Investigating Causes of Medical Errors in Intensive Care Units in Iran: A Cross-sectional Study.

Background: Medical errors cause disability and mortality in intensive care units (ICUs). We aimed to determine the occurrence and causes of medical errors in the ICUs of Iran. Methods: In this cross-sectional study, data from the family complaint files referred to The disciplinary authority of Iran Medical Council was retrospectively reviewed to explore the causes of medical errors. Statistical analysis was performed in SPSS Version 26.0. Results: A total of 293 complaint files were referred to the disciplinary commission from 2014 to 2019, of which 95 files were related to medical errors in ICUs. The median age of patients was 62 years (46-74 years) and 52 (54.7%) patients were men. Also, 37 (38.9%) patients had decreased levels of consciousness and 42 (42.2%) patients had cardiovascular disease. A total of 40 (42.1%) patients experienced a single medical error and 55 (57.9%) patients experienced more than 1. Causes of medical errors in patients were physician's or nurse's negligence in 53 (55.8%) patients, weak interaction of physician and nurse with the patient and family members in 11 (11.6%) patients, weak interprofessional interaction among physicians in 7 (7.4%) patients, equipment and structure of ICUs in 7 (7.4 patients, nature of ICUs and patients in 6 (6.3%) patients, weak physician-nurse interprofessional interaction in 5 (5.2%) patients) patients, low attention of the physician and the nurse to medication safety in 6 (6.3%) patients. Conclusion: Patient safety is impacted by a variety of medical mistakes. Interprofessional strategies can be developed and put into action to mitigate medical errors in ICUs.

Kinetic and thermodynamic insights into interaction of erlotinib with epidermal growth factor receptor: Surface plasmon resonance and molecular docking approaches.

Epidermal growth factor receptor (EGFR) plays an important role in cell proliferation at non-small cell lung cancer (NSCLC). Therefore, targeted therapy of cancer via this kind of receptor is highly interested. Small molecule drugs such as erlotinib and gefitinib inhibit EGFR tyrosine kinase and thus suppress cell proliferation. At this paper, erlotinib interaction with EGFR on the cell surface was studied via surface plasmon resonance (SPR) and molecular docking methods. Kinetic parameters indicated that erlotinib affinity toward EGFR was increased through increment of temperature. The thermodynamic analysis showed that van der Waals and hydrogen binding forces play a major role in the interaction of erlotinib with EGFR. Docking results showed that Domain II in EGFR has role in the interaction with erlotinib. Besides, the binding energy for this interaction was -10.7 kcal/mol, which is suitable for binding of erlotinib to Domain II in EGFR.

Segmentation of cardiac fats based on Gabor filters and relationship of adipose volume with coronary artery disease using FP-Growth algorithm in CT scans.

Heart mediastinal and epicardial fat tissues are related to several adverse metabolic effects and cardiovascular risk factors, especially coronary artery disease (CAD). The manual segmentation of those fats is that the high dependence on user intervention and time-consuming analyzes. As a result, the automated measurement of cardiac fats could be considered as one of the most important biomarkers for cardiovascular risks in imaging and medical visualization by physicians. In this paper, we validate an automatic approach for the cardiac fat segmentation in non-contrast CT images then investigate the correlation between cardiac fat volume and CAD using the association rule mining algorithm. The pre-processing step includes threshold and contrast enhancement, the feature extraction step includes Gabor filter bank based on GLCM, the cardiac fat segmentation step is predicated on pattern recognition classification algorithms, and eventually, the step of investigating the relationship between cardiac fat volume and CAD is using FP-Growth algorithm. Experimental validation using CT images of two databases points to a good performance in cardiac fat segmentation. Experiments showed that the accuracy of the designed algorithm using the ensemble classifier with the best performance over other classifiers for the cardiac fat segmentation was 99.2%, with a sensitivity of 96.3% and a specificity of 99.8%. The results of using the FP-Growth algorithm showed that the low volume of epicardial (Confidence = 0.6818, Lift = 1.0626) and mediastinal (Confidence = 0.6696, Lift = 1.0436) fat are associated with healthy individuals and the high volume of epicardial (Confidence = 0.8, Lift = 2.2326) and mediastinal (Confidence = 0.75, Lift = 2.093) fat are related to individuals of CAD. As a result, cardiac fats can be used as a reliable biomarker tool in predicting the extent of CAD stenosis.

Nanomaterials and phase sensitive based signal enhancment in surface plasmon resonance.

Measurement of small molecules in extremely dilute concentrations of analyte play an important role in different issues ranging from food industry to biological, pharmaceutical and therapeutical applications. Surface plasmon resonance (SPR) sensors can be a suitable choice for detection of small molecules based on interactions with biomolecules. However, sensitivity of the system for detection of these molecules is very low. Improving sensitivity has been a challenge for years. Therefore, different methods have been used to enhance SPR signals. The SPR signal enhancement using numerous nanomaterials has provided exciting results. Among various nanomaterials, metal nanoparticles (for instance gold, silver and magnetic nanoparticles), quantum dots, nanorads, and carbon-based nanostructures have got much attention due to ease in fabrication, appropriate size and shape. In addition to the advantages provided by using nanomaterials, signal enhancement provided by the appropriate use of phase information of the reflected light could be also important to improve SPR sensitivity. Phase-sensitive SPR sensors are able to detect infinitesimal changes in external properties of target while traditional type of SPR cannot demonstrate these changes. This article provides an overview on signal enhancment in SPR using nanomaterials and properties of light. We also discuss on recent progresses of the field, describing basic concepts concerning nanostructures as well as phase-sensitive sensors as platform for enhancement of signal in SPR.

Design and construction of an optical computed tomography scanner for polymer gel dosimetry application.

Polymer gel dosimeter is the only accurate three dimensional (3D) dosimeter that can measure the absorbed dose distribution in a perfect 3D setting. Gel dosimetry by using optical computed tomography (OCT) has been promoted by several researches. In the current study, we designed and constructed a prototype OCT system for gel dosimetry. First, the electrical system for optical scanning of the gel container using a Helium-Neon laser and a photocell was designed and constructed. Then, the mechanical part for two rotational and translational motions was designed and step motors were assembled to it. The data coming from photocell was grabbed by the home-built interface and sent to a personal computer. Data processing was carried out using MATLAB software. To calibrate the system and tune up the functionality of it, different objects was designed and scanned. Furthermore, the spatial and contrast resolution of the system was determined. The system was able to scan the gel dosimeter container with a diameter up to 11 cm inside the water phantom. The standard deviation of the pixels within water flask image was considered as the criteria for image uniformity. The uniformity of the system was about ±0.05%. The spatial resolution of the system was approximately 1 mm and contrast resolution was about 0.2%. Our primary results showed that this system is able to obtain two-dimensional, cross-sectional images from polymer gel samples.

Discriminant analysis between myocardial infarction patients and healthy subjects using wavelet transformed signal averaged electrocardiogram and probabilistic neural network.

There are a variety of electrocardiogram based methods to detect myocardial infarction (MI) patients. This study used the signal averaged electrocardiogram (SAECG) and its wavelet coefficient as an index to detect MI. Orthogonal leads signals from 50 acute myocardial infarction (AMI) and 50 healthy subjects were selected from the national metrology institute of Germany (PTB diagnostic database). They were filtered and discrete wavelet transformed was exerted on them. Four conventional features and two new features introduced in this study were extracted from SAECG and its wavelet decompositions. Finally for data classification, probabilistic neural network were used. This method was able to detect and discriminate AMI patients from healthy subjects using the probabilistic neural network, which shows 93.0% sensitivity at 86.0% specificity with 89.5% accuracy. This technique and the new extracted features showed good promise in the identification of MI patients. However, the sensitivity and specificity is comparable with other findings and has high accuracy although we extracted only 6 features.

Bladder cancer detection using electrical impedance technique (tabriz mark 1).

Bladder cancer is the fourth most common malignant neoplasm in men and the eighth in women. Bladder pathology is usually investigated visually by cystoscopy. In this technique, biopsies are obtained from the suspected area and then, after needed procedure, the diagnostic information can be taken. This is a relatively difficult procedure and is associated with discomfort for the patient and morbidity. Therefore, the electrical impedance spectroscopy (EIS), a minimally invasive screening technique, can be used to separate malignant areas from nonmalignant areas in the urinary bladder. The feasibility of adapting this technique to screen for bladder cancer and abnormalities during cystoscopy has been explored and compared with histopathological evaluation of urinary bladder lesions. Ex vivo studies were carried out in this study by using a total of 30 measured points from malignant and 100 measured points from non-malignant areas of patients bladders in terms of their biopsy reports matching to the electrical impedance measurements. In all measurements, the impedivity of malignant area of bladder tissue was significantly higher than the impedivity of non-malignant area this tissue (P < 0.005).

Effect of wedge filter and field size on photoneutron dose equivalent for an 18MV photon beam of a medical linear accelerator.

Photoneutrons produced during radiation therapy with high energy photons is the main source of unwanted out-of-field received doses of patients. To analyze the neutron dose equivalent (NDE) for wedged beams and its variation with field size, Monte Carlo (MC) modeling of an 18MV photon beam was performed using MCNPX MC code. The results revealed that the NDE is on average 6.5 times higher for wedged beams. For open beams, the NDE decreased with increasing field size especially for field sizes >20x20cm(2). While, for wedged beams, the NDE increased with field size. It was suggested that the increase of NDE for wedged beams should be taken into account in radiation-induced secondary cancer risk estimations and radiation protection calculations.

The feasibility of computational modelling technique to detect the bladder cancer.

A numerical technique, finite element analysis (FEA) was used to model the electrical properties, the bio impedance of the bladder tissue in order to predict the bladder cancer. This model results showed that the normal bladder tissue have significantly higher impedance than the malignant tissue that was in opposite with the impedance measurements or the experimental results. Therefore, this difference can be explained using the effects of inflammation, oedema on the urothelium and the property of the bladder as a distensible organ. Furthermore, the different current distributions inside the bladder tissue (in histological layers) in normal and malignant cases and finally different applied pressures over the bladder tissue can cause different impedances for the bladder tissue. Finally, it is believed that further studies have to be carried out to characterise the human bladder tissue using the electrical impedance measurement and modelling techniques.

Comparison of radiation dose to patient and staff for two interventional cardiology units: a phantom study.

The purpose of this investigation was to measure the patient and staff dose during routine interventional cardiology procedures for an image intensifier-based and a flat detector system using a water phantom. The Integris BH3000 image intensifier-based (Philips) and the Axiom Artis flat detector-based (Siemens) angiography units were used in this study. The accuracy of tubes potential and irradiation timers and also internal dosimeters were verified and confirmed. A water phantom with a thickness of 18 cm was used for patient and staff dose measurements. For the Philips system, phantom entrance dose rates were 2.77 and 38.97 microGym(2) s(-1) during fluoroscopy and cineangiography. The respective dose rates for the Siemens were 1.98 and 13.46 microGym(2) s(-1). Phantom entrance dose rate was 28.5 and 65% higher for the Philips system during fluoroscopy and cineangiography, respectively. Comparing the scattered dose rates at the operator location showed that the flat detector-based Siemens system delivers five times lower dose to the operator in comparison with the image intensifier-based Philips unit. The results suggest that the decrease in received dose of the patient and staff is achievable using the flat detector system. In addition, application of lead curtain and glass is recommended to lower the cardiologist dose especially for the image intensifier-based Philips system.

Modeled current distribution inside the normal and malignant human urothelium using finite element analysis.

When the tissue is changing from normal to abnormal, the distribution of tissue liquids between intra and extra cellular space will be changed and then the measured conductivity and impedivity will also be changed. Therefore, it will cause a different current distribution inside the human bladder tissue in normal and malignant cases. By knowing the amount of electrical impedance inside the bladder tissue and the morphological parameters of the different layers of this tissue, the current distribution inside the bladder tissue (surface fluid, superficial urothelium, intermediate urothelium, basal urothelium, basement membrane, and connective tissue) was modelled and calculated in different frequencies using the finite element analysis. The model results showed that very little of the current actually flows through the urothelium and much of the injected current flows through the connective tissue beneath the urothelium (in normal cases). However, most of the current flows through the surface fluid in the low frequency range in normal tissue. Furthermore, for the high frequencies, the tight junctions are short-circuited, so the current penetrates deeper, flowing through the connective tissue beneath the urothelium, while, in the malignant cases, at least 50% of the injected current flows beneath transformed urothelium across the frequency range modelled.

Surface fluids effects on the bladder tissue characterisation using electrical impedance spectroscopy.

The electrical impedance of the human urinary bladder in both benign and malignant areas can be measured using an electrical impedance spectroscopy system (EIS). Glycine is usually used in the bladder surgery in the theatre to make an insulation medium for electro-surgery and the extension of the mucosa. In addition, a saline solution is usually used to wash the inside of the bladder after bladder surgery and it is used to extend the bladder tissue mucosa. Therefore, the effect of glycine and the saline solution that fills the bladder is important, because it was expected that the application of common surface fluids (air, saline solution and glycine solution) in the bladder epithelium would affect the measured electrical impedance of the urothelium, to differentiate the malignant area from the normal bladder tissue. In this study, bladders were removed from the patients' bodies and then were moved from theatre to the histopathology department immediately after excision. These bladder samples were then opened and pinned to a corkboard to take the impedance readings, using the impedance spectroscopy system. Following this, the bladder and corkboard were completely submerged in a saline solution and readings were taken at about 1cm from the sutures. Subsequently, this procedure was repeated with the bladder submerged in glycine and then air, respectively. According to the statistical work, these fluids were found to have a significant effect on the measured impedance of the bladder tissue in benign and malignant areas. Furthermore, the best fluid between air, glycine and saline, to measure the impedance of the urinary bladder, is air (P<0.0001).

Dosimetric properties of a flattening filter-free 6-MV photon beam: a Monte Carlo study.

PURPOSE: The dosimetric features of an unflattened 6-MV photon beam of an Elekta SL-25 linac was calculated by the Monte Carlo (MC) method. MATERIAL AND METHODS: The head of the Elekta SL-25 linac was simulated using the MCNP4C MC code. The accuracy of the model was evaluated using measured dosimetric features, including depth dose values and dose profiles in a water phantom. The flattening filter was then removed, and beam dosimetric properties were calculated by the MC method and compared with those of the flattened photon beam. RESULTS: Our results showed a significant (twofold) increase in the dose rate for all field sizes. Also, the photon beam spectra for an unflattened beam were softer, which led to a steeper reduction in depth doses. The decrease in the out-of-field dose and increase in the contamination electrons and a buildup region dose were the other consequences of removing the flattening filter. CONCLUSION: Our study revealed that, for recent radiotherapy techniques, the use of multileaf collimators for beam shaping removing the flattening filter could offer some advantages, including an increased dose rate and decreased out-of-field dose.

Cellular morphological parameters of the human urinary bladder (malignant and normal).

The normal and malignant cellular morphological parameters (intra- and extracellular spaces of the human urinary bladder) were obtained from analysis of digital images of bladder histology sections. Then these cellular morphological parameters were compared with the same parameters obtained from the literature for the bladder tissue. However, the limited quantitative data about these parameters available in the literature for bladder cell sizes and other geometrical parameters such as extra-cellular space does not provide a scientific basis to construct accurate structural models of normal and malignant bladder tissue. Therefore, there is usually no quantitative discussion of cell sizes in literature but the measured data in this work can provide a reasonable estimation of expected morphological parameter changes of bladder tissue with pathology. To produce this quantitative information, and also, to build a suitable models in another study using electrical properties of the tissue, 10 digital images of histological sections of normal, and six sections from malignant areas of the human urinary bladder, were chosen randomly (ex vivo). Finally, the measured data showed that there is a significant difference between the cell dimensions (in basal and intermediate layers) of normal and malignant bladder tissues.

Design and construction of small sized pencil probe to measure bio-impedance.

Currently, bio-impedance measurements are performed with relatively large probes which are not suitable for all in vivo studies. These are typically designed and constructed for different uses, such as for cervical and oesophagus tissues and are too large for many investigations, including those involving the bladder. Therefore, it was decided to design and construct a small sized pencil probe, using a microscope to solder very small wires to a tiny tip (about 2mm in diameter). In addition, different approaches were used to construct, treat, and perform the safety tests and calibration procedure on the probe before taking impedance measurements of the urinary bladder.

Electrical impedance spectroscopy and the diagnosis of bladder pathology.

Bladder pathology is usually investigated visually by cystoscopy. At present, definitive diagnosis of the bladder can be made by biopsy only, usually under general anaesthesia. This is a relatively high-cost procedure in terms of both time and money and is associated with discomfort for the patient and morbidity. Thus, we used an electrical impedance spectroscopy technique for differentiating pathological changes in the urothelium and improving cystoscopic detection. For ex vivo study, a whole or part of the patient's urinary bladder was used to take the readings less than half an hour after excision at room temperature, about 27 degrees C, using the Mk3.5 Sheffield System (2-384 kHz in 24 frequencies). In this study, 145 points (from 16 freshly excised bladders from patients) were studied in terms of their biopsy reports matching to the electrical impedance measurements. For in vivo study, a total of 106 points from 38 patients were studied to take electrical impedance and biopsy samples. The impedance data were evaluated in both malignant and benign groups, and revealed a significant difference between these two groups. The impedivity of the malignant bladder tissue was significantly higher than the impedivity of the benign tissue, especially at lower frequencies (p < 0.001). In addition, the receiver operating characteristic (ROC) curve for impedance measurements indicated that this technique could provide diagnostic information (individual classification is possible). Thus, the authors have investigated the application of bio-impedance measurements to the bladder tissue as a novel and minimally invasive technique to characterize human bladder urothelium. Therefore, this technique, especially at lower frequencies, can be a complementary method for cystoscopy, biopsy and histopathological evaluation of the bladder abnormalities.