فهرست مطالب

Patient safety and quality improvement - Volume:5 Issue: 1, Winter 2017

Journal Of Patient safety and quality improvement
Volume:5 Issue: 1, Winter 2017

  • تاریخ انتشار: 1395/10/16
  • تعداد عناوین: 8
|
  • Ali Eshraghi, Sajjad Imen, Mohammad Vojdanparast, Ramin Khameneh Bagheri, Majid Jalalyazdi Page 471
    Introduction
    There are some reports suggesting a link between lead exposure and cardiovascular disease but understanding the contribution of lead to specific cardiovascular diseases has remained incompletely.
    Materials And Methods
    In this case-control study, serum lead level in 30 patients with diagnosed coronary slow flow phenomenon (CSFP) documented by coronary angiography was evaluated and compared with the values of the control group containing 30 patients with normal coronary angiography.
    Results
    Age, sex, major clinical risk factors for coronary artery disease, laboratory and echocardiographic parameters were similar in patients with and without CSFP (p > 0.05). Significant differences were found between the 2 study groups regarding serum lead level.
    Conclusion
    Lead is a highly poisonous metal (whether inhaled or swallowed), affecting almost every organ and system in the body. Long-term exposure to lead can cause nephropathy and rise in blood pressure. We found it may also contribute to ischemic heart disease and CSFP. The suspected mechanism is oxidative stress and inflammation.
    Keywords: Cardiovascular disease, Coronary slow flow phenomenon, Serum lead level
  • Mohammad Alboliteeh, Ibrahim Mohammed Almughim Page 475
    Introduction
    To determine the influence of physicians and nurses’ Knowledge, Attitude and Practice (KAP) on Occurrence, Variance and Accident or OVA Reporting System usage in order to improve and to contribute to patient safety.
    Materials And Methods
    The study utilized a quantitative research methodology specifically descriptive design. The samples of this study were primary health care physicians and nurses working at NGHA, Saudi Arabia. A hard copy of the survey was distributed to two Primary Care Centers which are Yarmook and Khashim ala’an.
    Results
    Most of the physicians and nurses had a good knowledge of OVA utilization (89.5%), although nurses were more likely than physicians to have good knowledge (94% vs. 53.6%) and to have a better practice level of the OVA system (82.1% vs. 52.4%). In another point, physicians were more likely to have negative attitude toward the OVA system than nurses (71.4% vs.42.9%). A significant difference emerged between physicians’ and nurses’ KAP toward the OVA reporting system and nationality, language, and working site as revealed by the results.
    Conclusion
    This was the first survey to assess nurses’ and physicians’ KAP toward the use of the OVA reporting system among primary health care level in Saudi Arabia. Apparently, 6% of the participants were not aware of the existing OVA reporting system. The findings of the survey demonstrated that nurses had better knowledge and practice and a less negative attitude to the system.
    Keywords: KAP, NGHA, Nurses, OVA, Physicians
  • Javad Sahhinfar, Hossein Zeraati, Shiva Imani Hesary, Mahnaz Masrorniya, Saeid Shojaei Page 482
    Introduction
    Nausea and vomiting are one of the most common complications of cesarean section under spinal anesthesia. Recently, the use of drugs has decreased and non-pharmaceutical and traditional alternative medicine are often preferred.
    The aim of this study was to investigate the effect of mint extract on the incidence and severity of nausea and vomiting after cesarean section under spinal anesthesia with placebo.
    Materials And Methods
    This double-blind, randomized, clinical trial was performed 92 pregnant women who underwent cesarean section under spinal anesthesia. They were randomly divided into two groups of control and intervention. The intervention group received 25 drops of mint extract mixed in 30 cc of water and the control group only received 30 cc of water 1 h before the surgery. The incidence and severity of nausea and vomiting during the surgery, as well as two and four h after the surgery was assessed by a self-report questionnaire. Data analysis was performed using statistical tests in SPSS.
    Results
    There was no statistically significant difference between the two groups in terms of maternal age, fasting and surgery duration, as well as other confounding factors (P>0.05). According to independent t-test, there was a significant relationship between the two groups in terms of the incidence and mean severity of nausea (26.1% and 52.2% for the intervention and control groups, respectively; P
    Conclusion
    The findings of this study showed that mint extract can be used to prevent nausea and vomiting during cesarean section under spinal anesthesia.
    Keywords: Cesarean section, Mint, Nausea, Spinal anesthesia, Vomiting
  • Kirill Alekseyev, Zachary Fallon, Adrian Cristian, Marc K. Ross Page 488
    Introduction
    The aim of this study is twofold. Firstly, it attempts to examine the causes of the patient discharge from an inpatient rehabilitation facility (IRF) to an acute care hospital. Secondly, it is intended to develop a Pre-admission Screening Checklist (PSC) and examine its utility in minimizing the acute discharges to improve the care quality.
    Materials and Methods
    A retrospective chart review was completed, examining the data from the patients’ medical charts admitted to an inner-city IRF over a 6-month period. A PSC was developed and implemented as a part of admission record review prior to deciding on the patient admission to the IRF. The PSC included information relevant to the patient’s medical condition, rehabilitation potential, and the risk of acute discharge, which was completed over a 4-month period.
    Results
    According to the results, the rate of acute discharge in the IRF patients was 15.7% in the 6-month period prior to the implementation of the PSC, which included 549 referrals and 86 patients. Additionally, the PSC was applied for 324 referrals over the subsequent 4-month period. Out of the patients that were reviewed using the PSC, 37 cases were acutely discharged from the IRF during their rehabilitation (11.4%). The most common reasons for acute discharge were heart diseases, sepsis, and change in neurological status.
    Conclusion
    As the findings indicated, the PSC is a useful instrument that can improve the care quality by identifying the patients at the risk of acute discharge before admission to the IRF. The PSC can be a useful adjunct to the efforts made to prevent acute discharges from the IRF by creating a standardized assessment that optimizes the care.
    Keywords: Acute discharge, Quality improvement, Rehabilitation, Screening
  • Farnaz Zand Vakili, Masomeh Rezaie, Sirous Shahsavari, Roonak Niazi Page 493
    Introduction
    Early diagnosis and prediction of preeclampsia needs appropriate obstetric care. Preeclampsia predicting methods are important. This study was designed to determine the correlation between preeclampsia and quadruple screening test in the nulliparous.
    Materials And Methods
    This case - control study was conducted on 54 pregnant women with preeclampsia (case group) and 108 healthy pregnant women (control group) who referred to health centers in Sanandaj, Iran. Ultrasonography was performed to determine the gestational age by a radiologist. Maternal serum levels of alpha fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin-A were measured in the second trimester of pregnancy. Data were analyzed using SPSS statistical software and Chi-square test, T-test, sensitivity, specificity, positive and negative predictive values.
    Results
    The results showed that the sensitivity and specificity for the diagnosis of preeclampsia in pregnant women for hCG were 35.2% and 79.6 respectively. These findings for estriol were 20.4% and 88.9%, for inhibin-A were 38.8% and 88% and for alpha fetoprotein were 38.8% and 74.1%. The positive predictive value for hCG, estriol, inhibin-A and alpha fetoprotein were 46.3%, 47.8%, 61.8% and 42.9% respectively. The negative predictive value for hCG, estriol, inhibin-A and alpha fetoprotein were also 71%, 69.1%, 74.2% and 70.8% respectively.
    Conclusion
    There was a relationship between preeclampsia and high levels of inhibin-A and hCG. Further studies on these markers and evaluating their usefulness in the diagnosis and management of preeclampsia are recommended.
    Keywords: Preeclampsia, Pregnant women, Quadruple screening test
  • Marzieh Saberi, Ashraf Tavanaii Sani Page 497
    Human immunodeficiency virus type-1 (HIV–1) and human T-cell leukemia virus (HIV-1/HTLV) co-infection is a serious health problem worldwide, especially in endemic areas and vulnerable subjects like intravenous drug abusers. This is due to the fact that CD4 and CD8 T-cells are the primary targets of HTLV-1 and HTLV-2, respectively. The influence of HTLV-1 and HTLV-2 on CD4 count can shortened or prolong progression to AIDS and the development of more clinical complications. Opportunistic infections may differ between HIV-1/HTLV-1 and HIV-1/HTLV-2 co-infection subjects. Several epidemiologic studies have discussed molecular bases of HIV-1/HTLV co-infection, including cytokine and chemokine mediated pathways; however, they have yielded discrepant results.
    Keywords: Co, infection, HIV, HTLV, 1
  • Seyede Narjes Roudbaraki, Fatemeh Behdani, Paria Hebrani, Majid Ghayour, Mobarhan, Sadegh Vahabi Amlashi Page 502
    Various studies have revealed that schizophrenia is related to components of the metabolic syndrome. Its manifestations include visceral obesity, impaired lipid metabolism, hyperglycemia and hypertension. Its prevalence rate varies indifferent countries. There are various evidences about the higher incidence of cardiovascular events in schizophrenic patients with metabolic syndrome. So, prevent or treat this condition in schizophrenia is crucial. Fish oil is commonly used by consumers. There are evidences about the efficacy of omega-3 in metabolic syndrome.
    Keywords: Co, infection, HIV, HTLV, 1
  • Reza Jalaeian Taghadoomi, Hengameh Rezaei Boroujerdi Page 505
    Introduction
    Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations . To evaluate the effect of ANH method and tranexamic acid on blood transfusion requirements and blood loss after off pump coronary artery bypass surgery (OPCAB).
    Materials And Methods
    The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from inception to December 2014; reference lists of published guidelines, reviews, and associated articles, as well as conference proceedings.We included articles with available abstract in English language. Manual searching was done within the reference list of articles. Three reviewers independently reviewed and assessed eligibility criteria, assessed quality, and extracted data.
    Results
    Bleeding and hemorrhagic complications and the consequent need for allogeneic transfusion are still major problems after off-pump coronary artery bypass surgery that can reduced in combination of ANH method and tranexamic acid.
    Conclusion
    Tranexamic acid and ANH appear to be effective in reducing postoperative bleeding and the need for allogeneic blood products.
    Keywords: Acute normovolemic hemodilution, Off, pump coronary artery bypass, Tranexamic acid