Journal Of Patient safety and quality improvement
Volume:2 Issue: 3, Summer 2014

Customer Quality (CQ) refers to customer’s characteristics and is related to the consumer knowledge, skills and self confidence in active participating in care process and life style improvement. This study was aimed to assess customer quality among people with Rheumatoid Arthritis (RA) according to the patients’ perspective. This cross-sectional study was carried out on 170 patients who received care from specialist clinics of Isfahan University of Medical Sciences in 2013. Customer Quality was assessed using Comprehensive Quality Measurement in Health care questionnaire (CQMH_CQ). Questionnaire content validity was reviewed and confirmed by 10 experts and its reliability was confirmed based on Chronbach''s alpha index (α=0.803). SPSS-17 statistical software was used to analyze the data. Independent Samples T test and ANOVA were conducted to compare CQ score between categorical variables. The average CQ score was 70.25 (13.20). According to self-reported customer quality score, all participants achieved the scores at the level of stage one. Some (9.2%) of participants didn’t reach the action stage (stag three), then 90.8% took action in facing with health related problem and finally only 19.8% of participant achieved highest level of Self-management. Customer Quality score of employed patients (P=0.026) and patient who had active disease (P =0.030) were significantly. Customer quality scores of illiterate participants were lower than that of the educated (P= 0.001). According to overall score of customer quality, findings indicate the necessity of patients'' involvement in care process and self-thought behavior-change skills for ongoing self-management and enhancing their self care abilities in daily life.

Menopause associates with some psychological and physical changes in the body as well as various unpleasant symptoms in the orofacial complex such as xerostomia and a sense of burning, the mechanisms of which are yet to be fully understood. The goal of this study is to compare the quantity of unstimulated whole saliva between postmenopausal and premenopausal women. In the current study, 40 postmenopausal and 40 premenopausal (20-50 years old) women were chosen. After investigating the psychological condition of patients by Hospital Anxiety and Depression Scale (HADS), the frequency of xerostomia was estimated using a special questionnaire. The volume of accumulative non-stimulated saliva was measured by the spitting method, and the results were analyzed by Chi Square, Mann-Whitney and Kruskal-Wallis test. According to the results, there was no difference in mean volume of unstimulated whole saliva between the two groups. Postmenopausal women, complained from xerostomia significantly more than premenopausal women (%45 versus %17, P= 0.003). Psychological conditions of the two study groups did not show any significant difference. According to the current research, menopause has no effect on the volume of unstimulated saliva in women.

This study was designed to compare the lipid profiles of hypertensive and non-hypertensive cases. In this case-control study, we assessed 200 hypertensive patients alongside 200 healthy individuals who were referred to our cardiology clinics from 2007 to 2008, in Mashhad, Iran. Blood pressure and serum lipids profile including total cholesterol, triglyceride, High-density lipoprotein (HDL) and low-density lipoprotein (LDL) were evaluated in both the case and control group. Total cholesterol and the mean of serum LDL level were significantly higher in the hypertensive patients compared to non-hypertensive cases (P=0.001), while the mean of serum triglyceride levels was higher in the case group compared to the control group (P= 0.001). We concluded that only the serum triglyceride levels were significantly different between the hypertensive and non-hypertensive individuals.

To evaluate main aspects of esophageal strictures in children. This cross-sectional study was performed on 43 cases of esophageal stenosis ranging from 1 month to 10 years of age who were admitted in Ghaem and Dr. Sheikh Hospitals from 1995 to 2003 in Mashhad, Iran. Most cases were male (56%). The most common cause of esophageal stricture was anastomotic stricture after esophageal atresia surgery (34.9%) followed by strictures due to gastroesophageal reflux (25.6%), chemical burns (11.6%), and congenital a (11.6%). Proximal esophagus was the most common site of stricture (48.8%). Dilatation and operation had been chosen as the treatment of choice for most of our cases (42%). The majority of our patients recovered after receiving the proper treatment (60.5%). Anastomotic stricture after surgical repair of esophageal atresia comprised the most common cause of esophageal stricture. Proximal esophagus was the most common site of stricture. Most of the patients recovered with dilatation, surgery, or a combination of the two.

This study aimed to identify the challenges of risk management in the context of clinical governance in selected hospitals of Tehran University of Medical Sciences. This study was implemented in two phases: qualitative step and quantitative step (survey). The first step was conducted using in-depth interviews and the second was carried out through a survey by questionnaire. Data were collected in hospitals through in-depth interviews with hospitals managers and the experts involved in clinical governance who had been introduced by the hospital manager. All professionals affiliated with clinical governance in Baharloo, Firoozgar, Farabi, Shahid Rajai, Ziaeian, Motahari and Sina hospitals were selected. 35 experts involved in clinical governance were interviewed. According to these experts, the main obstacles in hospital risk management were: Lack of an error reporting culture, exaggerated fear of the consequences, and physicians'' lack of interest in this domain. High workloads in this area have led to a reduction in employees'' contributions. Establishing clinical governance in health care organizations has had many benefits, such as improving patient care, increased level of patients'' satisfaction, establishment of a risk management system, improvement in staff and health-care personnel cooperation, and achieving a more successful organizational management. Appropriate changes in the organizational culture are necessities for the successful establishment of risk management. Human and cultural obstacles that hinder the implementation of risk management in hospitals are evident; thus, major actions are necessary to implement risk management properly in a disciplined manner.

Clinical Governance (CG) is a systematic approach to the maintaining and improving the quality of provided services for patients in the health system. With regards to the implementation of clinical governance in hospitals affiliated to Mashhad University of Medical Sciences and the role of matrons in ensuring quality care, little is known about the relationship between matrons’ participation in this plan and hospital success in clinical governance fulfillment. This cross-sectional, analytic-descriptive study was conducted to investigate the relationship between matrons’ knowledge, attitude, and performance in clinical governance and Mashhad hospitals'' fulfillment of clinical governance. A researcher-made questionnaire was used for data collection on matrons’ knowledge, attitude, and performance. The standard checklist of the health ministry and observation were used to assess hospital clinical governance fulfillment. Data was analyzed at the hospital level by SPSS16. The mean scores of matrons'' knowledge, attitude, and performance were above average. Matrons'' attitude towards clinical governance achieved the highest mark (4.46). There was no significant correlation between matrons'' knowledge/attitude/performance and hospital scores for clinical governance fulfillment (P>0.05). While the levels of matrons'' knowledge, attitude, and performance were satisfactory, there is still a need for improving matrons'' knowledge. Absence of any statistically significant relationship between matrons'' knowledge, attitude, performance and hospitals scores for clinical governance fulfillment may be due to the study small sample size.

Atherosclerotic carotid artery stenosis is one of the most common causes of stroke worldwide. Carotid revascularization using Carotid Endarterectomy (CEA) may play an important role in reducing the stroke prevalence in selected patients. Post-CEA complications of significant concern include cerebral hyperperfusion syndrome, ischemic stroke and cranial nerve injury, perioperative myocardial infarction, unstable angina, respiratory problems, renal failure, wound complications, and postoperative hyper- or hypotension. With regards to CEA complications, the individual risk assessment plays an inevitable role in reducing the negative outcomes and increasing the procedure efficacy. In this review, we studied CEA complications by reviewing the previously published literature. In addition to its benefits, CEA has its own complications, but at a lower severity. Reducing the incidence of post-CEA complications is crucial, especially in the patients with a less remarkable margin of benefit in stroke prevention. Despite its complications, CEA remains the gold standard for treating carotid stenosis in selected symptomatic and asymptomatic patients. Accurate perioperative diagnosis and evaluation may help us develop a practical approach to more a beneficial and accurate surgical strategy.

Duane retraction syndrome and Coats'' disease are two relatively rare ocular conditions that occur in congenital and acquired forms in children. We present a 12-year-old boy with the chief complaint of eye deviation who was diagnosed later on to have Duane retraction syndrome in one eye and Coats'' disease in the other. After a comprehensive review of literature, we assume that this is the first case of simultaneous presentation of these two disorders ever to be published. However, we do believe that these are two separated entities and their simultaneous presentation in this patient is pure coincident. Case:A twelve-year-old Asian male was presented with about 25 prism diopters of exotropia in primary position, limited abduction/adduction, and narrowing of palpebral fissure of the right eye since childhood. The left eye showed lipid deposition, macular edema, and peripheral retinal telangiectasia. The occurrence of two different congenital and acquired ocular diseases is rare. This is the first simultaneous presentation of Duane syndrome and Coats'' disease ever to be reported in a young patient.