Clinical audit of emergency unit before and after establishment of the emergency medicine department.

OBJECTIVE: To assess the deficiencies and potential areas through a medical audit of the emergency departments, in six general hospitals affiliated to Shahid Beheshti University of Medical Sciences at Tehran, Iran, after preparing specific wards-based international standards. METHODS: A checklist was completed for all hospitals which met our eligibility criteria mainly observation and interviews with head nurses and managers of the emergency medicine unit of the hospitals before (2003) and after (2008) the establishment of emergency departments there. Domains studied included staffing, education and continuing professional development (CPD), facility (design), equipment, ancillary services, medical records, manuals and references, research, administration, pre-hospital care, information systems, disaster planning, bench-marking and hospital accreditation. RESULTS: Education and CPD (p = 0.042), design and facility (p = 0.027), equipment (p = 0.028), and disaster (p = 0.026) had significantly improved after the establishment of emergency departments. Nearly all domains showed a positive change though it was non-significant in a few. In terms of observation, better improvement was seen in disaster, security, design, and research. According to the score for each domain compared to what it was in the earlier phase, better improvement was observed in hospital accreditation, information systems, security, disaster planning, and research. CONCLUSION: Security, disaster planning, research, design and facility had improved in hospitals that wave studied, while equipment, records, ancillary services, administration and bench-marking had the lowest improvement even after the establishment of emergency department, and, hence, needed specific attention.

Exploratory study of factors affecting continuity of cancer care: Iranian Women's perceptions.

BACKGROUND: Today, breast cancer is increasing in nearly all societies. Currently, cancers are the third leading cause of death in Iran after cardiovascular diseases and accidents. Of the cancers, breast cancer is spreading particularly rapidly among Iranian women. Negative effects of discontinuation of care on patient survival have been well documented. Inhibiting or facilitating factors affecting continuity of care at different stages of the patient care continuum should be identified. MATERIALS AND METHODS: The current study implemented a qualitative method that provided tools to examine factors in detail. This study was conducted on 22 women, undergoing surgery and chemotherapy after being diagnosed with breast cancer. Content analysis was the technique adopted. RESULTS: The effective factors in continuity of care from the patients' perception, based on the participant statements, were classified into three categories of evaluation of symptoms, psychological reactions, and care triggers with several subcategories. CONCLUSIONS: According to the outcomes of the current study, it can be noted that, the patient experiences can be brought into use by health-care professionals and assist them in providing patient sand their families with adequate consulting services. It can also provide an opportunity for making interventions tailored to the community culture, and closer adherence of patients to the prescribed treatments.

Process of coping with mastectomy: a qualitative study in Iran.

BACKGROUND: Breast cancer is the most prevalent cancer among Iranian women and mastectomy comprises 81% of surgeries for treatment of breast cancer. Mastectomy may create feelings such as deformation or impairment in patients, cause body-image disorder, and reduce sexuality and sexual activity which in turn may entail mental disorders. The study aimed to elaborate coping processes. MATERIALS AND METHODS: A grounded theory method was used in conducting this study. Twenty Iranian participants undergoing mastectomy were recruited with purposive sampling. An open, semi-structured questionnaire were developed. Obtaining consent, conversations were recorded and immediately transcribed after each session. Data analysis was carried out with the constant comparative method using the Strauss Corbin approach. RESULTS: Analyzing the collected data, the study came up with seven main categories which affected the coping process in patients with breast cancer, namely: reactions to mastectomy; loss and death contest; reconstruction of evaluation system; consent for undergoing mastectomy; reactions and troubles after loss; confrontation of loss and health; and reorganization and compatibility with changes. CONCLUSIONS: The results of the study indicated: when patients become informed of their breast cancer and the necessity of undergoing mastectomy as the treatment, they probably pass through seven categories to adapt after mastectomy. Having insight about them is likely to contribute medical personnel in leading patients to the highest degree of feeling healthy.

Breast cancer in Ardabil province in the north-west of Iran: an epidemiological study.

Breast cancer accounts for about 26% of all newly diagnosed cancers in women aged 20 to 59 years. As part of a basic program for cancer control, the present cross sectional descriptive study was conducted with the objective of determining the epidemiology of breast cancer in Ardabil province during 2003-2010. Necessary information on 469 recorded cases of breast cancer in the registry were collected by check list from patient's files and then analyzed by statistical methods with SPSS.16 software. Some 455 of the patients (97%) were female, 329 (70.1%) residing in Ardabil. The mean age was 46.8 ± 13.6 and most were in the age group of 40 - 60. The most prevalent pathologic form was infiltrative ductal carcinoma with 316 cases (67.4%), the largest proportion being grade II (30.6%), but very many belonged to grades III and IV (40.5%). Breast cancer in Ardabil province appeared to slightly increase over the period studied. The results were similar to other places in Asia. With regard to this, more widespread studies are required to determine factors influencing the prevalence at low age and also how to promote early detection.