eng
Mashhad University of Medical Sciences
Journal of Patient Safety & Quality Improvement
2345-4482
2345-4490
2014-01-01
2
1
34
35
10.22038/psj.2014.2091
2091
That's the Patient's Right and Our Responsibility
Sadat S.M
sadat@health.gov.ir
1
Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
https://psj.mums.ac.ir/article_2091_eb5852c3bbc5824876df1710c03c924d.pdf
eng
Mashhad University of Medical Sciences
Journal of Patient Safety & Quality Improvement
2345-4482
2345-4490
2014-01-01
2
1
36
43
10.22038/psj.2014.2092
2092
Nicotinic Acid Treatment for Retinal Vein Occlusion
Abrishami M
1
Mousavi Mn
2
Zarei-Ghanavati S
3
Banaee T
4
Zarei-Ghanavati M
mehran_zarei@yahoo.com
5
Professor of Ophthalmology, Khatam-Al-Anbia Eye Hospital, Mashhad University of Medical Science, Mashhad, Iran.
Professor of Ophthalmology, Khatam-Al-Anbia Eye Hospital, Mashhad University of Medical Science, Mashhad, Iran.
Assistant Professor of Ophthalmology, Research Center for Patient Safety, Mashhad University of Medical Science, Mashhad, Iran.
Associate Professor of Ophthalmology, Khatam-Al-Anbia Eye Hospital, Mashhad University of Medical Science, Mashhad, Iran.
Assistant Professor of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Objectives: To evaluate the effect of nicotinic acid in management of retinal vein occlusions (CRVO or BRVO). Materials and Methods: This prospective nonrandomized pilot study included 20 patients (21 eyes) with CRVO or BRVO that received nicotinic acid (3 g/day) for 3 months. A complete ophthalmologic examination uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), testing for a relative afferent pupillary defect (RAPD), slit-lamp examination, gonioscopy, intraocular pressure (IOP) measurement, fundoscopy and fundus photography was performed. Results: Four patients did not appear for follow-up and hypersensitivity reaction to nicotinic acid and severe hyperglycemia happened in two patients. Therefore, the results of treatment in 16 eyes of 15 are reported. These patients had a mean age of 59.56 ± 11.12 years. The average length of follow-up was 8.6 ± 2.7 months. The mean BSCVA was 1.56 ± 0.66 before treatment, 1.38 ± 0.72 (p >0.05) at one month and 0.88 ± 0.69 (p<0.01) at three months. The last BSCVA of all 16 eyes averaged 0.97 ± 0.73 (p<0.01). All patients had reduction of hemorrhagic events, cotton wool spots, edema in macula and disc, venous tortuosity, and dilation on basis of fundus photographs 3 months after treatment. Conclusion: Nicotinic acid usage provides enough time for development of collateral vessels, by induction of vasodilatation. Nicotinic acid use is tolerable and is related with mild systemic side effects.
https://psj.mums.ac.ir/article_2092_f18f2ceab4d88bc9c2fee0f6650c18ef.pdf
BRVO
CRVO
Niacin
Nicotinic acid
retinal vein occlusion
eng
Mashhad University of Medical Sciences
Journal of Patient Safety & Quality Improvement
2345-4482
2345-4490
2014-01-01
2
1
44
47
10.22038/psj.2014.2093
2093
Clinical Aspects of Patients with Febrile Convulsion: A survey in Mashhad
Heydarian F
heydarianf@mums.ac.ir
1
Hamedi A
2
Khalesi M
3
Hoseini Noude S
4
Rahmani Sh
5
Associate Professor of Pediatrician, Research Center for Patients' Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Professor of Pediatrician, Imam Reza Hospital Mashhad, Iran.
Assistant Professor of Pediatrician, Ghaem Hospital Mashhad, Iran.
MD, Ghaem Hospital, Mashhad, Iran
MD, Research Center for Patients’ Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Objectives: Febrile seizures (FS) happen in 2-5% of children aged 6 months to 5 years. Several studies have confirmed that between 2 to 7% of children with FS, develop epilepsy later in life. This study was performed to evaluate the clinical aspects of patients with febrile seizure in our region. Materials and Methods: This is a retrospective descriptive cross- sectional study that was performed in the pediatric ward of Ghaem hospital in Mashhad, Iran from Sep. 2004 to March 2005. 68 patients aged 6 months to 5 years were evaluated. Results: Most patients were male and aged between 1 to 3 years. 25% had a past history of febrile seizures. Upper respiratory tract infections and gastroenteritis were among the most common causes of febrile seizures, respectively. Simple febrile seizures were seen in 64.7% of the cases. Most of such patients had body temperature above 38.5˚c at the time of seizure occurrence. Conclusion: Febrile seizures were more frequently seen in boys aged 1 to 3 years. It most commonly occurred following an upper respiratory tract infection and due to rise in body temperature above 38.5 ۫c.
https://psj.mums.ac.ir/article_2093_3785975de6710700ea705b425737dea9.pdf
Children
Convulsion
Fever
Infections
eng
Mashhad University of Medical Sciences
Journal of Patient Safety & Quality Improvement
2345-4482
2345-4490
2014-01-01
2
1
48
52
10.22038/psj.2014.2094
2094
Clinical Governance: Efficacy of Establishment in Mashhad Hospital
Davoodi R
1
Soltanifar A
soltanifara1@mums.ac.ir
2
Rahmani Sh
3
Sabouri G
4
Asadi M
5
Zare Hoseini M
6
Takbiri A
7
Koleini F
8
Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University
of Medical Sciences, Tehran, Iran.
Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Objectives: Clinical governance is a framework in which the organizations providing clinical services are responsible in exchange for the permanent improvement of quality and preserving the service’s high standard. It relies on the responsibility to maintain current levels of care and on clinical governance pillars to improve the quality of future care. Also, it is a concept that attempts to integrate the previous methods and tools in measuring and improving quality of care. Materials and Methods: This descriptive-analytic-interventional study was conducted to evaluate the hospitals of Mashhad before and after the establishment of clinical governance in 2011. Data were collected by both questionnaires and observation. Results: Comparing the range of clinical governance’s pillars obtained, from the selected hospitals, showed a significant improvement in all studied axes following the establishment of clinical governance. The highest effectiveness was related to clinical audit, staff management and training axes, whereas the least effective part was the interaction with patients, their relatives and the community. Conclusion: Regarding the significant difference in the obtained results after the establishment of clinical governance in this study, it could be concluded that the establishment of clinical governance and its performance could remarkably improve the quality of health services.
https://psj.mums.ac.ir/article_2094_a164c3bbdf8c0c9388a2ad6ccd7b77fc.pdf
Clinical governance
Health Services
Mashhad-Iran hospitals
eng
Mashhad University of Medical Sciences
Journal of Patient Safety & Quality Improvement
2345-4482
2345-4490
2014-01-01
2
1
53
57
10.22038/psj.2014.2095
2095
Patient Safety Culture: Nurses’ Attitude in Marvdasht Shahid Motahary Hospital, 1392
Zarei M
mzarei570@gmail.com
1
Emadi F
2
Fallah K
3
Zarei H
4
MSc Student of Health Care Management, Hospital Management Expert, Research Center for Patients' Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
BSc of Nursing, Director of Nursing and Midwifery, Marvdasht Shahid Motahary, Educational Hospital, Shiraz University of Medical Sciences, Marvdasht, Iran.
MSc of Educational Management, Risk Management Expert, Marvdasht Shahid Motahary, Educational Hospital, Shiraz University
of Medical Sciences, Marvdasht, Iran.
MSc Student of Medical Education, Hospital Manager, Marvdasht Shahid Motahary, Educational Hospital, Shiraz University of
Medical Sciences, Marvdasht, Iran.
Objectives:Improving the safety culture has been implemented as a key strategy to improve patient safety in health care systems. Several surveys have shown that assessment of patient safety attitude and examining to what extent these attitudes exist could be used as an effective tool for promoting patient safety and such data meet the managers’ information needs over time. Thus, considering the importance of patient safety as a basic principle in improving the quality of clinical services and patient satisfaction, this study was aimed to examine nurse’s attitudes towards the safety culture. Materials and Methods: In this cross-sectional study the study population included nurses who were working in Marvdasht Shahid Motahary hospital, 2013. The sample size was selected by using a stratified randomization method as 114. The data were collected through HSOPSC questionnaire that has been introduced by the Health Care Research and Quality agency in 2004. The questionnaire is composed of eight parts. One part is about demographic and career information and other parts are about different dimensions of the patient safety culture. The collected data were then analyzed using the SPSS software and descriptive statistical tests. Results: The obtained results showed that the manager and supervisor expectations and actions in order to promote patient safety and the overall understanding of patient safety dimensions received the highest rating. On the other hand, staffing and non-punitive response to errors dimensions received the lowest score among the 12 dimensions of patient safety culture. Nonetheless, 44% of the studied population considered the patient safety status in their units as acceptable. However, 39% of the population had not reported any errors in the past 12 months. Conclusion: Based on the results of the present study, the need to improve the safety culture at different dimensions seems necessary. Also, the culture of error reporting without any fear of censure or punishment should be institutionalized in future.
https://psj.mums.ac.ir/article_2095_2d9cb1259c6f27437a0917cd7cf6866c.pdf
Attitude
Error
Patient safety
Safety culture
eng
Mashhad University of Medical Sciences
Journal of Patient Safety & Quality Improvement
2345-4482
2345-4490
2014-01-01
2
1
58
64
10.22038/psj.2014.2096
2096
Quality of Labor Support during Labor
Bahri N
1
Vafaee-Najar A
2
Ebrahimipour H
3
Askari F
faribaaskari10@yahoo.com
4
Bashiri Kh
5
PhD Candidate of Reproductive Health, Department of Midwifery, School of Nursing & Midwifery, Gonabad University of
Medical Science, Gonabad, Iran.
Associate Professor of Health Care Management, Health Sciences Research Center, Department of Health and Management,
School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
Associate Professor of Health Services Management, Research Center for Health Services management, Institute for Futures
Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
MSc of Midwifery, Department of Midwifery, School of Nursing & Midwifery, Gonabad University of Medical Science, Gonabad, Iran.
BA of Midwifery, Student Research Committee, School of Nursing & Midwifery, Gonabad University of Medical Science, Gonabad, Iran.
Objectives:Providing appropriate and quality care for delivery process can be done in the form of the "Labor Support". This approach is one of the key factors in reducing maternal and neonatal mortality rates and fulfilling the Millennium Development Goals. It has also an important role in the promoting maternal satisfaction. This study aims at assessing mothers’ view regarding the labor support quality. Materials and Methods: In this cross-sectional study, 100 women who were hospitalized in the postpartum ward of Gonabad 22 Bahman Hospital, and had normal vaginal delivery were chosen using convenience sampling method. Participants were asked to fill in the demographic questionnaire and the form of assessment quality of labor support. Data analysis was performed by SPSS11.5 software. Results: In this study, the data showed a mean participants’ age of 27/14 ± 5/89 years and a mean admission-delivery time interval of 305/13 ± 147/30 minutes. Results showed that 74 percent of women evaluated the emotional support as good, 93% of the women had reported that they are satisfied with physical support, and 92 percent of the participants had expressed that they were content with the instructions/information provided by the personnel. Conclusion: According to this study, overall satisfaction from the quality of labor support has been acceptable in Gonabad 22 Bahman Hospital. Emotional supports stood lower when compared in terms of quality to two other categories.
https://psj.mums.ac.ir/article_2096_9d3a72fd74753239e76fcee0460a3553.pdf
Continuous Labor Support
Emotional support
Instruction/Information
Physical support
Quality
eng
Mashhad University of Medical Sciences
Journal of Patient Safety & Quality Improvement
2345-4482
2345-4490
2014-01-01
2
1
65
68
10.22038/psj.2014.2097
2097
Delayed Awakening from Anesthesia Following Electrolyte and Acid-Base Disorders, Two Cases
Razavi M
1
Bameshki AR
2
Taghavi Gilani M
taghavim@mums.ac.ir
3
Assistant professor of Anesthesiology, Cardiac Anesthesia Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Associate Professor of Anesthesiology, Cardiac Anesthesia Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Assistant professor of Anesthesiology, Research Center for Patients' Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Introduction: Delayed awakening from anesthesia remains one of the biggest challenges that involve anesthesiologists. Most commonly, delayed awakening is due to drugs effects persistence. Metabolic (like hypo- hyperglycemia), electrolyte, acid-base disorders and hypothermia may cause delayed emergence from anesthesia. Structural disorders of cerebral nervous system (like increase in intracranial pressure, brain ischemia) and psychological disorders can be regarded as other uncommon causes of this condition. Hypokalemia is induced by low potassium intake, excessive excretion from gastrointestinal (GI) and kidneys (like using diuretics) or a shift from extracellular space into intracellular space. Cases: In these two reported cases, although proper measures had been taken to reverse the effects of anesthetic drugs, the patients did not regain their consciousness as fast as expected. The only significant finding in postoperative tests, along with respiratory alkalosis, was low serum potassium level (K=2.5 and K=2.9 in the first and the second patients, respectively). Correction of serum potassium (to K=3.3 and K=3.2 in the first and the second, respectively) improved patients level of consciousness, and they were discharged from intensive care unit (ICU) with good general condition. Conclusion: During surgery; pain, stress, sympathetic increase, catecholamine release and the consequent β-stimulation, certain drugs, and respiratory alkalosis due to hyperventilation may cause acute shift of potassium into the cells, which will be intensified in the patients with preoperative hypokalemia. Hypokalemia induces consciousness impairment and increases muscle relaxation, both of which affect patient awakening. Serum potassium evaluation is recommended in cases of delayed emergence from anesthesia.
https://psj.mums.ac.ir/article_2097_eef1378992f103ca580491205bd46a1a.pdf
Alkalosis
Delayed Emergence
General anesthesia
Hypokalemia
Impaired consciousness
eng
Mashhad University of Medical Sciences
Journal of Patient Safety & Quality Improvement
2345-4482
2345-4490
2014-01-01
2
1
69
72
10.22038/psj.2014.2098
2098
Modified Surgical Epikeratoplasty for Keratoglobus: Anatomic and Visual Findings
Khakshoor H
1
Shokoohi Rad S
shokoohirads@gmail.com
2
Eslampoor AR
3
Askari S.A
4
Associate Professor Ophthalmology, Research Center for Patients' Safety, Mashhad University of Medical Sciences, Mashhad, Iran.
Eye Research Center, Khatam-Al-Anbia Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Assistant Professor Vitreous-Retinal Research Center, Khatam-Al-Anbia Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Retina Research Centre, Khatam-Al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Introduction: Keratoglobus is a controversial issue and still remains as one of the ambiguous corneal disorders; it can be managed by different surgical techniques successfully; yet the risk of globe rupture is high in these patients due to corneal weakness. In cases of progressive involvement, a large corneal graft is needed due to extreme thinness of the cornea. Recent adventures in surgical techniques have led to the introduction of new managements particularly in Keratoglobus treatment such as the "tuck procedure" in which a 12 mm corneo-scleral graft is miniaturized at its peripheral margin. A pocket is formed at the limbus of the recipient and the donor graft is "tucked" into it. We present a case of epikeratoplasty in Keratoglobus management. Case: A 45-year-old man with no history of a systemic disease underwent epikeratoplasty with the diagnosis of advanced bilateral keratoglobus since three years and six months before in the left and right eye, respectively. Pachymetry and best-corrected visual acuity (BCVA) were recorded before and six months after surgery. The highest recorded BCVA was 5/200 before the operation, whereas it was measured 6/10 (left eye) and 4/10 (right eye) at six-month follow-up examinations. Pachymetric findings improved from 244 to 773 and 212 to 744 (thinnest points) in the left and right eyes, respectively. Conclusion: Epikeratoplasty is a relatively safe, effective and reversible extraoccular procedure in the management of keratoglobus. It can also be performed to flatten the cornea and protect it against acute corneal hydrops and perforation.
https://psj.mums.ac.ir/article_2098_147b5f9cd8ab2db49211b0ce98150d79.pdf
Epikeratoplasty
Keratoglobus
surgical technique
eng
Mashhad University of Medical Sciences
Journal of Patient Safety & Quality Improvement
2345-4482
2345-4490
2014-01-01
2
1
58
64
10.22038/psj.2014.14871
14871
Quality of labor support during intrapartum
narjes bahri
nargesbahri@yahoo.com
1
narjes bahri
bahribn901@mums.ac.ir
2
Gonanbad University of Medical Sciences
GMU
Quality of labor support during intrapartum Introduction: Providing appropriate and quality care delivery process in the form "support labor" One of the key factors in reducing maternal and infant mortality and achieving Millennium Development Goals are known and has an important role in the increased maternal satisfaction. This study aimed assessing mothers’ view of the quality of labor has been done. Method: This is a cross sectional study. 100 women who were hospitalized in the postpartum ward of 22 Bahman Hospital Gonabad, and had normal vaginal delivery selected with convenience Sampling methods. Participants filled the demographic questionnaire and the form of assessment quality labor support. Data analysis was performed by SPSS11.5 software and p <0/05 was considered as statistically significant. Results: In this study, the mean and SD 0f participants’ age was 27/14 ±5/89 years and the mean and standard deviation of the time between submission until delivery was 305/13 ±147/30 minutes. Results showed 74 percent of women assessed emotional support as well as good, in the 93% of the mothers' view the physical support was good and 92 percent of participants expressed their opinion in support of instruction /information has been good. Conclusion: According to this study, the total satisfaction of the quality of labor support has been good in 22 Bahman Hospital Gonabad, But emotional supports was weaker than other aspects. Keywords: quality, labour support, physical support, emotional support, instruction/information Keywords: quality, labour support, physical support, emotional support, instruction/information Keywords: quality, labour support, physical support, emotional support, instruction/information
https://psj.mums.ac.ir/article_14871_d41d8cd98f00b204e9800998ecf8427e.pdf
Quality
labour support
Physical support
Emotional support
Instruction/Information