Quantitative Evaluation of Diabetic Medical Record Documentation.

BACKGROUND: The documentation of medical records of diabetic patients is very important for the treatment of diabetes. The purpose of this study was to conduct quantitative evaluations of the Diabetic Medical Record (DMR) and Documentation Completeness Rate (DCR). METHODS: In this retrospective study, we evaluated the DCR of DMRs in the Comprehensive Diabetes Center of Imam Reza Hospital (CDRIRH). A checklist was prepared to evaluate the DCR. The overall assessment of the DCR was represented according to the following rating: 95-100% as strong, 75-94% as moderate, and less than 75% as weak. The free texts that physicians recorded in the DMRs were extracted to identify the data elements that physicians must record. In addition, the clinical importance of the data elements of the DMRs from the perspective of the endocrinologists was determined and then compared with the DCR. RESULTS: In this study, 1,200 DMRs and DCRs for 50 data elements in eight major categories were evaluated. The total DCR average was 30% and data elements in the laboratory test results category demonstrated the highest DCR (50.5%), whereas the least percentage was demonstrated in the internal visits category. The DCR for the other main categories was: demographic information = 48.5%; patient referral information = 14.2%; diagnosis = 5%; anti-hyperglycemic medications = 25.5%; diabetic complications = 17.7%; and results of specialty and subspecialty consultation = 41.7%. The evaluation of the free text data element in the DMRs indicated that physicians documented free text data elements in three categories. CONCLUSION: Our results demonstrated a weak level of documentation in the DMRs. The physicians had written many data elements in the margins of the DMRs. Therefore, it indicates the necessity to modify and change the structure of the DMR.

Methimazole discontinuation before radioiodine therapy in patients with Graves' disease.

INTRODUCTION: Although radioiodine therapy (RIT) has been used for the treatment of hyperthyroidism for many decades, there is no consensus on the optimal time of methimazole (MMI) discontinuation before RIT. The aim of this clinical trial is to study the effect of three different time points of MMI discontinuation on response to RIT. METHOD AND PATIENTS: Overall, 151 patients (18-65 years old), with Graves' disease who were taking MMI and referred to I-131 therapy, were consecutively assigned to one of three groups, and MMI was discontinued for 24-48, 48.1-72, and 72.1-168 h in group, 1, 2, and 3, respectively. Radioiodine uptake was measured in all patients and the radioiodine dose was calculated according to the Quimby formula to deliver 7.4 MBq of I-131 per gram of thyroid weight. Response to RIT was assessed at 1, 3, 6, and 12 months after RIT. RESULTS: A total of 102 women and 49 men were included in the study. The mean administered dose of I-131 was 362.9±188.7 MBq (9.8±5.1 mCi) and the mean time to response for radioiodine was 4.1±3.6 months. There was no significant difference between the three groups in age, thyroid weight, anti-TPO level, radioactive iodine uptake level, and radioiodine dose (P>0.1). Response to RIT at 1, 3, 6, and 12 months after administration was also not different between the three groups (P>0.57). CONCLUSION: No difference was found in the response to treatment between patients with MMI discontinuation for 24-48, 48.1-72, and 72.1-96 h before RIT. Shorter discontinuation of MMI before RIT may be preferable in most patients. Video Abstract: http://links.lww.com/NMC/A39.

Antibacterial Effect of Diclofenac Sodium on Enterococcus faecalis.

OBJECTIVE: Non-steroidal anti-inflammatory drugs (NSAIDs) have shown antibacterial activity in some recent studies. The aim of this study was to evaluate the antibacterial effect of diclofenac against Enterococcus faecalis (E. faecalis) as a resistant endodontic bacterium in comparison with ibuprofen, calcium hydroxide and amoxicillin. MATERIALS AND METHODS: The antibacterial activity of materials was evaluated using agar diffusion test and tube dilution method. Mixtures of 400 mg/ml of materials were prepared. The bacteria were seeded on 10 Muller-Hinton agar culture plates. Thirty microliter of each test material was placed in each well punched in agar plates. After incubation, the zone of bacterial inhibition was measured. Minimum inhibitory concentration (MIC) of the test materials was determined by agar dilution method. One-way Analysis of Variance (ANOVA) followed by Sidak post hoc test was used to compare the mean zone of microbial growth in the groups. RESULTS: There were significant differences between the two groups (p< 0.05). Results of the agar diffusion test showed that antibiotics (amoxicillin, gentamycin) had the greatest antibacterial activity followed by NSAIDs (ibuprofen, diclofenac). Ca(OH)2 failed to show antibacterial activity. Diclofenac and ibuprofen showed distinct antibacterial activity against E. faecalis in 50 µg/ml and above concentrations. CONCLUSION: Within the limitations of this in vitro study, it is concluded that diclofenac and ibuprofen have significantly more pronounced antibacterial activity against E. faecalis in comparison with Ca(OH)2.

Evaluation of Genetic Pattern of Gentamicin-resistant Enterococci Isolated from Clinical Samples.

BACKGROUND AND AIMS: Enterococci are among resistant microorganisms to antibiotics and are responsible for some of acute gingival infections. This study aimed at molecular evaluation of gentamicin-resistant enterococcus species and determining the resistance genes. MATERIALS AND METHODS: Clinical samples were cultured on BHI medium and enterococci were isolated by specific methods and antibiograms were prepared. DNA was derived from gentamicin-resistant species by alkaline lysis method and replicated by PCR method. Four gentamicin-resistant genes were evaluated by electrophoresis method on agarose gel. RESULTS: From 105 Enterococcus faecalis isolates, 36.2% and from 38 Enterococcus faecium isolates, 78.2% were resistant to gentamicin. 60% of these species bore aac (6')- le - aph(2")- la gene. ph(2")- Ib,Ic,Id genes were not seen in any of the evaluated species. CONCLUSION: In gentamicin-resistant species of E. faecalis and E. faecium, the aac (6')- le - aph(2")- la gene was identified as the main cause of resistance.

Microbial Flora of Root Canals of Pulpally-infected Teeth: Enterococcus faecalis a Prevalent Species.

BACKGROUND AND AIMS: The aim of this study was to determine the microorganisms prevalent in the necrotic dental pulp and root canals of unsuccessfully treated teeth. MATERIALS AND METHODS: The present study was conducted on 150 single-rooted teeth of patients referring to a dental clinic. Sampling was performed by placing a sterile paper point in the canal for 60 s. Bacterial samples were evaluated by a microbiological technique specific for anaerobic species, used for isolation and identification of sampled strains. RESULTS: From the 150 samples taken, 101 were from necrotic pulps (primary infection) and 49 were from the teeth with an unsuccessful endodontic treatment (secondary infection). CONCLUSION: Enterococcus faecalis was a prevalent species in the failed root canals evaluated.