- Volume:5 Issue: 3, 2016
- تاریخ انتشار: 1395/09/23
- تعداد عناوین: 6
Pages 82-86Background And ObjectivesAntimicrobial prophylaxis has proven effective in controlling postoperative infection in almost all types of surgery. The American Society of Health-System Pharmacists (ASHP) guideline summarizes current knowledge on the appropriate use of antimicrobials for surgical prophylaxis. However, there is limited information on the extent to which the surgical prophylaxis procedures in Iran follow the standard recommendations. Hence, this study was conducted to make the situation clearer by auditing the use of prophylactic antimicrobials in a referral tertiary care center based on of ASHP guideline.MethodsThis cross-sectional study was carried out from April to September 2015 in the surgical wards of a 850-bed hospital (Alzahra Hospital, Isfahan, Central Iran). All patients aged ≥ 18 years admitted for elective surgery during the study period were recruited. Data on antibiotic indication and choice, dose, dosing interval, route of administration, timing of first administration, and duration of prophylaxis were collected prospectively from medical records and compared with ASHP guideline.
Findings: Only 22% of procedures fully complied with the guideline recommendations, and in all but half of the criteria the level of compliance was below 50%. The lowest level of compliance was found in duration of prophylaxis (14%), followed by appropriate agent choice (35%), and timing of the initial dose (42%).ConclusionsOur study revealed that the majority of antibiotic prescriptions in surgical prophylaxis do not follow the standard treatment guideline. The situation calls for development of national/local standards and encouraging hospitals to adopt institutionalizing interventions to alleviate the health risks associated with inappropriate prophylactic antimicrobial treatment.Keywords: Antibiotic prophylaxis, Clinical guideline, Medical practice, surgery, Health care
Professional Practices Promoting Health of Healthcare Workers: Comparison of Public and Private Hospitals in PakistanPages 87-92Background And ObjectivesHealth and safety of healthcare workers (HCWs) is a determinant of the quality of healthcare delivered to the population at large. This study aimed at comparing various dimension of HCWs health and safety between public and private hospitals (PHs) in the Pakistan context.MethodsA sample of 1146 HCWs from 2 public and 2 PHls in a metropolitan city were invited to response to a structured questionnaire, assessing various aspects of health and safety promotion practices in their hospital. Categorical data were compared using chi-square test or Fisher exact test or likelihood ratio tests.
Findings: According to the responders, lack of written policies and guidelines for health promotion was 84% in public hospitals (GHs) vs. 22% in PH (PConclusionsAs revealed by our study, there is a large gap in HCWs health and safety promoting practices between public and PHs. The situation calls for increased budget and focused program to improve health and safety of HCWs in Pakistans GH.Keywords: Healthcare workers, Health promotion, Promotional activities, Communication
Pages 93-97Background And ObjectivesResponsiveness is a measure of how well a healthcare organization performs in accordance with patients expectations and is a central factor to patient satisfaction. To enhance responsiveness in a health facility, the first step is to identify its current situation. This study was conducted to evaluate the responsiveness of a sample of hospitals in Yazd Province (Central Iran) as perceived by their managers.MethodsThree hospitals of various types (one public, one private and one charity) were selected for survey, based on simple sampling. All hospital administrators, matrons, supervisors and head of the departments were asked to complete the study questionnaire. Based on an adapted version of WHO-proposed assessment model, responsiveness was measured in seven dimensions, including respect and dignity, informed choice, confidentiality, patient education and provider-patient communication, access to prompt services, quality of physical amenities and social support. The data were summarized by descriptive statistical methods.
Findings: A majority of respondents (37.9%) considered dignity and respect as the key responsiveness dimension. The mean score of responsiveness was found to be 2.27.39 in a public hospital, 2.02.35 in a private and 2.24.32 in a charity hospital. Respect and dignity scored the highest among responsiveness dimensions (2.35.44), followed by patient education (2.34.32), and quality of physical amenities (2.23.39). The lowest score was given to informed choice (1.73.34), followed by access to services (1.95.43), and confidentiality (1.99.27).ConclusionsResponsiveness and all of its dimensions were scored at moderate. Responsiveness and all its dimensions were scored at moderate level by the hospital managers. One should notice that the scores may be even lower from the patients perspective. Thus, our study in line with previous ones conducted in Iran indicates a large room to improve responsiveness in the health facilities. Based on our data, informed choice, access to the services, and confidentiality are the prime domains for improvement.Keywords: Responsiveness, Nonclinical services, Hospital management, Patient satisfaction, Health system performance
Effect of Lithium on Brain-derived Neurotrophic Factor (BDNF) Level in Patients with Ischemic Stroke: A Clinical TrialPages 98-101Background And ObjectivesPrevious studies have indicated that lithium may increase the level of the brain-derived neurotrophic factor (BDNF), which in turn improves the recovery of patients with stroke. In this controlled trial we evaluated the effect of lithium on BDNF serum level in patients with ischemic stroke.MethodsIn this randomized controlled trial (IRCT2013110515290N1), 46 patients with ischemic stroke in the territory of middle cerebral artery in lithium group who received aspirin (80 mg/d), atorvastatin (20 mg/d), folic acid (1mg/d), physiotherapy (10 sessions) and lithium carbonate (300 mg /BD/30d) 48 hours after stroke, were compared with 47 patients in the control group who received the same treatment regimen except lithium, in terms of the level of BDNF at 5 and 30 days after treatment,
Findings: TheBDNF level after 30 days of treatment was found to be significantly higher in lithium group compared with control group. No significant difference in mortality rate between the two groups was identified.ConclusionsWe obtained further indications for the positive effect of lithium on BDNF level. Administration of lithium carbonate, therefore, may provide an inexpensive approach to reduced rate of stroke-induced disability and improved patient outcome.Keywords: Lithium, brain-derived neurotrophic factor (BDNF), Ischemic stroke, Clinical trial
Performance Indicators of Hospital Safety and Health Management Systems Based on the Nursing Staff ViewpointsPages 102-103Background And ObjectivesHealth management systems play a very pivotal role in prevention and reduction of hazards and improvement of staff performance; therefore, this study was aiming to evaluate the performance indicators of safety and health management systems in Vali Asr hospital of Fasa from the perspective of its nursing staff.MethodThis descriptive-analytical study was performed in Vali Asr hospital, Fasa, Iran. Sampling was done via census; sample size consisted of 200 employees. Data collection tool was the standard hospital safety and health management system questionnaire. This questionnaire consisted of 53 items covering the 6 domains of: Management leadership, Employee participation, Hazard identification, Hazard prevention and control, Education and training, and Program evaluation and improvement. Each item was rated from 1 to 4 based on the Likert-type scale: Strongly disagree, Disagree, Agree, Strongly agree; 4 being the highest and 1 the lowest score. Data analysis was done via SPSS-19 using descriptive statistics, a t-test and analysis of variance. Significance level was determined at P≤0.05.
Finding: Based on our findings, poor conditions in all domains were observed excepted in the employee participation domain. A significant relationship was observed between gender and the hazard identification, hazard prevention and program evaluation and improvement domains. No significant relationship was witnessed between work experience and the mentioned domains.ConclusionsIt seems necessary for hospital administration to put in more effort and pay more attention to occupational safety and health in the workplace. In order to eliminate faults and weaknesses, we need effective evaluation, continuous improvement of staff training programs.Keywords: Health management, Hospital safety, Nursing staff
Pages 107-112Statistics and information are considered the most important source of power in organizations and the source for all managerial activities. If correct and comprehensive information are readily at hand, incorrect decisions will be reduced to a minimum. The purpose of this study is to review the effects of hospital information system in regards to effectiveness of decisions made by managers. The present study is a review and search of relevant articles in authentic national and international databases including articles from 2001 to 2016. Keywords used were: health information system, hospital information system, etc. Seventy articles were obtained from the search and 32 (abstracts and whole articles) were ultimately selected after removing irrelevant articles. During initial review, abstracts were first read and if needed the entire article was studied. Results of this review indicate that hospital information system play a significant role in improving hospital management performance along with performance of medical staff. Use of such systems were highly recommended in all articles. Application of such systems has also been considered amongst main requirements of managerial development. Also, most articles claimed that managerial decision making based on real information lead to increased performance and progress of management and ultimately increased hospital effectiveness and performance. In conclusion, hospitals must create and develop hospital information systems and recruit trained experts in providing practical information and knowledge in order to improve their current status.Keywords: Health information system, Hospital performance, Hospital information system, Hospital management