ORIGINAL_ARTICLE
Diagnostic reasoning as a medium for promoting patient safety
Introduction:Diagnostic reasoning is a key skill practised by clinicians. It is a process by which correct clinical diagnosis is reached. Learning theories offer some guidance on how this cognitive skill is best taught; what curriculum best supports it and how it is learned and used by expert and novice learners. Novice and expert learners have different needs when it comes to developing this skill. This paper aims to explore the unique role of the medical educator; exploring how they facilitate diagnostic reasoning amongst learners with an emphasis on improving patient safety.Materials and methods:The bibliography assembled for this literature review includes original articles, quantitative and qualitative papers, narrative review articles, editorials and other documents identified through PubMed, Scopus, ERIC, Australian Education Index, British Education Index and Google Scholar Database searches. Results – Medical educators employ a variety of teaching strategies including ‘thinking aloud’ techniques and hypothesis generation. There is some dispute in the literature as to which teaching strategies and which curricula best support the learning of diagnostic reasoning. The contribution of good diagnostic reasoning skills in reducing clinical error and maintaining patient safety is clear.Conclusions – It is important to continue to encourage the teaching of diagnostic reasoning with an emphasis on patient safety and its role in reducing clinical error and adverse events for patients.
https://psj.mums.ac.ir/article_12437_f9a16ecb6f07af211ab5d8b44f05b6e2.pdf
2019-04-01
36
40
10.22038/psj.2019.35489.1193
Patient safety
Clinical error
Diagnostic reasoning
Clinical reasoning
Medical education
Leona
Lally
lelally@yahoo.ie
1
School of Medicine, National University of Ireland, Galway, Ireland.
LEAD_AUTHOR
Geraldine
Mc Carthy
mccarthy@nuigalway.ie
2
Sligo Medical Academy, Sligo University Hospital, Sligo, Ireland.
AUTHOR
Gerard
Flaherty
gerard.flaherty@nuigalway.ie
3
School of Medicine, National University of Ireland, Galway, Ireland.
AUTHOR
1. Nuland SB. How we die: reflection on life’s final chapter. New York: Vintage Books; 1994.
1
2. Croskerry P. A universal model of diagnostic reasoning. Acad Med. 2009; 84(8):1022-8.
2
3. Eva KW. What every teacher needs to know about clinical reasoning. Med Educ. 2005; 39(1):98-106.
3
4. Charlin B, Lubarsky S, Millette B, Crevier F, Audétat MC, Charbonneau A, et al. Clinical reasoning processes: unravelling complexity through graphical representation. Med Educ. 2012; 46(5):454-63.
4
5. Norman G. Research in clinical reasoning: past history and current trends. Med Educ. 2005; 39(4):418-27.
5
6. Newman-Toker DE, Pronovost PJ. Diagnostic reasoning-the next frontier for patient safety. JAMA. 2009; 301(10):1060-2.
6
7. Shojania KG, Burton EC, McDonald KM, Goldman L.Changes in rates of autopsy-detected diagnostic errors over time: a systematic review. JAMA. 2003; 289(21):2849-56.
7
8. Croskerry P. Critical thinking and decision making: avoiding the perils of thin-slicing. Ann Emerg Med.2006; 48(6):720-2.
8
9. Neufeld VR, Norman GR, Feightner JW, Barrows HS. Clinical problem solving by medical students: across-sectional and longitudinal analysis. Med Educ. 1981; 15(5):315-22.
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10. Risen J, Gilovich T, Sternberg RJ, Halpern D, Roediger H. Informal logical fallacies. In: Sternberg RJ, Roediger HL, Halpern DF, editors. Critical thinking in psychology. New York: Cambridge University Press; 2007. P. 110-30.
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11. Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, et al. Effect of reducing interns’work hours on serious medical errors in intensive care units. N Engl J Med. 2004; 351(18):1838-48.
11
12. Elstein AS, Schulman LS, Sprafka SA. Medical problem solving: an analysis of clinical reasoning.Cambridge: Harvard University Press; 1978. P.49-59.
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13. Coderre S, Mandin H, Harasym PH, Fick GH.Diagnostic reasoning strategies and diagnostic success. Med Educ. 2003; 37(8):695-703.
13
14. Rajkomar A, Dhaliwal G. Improving diagnostic reasoning to improve patient safety. Perm J. 2011;15(3):68-73.
14
15. Bowen JL. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2014;355(21):2217-25.
15
16. Norman G. Building on experience-the development of clinical reasoning. N Engl J Med. 2006; 355(21):2251-2.
16
17. Wigton RS, Patel KD, Hoellerick VL. The effect of feedback in learning clinical diagnosis. J Med Educ.1986; 61(10):816-22.
17
18. Ark T, Brooks LR, Eva KW. The best of both worlds:adoption of a combined (analytic and non- analytic) reasoning strategy improves diagnostic accuracy relative to either strategy in isolation. Presented at the Annual Meeting at the Association of American Medical Colleges; Boston, MA; 6 November 2004.
18
19. Eva KW, Brooks LR, Norman GR. Forward reasoning as a hallmark of expertise in medicine:logical, psycho- logical and phenomenological inconsistencies. Adv Psychol Res. 2002; 8:41-69.
19
20. Eva KW, Neville AJ, Norman GR. Exploring the aetiology of content specificity: factors influencing analogic transfer and problem solving. Acad Med.1998; 73:1-5.
20
21. Moulton CA, Regehr G, Mylopoulus M, MacRae HM.Slowing down when you should: a new model of expert judgement. Acad Med. 2007; 82(10Suppl):S109-16.
21
22. Delany C, Golding C. Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators. BMC Med Educ. 2014; 14:20.
22
23. Barrows HS, Tamblyn RM. Problem-based learning an approach to medical education. New York Springer Publishing; 1980. P. 3077-80.
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24. Barrows HS. Problem-based, self-directed learning JAMA. 1983; 250(22):3077-80.
24
25. Patel VL, Evans DA, Groen GJ. Reconciling basic science and clinical reasoning. Teach Learn Med In J. 1989; 1(3):116-21.
25
26. Goss B, Reid K, Dodds A, McColl G. Comparison of medical students’ diagnostic reasoning skills in a traditional and a problem based learning curriculum. Int J Med Educ. 2011; 2:87-93.
26
27. Amjad A. Clinical diagnostic reasoning and the curriculum: a medical student’s perspective. Med Teach. 2008; 30(4):426-7.
27
28. Fyrenius A, Bergdahl B, Silen C. Lectures in problem-based learning--why, when and how? An example of interactive lecturing that stimulate meaningful learning. Med Teach. 2005; 27(1):61-5
28
29. Mandin H, Harasym P, Eagle C, Watanabe M .Developing a ‘clinical presentation’ curriculum at the University of Calgary. Acad Med. 1995 .70(3):186-93.
29
30. Page G, Bordage G, Allen T. Developing key-featur problems and examinations to assess clinica decision-making skills. Acad Med. 1995; 70(3)194-201.
30
31. General Medical Council. Tomorrow’s doctors recommendations on undergraduate medical education. London: General Medical Council; 2002
31
32. O’Neill PA, Metcalfe D, David TJ. The core content of the undergraduate curriculum in Manchester. Med Educ. 1999; 33(2):121-9.
32
33. Medical Council Medical Education. Training and practice in Ireland 2008-2013 a progress report. Dublin: Medical Council; 2014.
33
34. Graber ML. The incidence of diagnostic error in medicine. BMJ Qual Saf. 2013; 22:ii21-7.
34
35. Monteiro S, Norman G. Diagnostic reasoning: where we’ve been, where we’re going. Teach Learn Med.2013; 25(Suppl 1):S26-32.
35
36. Ericsson KA, Krampe RT, Tesct-Romer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev. 1993; 100(3):363-406.
36
37. Croskerry P. Cognitive forcing strategies in clinical decision making. Ann Emerg Med. 2003; 41(1).110-20.
37
38. Ely JW, Graber ML, Croskerry P. Checklists to reduce cognitive errors. Acad Med. 2011; 86(3).307-13.
38
ORIGINAL_ARTICLE
The impact of medical errors on the practice of Brazilian physicians
Introduction: This article discusses how Brazilian physicians think about medical errors and the consequences on their professional careers. A retrospective study with a qualitative approach based on the professional experience of Brazilian physicians who work in a private hospital in Sao Paulo, Brazil. Materials and methods: The participants were twenty Brazilian physicians, including ten without medical errors and ten with medical errors. In-depth interviews were conducted with the physicians, and content analysis was conducted based on the phenomenological method. Results: No significant difference between the two groups was found. Both groups indicated that there is no error-free practice and that educational and health institutions offer no specific training for what to do when an error occurs. Physicians believe that they should not let themselves be influenced by society’s judgment of a physician who commits an error or by the medical error concept. The Brazilian media and society tend to blame physicians for their errors. The availability of a service or an institution that supports physicians who have committed a medical error is important because these professionals do not feel supported when an error occurs and feel that they require mental health support to face the ethical and civil proceedings. Well-established doctor-patient relationships can promote the well-being of medical practitioners. Conclusion: It is necessary to implement training and institutional practices that specify conduct conducive to improving Brazilian medical practice.
https://psj.mums.ac.ir/article_12414_8ae8dafa2fbbfd7c6b1f0e3bf7d986ce.pdf
2019-04-01
41
46
10.22038/psj.2019.36843.1199
Medical error
Qualitative research
Professional Practice
Vitor
Mendonca
vitor.mendonca@usp.br
1
University of Sao Paulo, Institute of Psychology, Brazil.
LEAD_AUTHOR
Maria Luisa
Scmidt
maluschim@uol.com
2
University of Sao Paulo, Institute of Psychology, Brazil.
AUTHOR
1. Gomes JCM, Drumond JG, França GV. Erros médicos. Montes Claros: Unimontes; 2001. P. 27.
1
2. David G, Sureau C. De la sanction à la prévention del’erreur médicale. Paris: Lavoisier; 2006. P. 34-57.
2
3. Etchegaray JM, Ottosen MJ, Aigbe A, Sedlock E, Sage WM, Bell SK, et al. Patients as partners in learning from unexpected events. Health Serv Res. 2016;51:2600-14.
3
4. Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington: National Academy Press; 2000. P. 13-49.
4
5. Department of Health. An organization with a memory: report of an expert group on learning from adverse events in the NHS. London: The Stationery Office; 2000.
5
6. Grange P, Papilon F. Erreurs médicales. Paris: Nil; 2008. P. 25-38.
6
7. Hiatt HO. Medical malpractice. Bull N Y Acad Med.1992; 68(2):254-64.
7
8. Weerakkody RA, Cheshire NJ, Riga C, Lear R, Hamady MS, Moorth K, et al. Surgical technology and operating-room safety failures: a systematic review of quantitative studies. BMJ Qual Saf. 2013;22(9):710-8.
8
9. Truog RD, Browning DM, Johnson JA, Gallagher TH.Talking with patients and families about medical error: a guide for education and practice. Baltimore: The Johns Hopkins University Press; 2011. P. 19-66.
9
10. Wu AW, McCay L, Levinson W, Iedema R, Wallace G, Boyle DJ, et al. Disclosing adverse events to patients: International norms and trends. J Patient Saf. 2017; 13(1):43-9.
10
11. Critelli DM. Analitica do sentido: uma aproximacao einterpretacao do real de orientacao fenomenologica. Sao Paulo: EDUC Brasiliense; 1996. P. 16-27.
11
12. Giorgi A, Sousa D. Metodo fenomenologico de investigacao em Psicologia. Lisboa: Fim Do Seculo; 2010. P. 10-77.
12
13. Giostri HT. Erro medico a luz da jurisprudencia comentada. Curitiba: Jurua; 2002. P. 8-91.
13
14. Resolucao CN. Federal council of medicine. Brasilia: Secao; 2009. P. 90.
14
15. Kfouri Neto M. Responsabilidade civil do medico.Sao Paulo: Editora Revista dos Tribunais; 2010. P.11-91.
15
16. Gomes AP, Rego S. Transformacao da educacao medica: e possivel formar um novo medico a partir de mudancas no metodo de ensino-aprendizagem? Rev Braz Educ Med. 2011; 35(4):557-66.
16
17. Mendonca VS, Gallagher TH, De Oliveira RA. The function of disclosing medical errors: new cultural challenges for physicians. HEC Forum. 2018; 30:1-9.
17
18. Gallagher TH, Studdert D, Levinson W. Disclosing harmful medical errors to patients. N Engl J Med. 2007; 356(26):2713-9.
18
19. Shapiro J, Galowitz P. Peer support for clinicians: a programmatic approach. Acad Med. 2016; 91(9):1200-4.
19
20. Lee BS, Gallagher TH. Saying I’m sorry: error disclosure for ophthalmologists. Am J Ophthalmol. 2014; 157(6):1108-10.
20
ORIGINAL_ARTICLE
The relationship between knowledge of ergonomic science and occupational injuries in nurses
Introduction: The goal of ergonomics science is to achieve an effective adaptation between the user and the workstation to improve productivity, increase the safety and reduce occupational injuries. Therefore, this study was conducted with the aim of studying knowledge about ergonomics, determining working conditions and occupational injuries of nurses in selected hospitals of Shahid Beheshti University of Medical Sciences.Material and Methods: This cross-sectional study was done on nurses working in hospitals affiliated to Shahid Beheshti University of Medical Sciences by one standard questionnaire. Using descriptive statistics, Kolmogorov-Smirnov, chi-square, independent t-test and one-way ANOVA, data were analyzed.Results: The mean and standard deviation of age and work experience were about 32.67 ± 8.63 and 8.84 ± 7.46 years, respectively. Results showed the level of nurses 'knowledge about ergonomics with an average of 0.72 ± 3.14 was good. Also, the extent of occupational problems and injuries, such as musculoskeletal disorders (MSDs), with a mean of 0.95 ± 2.10 was also weak. The results showed that there was a significant reverse relationship between the level of knowledge of ergonomic science and the level of occupational injury (P-value = 0.00, R = -0.299) and between working conditions and occupational injuries (P-value = 0.000, R = -0.357).Conclusions: There was a reverse relationship between the level of knowledge of ergonomic and occupational injuries. Also, there was a significant reverse relationship between working conditions and occupational injuries. Therefore, use of training and ergonomic interventions can be useful.
https://psj.mums.ac.ir/article_12454_0bcf279741cc2bc58f41c78dfa60d8f8.pdf
2019-04-01
47
51
10.22038/psj.2019.34104.1189
Knowledge
Ergonomic science
Occupational injuries
Nurses
Mahnaz
Saremi
saremim@yahoo.com
1
Faculty of Health, Safety, and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
AUTHOR
Rohollah
Fallah Madvari
fallah134@gmail.com
2
Ph.D Candidate of occupational health engineering, Student Research Committee, School of Public Health and safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
AUTHOR
Elham
Akhlaghi Pirposhte
e.akhlaghi3@yahoo.com
3
Department of occupational health, School of public health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
AUTHOR
Abbas
Mohammad Hosseini
4
Department of occupational health, School of public health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
AUTHOR
Fereydoon
Laal
fereydoonlaal@gmail.com
5
Student Research Committee, Department of occupational health, School of public health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
LEAD_AUTHOR
Hossein Ali
Adineh
payam.health@yahoo.com
6
Department of Epidemiology and Biostatistics, Iranshahr University of Medical Sciences, Iranshahr, Iran.
AUTHOR
1. Sirajudeen MS, Pillai PS, Vali GMY. Assessment of knowledge of ergonomics among information technology professionals in India. Age (Years). 2013;20(29):135.
1
2. Mosadeghrad M. Investigate the relationship between knowledge of ergonomics and occupational injury in nurses. Journal of Shahrekord University of Medical Sciences.2004;6(3):21-32.
2
3. Khan R, Surti A, Rehman R, Ali U. Knowledge and practices of ergonomics in computer users. JPMA Journal of the Pakistan Medical Association.2012;62(3):213.
3
4. Carayon P, Kianfar S, Li Y, Xie A, Alyousef B.Wooldridge A. A systematic review of mixed methods research on human factors and ergonomics in health care. Applied ergonomics.2015;51:291-321.
4
5. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries.1990–2010: a systematic analysis for the Globa Burden of Disease Study 2010. The lancet.2012;380(9859):2163-96.
5
6. Tinubu BM, Mbada CE, Oyeyemi AL, Fabunmi AA.Work-related musculoskeletal disorders among nurses in Ibadan, South-west Nigeria: a cross sectional survey. BMC Musculoskeletal disorders.2010;11(1):12.
6
7. Bernard BP, Putz-Anderson V. Musculoskeletal disorders and workplace factors; a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. 1997.
7
8. Sauter S, Moon SD. Beyond biomechanics psychosocial aspects of musculoskeletal disorders in office work: CRC Press; 1996.
8
9. Menzel NN, Brooks SM, Bernard TE, Nelson A.The physical workload of nursing personnel association with musculoskeletal discomfort.International journal of nursing studies.2004;41(8):859-67.
9
10. Nelson A, Fragala G, Menzel N. Myths and Facts About Back Injuries in Nursing: The incidence rate
10
of back injuries among nurses is more than double that among construction workers, perhaps because misperceptions persist about causes and solutions. The first in a two-part series. AJN The American. Journal of Nursing. 2003;103(2):32-40.
11
11. Nussbaum MA, Torres N. Effects of training in modifying working methods during common patient-handling activities. International Journal of Industrial Ergonomics. 2001;27(1):33-41.
12
12. Karahan A, Kav S, Abbasoglu A, Dogan N. Low back pain :prevalence and associated risk factors among hospital staff. Journal of advanced nursing.2009;65(3):516-24.
13
13. Menzel NN. Back pain prevalence in nursing personnel: measurement issues. Aaohn Journal.2004;52(2):54-65.
14
14. Punnett L, Wegman DH. Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. Journal of electromyography and kinesiology. 2004;14(1).13-23.
15
15. North F, Syme SL, Feeney A, Head J, Shipley MJ, Marmot MG. Explaining socioeconomic differences in sickness absence: the Whitehall II Study. Bmj.1993;306(6874):361-6.
16
16. Leijon M, Hensing G, Alexanderson K. Gender trends in sick-listing with musculoskeletal symptoms in a Swedish county during a period of rapid increase in sickness absence. Scandinavian journal of social medicine. 1998;26(3):204-13.
17
17. Deros BM, Daruis DDI, Basir IM. A study on ergonomic awareness among workers performing manual material handling activities. Procedia-Social and Behavioral Sciences. 2015;195:1666-73.
18
18. Cheung K, Szeto G, Lai GKB ,Ching SS. Prevalence of and factors associated with work-related musculoskeletal symptoms in nursing assistants working in nursing homes. International journal of environmental research and public health. 2018;15(2):265.
19
19. Shaik AR, SripathiRao B, Husain A, LinnetteD'Sa J,editors. Effectiveness of Ergonomics AwarenessTraining Programme in Minimizing The Ergonomic Risk Factors in Dental Surgeons. Advanced Engineering Forum; 2013.
20
ORIGINAL_ARTICLE
Comparison of whole body 131Iodine scan results in four, seven and nine days after radio-iodine therapy of differentiated thyroid cancer
Introduction: Finding optimum time of post ablation whole body iodine scan in patients with differentiated thyroid cancer(DTC) treated with I-131.Material and Methods: 20 patients with DTC, who were treated with I131 underwent post ablation whole body iodine scan (WBIS) in days 4, 7 and 9 after treatment. A dual head gamma camera (e-cam, Siemens) equipped with high energy parallel hole collimator was used for imaging. The images were acquired with 7cm/min and stored in a 1024 ×256 matrix. Results: 3 Patients had negative WBIS in all three sets of imaging and 17 patients had postsurgical thyroid remnants on all 3 scans. On days 4 and 7 we detected 11 patients with cervical lymph node metastases while on day 9 only 9 patients showed cervical lymph node metastases.(P=0.135)On all 3 sets of images, we encountered 4 patients with mediastinal lymph node metastases and 1 patient with bone metastasis. In addition, all 3 sets of images detected lung metastases in three patients. The total number of affected foci did not have any statistical differences in whole body scan of day 4, 7 and 9. (P = 0.083)Conclusion: According to the radiation safety hazards for staff and technicians of nuclear medicine department and lack of difference in scan findings between 4 and 7 days after RAI, scanning the DTC patients in the day 7 after RAI administration , is more practicable, with less probability of missing the sites of involvement. Performing whole body iodine scans after 1 week is not recommended.
https://psj.mums.ac.ir/article_12688_91903de0094c28fc8d7787b8b9207b79.pdf
2019-04-01
52
55
10.22038/psj.2019.37525.1207
whole body I131 scan
Differentiated thyroid cancer
radio-iodine
Kamran
Aryana
aryanak@mums.ac.ir
1
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Mohammad
Ramezani
ramezanim@mums.ac.ir
2
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Seyed Rasoul
Zakavi
zakavir@mums.ac.ir
3
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Atena
Aghaee
aghaeeat@mums.ac.ir
4
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
LEAD_AUTHOR
1. Li N, Du XL, Reitzel LR, Xu L, Sturgis EM. Impact of enhanced detection on the increase in thyroid cancer incidence in the United States: review of incidence trends by socioeconomic status within the surveillance, epidemiology, and end results registry, 1980–2008. Thyroid. 2013; 23(1):103-10.
1
2. Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJ, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008; 35(10):1941-59.
2
3. Chen AY, Jemal A, Ward EM. Increasing incidence of differentiated thyroid cancer in the United States, 1988-2005. Cancer. 2009; 115(16):3801-7.
3
4. Kent WD, Hall SF, Isotalo PA, Houlden RL, George RL, Groome PA. Increased incidence of differentiated thyroid carcinoma and detection of subclinical disease. CMAJ. 2007; 177(11):1357-61.
4
5. Pellegriti G, Frasca F, Regalbuto C, Squatrito S, Vigneri R. Worldwide increasing incidence of thyroid cancer: update on epidemiology and risk factors. J Cancer Epidemiol. 2013; 2013:965212.
5
6. Aghaei A, Ayati N, Shafiei S, Abbasi B, Zakavi SR. Comparison of treatment efficacy 1 and 2 years after thyroid remnant ablation with 1110 versus 5550 MBq of iodine-131 in patients with intermediate-risk differentiated thyroid cancer. Nucl Med Commun. 2017; 38(11):927-31.
6
7. Schmidbauer B, Menhart K, Hellwig D, Grosse J. Differentiated thyroid cancer-treatment: state of the art. Int J Mol Sci. 2017; 18(6):E1292.
7
8. Carhill AA, Litofsky DR, Ross DS, Jonklaas J, Cooper DS, Brierley JD, et al. Long-term outcomes following therapy in differentiated thyroid carcinoma: NTCTCS registry analysis 1987-2012. J Clin Endocrinol Metab. 2015; 100(9):3270-9.
8
9. Jonklaas J, Sarlis NJ, Litofsky D, Ain KB, Bigos ST, Brierley JD, et al. Outcomes of patients with differentiated thyroid carcinoma following initial therapy. Thyroid. 2006; 16(12):1229-42.
9
10. Tuttle RM. Differentiated thyroid cancer: Radioiodine treatment. Waltham MA: UpToDate; 2016.
10
11. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994; 97(5):418-28.
11
12. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19(11):1167-214.
12
13. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006; 16(2):109-42.
13
14. Haugen BR, Sawka AM, Alexander EK, Bible K, Caturegli P, Doherty G, et al. American thyroid association guidelines on the management of thyroid nodules and differentiated thyroid cancer task force review and recommendation on the proposed renaming of encapsulated follicular variant papillary thyroid carcinoma without invasion to noninvasive follicular thyroid neoplasm with papillary-like nuclear features. Thyroid. 2017;27(4):481-3.
14
15. Fatourechi V, Hay ID, Mullan BP, Wiseman GA, Eghbali-Fatourechi GZ, Thorson LM, et al. Are posttherapy radioiodine scans informative and do they influence subsequent therapy of patients with differentiated thyroid cancer? Thyroid. 2000; 10(7):573-7.
15
16. Ronga G, Fiorentino A, Paserio E, Signore A, Todino V, Tummarello MA, et al. Can iodine-131 wholebody scan be replaced by thyroglobulin measurement in the post-surgical follow-up of differentiated thyroid carcinoma. J Nucl Med. 1990;31(11):1766-71.
16
17. Schlumberger M. Can iodine-131 whole-body scan be replaced by thyroglobulin measurement in the post-surgical follow-up of differentiated thyroid carcinoma? J Nucl Med. 1992; 33(1):172-3.
17
18. Hung BT, Huang SH, Huang YE, Wang PW. Appropriate time for post-therapeutic I-131 whole body scan. Clin Nucl Med. 2009; 34(6):339-42.
18
19. Castro MR, Bergert ER, Goellner JR, Hay ID, Morris JC. Immunohistochemical analysis of sodium iodide symporter expression in metastatic differentiated thyroid cancer: correlation with radioiodine uptake.J Clin Endocrinol Metab. 2001; 86(11):5627-32.
19
20. Wang S, Liang J, Lin Y, Yao R. Differential expression of the Na+/I‑ symporter protein in thyroid cancer and adjacent normal and nodular goiter tissues. Oncol Lett. 2013; 5(1):368-72.
20
ORIGINAL_ARTICLE
Differences in near miss incident reports across clinical experience levels in nurses: using national wide data base from the Japan council for quality healthcare
Introduction: Medical incidents occur frequently, necessitating a more effective prevention policy. Nurses have the highest employment rates in the healthcare occupations; therefore, they are a key to improving patient safety. Most reports of errors have focused on medicine errors by nurses or patient falls; however, the effects of different types of error and nurses’ experience have not been examined. The present study aimed to elucidate the factors that influence differences in reported near-miss incidents across clinical experience levels and department assignments. Material and Methods: A quantitative study was conducted using published data from the Japan Council for Quality Health Care. We analysed clinical experience level by near miss types. Results: A total of 17,105 cases were analysed (14,896 drug near misses, 1,857 medical device near misses, and 162 nursing near misses). Participants had a mean of 7.4 years of experience and a mean of 2.3 years within the department. Statistically significant differences between clinical experience level, events, drug administration, and medical devices used were observed. However, no differences were found in terms of nursing care near misses. Length of department assignment was related to the “human factors” in participants at Novice/Advanced beginner levels, as well as “environment/facilities and devices” in those at Competent and Proficient/Expert levels. The percentage of “environment/facilities and devices” that caused near misses with drugs and medical devices increased as clinical experience increased. Conclusion: The present study described the characteristics of clinical experience levels, providing meaningful information useful for developing new educational paradigms for effective training.
https://psj.mums.ac.ir/article_12690_3f075c1dd48c0033000cfe994b3358b1.pdf
2019-04-01
56
63
10.22038/psj.2019.37331.1204
Medical error
nurse
clinical experience level
Naomi
Akiyama
nakiyama@iwate-med.ac.jp
1
Department of Patient Safety, Iwate Medical University Hospital, Morioka, Iwate, Japan.
LEAD_AUTHOR
Tomoya
Akiyama
akiyamat@iwate-med.ac.jp
2
School of Nursing Iwate Medical University, Yahaba-cho, Iwate, Japan.
AUTHOR
Kenshi
Hayashida
kenshi@clnc.uoeh-u.ac.jp
3
Department of Medical Informatics and Management, Hospital of the University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
AUTHOR
Junko
Igawa
igawa@kuhp.kyoto-u.ac.jp
4
Department of Nursing, Kyoto University Hospital, Kyoto, Kyoto, Japan.
AUTHOR
Tomomi
Matsuno
tmatsuno@kuhp.kyoto-u.ac.jp
5
Department of Nursing, Kyoto University Hospital, Kyoto, Kyoto, Japan.
AUTHOR
Riju
Kono
konor@kuhp.kyoto-u.ac.jp
6
Department of Nursing, Kyoto University Hospital, Kyoto, Kyoto, Japan.
AUTHOR
Takeru
Shiroiwa
shiroiwa@niph.go.jp
7
Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako, Saitama, Japan.
AUTHOR
Keisuke
Koeda
keikoeda@iwate-med.ac.jp
8
Department of Patient Safety, Iwate Medical University Hospital, Morioka, Iwate, Japan.
AUTHOR
Katsuya
Kanda
kanda-tky@umin.ac.jp
9
Aino University, Ibaraki, Osaka, Japan.
AUTHOR
1. Jha AK, Prasopa-Plaizier N, Larizgoitia I, Bates DW.Patient safety research: An overview of the global evidence. BMJ Qual Saf 2010; 19: 42-7.
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2. Andel C, Davidow SL, Hollander M, Moreno DA. The economics of health care quality and medical errors. J Health Care Finance 2012; 39: 39-50.
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3. World Health Organization. Data and statistics. [cited March 2018]. Available from: http://www.euro. who. int/en /health-topics/Health-systems/patient safety/data-and-statistics
3
4. Metsälä E, Vaherkoski U. Medication errors in elderly acute care–a systematic review. Scand J Caring Sci 2014; 28: 12-28.
4
5. Karavasiliadou S, Athanasakis E. An inside look into the factors contributing to medication errors in the clinical nursing practice. Health Sci J 2014; 8: 32-44.
5
6. Department of Health Expert Group (Chairman,CMO). An organisation with a memory: Report of an expert group on learning from adverse events in the NHS chaired by the Chief Medical Officer. [cited June 2000]. Available from: http://webarchive.nationalarchives.gov.uk/20130105144251/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digit
6
alassets/@dh/@en/documents/digitalasset/dh_4065086.pdf.
7
7. JCQHC. Burns during a footbath or shower. [cited February 2014]. Available from: http://www.med safe.jp/pd /No.87 _MedicalSafetyInformation.pdf
8
8. JCQHC. Blood transfusion to wrong patient. [cited January 2016]. Available from: http://www.med safe.jp/pdf/No.110 _MedicalSafetyInformation.pdf
9
9. JCQHC. Failure to check oxygen remaining. [cited November 2010]. Available from: http://www.med safe.jp/pdf/ No.48_MedicalSafetyInformation.pdf
10
10. JCQHC. Project to Collect Medical Near-miss/Adverse Event Information 2015 Annual Report.[cited 2016]. Available from: http://www.med safe.jp/pdf/year_report_english_2015.pdf.
11
11. OECD Reviews of health care quality: Japan 2015.Paris: OECD publishing; 2015:1-211.
12
12. Hawkins FH, Orlady HW, eds. Human factors in flight. 2 nd ed. England: Avebury Technical; 1993.
13
13. Benner P. From novice to expert. AJN 1982;82:402-7.
14
14. Vrbnjak D, Denieffe S, O’Gorman C, Pajnkihar M.Barriers to reporting medication errors and near misses among nurses: A systematic review. Int J Nurs Stud 2016; 63: 162-78.
15
15. King L, Clark JM. Intuition and the development of expertise in surgical ward and intensive care nurses. J Adv Nurs 2002; 37: 322-9.
16
16. Ebright PR, Urden L, Patterson E, Chalko B. Themes surrounding novice nurse near-miss and adverse event situations. J Nurs Adm 2004; 34: 531-8.
17
17. Seki Y, Yamazaki Y. Effects of working conditions on intravenous medication errors in a Japanese hospital. J Nurs Manag 2006; 14: 128-39.
18
18. Esi Owusu Agyemang R, While A. Medication errors: types, causes and impact on nursing practice. Br J Nurs 2010; 19: 380-5.
19
19. Numata Y, Schulzer M, van der Wal R, Globerman J, Semeniuk P, Balka E, et al. Nurse staffing levels and hospital mortality in critical care settings:Literature review and meta-analysis. J Adv Nurs 2006; 55: 435-48.
20
20. Kane RL, Shamliyan TA, Mueller C, Duval S, Wilt TJ.The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Med Care 2007; 45: 1195-204.
21
21. Kendall-Gallagher D, Blegen MA. Competence and certification of registered nurses and safety of patients in intensive care units. Am J Crit Care 2018; 18: 106-13.
22
22. Polisena J, Gagliardi A, Urbach D, Clifford T, Fiander M. Factors that influence the recognition, reporting and resolution of incidents related to medical devices and other healthcare technologies: A systematic review. Syst Rev 2015; 4: 1-11.
23
ORIGINAL_ARTICLE
The Neurosurgical Registrar – are we still as busy as we were? A Quality Improvement Study
Introduction: Bleeps represent an important element of the on-call neurosurgical registrar’s workday. They provide instant contact between healthcare staff, while allowing doctors to perform tasks across the hospital. However the paging system causes interruptions and can interfere with patient care. We aim to develop and implement strategies to improve paging patterns and ultimately reduce unnecessary calls. Material and Methods: we conducted a retrospective analysis of electronic hospital bleep records over a 7-months period (March-September-2015) in which bleep logs were retrieved from the hospital paging system at University Hospital of Wales. The first cycle was followed by a set of interventions followed by a second data-collection cycle 12 months later.Results: The first cycle showed that on average the neurosurgical registrar received 57 bleeps per 24hrs. Almost a third of on-call bleeps were new referrals received from the local accident & emergency department or from other district hospitals. Other calls were received from our own hospital’s wards and Intensive Therapeutic Unit (10%), the paediatric ward (5%), neurosurgical theatres (5%) and emergency theatre (5%). The second cycle showed a 23% drop in the total number of bleeps compared to first cycle. The difference in bleep numbers was evident during the day shift, and no difference was noted during the night shift. No difference in the number of new referrals was noted. Conclusion: This project has shown that a simple change can result in a significant improvement. It also confirmed the value of team work and communication in improving quality of care.
https://psj.mums.ac.ir/article_12759_440c62da6a159eef19469782538a10fd.pdf
2019-04-01
64
68
10.22038/psj.2019.38591.1217
neurosurgical registrar
Quality Improvement
bleep frequency
Feras
Sharouf
sharouffh@cardiff.ac.uk
1
Department of Neurosurgery, University Hospital of Wales, United Kingdom.
LEAD_AUTHOR
Malik
Zaben
2
Clinical Lecturer in Neurosurgery, Neuroscience and Mental Health Research Institute, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park,United Kingdom
AUTHOR
Paul
Leach
3
Consultant Neurosurgeon, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
AUTHOR
1. Bhaduri M, Bew D. Quality improvement project on the acute surgical house-officer bleep. Int J Surg.2015;23(1):S102.
1
2. Ibrahim W, Lin S. Reducing time spent by junior doctors on call performing routine tasks at weekends. BMJ Qual Improv Rep. 2013;2(1):u200359.w932.
2
3. Brady AM, Byrne G, Quirke MB, Lynch A, Ennis S,Bhangu J, et al. Barriers to effective, safe communication and workflow between nurses and non-consultant hospital doctors during out-ofhours. Int J Qual Health Care. 2017; 29(7): 929-34.
3
4. Chisholm CD, Collison EK, Nelson DR, Cordell WH.Emergency department workplace interruptions are emergency physicians “interrupt‐Driven” and “multitasking”? Acad Emerg Med. 2000; 7(11):1239-43.
4
5. Agarwal R, Sands DZ, Schneider JD. Quantifying the economic impact of communication inefficiencies in U.S. hospitals. J Healthc Manag. 2010; 55(4):265-81.
5
6. Beary E. Appropriateness of bleeps: an audit of the bleep system over two week period. Irish Med J.2012; 105(7):249-50.
6
7. Thomas J, Davies C. The nursing shortage and the scope for reducing it by redefining their role.Health Serv Manage Res. 2005; 18(4):217-22.
7
8. Blum NJ, Lieu TA. Interrupted care. The effects of paging on paediatric resident activities. Am J Dis Child. 1992; 146(7):806-8.
8
9. Menon R, Rivett C. Time-motion analysis examining of the impact of Medic Bleep, an instant messaging platform, versus the traditional pager: a prospective pilot study. Digit Health. 2019; 5:2055207619831812.
9
10. Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, et al. Communication failures in the operating room: an observational classification of recurrent types and effects. Qual Saf Health Care.2004; 13(5):330-4.
10
11. Weiner BJ, Alexander JA, Shortell SM, Baker LC,Becker M, Geppert JJ. Quality improvement implementation and hospital performance on quality indicators. Health Serv Res. 2006; 41(2):307-34.
11
12. Guttman OT, Lazzara EH, Keebler JR, Webster KL, Gisick LM, Baker AL. Dissecting communication barriers in healthcare: a path to enhancing communication resiliency, reliability, and patient safety. J Patient Saf. 2018; 10:41.
12
13. Nagpal K, Vats A, Lamb B, Ashrafian H, Sevdalis N, Vincent C, et al. Information transfer and communication in surgery: a systematic review.Ann Surg. 2010; 252(2):225-39.
13
14. Nagpal K, Arora S, Vats A, Wong HW, Sevdalis N,Vincent C, et al. Failures in communication and information transfer across the surgical care pathway: interview study. BMJ Qual Saf. 2012;21(10):843-9.
14
15. Iversen TB, Melby L, Toussaint P. Instant messaging at the hospital: supporting articulation work? Int J Med Inform. 2013; 82(9):753-61.
15
16. Wu RC, Morra D, Quan S, Lai S, Zanjani S, Abrams H, et al. The use of smartphones for clinical communication on internal medicine wards. J Hosp Med. 2010; 5(9):553-9.
16
17. Joseph B, Pandit V, Khreiss M, Aziz H, Kulvatunyou N, Tang A, et al. Improving communication in level 1
17
trauma centers: replacing pagers with smartphones.Telemed J E Health. 2013; 19(3):150-4.
18
18. Haroon M, Yasin F, Eckel R, Walker F. Perceptions and attitudes of hospital staff toward paging system and the use of mobile phones. Int J Technol Assess Health Care. 2010; 26(4):377-81.
19
19. Martin G, Janardhanan P, Withers T, Gupta S. Mobile revolution: a requiem for bleeps? Postgrad Med J. 2016; 92 (1091):493-6.
20
20. Patel RK, Sayers AE, Patrick NL, Hughes K, Armitage J, Hunter IA. A UK perspective on smartphone use amongst doctors within the surgical profession.Ann Med Surg. 2015; 4(2):107-12.
21
21. Mobasheri MH, King D, Johnston M, Gautama S, Purkayastha S, Darzi A. The ownership and clinical use of smartphones by doctors and nurses in the UK: a multicentre survey study. BMJ Innov. 2015;1(4):174-81.
22
22. Morgan L, Hadi M, Pickering S, Robertson E, Griffin D, Collins G, et al. The effect of teamwork training on team performance and clinical outcome in elective orthopaedic surgery: a controlled interrupted time series study. BMJ Open. 2015;5(4):e006216.
23
ORIGINAL_ARTICLE
Relation between HER-2 gene expression and prognostic prostate cancer parameters in trus guided biopsies
Introduction: Prostate carcinoma is the most common type of cancer and the second lethal cancer in men. Overexpression of Her2-neu gene affects the growth and prognosis of some tumors. HER2 gene amplification is seen in about one-third of prostatic adenocarcinoma cases.it also seems to correlate with androgen independence of the prostate tumors. We evaluated the HER2-neu expression in prostate cancer and its relation with known prognostic factors, in this study. Material and Methods: Immunohistochemical staining was used to evaluate the expression of Her2-neu in 60 cases of prostate carcinoma. The relation between HER2-neu expression and prognostic factors of prostatic carcinoma was evaluated,which included serum PSA values , number of core involvement, high percentage of core involvement,Gleason score,Gleason grade,extra prostatic extension of the tumoral cells and tumor volume.Results: Among 60 patients included in our study ,Her2-neu was negative in 49 (81.7%) cases (zero score in 35 cases and score 1+ in 14 cases) , and a weakly positive expression (score 2+) was seen in 11 (%18/3) cases.Among evaluated factors, tumor volume was the only factor which significantly correlated with Her2-neu expression.Conclusion:The rate of Her2-neu expression was not high in our patients. Among various variables evaluated in our study,only tumor volume had significant statistical correlation with the expression of Her2-neu. According to low expression of Her2-neu in evaluated specimens in this study, it is necessary to conduct more studies to confirm the relationship of her2-neu and the known prognostic factors of prostate carcinoma.
https://psj.mums.ac.ir/article_12905_b815edbeaeab624cf90566f9edf82351.pdf
2019-04-01
69
74
10.22038/psj.2019.38482.1214
Prostate cancer
HER2-neu peptide
imaging guided biopsies
Gleason score
Mahmoud Reza
Kalantari
kalantarim@mums.ac.ir
1
Department of Pathology,Faculty of Medicine,Mashhad University of Medical Sciences,Mashhad,Iran.
AUTHOR
Reza
Mahdavi Zafarghandi
mahdavirz@mums.ac.ir
2
Kidney Transplantation and Complications Research Center,Mashhad University of Medical Sciences,Mashhad,Iran.
AUTHOR
Mahmoud
Tavakkoli
tavakkolim@mums.ac.ir
3
Kidney Transplantation and Complications Research Center,Mashhad University of Medical Sciences,Mashhad,Iran.
AUTHOR
Shakiba
Kalantari
kalantarish931@mums.ac.ir
4
Students Research Committee,Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Atena
Aghaee
aghaeeat@mums.ac.ir
5
Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Amin
Mirsani
amin.mirsani92@gmail.com
6
Kidney Transplantation and Complications Research Center,Mashhad University of Medical Sciences,Mashhad,Iran.
AUTHOR
Salman
Soltani
soltanis@mums.ac.ir
7
Kidney Transplantation and Complications Research Center,Mashhad University of Medical Sciences,Mashhad,Iran.
LEAD_AUTHOR
1. Kolahdoozan S, Sadjadi A, Radmard AR, Khademi H.Five common cancers in Iran. Arch Iran Med. 2010;13(2):143-6.
1
2. Tao Z, Shi A, Wang K, Zhang W. Epidemiology of prostate cancer: current status. Eur Rev Med Pharmacol Sci. 2015; 19(5):805-12.
2
3. Bashir MN. Epidemiology of prostate cancer. Asian Pac J Cancer Prev. 2015; 16(13):5137-41.
3
4. Pernar CH, Ebot EM, Wilson KM, Mucci LA. The epidemiology of prostate cancer. Cold Spring Harb Perspect Med. 2018; 8(12):a030361.
4
5. Olayioye MA, Neve RM, Lane HA, Hynes NE. The ErbB signaling network: receptor heterodimerization in development and cancer. EMBO J. 2000; 19(13):3159-67.
5
6. Yeh S, Lin HK, Kang HY, Thin TH, Lin MF, Chang C.From HER2/Neu signal cascade to androgen receptor and its coactivators: a novel pathway by induction of androgen target genes through MAP kinase in prostate cancer cells. Proc Natl Acad Sci.1999; 96(10):5458-63.
6
7. Edwards J, Mukherjee R, Munro AF, Wells AC, Almushatat A, Bartlett JM. HER2 and COX2 expression in human prostate cancer. Eur J Cancer.2004; 40(1):50-5.
7
8. Fonseca GN, Srougi M, Leite KR, Nesrallah LJ, Ortiz V. The role of HER2/neu, BCL2, p53 genes and proliferating cell nuclear protein as molecular prognostic parameters in localized prostate carcinoma. Sao Paulo Med J. 2004; 122(3):124-7.
8
9. Lara PN, Meyers FJ, Gray CR, Edwards RG, Gumerlock PH, Kauderer C, et al. HER‐2/neu is overexpressed infrequently in patients with prostate carcinoma. Results from the California Cancer Consortium Screening Trial. Cancer. 2002; 94(10): 2584-9.
9
10. Carles J, Lloreta J, Salido M, Font A, Suarez M, Baena V, et al. Her-2/neu expression in prostate cancer: a dynamic process? Clin Cancer Res. 2004;10(14):4742-5.
10
11. Nishio Y, Yamada Y, Kokubo H, Nakamura K, Aoki S, Taki T, et al. Prognostic significance of immunohistochemical expression of the HER2/neu oncoprotein in bone metastatic prostate cancer. Urology. 2006; 68(1):110-5.
11
12. Rubin MA, Girelli G, Demichelis F. Genomic correlates to the newly proposed grading prognostic groups for prostate cancer. Eur Urol. 2016; 69(4):557-60.
12
13. Sauter G, Steurer S, Clauditz TS, Krech T, Wittmer C, Lutz F, et al. Clinical utility of quantitative Gleason grading in prostate biopsies and prostatectomy specimens. Eur Urol. 2016; 69(4):592-8.
13
14. Sadjadi A, Nooraie M, Ghorbani A, Alimohammadian M, Zahedi MJ, Darvish-Moghadam S, et al. The incidence of prostate cancer in Iran: results of a population-based cancer registry. Arch Iran Med.2007; 10(4):481-5.
14
15. Mofid B, Jalali Nodushan M, Rakhsha A, Zeinali L, Mirzaei H. Relation between HER-2 gene expression and Gleason score in patients with prostate cancer. Urol J. 2009; 4(2):101-4.
15
16. Siampanopoulou M, Galaktidou G, Dimasis N,Gotzamani-Psarrakou A. Profiling serum HER2/NEU in prostate cancer. Hippokratia. 2013;17(2):108-12.
16
17. Baltaci S. Her-2/neu oncogene expression in prostate carcinoma: evaluation of gene amplification by FISH method. Turkish J Pathol.2008; 24(2):76-83.
17
18. Fantinato AP, Tobias-Machado M, Fonseca F, Pinto JL, Wroclawski ML, Wroclawski E, et al. HER2/neu expression by reverse transcriptase-polymerase chain reaction in the peripheral blood of prostate cancer patients. Tumori. 2007; 93(5):467-72.
18
19. Zhang YF, Guan YB, Yang B, Wu HY, Dai YT, Zhang SJ, et al. Prognostic value of Her-2/neu and clinicopathologic factors for evaluating progression and disease-specific death in Chinese men with prostate cancer. Chin Med J. 2011; 124(24):4345-9.
19
20. Shuch B, Mikhail M, Satagopan J, Lee P, Yee H, Chang C, et al. Racial disparity of epidermal growth factor receptor expression in prostate cancer. J Clin Oncol. 2004; 22(23):4725-9.
20
21. Mofid B, Nadoushan MJ, Rakhsha A, Mirzaei H, Zeinali L. Epidermal growth factor receptor gene in prostate cancer after radical prostatectomy. Iran J Cancer Prev. 2010; 3(4):174-7.
21
ORIGINAL_ARTICLE
Epidemiology and Burn out Consequences in a Large Therapeutic Center in Iran (2010-2015)
Introduction: Burns have impacts including medical, psychological, economic and social that involve patients and health care system. Epidemiologic factors of burns vary in different societies. While the effects of some burn variables on mortality rate, in similar circumstances, are expected to be universal. The present study was carried out to analyze the epidemiology, mortality, and current etiological factors of burn injuries.Material and Methods: This cross-sectional study was conducted during a period of 6 years (from 2010 to 2015). Data were obtained by the analysis of medical records of patients hospitalized in the Imam Reza Burn Center in Mashhad, Iran. The data were recorded by the nurses and staffs in the burn ward.Results: In our study, 1334 in-hospital burn patients were recorded. The mean age was 27 ± 5.67 years. The most common mechanism of burn was flame. The multivariable logistic regression modeling revealed, that the most important risk factors of patient mortality were length of stay (LOS) (OR=2.53(95% CI: 1.75-3.66), percentage of burn regarding body surface (BBS) OR=10.64(95% CI: 7.58-14.43), degree of burns OR=6.39(95% CI: 1.46-27.99). Conclusion: The results of our study revealed a high incidence of burns. Prevention plans should be made in this regard
https://psj.mums.ac.ir/article_13172_383e21c278e75cd2ecb3e73fe74405b7.pdf
2019-04-01
75
80
10.22038/psj.2019.40369.1229
Burn
Injury
Infection
Epidemiology
Maliheh
Ziaee
malihehziaee@gmail.com
1
Department of Community Medicine, School of Medicine, Social Determinants of Health Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
AUTHOR
Hamidreza
Naderi
naderihr@mums.ac.ir
2
Department of Infectious Disease and Tropical Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Maryam
Yaghubi
myaghooobi@yahoo.com
3
Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran . Department of Epidemiology, Faculty of Public Health, Iran University Of Medical Sciences, Tehran, Iran.
LEAD_AUTHOR
Nasrin
Khosravi
khosravin3@mums.ac.ir
4
Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Farnaz
Kamelfoladi
farnazfooladi.76@gmail.com
5
Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Fatemeh
Ghasimii
moghaddasf961@mums.ac.ir
6
Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Irandokht
Mostafavi
mostafavii2@mums.ac.ir
7
Mashhad University of Medical Sciences, Mashhad, Iran.
AUTHOR
Kamyar
Mansori
kamyarmansori@yahoo.com
8
Department of Epidemiology, Faculty of Public Health, Iran University Of Medical Sciences, Tehran, Iran.
AUTHOR
1. Lari AR, Alaghehbandan R, Nikui R. Epidemiological study of 3341 burns patients during three years in Tehran, Iran. Burns. 2000;26(1):49-53.
1
2. Lionelli G, Pickus E, Beckum O, Decoursey R, Korentager R. A three decade analysis of factors affecting burn mortality in the elderly. Burns. 2005;31(8):958-63.
2
3. Rafla K, Tredget EE. Infection control in the burn unit. Burns. 2011;37(1):5-15.
3
4. Lari AR, Alaghehbandan R. Nosocomial infections in an Iranian burn care center. Burns. 2000;26(8):737-40.
4
5. Askarian M, Hosseini RS, Kheirandish P, Assadian O. Incidence and outcome of nosocomial infections in female burn patients in Shiraz, Iran. Am J Infect Control. 2004;32(1):23-6.
5
6. Heideman M, Bengtsson A. The immunologic response to thermal injury. World J Surg. 1992;16(1):53-6.
6
7. Haik J, Liran A, Tessone A, Givon A, Orenstein A, Peleg K. Burns in Israel: demographic, etiologic and clinical trends, 1997–2003. Isr Med Assoc J.2007;9(9):659-62.
7
8. Padovese V, De Martino R, Eshan MA, Racalbuto V,Oryakhail MA. Epidemiology and outcome of burns in Esteqlal Hospital of Kabul, Afghanistan. Burns.2010;36(7):1101-6.
8
9. Tekin R, Yolbas I, Dal T, Okur M, Selçuk C. The evaluation of patients with burns during fifteen years period. Clin Ter. 2013;164(5):385-9.
9
10. Kobayashi K, Ikeda H, Higuchi R, Nozaki M,Yamamoto Y, Urabe M, et al. Epidemiological and outcome characteristics of major burns in Tokyo.Burns. 2005;31(1):S3-S11.
10
11. Iqbal T, Saaiq M, Ali Z. Epidemiology and outcome of burns: early experience at the country's first national burns centre. Burns. 2013;39(2):358-62.
11
12. Seo DK, Kym D, Yim H, Yang HT, Cho YS, Kim JH, et al. Epidemiological trends and risk factors in major burns patients in South Korea: a 10-year experience. Burns. 2015;41(1):181-7.
12
13. Agbenorku P, Edusei A, Ankomah J. Epidemiological study of burns in Komfo Anokye Teaching Hospital, 2006–2009. Burns. 2011;37(7):1259-64.
13
14. Groohi B, Alaghehbandan R, Lari AR. Analysis of 1089 burn patients in province of Kurdistan, Iran.Burns. 2002; 28(6):569-74.
14
15. Panjeshahin M-R, Lari AR, Talei A-R, Shamsnia J, Alaghehbandan R. Epidemiology and mortality of burns in the South West of Iran. Burns. 2001;27(3):219-26.
15
16. Alaghehbandan R, Rossignol AM, Lari AR. Pediatric burn injuries in Tehran, Iran. Burns. 2001; 27(2):115-8.
16
17. Barret J, Gomez P, Solano I, Gonzalez-Dorrego M, Crisol F. Epidemiology and mortality of adult burns in Catalonia. Burns. 1999;25(4):325-9.
17
18. Bang R, Ghoneim I. Epidemiology and mortality of 162 major burns in Kuwait. Burns. 1996;22(6):433-8.
18
19. Jerwood D, Dickson G. Audit of intensive care burn patients: 1982–1992. Burns. 1995;21(7):513-6.
19
20. Mabrouk AR, Omar ANM, Massoud K, Sherif MM, El Sayed N. Suicide by burns: a tragic end. Burns. 1999;25(4):337-9.
20
21. Sheth H, Dziewulski P, Settle J. Self-inflicted burns:a common way of suicide in the Asian population. A 10-year retrospective study. Burns. 1994;20(4):334-5.
21
22. Liu E, Khatri B, Shakya Y, Richard B. A 3 year prospective audit of burns patients treated at the Western Regional Hospital of Nepal. Burns. 1998;24(2):129-33.
22
23. El Danaf A. Burn variables influencing survival: a study of 144 patients. Burns. 1995;21(7):517-20.
23
24. Mzezewa S, Jonsson K, Aberg M, Salemark L. A prospective study on the epidemiology of burns in patients admitted to the Harare burn units. Burns.1999;25(6):499-504.
24