cancer is a major life-threatening disease that can evoke deep-rooted fear of death and sense of loss of hope. Even the word, cancer, has powerful connotations of anxiety, pain and suffering. Cancer has a great impact on patients’ lives, so the extent to which physicians should inform them of the diagnosis poses a difficult decision in clinical settings. Therefore, truth telling is one of the most important issues in patients- physicians’ relationship. Besides the ethical aspect, telling or not telling the truth has some legal aspects, therefore, it is important to know the effective factors and understand how to deal with this issue especially for incurable diseases such as cancer. Therefore, the aim of this research was to analyses the effective factors in physician’s truth telling to cancer-patients.
Methods: The samples of this descriptive and analytical study, (survey study) consist of 161 cancer-specialists from Tehran University of Medical Sciences who have been selected by simple random sampling method in 2015 and 2016. The data was obtained by survey approach and the data collected using a questionnaire. In order to evaluate the validity and reliability of the research, expert’s opinion and Cronbach alpha coefficient have been used. The questionnaire included scales designed to measure attitude, intention, subjective norms; perceived behavior control. Statistical package for social science software (SPSS) were used to analyses the data. T-test and ANOVA were used to compare groups.
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Results: Fifty-nine hudred percent male and 41% female physicians took part in this study. The average age of the participants was 43.4±11.27 years. The best person for truth-telling was physician and psychologist. Results showed that there was no significant difference between attitudes of male and female specialist but there was significant difference between oncologist and non-oncologist tendency to tell the truth. Results also showed that there was difference between physician’s behaviors (average 8.87). There was difference between behavior of private and public-private sectors physicians (62.8). Conclusion: Although the results show that there are differences in specialists’ attitude toward truth telling, it is not a good reason for not telling the truth. Although the physicians should consider several factors when telling the truth. |
Ali Mohammad Mosadeghrad , Ensieh Ashrafi ,
Volume 75, Issue 3 (6-2017)
Volume 75, Issue 3 (6-2017)
Abstract
Background: Patient satisfaction is an important indicator of healthcare quality and effectiveness. Quality management as an organizational strategy enhances the quality of hospital services through continuously improving hospital structures and processes. This study aimed to examine the impact of quality management on patient satisfaction.
Methods: A participatory action research was conducted in respiratory intensive care unit, at Labafinejad hospital, Tehran, Iran, in 2013. A quality improvement team was established. Operational processes were improved using a quality management model. The quality improvement team standardized processes, identified quality goals for the processes and improved them until achieved quality goals. Patients’ satisfaction data was collected before and after the intervention using a valid and reliable questionnaire.
Results: Patients’ satisfaction was 75 percent at the beginning of the study. Patients were mostly dissatisfied with the nutrition services, amenities, lack of attention to their personal needs and lack of involving them in their treatment processes. An action plan was developed for improving patient satisfaction. After the quality management intervention, patient satisfaction reached to 81 percent at the end of this study. The quality management model improved the quality of services by 54.5 percent and consequently increased patient satisfaction by 7.2 percent. Almost half of the patients at the beginning of this study were definitely willing to recommend the hospital to their friends and relatives. This figure increased to 76 percent. The rest of patients stated that they may recommend the hospital to others.
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Conclusion: Implementing an appropriate quality management model appropriately in a supportive environment helps improve the quality of services and enhance patient satisfaction and loyalty. |
Mohsen Soleimani , ,
Volume 76, Issue 1 (4-2018)
Volume 76, Issue 1 (4-2018)
Abstract
Background: Endotracheal tube cuff pressure must be maintained in safe range. Many factors could be affecting on endotracheal tube cuff pressure in patients on mechanical ventilation. Patients undergoing mechanical ventilation (MV) in critical care settings require changing position for different reasons. The aim of this study was to determine the effect of changes in body position and head of bed on the endotracheal tube cuff pressure in patients with mechanical ventilation.
Methods: This quasi-experimental study (pre-post design) was performed from April to October 2016 on 70 patients with positive pressure mechanical ventilation in critical care settings in two university hospitals in the cities of Semnan and Shahroud, Semnan Province, Iran. At first, the endotracheal tube cuff pressure of patients was regulated on 25 cmH2O in the bed position of 30 degree. Then the patients were randomly positioned on zero degree bed position, 45 degree bed position, lateral position of patients toward mechanical ventilation apparatus and lateral position opposite the MV apparatus. In each position cuff pressure was measured after 5 minutes pause and head and neck of the patients was not flexed or extended. Tube cuff pressure was measured and recorded in the end expiratory with aneroid manometer after each position change. Data analysis was performed with software of SPSS software, version 18 (Armonk, NY, USA) in the significant level of 0.05.
Results: Most of study patients (58.6%) were male and no smokers (81.4%). Age mean of patients were 63.37±20.9 years. Most of patients connected to MV because of respiratory failure. In each change positions and head of bed regulation, the mean of endotracheal tube cuff pressures were significantly increased (P<0.001). Endotracheal tube cuff pressure in the lateral position opposite to the apparatus had maximum increase (29.12±0.41 cmH2O) and in the zero degree bed position tube cuff pressure had minimum increase (27.6±0.38 cmH2O).
Conclusion: Findings of this study showed that changing position of bed and patients undergoing mechanical ventilation, especially in lateral position opposite to the apparatus could increase endotracheal tube cuff pressure. This increase may reach to abnormal range and cause tracheal injury.
Methods: This quasi-experimental study (pre-post design) was performed from April to October 2016 on 70 patients with positive pressure mechanical ventilation in critical care settings in two university hospitals in the cities of Semnan and Shahroud, Semnan Province, Iran. At first, the endotracheal tube cuff pressure of patients was regulated on 25 cmH2O in the bed position of 30 degree. Then the patients were randomly positioned on zero degree bed position, 45 degree bed position, lateral position of patients toward mechanical ventilation apparatus and lateral position opposite the MV apparatus. In each position cuff pressure was measured after 5 minutes pause and head and neck of the patients was not flexed or extended. Tube cuff pressure was measured and recorded in the end expiratory with aneroid manometer after each position change. Data analysis was performed with software of SPSS software, version 18 (Armonk, NY, USA) in the significant level of 0.05.
Results: Most of study patients (58.6%) were male and no smokers (81.4%). Age mean of patients were 63.37±20.9 years. Most of patients connected to MV because of respiratory failure. In each change positions and head of bed regulation, the mean of endotracheal tube cuff pressures were significantly increased (P<0.001). Endotracheal tube cuff pressure in the lateral position opposite to the apparatus had maximum increase (29.12±0.41 cmH2O) and in the zero degree bed position tube cuff pressure had minimum increase (27.6±0.38 cmH2O).
Conclusion: Findings of this study showed that changing position of bed and patients undergoing mechanical ventilation, especially in lateral position opposite to the apparatus could increase endotracheal tube cuff pressure. This increase may reach to abnormal range and cause tracheal injury.
Abbasali Ebrahimian , Ali Fakhr-Movahedi , Raheb Ghorbani , Hossein Ghasemian-Nik,
Volume 76, Issue 7 (10-2018)
Volume 76, Issue 7 (10-2018)
Abstract
Background: Hospital bed capacity is one of problems in intensive care unit during at the time of crisis, emergencies and disasters. At this regard, it seems reverse triage can resolve this issue by using predictive score systems. This study was purposed to develop a reverse triage system in intensive care unit using APACHE II scoring system for crisis, emergencies and disasters situations.
Methods: This study was performed by a prospective longitudinal design that lasted from March 2016 to February 2017. Research population were 420 internal patients that were admitted in intensive care units of Imam Reza Hospital in Mashhad, Iran. Data were collected and documented for each patient by demographic questionnaire and APACHE II scoring system daily until discharging time from intensive care units. The patient’s status after discharge from the intensive care unit was used as a criterion for statistical tests.
Results: APACHE II mean score in first day of admission was 18.9±16.20. Risk ratio of patients’ discharging from intensive care unit was 1.034. The patients were placed in four levels of inverse triage according to mortality rate and risk ratio. The scores of four levels were including: 0-10 (first level and green color), 11-16 (second level and yellow color), 27-71 (third level and black color) and 17-26 (fourth level and red color).
Conclusion: The Apache II system can be used as a tool for reverse triage in intensive care units during at the time of crisis, emergencies and disasters. When using this system for reverse triage, patients at the first to third levels can be discharged from intensive care unit. However, patients on the fourth level should not be discharged from intensive care units under any circumstances.
Methods: This study was performed by a prospective longitudinal design that lasted from March 2016 to February 2017. Research population were 420 internal patients that were admitted in intensive care units of Imam Reza Hospital in Mashhad, Iran. Data were collected and documented for each patient by demographic questionnaire and APACHE II scoring system daily until discharging time from intensive care units. The patient’s status after discharge from the intensive care unit was used as a criterion for statistical tests.
Results: APACHE II mean score in first day of admission was 18.9±16.20. Risk ratio of patients’ discharging from intensive care unit was 1.034. The patients were placed in four levels of inverse triage according to mortality rate and risk ratio. The scores of four levels were including: 0-10 (first level and green color), 11-16 (second level and yellow color), 27-71 (third level and black color) and 17-26 (fourth level and red color).
Conclusion: The Apache II system can be used as a tool for reverse triage in intensive care units during at the time of crisis, emergencies and disasters. When using this system for reverse triage, patients at the first to third levels can be discharged from intensive care unit. However, patients on the fourth level should not be discharged from intensive care units under any circumstances.
Shaban Mehrvarz , Hassan Ali Mohebbi , Shahram Manoochehry , Saied Arjmand , Hamid Reza Rasouli ,
Volume 76, Issue 10 (1-2019)
Volume 76, Issue 10 (1-2019)
Abstract
Background: Sacrococcygeal pilonidal disease (PD) is prevalent in the young adults. The cause of PD is unclear, and there are different surgical procedures for the treatment. The Pilonidal sinus disease is an unpleasant, chronic relapsing condition that is difficult to cure. There is a wide variety of surgical treatments with sub-optimal results for it. The ideal treatment for the pilonidal sinus disease has yet to be defined. There are many surgical approaches described in the literature. In this study, the long-term outcomes of four current surgical methods for PD were evaluated and compared. We aimed to assess recurrence, satisfaction, complications rate and wound healing time in the four current surgical methods for PD.
Methods: This cross-sectional study was conducted in the Department of Surgery at the Baqiyatallah University Hospital, Tehran, Iran, from April 2017 to September 2017. The study was carried out on 182 postoperative patients. Surgeries were performed in different methods such as; open, closed, semi-closed and limited excision. Diabetics, obese patients and patients with acute pilonidal abscess or prior PD surgery were excluded. All patients were followed for at least three years after surgery. During the follow -up period, patients were assessed for recurrence, satisfaction, complications rate and wound healing time. The outcomes were assessed by case notes analysis and follow-up telephone and postal questionnaires.
Results: In this study forty-four patients were operated via closed Method, 48 patients through open, 48 via semi-closed and 42 one's trough limited excision methods. The highest rate of recurrence was in the open group. There were no cases of recurrence in the closed group. There were also less postoperative hemorrhage and faster wound healing in the closed group. The average satisfaction of all patients was 88.9±8.7. The mean satisfaction rate in the closed group was 95.9±5.3 which was higher than other groups.
Conclusion: The results of this study demonstrated that in the non-recurrent cases of sacral pilonidal sinus, complete Excision and primary repair have fewer complications and shows higher satisfaction rate.
Methods: This cross-sectional study was conducted in the Department of Surgery at the Baqiyatallah University Hospital, Tehran, Iran, from April 2017 to September 2017. The study was carried out on 182 postoperative patients. Surgeries were performed in different methods such as; open, closed, semi-closed and limited excision. Diabetics, obese patients and patients with acute pilonidal abscess or prior PD surgery were excluded. All patients were followed for at least three years after surgery. During the follow -up period, patients were assessed for recurrence, satisfaction, complications rate and wound healing time. The outcomes were assessed by case notes analysis and follow-up telephone and postal questionnaires.
Results: In this study forty-four patients were operated via closed Method, 48 patients through open, 48 via semi-closed and 42 one's trough limited excision methods. The highest rate of recurrence was in the open group. There were no cases of recurrence in the closed group. There were also less postoperative hemorrhage and faster wound healing in the closed group. The average satisfaction of all patients was 88.9±8.7. The mean satisfaction rate in the closed group was 95.9±5.3 which was higher than other groups.
Conclusion: The results of this study demonstrated that in the non-recurrent cases of sacral pilonidal sinus, complete Excision and primary repair have fewer complications and shows higher satisfaction rate.
Mehdi Sanatkar, Seyed Hossein Sadrossadat, Hamed Ghassemi , Ali Reza Ebrahim Soltani , Mohammad Reza Shaverdi, Habibeh Bagheri ,
Volume 77, Issue 2 (5-2019)
Volume 77, Issue 2 (5-2019)
Abstract
Background: Although significant advances have been made in scientific and medical technology, but the rate of medical complaints has also risen. The purpose of this study was to investigate the effect of handling of medical malpractice cases in the hospital complaints committee on the reduction of patient complaints to law enforcement authorities.
Methods: In this descriptive study, patients complained about ophthalmology from April 2005 to December 2005 at Farabi Hospital, Tehran, were evaluated. The complainant's patients, if confirmed by the trusted doctors, were invited to complaints committee, and the subject of the complaint was examined and tried to obtain patient satisfaction.
Results: A total of 87 patients complained to ophthalmologists completed a complaint form 71 (81.7%) of the cases were male. Statistically, the number of complaints was significantly lower in those with lower education (P=0.02). The prevalence of primary disease, 52 cases (59.8%) was cataract and 14 cases (16%) due to refractive errors and refractory surgery. In the examination of complaints by trusted doctors in the hospital, 11 cases of ophthalmologic error were identified, with a mantle rate of 12.6%, and the cases were reviewed by the complaints committee. Of the cases of complained that confirmed by the committee, only one person sued the law enforcement, which represented 9% of the defaulted item. These statistics showed a significant decline compared to the past year at the same center, and the percentage of defaults to law enforcement was 37.5% (P<0.05).
Conclusion: Establishing committees to handle complaints of ophthalmologic failures in hospitals and providing a clear and honest atmosphere to hear the subject of complaints by patients and their companions, and then trying to get patients' satisfaction and helping them continue their treatment can lead to reduced complaints of patients to the authorities Legal, like forensics medicine department and medical council.
Methods: In this descriptive study, patients complained about ophthalmology from April 2005 to December 2005 at Farabi Hospital, Tehran, were evaluated. The complainant's patients, if confirmed by the trusted doctors, were invited to complaints committee, and the subject of the complaint was examined and tried to obtain patient satisfaction.
Results: A total of 87 patients complained to ophthalmologists completed a complaint form 71 (81.7%) of the cases were male. Statistically, the number of complaints was significantly lower in those with lower education (P=0.02). The prevalence of primary disease, 52 cases (59.8%) was cataract and 14 cases (16%) due to refractive errors and refractory surgery. In the examination of complaints by trusted doctors in the hospital, 11 cases of ophthalmologic error were identified, with a mantle rate of 12.6%, and the cases were reviewed by the complaints committee. Of the cases of complained that confirmed by the committee, only one person sued the law enforcement, which represented 9% of the defaulted item. These statistics showed a significant decline compared to the past year at the same center, and the percentage of defaults to law enforcement was 37.5% (P<0.05).
Conclusion: Establishing committees to handle complaints of ophthalmologic failures in hospitals and providing a clear and honest atmosphere to hear the subject of complaints by patients and their companions, and then trying to get patients' satisfaction and helping them continue their treatment can lead to reduced complaints of patients to the authorities Legal, like forensics medicine department and medical council.
Ali Arash Anoushiravani , Abdollatif Moini , Reza Hajihossein , Abbas Alimoradian , Mojtaba Didehdar ,
Volume 77, Issue 5 (8-2019)
Volume 77, Issue 5 (8-2019)
Abstract
Background: With increasing immunocompromised patients, fungal infections especially lung infection, have also increased. In this study, fungal contamination of the respiratory system in immunocompromised patients was evaluated.
Methods: This descriptive cross-sectional study was conducted in immunocompromised patients suspicious of pulmonary infections referring to specialized lung clinic of Amir-Al-Momenin University Hospital in Arak City, Iran, from April 2017 to June 2018. Of these 64 patients, including 35 women and 29 men, were selected. After recording the demographic information, a bronchoalveolar lavage (BAL) sample was prepared by the physician from these patients and was immediately sent to the medical mycology laboratory, school of medicine. Bronchoalveolar lavage specimens were investigated by Grocott-Gomori's methenamine silver (GMS) staining and culture method. Data were analyzed by SPSS software, version 16 (IBM SPSS, Armonk, NY, USA).
Results: Of 64 patients, 9 (14%) were infected with pulmonary fungal infections. Among the patients infected with fungal infection, 9 (100%) were positive in the culture examine and 8 (72%) by GMS staining. Among infected people, 7 (77.8%) were female and 2 (22.2%) were male. The most common isolated fungi were Candida albicans, Aspergillus fumigatus and Mucor species (2 cases). The highest infection was seen in the age group of less than 60 (33.3%). 66.7% of infections were among the unemployed persons and 33.3% of other cases of infection were seen in people with free jobs, workers and employees. The most important factors in the development of pulmonary fungal infections in the patients were: 5 cases of malignancy (33.3%), corticosteroid use in 2 cases (33.3%), tuberculosis in 1 case (22.2%) and diabetes mellitus in 1 case (11.2%). There was no significant relationship between fungal contamination with sex, age, occupation, marriage and type of disease.
Conclusion: The results of this study showed that immunocompromised patients are prone to fungal infections, especially Candidiasis and Aspergillosis. Therefore, the use of control methods to reduce the probability of such patients to fungal infections should be considered.
Methods: This descriptive cross-sectional study was conducted in immunocompromised patients suspicious of pulmonary infections referring to specialized lung clinic of Amir-Al-Momenin University Hospital in Arak City, Iran, from April 2017 to June 2018. Of these 64 patients, including 35 women and 29 men, were selected. After recording the demographic information, a bronchoalveolar lavage (BAL) sample was prepared by the physician from these patients and was immediately sent to the medical mycology laboratory, school of medicine. Bronchoalveolar lavage specimens were investigated by Grocott-Gomori's methenamine silver (GMS) staining and culture method. Data were analyzed by SPSS software, version 16 (IBM SPSS, Armonk, NY, USA).
Results: Of 64 patients, 9 (14%) were infected with pulmonary fungal infections. Among the patients infected with fungal infection, 9 (100%) were positive in the culture examine and 8 (72%) by GMS staining. Among infected people, 7 (77.8%) were female and 2 (22.2%) were male. The most common isolated fungi were Candida albicans, Aspergillus fumigatus and Mucor species (2 cases). The highest infection was seen in the age group of less than 60 (33.3%). 66.7% of infections were among the unemployed persons and 33.3% of other cases of infection were seen in people with free jobs, workers and employees. The most important factors in the development of pulmonary fungal infections in the patients were: 5 cases of malignancy (33.3%), corticosteroid use in 2 cases (33.3%), tuberculosis in 1 case (22.2%) and diabetes mellitus in 1 case (11.2%). There was no significant relationship between fungal contamination with sex, age, occupation, marriage and type of disease.
Conclusion: The results of this study showed that immunocompromised patients are prone to fungal infections, especially Candidiasis and Aspergillosis. Therefore, the use of control methods to reduce the probability of such patients to fungal infections should be considered.
Ali Mohammad Mosadeghrad , Parvaneh Isfahani ,
Volume 77, Issue 6 (9-2019)
Volume 77, Issue 6 (9-2019)
Abstract
Background: Unnecessary patient admission to a hospital refers to the hospitalization of a patient without clinical indications and criteria. Various factors related to the patient (e.g., age, disease severity, payment method, and admission route and time), the physician and the hospital and its facilities and diagnostic technologies affect a patient unnecessary admission in a hospital. Unnecessary patient hospitalization increases nosocomial infections, morbidity and mortality, and decreases patient satisfaction and hospital productivity. This study aimed to measure unnecessary patient admissions in hospitals in Iran.
Methods: This study was conducted using a systematic review and meta-analysis at Tehran University of Medical Science in August 2019. Seven electronic databases were searched and evaluated for original research papers published between March 2006 and 2018 on patients’ unnecessary admission to a hospital. Finally, 12 articles were selected and analyzed using comprehensive meta-analysis software.
Results: All studies used the appropriateness evaluation protocol (AEP) for assessing patients’ unnecessary hospitalization in the hospitals. Overall, 2.7% of hospital admissions were rated as inappropriate and unnecessary (CI 95%: 1.5-4.9%). The highest unnecessary patients’ admissions were 11.8% in a teaching hospital in Meshginshahr city in 2016, (CI 95%: 8.8%-15.8%) and the lowest unnecessary patients’ admissions was 0.3% in a teaching hospital in Yasuj city in 2016 (CI 95%: 0%-3.6%). Unnecessary patient admission in public hospitals was higher than private hospitals. A significant statistical correlation was observed between unnecessary patient admission, and sample size (P<0.05).
Conclusion: The rate of unnecessary hospital admission in Iran is low. However, hospital resources are wasted due to unnecessary admissions. Expanding the primary health care network, reducing hospital beds, introducing an effective and efficient patient referral system, using a fixed provider payment method, and promoting residential and social services care at macro level, and establishing utilization management committee, using the appropriateness evaluation protocol, establishing short-stay units, and implementing quality management strategies at the hospital level are useful strategies for reducing avoidable hospital admissions.
Methods: This study was conducted using a systematic review and meta-analysis at Tehran University of Medical Science in August 2019. Seven electronic databases were searched and evaluated for original research papers published between March 2006 and 2018 on patients’ unnecessary admission to a hospital. Finally, 12 articles were selected and analyzed using comprehensive meta-analysis software.
Results: All studies used the appropriateness evaluation protocol (AEP) for assessing patients’ unnecessary hospitalization in the hospitals. Overall, 2.7% of hospital admissions were rated as inappropriate and unnecessary (CI 95%: 1.5-4.9%). The highest unnecessary patients’ admissions were 11.8% in a teaching hospital in Meshginshahr city in 2016, (CI 95%: 8.8%-15.8%) and the lowest unnecessary patients’ admissions was 0.3% in a teaching hospital in Yasuj city in 2016 (CI 95%: 0%-3.6%). Unnecessary patient admission in public hospitals was higher than private hospitals. A significant statistical correlation was observed between unnecessary patient admission, and sample size (P<0.05).
Conclusion: The rate of unnecessary hospital admission in Iran is low. However, hospital resources are wasted due to unnecessary admissions. Expanding the primary health care network, reducing hospital beds, introducing an effective and efficient patient referral system, using a fixed provider payment method, and promoting residential and social services care at macro level, and establishing utilization management committee, using the appropriateness evaluation protocol, establishing short-stay units, and implementing quality management strategies at the hospital level are useful strategies for reducing avoidable hospital admissions.
Alireza Mahoori , Nazli Karami , Shabnam Saeifar ,
Volume 77, Issue 12 (3-2020)
Volume 77, Issue 12 (3-2020)
Abstract
Background: Arterial pressure is one of the most important physiological variables and often needs to be monitored repeatedly or continuously in perioperative period. Arterial pressure monitoring is one of the standard monitoring in operating room. During general anesthesia, blood pressure can be measured by using a noninvasive arterial pressure method or continuous invasive arterial pressure by an invasive arterial line. Comparison of invasive measurements in the patient’s candidate to esophagectomy has not been assessed. The aim of this study was to compare invasive and noninvasive blood pressure in these patients.
Methods: In a prospective, cross-sectional, observational study, 42 hemodynamically stable patients candidate for esophagectomy under general anesthesia in supine position were evaluated at Urmia Imam Khomeini Hospital operating room from June 2017 to April 2018. The patients had American Society of Anesthesiologists (ASA) physical status II or III and the patients who had complete heart block and marked arterial blood pressure differences greater than 10 mmHg in the two arms were excluded. After induction of anesthesia and patients monitoring, the radial artery was cannulated for invasive blood pressure monitoring and noninvasive blood pressure was measured via the arm cuff on the other hand at the four-time intervals: after radial artery cannulation (T1), during release of esophagus (T2), during anastomosis (T3) and at the end of operation (T4).
Results: The mean difference between indirect and direct systolic blood pressure was 0.85±2.93, -8.42±2.9, 6.50±3.60 and 2.67±2.6 mmHg and for diastolic blood pressure was 3.53±2.67, 4.57±2.22, 2.10±2.58 and 1.03±1.53 mmHg respectively, at the T1 to T4. At the all-time intervals, there were no statistically differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure (P=0.77)
Conclusion: Noninvasive arterial blood pressure showed acceptable agreement with invasive measurements for systolic, diastolic and mean pressure. According to fhe finding of this study, there were no statistical differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure and these two methods can be used in selected patients.
Methods: In a prospective, cross-sectional, observational study, 42 hemodynamically stable patients candidate for esophagectomy under general anesthesia in supine position were evaluated at Urmia Imam Khomeini Hospital operating room from June 2017 to April 2018. The patients had American Society of Anesthesiologists (ASA) physical status II or III and the patients who had complete heart block and marked arterial blood pressure differences greater than 10 mmHg in the two arms were excluded. After induction of anesthesia and patients monitoring, the radial artery was cannulated for invasive blood pressure monitoring and noninvasive blood pressure was measured via the arm cuff on the other hand at the four-time intervals: after radial artery cannulation (T1), during release of esophagus (T2), during anastomosis (T3) and at the end of operation (T4).
Results: The mean difference between indirect and direct systolic blood pressure was 0.85±2.93, -8.42±2.9, 6.50±3.60 and 2.67±2.6 mmHg and for diastolic blood pressure was 3.53±2.67, 4.57±2.22, 2.10±2.58 and 1.03±1.53 mmHg respectively, at the T1 to T4. At the all-time intervals, there were no statistically differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure (P=0.77)
Conclusion: Noninvasive arterial blood pressure showed acceptable agreement with invasive measurements for systolic, diastolic and mean pressure. According to fhe finding of this study, there were no statistical differences between systolic and diastolic blood pressure measurement regarding invasive and noninvasive blood pressure and these two methods can be used in selected patients.
Mohammad Hossien Kamaloddini, Khadije Saravani ,
Volume 78, Issue 1 (4-2020)
Volume 78, Issue 1 (4-2020)
Abstract
Background: Discharge with personal satisfaction means the patient's withdrawal from the permission that had previously been given to the care unit for services. Discharge with personal satisfaction is initiated with the untimely termination of treatment by the patient or parents and in some cases leads to hospitalization or even death of the patient. This study aimed to determining the main causes of discharge with personal satisfaction in hospitalized patients.
Methods: The present cross-sectional study examines at hospitalized patients of Amiralmomenin Hospital in Zabol, Iran, to examine the reasons discharge with personal satisfaction in relation to the patient, hospital staff and the housing status of the hospital during the period from April 2017 to March 2018. All clearance patients with personal satisfaction entered the study. Demographic data, insurance status, type of insurance (social security, health services, resettlement, relief, armed forces, maternity, maternity, other supplementary insurance), number of admission days, hospital admission (morning, evening, night), type of illness or cause of referral (multiple trauma, surgery, orthopedics, neurology, neurology), the reason for possible re-admittance within the next two weeks and the main reasons for clearance with personal consent was collected and recorded using a pre-designed checklist.
Results: The most of the cases of which were due to neurological complaints (51%). 803 (80%) of patients referred back to the hospital due to self-correlated problems, 163 (16%) patients were hospital left with satisfaction due to the hospital-made staffing problem (P=0.001). The results of the study showed that the highest frequency was related to male (67%) and most of them were married (84%), while most of them had insurance (74%), especially army and municipality insurance (34%).
Conclusion: Based on the results of the present study, most cases of discharge were patient related. Adequate recovery feeling and the desire to continue treatment in private centers were the main causes.
Methods: The present cross-sectional study examines at hospitalized patients of Amiralmomenin Hospital in Zabol, Iran, to examine the reasons discharge with personal satisfaction in relation to the patient, hospital staff and the housing status of the hospital during the period from April 2017 to March 2018. All clearance patients with personal satisfaction entered the study. Demographic data, insurance status, type of insurance (social security, health services, resettlement, relief, armed forces, maternity, maternity, other supplementary insurance), number of admission days, hospital admission (morning, evening, night), type of illness or cause of referral (multiple trauma, surgery, orthopedics, neurology, neurology), the reason for possible re-admittance within the next two weeks and the main reasons for clearance with personal consent was collected and recorded using a pre-designed checklist.
Results: The most of the cases of which were due to neurological complaints (51%). 803 (80%) of patients referred back to the hospital due to self-correlated problems, 163 (16%) patients were hospital left with satisfaction due to the hospital-made staffing problem (P=0.001). The results of the study showed that the highest frequency was related to male (67%) and most of them were married (84%), while most of them had insurance (74%), especially army and municipality insurance (34%).
Conclusion: Based on the results of the present study, most cases of discharge were patient related. Adequate recovery feeling and the desire to continue treatment in private centers were the main causes.
Tahereh Yaghoubi , Hamid Sharif Nia , Mobin Mohammadi Nejad , Azar Jafari , Mostafa Hoseinoo , Amir Hossein Goudarzian ,
Volume 78, Issue 2 (5-2020)
Volume 78, Issue 2 (5-2020)
Abstract
Background: Long after the implementation of the “Health System Transformation Project”, no comprehensive assessment of patient and nurse satisfaction rate has been carried out in Iran based on available databases. Thus, this review study was designed and performed to answer this question: “How is the evaluation of the Health System Transformation Project in nurse and patient satisfaction dimensions.”
Methods: A systematic review of related studies based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was performed via keywords such as “Health System Transformation Project”, “Transformation Project”, “health”, “Iran”, “challenges”, “physician”, “nurse”, “patient”, and “satisfaction” to search Iranian (Magiran and Scientific Information Database, SID) and international databases (PubMed, ISI web of knowledge, Scopus, Google Scholar, and ProQuest) with OR and AND operators from March 2014 to April 2019. Also the quality of studies was assessed using STROB checklist (special for cross-sectional studies). Then required information (for example type of studies, sample size, mean age of participants and satisfaction score) were gathered from studies.
Results: From 43 articles that were gathered from primary stages, 18 articles were selected after passing different screening levels. On average, the level of patiaent satisfaction with the Health System Transformation Project was acceptable. Ghazvin province was seems more successful in satisfaction of patients against of other provinces. However, various positive and negative reports were found about the satisfaction of nursing groups. Generally, it seems that Tehran province (at the center of Iran) was more successful in performing the Health System Transformation Project (from the aspect of satisfaction of different groups).
Conclusion: Based on obtained results, patient’s satisfaction was appropriate in most of studies and also in nursing group was under average level.
Methods: A systematic review of related studies based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines was performed via keywords such as “Health System Transformation Project”, “Transformation Project”, “health”, “Iran”, “challenges”, “physician”, “nurse”, “patient”, and “satisfaction” to search Iranian (Magiran and Scientific Information Database, SID) and international databases (PubMed, ISI web of knowledge, Scopus, Google Scholar, and ProQuest) with OR and AND operators from March 2014 to April 2019. Also the quality of studies was assessed using STROB checklist (special for cross-sectional studies). Then required information (for example type of studies, sample size, mean age of participants and satisfaction score) were gathered from studies.
Results: From 43 articles that were gathered from primary stages, 18 articles were selected after passing different screening levels. On average, the level of patiaent satisfaction with the Health System Transformation Project was acceptable. Ghazvin province was seems more successful in satisfaction of patients against of other provinces. However, various positive and negative reports were found about the satisfaction of nursing groups. Generally, it seems that Tehran province (at the center of Iran) was more successful in performing the Health System Transformation Project (from the aspect of satisfaction of different groups).
Conclusion: Based on obtained results, patient’s satisfaction was appropriate in most of studies and also in nursing group was under average level.
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