Journal Of Patient safety and quality improvement
Volume:2 Issue: 2, Spring 2014

Basic Life Support (BLS) as the first level of medical care in sudden cardiac arrest and life-threatening illnesses can improve survival outcomes. The aim of this study was to compare the knowledge and skills of BLS among medical students at the beginning and the end of the training course in the emergency department. This study was a descriptive analytic cross- sectional study among 90 medical students in their sixth academic year during emergency medicine training course. At first, a standard Objective Structured Clinical Examination (OSCE) was performed to obtain their basic knowledge and skills of BLS. Then a training course was provided in two theoretical and practical parts using the 2006 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. At the end of the study, the same standard OSCE was performed. The mean score of the primary OSCE was 4.9 with 55 students (61.11%) having a score between zero to five and 35 (35.89%) between five to ten. The mean scores increased significantly after training regarding checking the patient''s response, head tilt and chin lift maneuvers, number of massages and correct breathing (p)

The Organizational Citizenship Behavior (OCB) is an important variable in the study of organization management. It is partly hard to build relationships and performance within the organization. The purpose of this study was to investigate the relationship between the quality of work life, job stress, job satisfaction, and citizenship behavior in Oshnaviyeh Hospital’s staff. To collect data, quality of work life by Walton, hospital job stress, job satisfaction, and citizenship behavior questionnaires were used. To determine the reliability of the questionnaires. To analyze data, Pearson Correlation Test,T test, Regression, Path analysis were used. The results show that there is a significant positive relationship between the quality of work life, job stress, job satisfaction, and citizenship behavior. The quality of work life is the most important variable among the independent variables since it was able to identify approximately 18% of citizen behavior. Because OCB is completely voluntary, behaviors are more influenced by their interactions and organizational procedures. Hence, it is fair to organizations to know how to deal with employees'' level of organizational citizenship behavior.

Respiratory and blood pressure changes as well as fluid administration alter the acid-base balance during the perioperative period which may cause consciousness disturbance and additional hemodynamic disorders. The aim of this study was to identify frequent postoperative acid-base disturbances in order to control postoperative complications. This prospective, observational study design was used on patients who underwent abdominal surgery during a six-month period. Gasometry was performed immediately after the patients’ admittion to ICU and six and 12 hours postoperatively. SPSS v13 software was used, and P 213 patients (123 male and 90 female) aged 14-85 years (51.7± 22.4) were evaluated. During admission, PH and PaCO2 were (7.29±0.13) and (38.3±11.9), respectively; however, although PH increased gradually (P=0.001), PaCO2 was reduced (P=0.03). Bicarbonate and base excess had opposite effects; bicarbonate initially decreased but increased after 12 hours (P=0.001), whereas base excess initially increased (-6.3±11.6) and then decreased gradually (P=0.003). The arterial oxygen pressure was reduced for 22.5% of the patients throughout the admission period, and this did not significantly change (P=0.57). According to the results, in admission, 65.7% had metabolic acidosis, but metabolic alkalosis was the least. Gradually, metabolic acidosis was modified, but metabolic alkalosis increased. Intraoperative hypotension and fluid infusion may be the main factors of early metabolic acidosis and control of hypotension, or correction of acidosis may increase metabolic alkalosis.

Primary PCI is the preferred modality to restore blood perfusion in STEMI patients, but myocardial reperfusion is sometimes lower than optimal. Distal embolization seems to play the leading role. There is rare evidence suggestive of M-Guard stents; a recent innovation which protects against distal embolization may be beneficial in this circumstance. This was a prospective single arm study. Patients with acute STEMI admitted at the Cardiac Emergency Unit of Imam Reza Hospital from July 2011 to November 2012 who had a large bulk of thrombus in their angiogram, underwent M-Guard stenting and were followed up for six months for chest pain and secondary revascularization. The 23 patients, aged between 34 and 84; 65. 2%, were male and had undergone primary PCI, mechanical thrombus aspiration, and M-Guard stenting. Left Anterior Descending (LAD) (63. 9%) and Right Coronary Artery (RCA) (39. 1%) were most commonly involved. 78. 2%, 13. 1%, and 8. 9% of patients had primary Thrombolysis in Myocardial Infarction (TIMI) Thrombus grade five, four, and three. Among them, 86. 9% achieved TIMI Flow grade three and 13. 04% TIMI Flow grade two. The rate of transient «no-reflow» phenomenon was 21%. One patient died after stenting in the setting of cardiogenic shock. There was one case of in-stent restenosis five months after the procedure. Of the other 15 accessible patients, after six months, none experienced a second angioplasty or any ischemic symptoms. Using M-Guard stents in acute STEMI patients having undergone primary PCI with high thrombus burden is probably associated with lower rates of the «no-reflow» phenomenon and improved vessel reperfusion.

To determine the distance of Extraocular Muscle (EOM) insertions to limbus in Iranian people. 173 cases (173 eyes) were entered in an observational cross-sectional study. Patients referred to the Khatam-al-Anbia Hospital were included. All of them had to be operated on specific indications. After 360 peritomy in the operating room, the distance between EM insertion and limbus were measured with the same caliper. All measurements were done by the same surgeon. 173 eyes of 173 cases (85 female, 49.13%) with the mean age of 39.70±4.22 years were evaluated. 114 eyes were left eyes (65.89%) and the others were right eyes. The mean and standard deviation of the distances of EM to limbus were obtained as mentioned below: Superior Rectus (SR): 8.63±0.89 millimeter, Inferior Rectus (IR): 6.36±0.40 millimeter, Lateral Rectus (LR): 7.029±0.35 millimeter, Medial Rectus (MR): 5.30±0.37 millimeter. The obtained values will be helpful in vitreoretinal surgery and specifically in strabismus surgery.

Free radical and peroxide production lead to intracellular damage. On the other hand, free radicals are used by the human immune system to defend against pathogens. The aging process could be limited by oxidative stress in the short term. Chronic diseases like diabetes mellitus (DM) are full-stress conditions in which remarkable metabolic functional destructions might happen. There is strong evidence regarding antioxidant impairment in diabetes. Performing a particular method for anesthesia in diabetic patients might prevent or modify excessive free radical formation and oxidative stress. It seems that prescribing antioxidant drugs could promote wound healing in diabetics.

Reducing infant mortality rate during delivery is a priority in the world. Even with the existing activities that take place in hospitals, due to a lack of simple and effective methods, this mortality reduction trend is slow. The objects of this study were to apply and investigate the effects of WHO evidence-based guidelines for safe delivery on the quality of maternal and neonatal support. This is a semi-experimental study with external control. After forward and backward translation of WHO safe childbirth checklist, in an expert meeting irrelevant/infeasible items in the checklist were omitted or modified. Personnel performance on checklist items was evaluated by researchers who were present in the whole period of mother and neonate hospitalization in two phases. Intervention was done in two hospitals and one hospital was considered as control. At first, the instructions were provided for all the collaborating personnel in forms of pamphlets, posters and booklets and after two weeks second phase began by arranging an educational session for personnel. The data of these two phases is being compared. If our prior assumption be proved, we anticipate improvements in some items of checklist. Some of these items are skin contact, breast feeding rate in first hour postpartum, hand hygiene, and mother''s knowledge regarding the parturition during the time in which they are hospitalized together with a decrease in episiotomy infection/dehiscence prevalence. These changes can be regarded as an overall promotion in maternal/neonatal support.

The worldwide increase in the cost of health services has now become a shared concern for all health managers and experts. Regarding the limited allocatable resources to hygiene and treatment systems and numerous needs in this section, both the politicians and the consumers have to look for the most optimum strategies available. This present study aims to elaborate on how a clinical policy-making module was formed and to discuss its main activities since 2011. The data used in this review study is based on evidence, recorded information, and reports. The very fact that the authors of this article are members of a clinical guidelines standardization and codification bureau can approve for the reliability of the gathered data. Evidence-based scientific products such as guidelines for clinical practice and diagnostic/therapeutic clinical policies that aid health care providers in correct decision-making are currently regarded as an organized set of the latest and most authentic scientific evidences and hold an important position in health service systems.

To describe clinical and electrophysiological features of a patient with unilateral Retinitis Pigmentosa (RP). Case: A 29-year-old female with a long history of progressive visual disturbance in the right eye has undergone multiple eye examinations during the past eight years. There was nothing noticeable in her past medical and ocular history. Comprehensive eye examinations were done in the first visit. All data was suggestive of right eye RP. Posterior segment fundal examination findings were: a pallor waxy disc, vessel attenuation, and extended pigmentary degeneration of the mid-peripheral retina. The left eye examination was normal. Comparing the automated 60 degree and 30 degree visual fields of both eyes obviously showed significant defects in the right eye visual field but normal in the left eye. All of the probable infectious agents, which can cause similar ocular manifestations, were ruled out by serological tests. The standard photopic and scotopic electroretinographies were significantly reduced in amplitude in the right eye; however, they were normal in the left eye. Also, the standard Electro-Oculography (EOG) results were the same as the Electro-Retinography (ERG) ones in both eyes. Eye examinations were normal in other family members. Over an eight-year follow-up period, progressive deteriorating vision has gradually become more noticeable in the right eye. The left eye has been completely normal since. This data was compatible with the Francois and Verriesr unilateral RP diagnostic criteria. Clinical signs and symptoms, a minimum of a five-year follow-up period, and confirmatory ERG and EOG are very helpful to diagnose andaffirm the case of unilateral RP.