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Hospital Practices and Research - Volume:2 Issue: 1, Winter 2017

Hospital Practices and Research
Volume:2 Issue: 1, Winter 2017

  • تاریخ انتشار: 1395/12/28
  • تعداد عناوین: 7
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  • Mohammadkarim Bahadori *, Seyed Mojtaba Hosseini Page 1
    The most important mission of hospitals is to provide appropriate and high quality care for patients. Different methods and models have been used to assess the quality of care. One conventional model used recently in many countries is the accreditation model which has been efficient in developing structural, process, and outcome standards. Accreditation is a systematic process carried out based on predetermined standards for evaluating the performance of hospitals.1,2 With the recent implementation of the hospital accreditation model in Iran, whether the accreditation has improved the quality of care is under question.
    Since its implementation, several studies in many countries have investigated the accreditation program and its related issues; however, there is too little evidence to make a general conclusion, and more studies are necessary. There are many contradictions in the experts’ opinions of the accreditation and financial and organizational effects, program evaluation, and measurement of quality. Greenfield conducted a systematic review on accreditation and came to the conclusion that, although accreditation has currently been accepted as an essential element in improving quality of care in many parts of the world, the evidence supporting it is insufficient. Many countries have studied this issue and found no evidence for the effect of accreditation on improving quality or the evaluation of the effectiveness of the system or the various methods of implementing the program.3 The fact is that there is too little evidence to judge in the world, and the situation is the same for Iran. It is still not possible to answer the question of whether accreditation leads to improved quality of care. The various aspects of accreditation must be assessed by studies in Iran so that it can be judged correctly.
    Following are some suggestions for areas to be studied in Iran:• The effectiveness of accreditation on the quality of healthcare from the viewpoints of all stakeholders
    • The relationship between accreditation and indicators of hospital performance
    • The disadvantages of accreditation from the viewpoints of all stakeholders
    • Evaluation of the barriers to implementation of accreditation standards in hospitals
    • Evaluation of the effects of an accreditation program on patient satisfaction
    • The impact of an accreditation program on indicators of patient safety
    • Assessment of assessor competence in an accreditation program
    • Evaluation of the effect of an accreditation program on the duration of patient hospitalization
    • Assessment of the accreditation program from the viewpoint of health experts.
  • Jose L. Alfonso Sanchez *, Belen Alfonso Landete, Maria Martinez Martinez Pages 2-8
    Background
    Avoidable mortality (AM) is one of the most important health indicators (HI) and represents the quality of care in a hospital.
    Objective
    This study measured the efficacy of a training program for a hospital healthcare staff to reduce AM.
    Methods
    This epidemiological study on community intervention analyzed time-series data on HI by semesters from 2008 to 2015. The pre-intervention phase was examined from January 2008 to December 2014; the intervention phase was investigated in the first semester of 2015; and the post-intervention phase was examined in the second semester of 2015.
    Results
    Resindicate a series with a rising tendency until the 14th semester and a pronounced descent in the 16th semester. The relative variation rate (RVR) was -20% to % with some exceptions. HI was 0.53% in the 16th semester rather than the expected 0.70% observed in the pre-intervention phase; therefore, 0.17% additional deaths were avoided because of the training seminar.
    Conclusion
    The positive results suggest that this strategy is an important element in decreasing avoidable deaths in hospitals.
    Keywords: Health services, Quality of health care, Cause of death
  • Albert Ahenkan*, Kofi Aduo Adjei Pages 9-14
    Background
    For over 2 decades, Ghana’s Ministry of Health (MOH) has been resolved to continuously improve the quality of healthcare in a cost-effective manner. Strategies have been adopted to enhance client satisfaction with healthcare services and delivery.
    Objective
    The current study examined patient satisfaction with the quality of healthcare in Ghana by comparing healthcare services at the University of Ghana Hospital (UGH) and the University of Cape Coast Hospital (UCH).
    Methods
    This cross-sectional study was conducted in 2014-2015 with primary data collected from patients at UGH and UCH. Structured questionnaires were administered based on the stratified and convenience sampling methods to select patients receiving healthcare at the outpatients departments of the 2 hospitals. Descriptive statistics and linear regression analysis were used to analyze the data with the help of SPSS version 20.
    Results
    The findings indicated that empathy (β=0.14, P=0.003), communication (β=0.26, P=0.00), culture (β=0.17, P=0.008), tangibles (β=0.12, P=0.040), and priority (β=0.18, P=0.002) are significant predictors of patient satisfaction.
    Conclusion
    Management at the 2 studied hospitals should streamline their quality healthcare policies based on the dimensions of effective communication, empathy, culture, tangibles, and priority to enhance patient satisfaction.
    Keywords: Healthcare, Hospitals, Patients, Satisfaction
  • Majid Sabouri, Farshad Najafipour, Mehran Jariani, Arya Hamedanchi, Parisa Karimi * Pages 15-20
    Background
    Today, patient safety is an important issue in providing hospital services. Any failure in this area can cause undesirable consequences.
    Objective
    The present study evaluated the status of patient safety culture in Educational Hospitals of Tehran, Iran.
    Methods
    This cross-sectional study surveyed 205 therapeutic and diagnostic personnel of three Tehran hospitals selected using the clustered method; samples were collected in a randomized manner. To examine patient safety culture, the standard questionnaire of patient safety culture with 12 dimensions was used. Data was analyzed using SPSS software.
    Results
    In the 12 dimensions of patient safety culture, exchange of data, expectations, and organization management had the lowest means of 3.28 (±0.87), and 3.32 (±0.74) among the various aspects of patient safety culture. Additionally, the two dimensions of teamwork within the organization’s units and frequency of reporting events with means of 3.71 (±0.79) and 3.73 (±0.7) had the highest means among the studied 12 dimensions of patient safety culture. The total mean of patient safety culture in the studied hospitals was 3.5 (±0.5).
    Conclusion
    Increasing the attention paid to patient safety culture will lead to the development and progress of hospitals in the country and will guide them toward becoming patient-friendly hospitals. Those dimensions which had low mean values in this study should be paid more attention so as to promote and protect them.
    Keywords: Patient safety, Medical Staff, Hospitals
  • Ahmet Karabulut * Pages 21-23
    Introduction
    Iatrogenic aortocoronary dissection (ACD) is a nightmare in interventional cardiology. Although ACD is rarely reported, the real-world prevalence is suspected of being higher due to unreported cases. The right coronary artery (RCA) ostium is involved in the majority of cases, and dissections are usually limited to the aortic sinus in half of the clinical presentations. There are different treatment strategies, including interventional approaches, surgery, and medical follow-up. Immediate stent deployment to the coronary osteum might be a life-saving procedure, and the surgical approach should be preferred in occasions of dissection extension beyond the sino-tubular junctions. Catheter trauma and subintimal progression of guidewires are major causes of ACD occurrence.
    Case Presentation
    Herein presented is a case report of spontaneous ACD observed after contrast injection to the RCA ostium. Approximately 8 cc of radiocontrast agent was injected into the right coronary ostium. Antegrade and retrograde dissections which extended to the distal RCA and aortic root were observed. The right sinus of Valsalva was stained with contrast agent, and the border of the stained area was extended to the sinotubular junction. Medical follow-up was proposed by the heart team. Close follow-up with echocardiographic examination indicated the complete regression of the dissection.
    Conclusion
    The authors consider conservative follow-up with echocardiogaphy rather than computed tomography and/or magnetic resonance to be the most appropriate imaging technique for use with stable patients.
    Keywords: Aortic dissection, Radiocontrast agent, Echocardiograhy, Iatrogenic disease, diagnosis
  • Kamran Hajinabi * Page 24
    With the prevalence of every type of cancer increasing globally, the inability to treat and the severe side effects caused by chemotherapy and radiotherapy are some of the biggest problems facing cancer patients and their physicians.1
    Many herbal medicines have replaced their chemical rivals; for example, emetine lost its ground to metronidazole as an amoebicidal agent, and digoxin has given its place to ACE inhibitors for treating congestive heart failure. Their use has particular importance in some areas due to the widespread side effects of synthetic drugs, especially in the treatment of incurable diseases such as cancer.2
    It is noteworthy that several natural anticancer agents are provided by lower organisms. For example, the anti-hyperlipidemic agent lovastatin comes from Aspergillus terreus, the immunosuppressant cyclosporin A is derived from Beauveria nivea, and some antibiotics (bleomycin, dactinomycin, daunorubicin, doxorubicin, mitomycin, plicamycin, streptozocin) also fall into this category; however, other higher plants have produced more complicated contributions as secondary metabolites. Among those, the antileukaemic alkaloids vinblastine and vincristine which are obtained from Catharanthus roseus are noted as earlier instances. Other popular and important plant components for use as anticancer agents are etoposide and teniposide which are isolated from Podophyllum peltatum and are effective against many types of tumors, and taxoids that are obtained from crude extracts of the bark of the Taxus brevifolia and are significantly active against ovarian cancer, advanced breast cancer, small and non-small cell lung cancer. Furthermore, these cases should be noted: Shikonin (from Lithospermum erythrorhizon), curcuminoid (from Curcuma longa), camptothecin (from Camptotheca acuminate), and ingenol mebutate (from Euphobia peplus), Trastuzumab emtansine (Kadcyla) which is an antibody conjugated to a synthetic derivative of the cytotoxic principle of the Ethiopian plant Maytenus ovatus and used to treat breast cancer.3
    Although more than half of the anticancer compounds used to treat cancer are obtained from plant sources or marine and microorganisms, it seems that there is still little knowledge about the power of natural resources in the face of incurable diseases such as cancer.4 Finally, the fewer side effects, availability, and lower cost of drugs obtained from plants compared to synthetic samples, especially for cancer patients who have weakened immune systems, make alternative medicine a very important issue. Expanding man’s knowledge on the discovery and use of these natural compounds requires a greater investment by related companies and more attention from the academic community and researchers.
  • Zahra Danial *, Malihe Sadat Moayed, Mohammad Hossain Kalantar Motamedi, Sedigheh Mirhashemi, Heshmatosadat Zamanian Pages 25-26
    Despite advancements in medical science, the treatment of AIDS remains a public health problem, and the number of cases has been rising steadily in recent years. Although there is no consensus, statistics collected by the Universities of Medical Sciences and Health Services indicate that, as of 2012, a total of 27 041 people with HIV/AIDS had been identified in Iran, 89.3% of whom were men and 10.7% were women. In 2009, 19 774 people had been recognized.1 Statistics show that the third wave of AIDS continues until women are its silent victims. Addicts and their wives have also been afflicted as have their children, and this completes the cycle of disaster. The percentage of women who have contracted HIV infection from sexual relations has risen to 60%.2 Data shows that transmission through the sharing of injecting needles is 56%.3 Growth in the number of patients involved, the increasing number of drug users, the sharing of needles, increased sexual contact, the rise in the age of marriage, and increases in the divorce rate have caused the rate of sexually transmitted infections to rise. Evidence offers that in addition to the development of patients, the risk of transmission is driven by unprotected sexual contact. Programs to control and prevent HIV/AIDS and educate the public, with a special emphasis on prevention, are top priority.4 Stopping unprotected sex is of specific importance. Results of another study indicated that only 5.2% of female sex workers use a condom, and 90% of them are addicts. Drug users are sexually active and have multiple partners; thus, unprotected sex is quite common. More than 35% of addicts are married and 40% are not; 27% had more than 5 sexual partners. The rate of men who have had sex with other men at least once was reported to be 7% in prison and 67% outside of prison.5 Prostitutes and injecting addicts are very worrying. Based on studies, it is clear that the need for educational measures to raise public awareness and expertise in the field of AIDS prevention are warranted. This is particularly true for women who are victims of these attacks; the World Health Organization and the Joint United Nations Program on AIDS (UNAIDS) emphasized the fact that sexually transmitted diseases, one of the problems in society today, necessitates integrated health care that provides peer education, empowerment, promotion of condom use, and effective treatment of sexually transmitted diseases in high-risk groups such as female sex workers.6 Studies conducted to evaluate the awareness of women sex workers have shown that these women have information about AIDS, but because of financial need and addiction they do not use the information they have. Due to cultural constraints and hidden relationships,4 a comprehensive plan to prevent and detect HIV/AIDS and to promote the use of health services among members of this group is essential. Due to the growing HIV epidemic in this group of people, there is a possibility that a subsequent increase in cases may follow.