Journal Of Patient safety and quality improvement
Volume:11 Issue: 2, Spring 2023

 One common method to evaluate healthcare professionals' practice is to develop a simulated client (SC) scenario. The present study was designed to assess community pharmacists' practice level regarding vitamin D products by an SC method.  Present study was a cross-sectional survey of 200 community pharmacists. SC scenario was designed and validated by an expert panel. The scenario consists of 22 questions to assess pharmacists' practice. This instrument includes four sections, demographic history taking, medical history taking, professional discipline, and clinical judgment, which are scored based on the 20-scoring system in each section. After data collection, an independent T-test was used to compare the mean ± standard deviation. The Mann-Whitney test was used to compare median and percentiles for non-parametric variables.  The overall practice score was 19.03 ± 9.08 out of 80. The scores were 0.55 ± 1.43 for demographic history taking, 2.13 ± 2.32 for medical history taking, 10.54 ± 5.38 for discipline, and 5.75 ± 3.87 for clinical judgment. Results showed that the pharmacists' vitamin D practice was lower than expected. The main limitation of the current study was the crowdedness of some pharmacies.The SC survey results showed that Iranian community pharmacists received poor scores in technical and professional practice fields.

Patient safety culture (PSC) was considered an essential predictor of healthcare quality. Measurement of PSC required a valid and reliable scale. So, the current study aimed to determine the validity and reliability of patients' perceptions of safety culture scale (PPSCS) in the context of Iran. This study was a scale psychometric assessment in the Iran context. Current study had three phases: preparation, translation and psychometric evaluation. Scale translation was performed based on the forward-backward framework. Face and content validity, test-retest reliability, and internal consistency were evaluated. Also, corrected item-total correlation for each item was reported based on data collection from 119 patients admitted to Esfarayen Imam Khomeini hospital. Analysis was done in SPSS V.16. Content validity ratio (CVR) and content validity index (CVI) were between 0.8 to 1. Also, corrected item-total correlation was between 0.604 and 0.864. Intra correlation coefficient (ICC) and alfa Cronbach were 0.974 and 0.939, respectively. Results showed PPSCS had acceptable validity and reliability in the Iran context. This scale can apply in different studies to measure patients' perceptions of safety culture in different hospital settings.

Standards improvement for public health promotion demands healthcare system development (HSD) in all nations. Iran works toward improving its position among the developing countries. Therefore, the present study aimed to design a development model for the healthcare system in Iran.  This study with a mixed-methods research was in 2020-22 fulfilled cross-sectionally. Utilizing the grounded theory in the qualitative phase, the opinions of the top-level managers and policy makers of the Ministry of Health, and the faculty members at the universities of medical sciences across Iran were elicited (n=21). The data were collected through a researcher-made questionnaire with the sample size of 217 top-level and middle managers affiliated to Khorasan Razavi University of Medical Sciences in Iran. The model was evaluated using the structural equation modeling (SEM) and the LISREL software package.  Analyzing the results of the data comprised of 14 categories and 40 concepts within 6 dimensions, including causal factors, governing system’s determination to develop the healthcare system, contextual/environmental conditions, intervening factors, strategies, and outcomes. The development model was further validated by the SEM, and confirmed via the goodness of fit index (GFI=0.97). The healthcare system in Iran was introduced among the most complex systems across the world. Therefore, designing and implementing a development model for the healthcare system in Iran requires much attention and willpower among policymakers and top-level managers in the governing system, and more emphasis on intersectoral collaboration at the highest political levels.

The primary objective is to encourage HCPs to report more ADRs by bringing out data on the incidence, rate and characteristics of ADRs, ADR-related hospital admissions and by exposing their impact on patient outcomes. This was a record-based retrospective cross-sectional analysis undertaken to investigate ADR monitoring and reporting in a tertiary care hospital. The databases from June 2016 to May 2020 were studied to assess the characteristics, causality, severity, and incidence rate of ADRs reported by the HCPs in accordance with the accepted criteria. The data was later analyzed using descriptive statistics. A total of 775 ADRs were identified and reported, extending over 4 years. 72.9% of the hospitalized patients experienced an ADR, 27.09% visited due to ADRs and 0.12% had a fatal ADR. The incidence of ADRs was estimated to be 1.8 per 1000 patient days, with preventable ADR constituting 0.4 per 1000 patient days. Skin (60.38%) was the most common organ system affected typically with Anti-infectives (48.38%). After causality assessment 624 (80.51%) of the cases were classified as probable while 141 (18.19%) were possible. The majority (52.7%) of the reactions were moderate in severity. It is crucial to encourage all concerned HCPs to apprehend their role and responsibility in the identification, monitoring and reporting of suspected ADRs. Educational programs, periodic dissemination of data on the reported ADRs to the healthcare practitioners, and improvement of interactions between the physicians, nurses and pharmacists may be programs to implement.

Liver function tests such as AST/ALT ratio may play an important role in the progression of nonalcoholic fatty liver disease (NAFLD) and its related cardiovascular dysfunctions. The study aims to assess whether AST/ALT was associated with arterial stiffness in a large population-based cohort of apparently healthy Persian women and men.

 To evaluate arterial stiffness non-invasively, Pulse Wave Velocity (PWV) and Augmentation Index (AI) were measured in 5031 healthy adults. Laboratory parameters, including AST and ALT, were measured after all subject's blood samples were collected. The one-way-ANOVA, the Kruskal-Wallis, and chi-square tests were used to compare the AST/ALT ratio among groups with baseline characteristics of participants following the calculation of AST: ALT through the division of AST levels by ALT levels. The univariate linear regression model was used to assess the association between mean pulse wave velocity (PWV) and AST/ALT ratio quartiles. 

 The results showed no statically significant difference in Age, HR, and MET among the different AST/ALT groups. Univariate analysis displayed that age, SBP, DBP, FBS, TG, MET, Fatty liver status, and hypertension status were positively correlated with Mean PWV. Evaluation of univariate linear regression models presented that AST/ALT has a significant correlation with Mean PWV (β = -0.139, 95% confidence interval (CI): -0.032 to -0.021, P-value < 0.001). We found that there was no linear relationship.

 According to the present study results, there was a significant negative correlation between AST/ALT with PWV. Moreover, a non-linear relationship between AST/ALT and PWV was observed as well.

One type of stroke is the Transient Ischemic Attack (TIA) which lasts less than twenty-four hours; of all patients, about 10 percent develop a stroke within three months after the first symptoms, and 30 percent develop over five years. Imaging is needed for differential diagnosis of this type of stroke. This study aimed to evaluate the recurrence of ischemic stroke and TIA three months after the first transient ischemic attack based on DWI results.

This cross-sectional study was done on 135 TIA patients referred to Alavi Hospital in Ardabil City. All patients were examined at admission time by DWI imaging and laboratory tests and followed up three months later by phone and hospitalization, and necessary information was collected by a checklist.

The average ABCD2 score in people with and without recurrence was 4.69 and 4.02, respectively. Also, the mean ABCD2 score in individuals with abnormal DWI was significantly higher than in individuals with normal DWI (4.72 vs. 4.04, p=0.001). After the first TIA attack, patients with abnormal DWIs had a significantly higher recurrence of TIA and stroke in the first 90 days.

This study showed that TIA patients with higher ABCD2 scores in the first 24 hours based on DWI are more likely to have a recurrence of TIA or the onset of stroke within 90 days.

Obesity is associated with many adverse health consequences. Apart from the problem of genetics, an unfavorable lifestyle can be the main cause. Due to significant technological advances and widespread acceptance by adolescents, technology can now be used to improve their lifestyles. This study assessed the effectiveness of online family-centered care on the lifestyle of adolescent girls with obesity.

This semi-experimental study was conducted after choosing 60 adolescent girls with obesity divided into two groups randomly. The research tools included demographic and HPLP_II questionnaires. 11 online sessions were held for the case group. The post-test was carried out after 1.5 months.

After the intervention, there was a significant difference between the control (112.23±8.53) and case (125.8±10.91) in the mean score of the Lifestyle (P<0.001). In contrast, before the intervention independent t-test showed no significant difference between the two groups (P=0.397). Before the study, the mean weight and BMI were not statistically significant between the two groups (P=0.511 and P=0.063). After the intervention, there were significant changes in girls’ weight (P=0.023) and BMI (P=0.144).

Results showed that family-centered care through new communication technologies effectively improved the lifestyle of adolescent girls with obesity.

Medical errors are among the major common challenges s that can lead to serious injuries. This study aimed to investigate the effect of active learning from medication errors on their incidence/reporting in nursing.
This interventional and quasi-experimental study was conducted in 2020 in six departments with internal patients. The participants included 93 nurses divided into two control and intervention groups. The nurses’ knowledge was assessed through drug safety management tests, and the active learning of errors was performed on the intervention group. The results and statistics of medication errors were analyzed using the SPSS software version 16 through the two-sample Wilcoxon test.
Changes in the medication error rate reported show a significant difference in the intervention group, while this difference does not exist in the control group (significance level = 0.589). Also, this trend was observed in the post-test and pre-test results. This rate improved in the intervention group in the post-test by 6.86%. Also, the ratio of reported medication errors increased to 60.8%.
Nurses are one of the most important elements of health services. Therefore, nurses’ continuous education and active participation in learning from errors can be critical in knowledge and awareness, medication error reports, and error rate reduction. Also, focusing on teaching the concepts of medical error, drug classification, and how to manage them can significantly impact this regard.