Journal Of Patient safety and quality improvement
Volume:3 Issue: 4, Automn 2015

In this study, we aimed to evaluate the rates of preoperative risk factors and intraoperative complications in phacoemulsification, performed by ophthalmology residents. Moreover, we assessed the relationship between these risk factors and complications. In this prospective study, the rates of and the relationship between preoperative risk factors and intraoperative complications in resident-performed phacoemulsification were evaluated in the anterior segment clinic of Khatam-al-Anbia Eye Hospital, Mashhad, Iran. In total, medical records of 475 patients undergoing phacoemulsification by 13 ophthalmology residents, were evaluated. The rate of intraoperative complications was estimated at 17.5%. Moreover, the rate of major complications including posterior capsule rupture, zonular dehiscence and vitreous loss, with potential effects on the final surgical results, was 7.2%. Based on the univariate analysis, preoperative risk factors, which were significantly associated with the incidence of intraoperative complications, were as follows: poor red reflex (P=0.001), pseudoexfoliation (P=0.002), poor pupil dilation (P=0.003), corneal clouding (P=0.003), dense cataract (P=0.004), shallow anterior chamber (P­=0.02) and advanced age (P<0.05). Considering the correspondence between intraoperative complications and some preoperative risk factors, careful preoperative examination or utilization of systematic risk stratification systems might facilitate the prediction of high-risk cases and prevention of complications in resident-performed phacoemulsification.

Nowadays, the most sustainable competitive advantage of all organizations, such as medical centers, is human capital. One of the most important ways to create a competitive advantage in healthcare centers is reducing job stress among nurses. Studies show that reducing job stress may lead to organizational commitment, which is a vital factor for achieving organizational efficiency. This descriptive and correlational study was conducted on 120 nurses as sample working in the hospitals of Behbahan. The participants were selected through simple random sampling. The data collection tools were Health and Safety Executives questionnaire (HSE) and organizational commitment questionnaire of Allen and Meyer. Pearson correlation coefficient and multiple regression analysis were performed to analyze the data. P-value less than 0.05 was considered statistically significant. In this study, job stress was considered as the independent variable and organizational commitment as the dependent variable. The results showed that there is a significant inverse relationship between job stress and organizational commitment. Moreover, there is a significant inverse relationship between job stress and affective, normative and continuance commitment. Taking regression analysis into account, it can be concluded that peer relation is the most powerful predictor of organizational commitment.

Violence is associated with individuals’ health and occupational safety and for many jobs, workplace violence represents a serious occupational hazard. Therefore, the aim of this study was to identify the reasons for violence from the viewpoint of hospital administrative support staff and to determine the steps necessary to eliminate or reduce this problem. In this qualitative study, we employed semi-structured interviews and opinions of 10 authorities and administrative support staff of Al-Zahra University Hospital on violence and its risk factors. After transcribing the contents of the interviews, the data were reduced and structured using thematic analysis. Subjects’ views on causes of violence in hospitals were classified into 40 sub-themes and 7 themes including: economic, social and structural factors, hospital problems, problems related to patients and their companions, difficulties arising from individual interactions and problems with staff. Considering the high prevalence of violence in hospitals and its adverse effects on the societies, organizations and individuals, necessary measures must be taken to diminish the occurrence of this problem, some of which include: increasing insurance coverage, changing physical structure of hospitals to increase security, limiting the entrance of individuals, making administrative processes more transparent, culture-making about terms of visiting and patient companionship, holding workshops on violence and proper relationship with patients and families and using experienced staff to interact with clients.

Considering the high rate of mortality in patients with Deep Vein Thrombosis (DVT) and pulmonary embolism, the aim of this study was to evaluate the role of daily measurement of lower limb circumference in early diagnosis of DVT in patients admitted to Infectious Diseases Ward of Imam Reza Hospital, Mashhad, during 2012-2013. This cross-sectional study was conducted in Infectious Diseases Ward of Imam Reza Hospital of Mashhad, Iran. Patients were divided into two age- and gender-matched groups. In the first group, the difference between the two legs was greater than 1 cm and in the second group it was 3 cm or more. Circumference of the two legs was assessed on a daily basis at 10 cm above tibial tuberosity. Doppler sonography was performed to rule out DVT. Data were analyzed using SPSS, Version 16. A total of 204 patients were enrolled in this study, 18 of whom (8/8%) were diagnosed with DVT through Doppler sonography. In addition, 17 patients (11/3%) had fever as a comorbidity. Mean difference of the two legs was more than 3 cm in 16 DVT patients (14%), and two patients with mean difference of less than 3 cm had DVT. Daily measurement of lower limb circumference was an accurate and cost-effective technique for early diagnosis of DVT.

Care for vascular access of patients undergoing hemodialysis is a critical issue. Inflammation and subsequent infection are the major factors which threaten patients'' health and diminish effectiveness of hemodialysis. Therefore, this study aimed to evaluate the severity and incidence of inflammation of vascular access in hemodialysis patients. This cross-sectional study was conducted on 90 patients undergoing hemodialysis in Emam Reza and Montazerie Hospitals in Mashhad, June, 2014. Evaluation of inflammation severity over the course of one month (12 hemodialysis sessions) was performed by means of an inflammation tool designed by the Board of Nursing. Data were analyzed using SPSS version 16, and performing descriptive and Chi-square tests. The mean and standard deviation of incidence of inflammation in the first session of hemodialysis was 3.2±1.3 cases. The mean and standard deviation of the intensity of inflammation was 12.5±4.7. Since inflammation of vascular access in hemodialysis patients impairs their safety and health improvement, necessary measures to reduce this complication must be taken.

According to the importance of managers’ role in improving quality of health services, we performed this study to survey hospital managers attitude about patient complaints investigating system in hospitals affiliated to Mashhad university of Medical sciences in 2015. This descriptive cross-sectional study was performed in 12 hospitals affiliated to Mashhad University of Medical Sciences. One questionnaire that we had confirmed the reliability and validity of that was used to assess hospitals managers’ attitude about patient complaints investigating system. Study population was all hospital managers in all levels. We studied them as census. Finally 130 completed questionnaires were analyzed with SPSS Version 16. 20% of managers assessed the current status of patient complaints investigating system as improper. 35% of manager expressed not using information that derived from patients’ complaint as most defect in patient complaints investigating system. 60% of managers believed that the most impact of reinforcement patient complaints investigating system is improvement of services quality and system validity. Finally 56% of managers expressed staff dissatisfaction is the great reason for patient complaints. According to the findings and relatively positive attitude of managers, it is necessary to organize a team for improving and revising patient complaints investigating system in each hospital. Also managers’ attention to staff satisfaction and their educational needs is important for reducing patient complaints.

Postoperative infectious complications impose substantial costs on patients, increase the length of hospitalization and adversely affect patient outcomes. Several predisposing factors have been suggested for the development of infections after elective surgeries. This study aimed to evaluate the rate of infectious complications following elective abdominal surgery. This systematic review was performed via searching in databases such as Cochrane Library and MEDLINE until December 2014, and articles with available abstracts were included in the study. In addition, manual search was conducted within the reference lists of selected articles. Inclusion criteria and quality of related articles were evaluated by two reviewers independently, and required data were extracted. Among related studies, the earliest article was published in 1988, and the most recent one was published in 2013. All studies were performed on adult patients. Surgical Site Infections (SSIs) were reported to be the third most frequent hospital-acquired infections, with the prevalence rate of 4.7-25% in patients undergoing elective colorectal surgery. According to the results of this study, postoperative infections are a global issue, leading to several health consequences and increased morbidity and mortality among different patients. Patient factors are considered as the main predisposing factors associated with these infections.

Due to loss of function and intolerable pain associated with Osteoarthritis (OA), this condition is regarded as one of the major causes of disability, worldwide. Aging and obesity are regarded as two fundamental causes of knee OA. The aim of this study was to review the literature on the efficacy of hyaluronic acid in compression [z1] in patients with knee OA. A systematic web-based search was conducted in Cochrane Library and MEDLINE to identify articles published before December 2014. English articles with available abstracts, relevant to the subject of the study, were retrieved. Moreover, manual search was performed in reference lists of the articles. Two commentators independently reviewed and assessed the inclusion criteria, evaluated the quality of articles and extracted the data. The evaluated articles were published during 2011-2014. All studies were conducted on adult patients with knee OA. Overall, 745 patients were evaluated in five studies. More than 100 participants were enrolled in four studies and 90 patients were included in only one study. Based on the findings, the application of single-dose platelet-rich plasma is safe, useful and cost-effective in patients with knee OA.