[Evaluating the performance of family physician in rural health centers, Bardaskan, 2013]

Background and Aims: The administration of family physician program is one of the leading health system corner stones with the aim of improving service delivery and achieving justice. The aim of present study is evaluation the performance of health team in implementation of family physician program in health centers of Bardaskan

Materials and Methods: In this cross-sectional study, 7 rural health centers which were affiliated with Bardaskan health center of Khorasan Razavi enrolled with census sampling method. The information are considered as visit of doctor and midwife, use of laboratory and radiology services, rates of referral and feedback which were collected through registration forms of patient information. In health center, using descriptive statistics, "chi-square" test and statistical analysis wereusedbySPSS 18

Results: The average number of patients visited by physicians in the study was 11.1 and the average number of references to the laboratorywas 6.6. The different months of the year showed a non-significant relationship [p-value=0.2-p-value=0.3] with these factors. Average percentage of referral was 6.6; there wassignificant difference in different months. [p value= 0.003]

Conclusion: Currenttrends in family physician performance do not show much changein term of visited patients by physicians and using the laboratory services. This could be due to the lack of an active approach in screening and service delivery. The possible reason for downside steps can be due to presence of specialist physician and self-referring ofpatients directly to the city physicians in order to get health services

Proactive risk assessment of the laboratory management process in Ghaem Hospital, Mashhad [2013]

Laboratory errors may occur in every stage of laboratory management process and lead to a considerable harm to inpatients. This study was aim to investigate the Proactive risk assessment of the laboratory management process in Ghaem Hospital, Mashhad [2013]. This was a descriptive research that quantitatively and qualitatively analyzed some failure modes and effects. In order to classify the modes of failure and effective causes of them and also determining the improvement strategies, we have used "nursing error management association", "Eindhoven" and "theory of inventive problem solving" models respectively. In 5 steps of laboratory management process which is conducted on17 listed sub-processes, on average 59 error modes in each ward was identified. 18.7% of error modes were identified as high risk errors [hazard score >/= 8]. Most of error causes were related to human factors [42.7%].In addition, 31.6% of preventive measures were assigned in human resources management strategy group and 16.9% in team work group. The Healthcare Failure Mode and Effect Analysis method was very efficient in identifying failure modes, determining causes which impact each failure mode, and proposing improvement strategies for laboratory management processes of Ghaem Department

Risk assessment of drug management process in women surgery department of qaem educational hospital [QEH] using HFMEA method [2013]

Evaluation and improvement of drug management process are essential for patient safety. The present study was performed whit the aim of assessing risk of drug management process in Women Surgery Department of QEH using HFMEA method in 2013. A mixed method was used to analyze failure modes and their effects with HFMEA. To classify failure modes; nursing errors in clinical management model, for classifying factors affecting error; approved model by the UK National Health System, and for determining solutions for improvement; Theory of Inventive Problem Solving, were used. 48 failure modes were identified for 14 sub-process of five steps drug management process. The frequency of failure modes were as follow: 35.3% in supplying step, 20.75% in prescription step, 10.4% in preparing step, 22.9% in distribution step and 10.35% in follow up and monitoring step. Seventeen failure modes [35.14%] were considered as non-acceptable risk [hazard score = 8] and were transferred to decision tree. Among 51 Influencing factors, the most common reasons for error were related to environmental factors [21.5%], and the less common reasons for error were related to patient factors [4.3%]. HFMEA is a useful tool to evaluating, prioritization and analyzing failure modes in drug management process. Revision drug management process based focus-PDCA, assessing adverse drug reactions [ADR], USE patient identification bracelet, holding periodical pharmaceutical conferences to improve personnel knowledge, patient contribution in drug therapy; are performance solutions which were placed in work order

Developing an appropriateness criteria for knee MRI using the rand appropriateness method [RAM]-2013

Knee pain Is one of the most common reasons patients visit their physician. In this regard Magnetic Resonance Imaging [MRI] is the tool of preference for diagnosis. The aim of this study was to determine appropriate guidelines for knee MRI administration using the RAND Appropriateness Method [RAM]-2013. This qualitative study was done in the Mashhad University of Medical Sciences in 2013. The most appropriate approved knee MRI administration clinical guidelines were evaluated using Guidelines Evaluation and Research Appraisal [AGREE]. Panel members consisting of six orthopedic and three rheumatologic doctors gave scores ranging from 1 to 9 for each scenario. The indications were grouped as appropriate, equivocal and inappropriate. Data were analyzed by descriptive statistics and SPSS ver. 18 software. Sixty-three scenarios were extracted from the guidelines and then the scenarios were evaluated in 26 indications. Thirty-two [50.79%] cases were considered appropriate, 12 [19.04%] cases uncertain and 19 [30.1%] cases inappropriate. The RAND appropriateness method is helpful in identifying the opinion of stakeholders in health care systems. Moreover, making practical use of clinical guidelines can improve patients' quality of care and prevent un-necessary costs

[Effect of nutrition education during puberty on nutritional knowledge and behavior of secondary school female students in Birjand in 2012]

Background and Aim: Growth spurt during adolescence, particularly the occurrence of menstruation in girls, increases their nutritional needs. The present study aimed at determining the effect of nutrition education on nutritional knowledge and Behavior of secondary school female students in the city of Birjand

Materials and Methods: In this quasi-experimental study, 120 second grade secondary students in Birjand in 2012 were selected through two-stage cluster sampling method and were randomly divided into intervention and control groups. Data collection tool was a questionnaire which was completed by the students both before and one month after intervention. The obtained data was analyzed by means of descriptive and analytical statistics including chi-square, independent and paired t-tests, and ANOVA at the significant level of 0.05 using SPSS software [V:16]

Results: Mean scores of nutritional knowledge in the intervention group after education increased from 21.35 +/- 4.57 to 26.66 +/- 4.4 [P>0.001] and their mean performance increased from 1.84 +/- 7.39 to 1.86 +/- 8.31 [P<0.04]. A significant difference in mean scores of knowledge between the control group and the intervention group was observed [P<0.05]. However, performance mean difference between the two groups was not significant

Conclusion: Education through lecture and asking/answering questions can significantly increase adolescents' awareness and to some extent, their nutritional performance, although more effective methods are advised to promote the situation

Quality of labor support during labor

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. 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. 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. 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.

Health Care Failure Mode and Effect Analysis: a Useful Proactive Risk Analysis of Nutrition and Food Distribution in Mashhad Qaem Hospital's Women's Surgery Ward in 2013

Good medical nutrition therapy [MNT] is crucial to inpatients' health and treatment, and is part of routine hospital cares. Surgery ward is a highly danger-prone section in any hospital. The present study was conducted for a proactive risk analysis of nutrition and food distribution in Mashhad Qaem Hospital' Women's Surgery Ward in 2013 through health care failure mode and effect analysis [HFMEA]. A qualitative-quantitative research identified and analyzed the failure modes and effects through HFMEA. To rank error modes, we drew upon nursing errors in the clinical management model; to rank the effective causes of failure, we approved the model by the UK National Health System; and to rank the performance improvement approaches, we used the theory of inventive problem solving, TRIZ [theory of inventive problem solving]. A total of 42 failure modes were identified for 15 sub-processes listed in 7 processes of nutrition and food distribution. In sum, 11.9% of the failures modes were classified as high risk [hazard scores >=8]. Of 15 effective failure modes, the highest number of cause failure modes was associated with team factors, and the lowest number was associated with facilities. Using proactive HFMEA is highly effective in detecting potential failures in medication, effective factors in failure modes, and performance improvement approaches in hospital food distribution. [Monitoring proper patient-wards relationship], [committee establishment on diet, nutrition and medications], [performance assessment checklist making] and [supervising by nutrition authority over food distribution in wards] were identified as effective performance approaches in the Women's Surgery Ward in Qaem Hospital

Nerve stimulator guided axillary block in painless reduction of distal radius fractures; a randomized clinical trial

Given the high prevalence of upper extremity fractures and increasing need to perform painless reduction in the emergency departments, the use of analgesic methods with fewer complications and more satisfaction appears to be essential. The aim of this study is comparison the nerve stimulator guided axillary block [NSAB] with intravenous sedation in induction of analgesia for painless reduction of distal radius fractures. In the present randomized clinical trial, 60 patients [18-70 years of age] suffered from distal radius fractures, were divided into two equal groups. One group received axillary nerve block by nerve stimulator guid-ance and the other procedural sedation and analgesia [PSA] using midazolam/fentanyl. Onset of analgesia, duration of analgesic effect, total procedure time and pain scores were recorded using visual analogue scale [VAS] and the outcomes were compared. Chi-squared and student t test were performed to evaluate differences between two groups. Sixty patients were randomly divided into two groups [83.3% male]. The mean age of patients was 31 +/- 0.7 years. While the onset of analgesia was significantly longer in the NSAB group, the mean total time of procedure was shorter than PSA [p<0.001]. The NSAB group needed a shorter post-operative observation time [P<0.001]. Both groups experienced equal pain relief before, during and after procedure [p>0.05]. It seems that shorter post-operative monitoring time and consequently lesser total time of procedure, make nerve stimulator guided axillary block as an appropriate alternative for procedural sedation and analgesia in painless reduction of distal radius fractures in emergency department

[Correlation between MRS and serum PSA in the diagnosis of local recurrence after radical prostatectomy]

Multifocality, multicentricity and extension beyond the prostate capsule are all characteristics of prostatic adenocarcinoma that may escape diagnosis by conventional CT scanning or MRI. This study was designed to assess the diagnostic value of magnetic resonance spectroscopy [MRS] in prostatic carcinoma and its compatibility with prostatic specific antigen [PSA] as the conventional method. In this cross-sectional study, we recruited 139 patients with previous radical prostatectomy referring to Radiology department of Hazrate-e-Rasul Hospital during the first half of 2011 for the evaluation of local recurrence. Traditionally, local recurrence is defined as serum PSA concentration >0.2 ng/dl. We used 1.5-tesla Siemens Avanto MRI unit with endorectal coil and measured creatine, choline and citrate levels before calculating choline-creatine/citrate ratio. Correlation between MRS findings with PSA concentration was evaluated in regards to the multiple levels of the previously mentioned ratio. Local recurrence was found in 107 [77%] patients based on PSA levels. The mean values for serum PSA levels and creatine-choline/citrate ratio were significantly different in patients with and without local recurrence. Creatine-choline/citrate ratios greater than 50, 100 and 150 [as different cut-off points of recurrence] were respectively seen in 104, 102 and 97 patients and agreement ratio between MRS and PSA in these levels were 94.1%, 94.4% and 85.1%, respectively. Correlation coefficient between these two methods was 0.481. MRS is a valuable tool for evaluating recurrence inpatients with prostate cancer treated by radical prostatectomy and it is in good agreement with serum PSA levels

[Design patterns in the crisis management Shohada hospital]

Iran is the fourth disaster prone country in Asia and tenth in the world. It constantly exposed to natural and manmade disasters and terrorist attacks. The paper is going to develop a crisis management plan for Shohada hospital. In this study, firstly crisis management programs in America and Europe are amended and compiled. Then, by providing aerial maps and positioning of units' establishment, the involved officials will provide necessary training and functional exercises in order to examine the lessons learned when the hospital is intact or has been destroyed Regarding the pre-designed organization chart training immediately after disaster, the program should be planned and hospital crisis committee comprising various units of the hospital should be established and a responsible associated with three successors considered for each unit. The operation should be started following the issuance of Chief of Staff to the hospital president and to the authorities of the units. Then, the authorities should recall their personnel, accomplish the predetermined tasks and also should end the operation by top officials command. The results indicated that the hospital crisis management programs should be compiled based on available facilities and equipment regarding the natural disasters around the world, failure of managers responsible for controlling crises such as Taiwan earthquake, and lack of adequate facilities to deal with nuclear and chemistry crises in America. At the end, the strength and weak points should be examined by providing the necessity training and performing as maneuver for the involved authorities in the hospital

Views of users towards the quality of hospital information system in training hospitals

Users of hospital information system [HIS] use these systems during working day and know its problems better than others know. Studying their views is very important and can be especially effective in the development of the information system. The aim of this study was to investigate the users' view towards the quality of hospital information system in the training hospitals in Mashhad University of medical sciences. The current study was an applied research in Training Hospitals of Mashhad [East of Iran], which was conducted with descriptive cross-sectional method. A four-section questionnaire was designed for data collection consisting of: characteristics of information quality, reasons of low quality of information, accessibility of information and decision support. Validity and reliability were tested and SPSS was used for data analysis. 62.8% of users explained that one of reasons of low quality information was a problem related to obtaining information. 47.7% of them were unsatisfied with hospital information system ability for decision-making support. In general, 53.2% of users were slightly satisfied with the overall quality information of the system. There are some problems concerning information quality of HIS in Mashhad training hospitals. These problems include inappropriate information quality of the system and incompatibility with user needs which leads to decreased satisfaction of users towards the system