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Table of Contents
January-March 2014
Volume 2 | Issue 1
Page Nos. -
Online since Wednesday, June 25, 2014
Accessed 67,637 times.
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REVIEW ARTICLES
A review on violence and related demographic factors in hospitals of Iran
p. 1
Mahmoud Keyvanara, Mohammad Reza Maracy, Azad Shokri, Ayan Kordi, Najmeh Bahman Ziari
DOI
:10.4103/2347-9019.135340
Today violence is considered as one of the issues relating to health and occupational safety of people, and healthcare workers are exposed to more violence than the others. This mater has not been well known in Iran too and limited actions have been done to evaluate the related risk factors of violence and thereby prevent and reduce its incidence in hospitals. Hence, this study aimed to investigate the research conducted at the country's hospitals on the incidence, and prevalence of violence and identify factors related to its incidence, among demographic factors. This narrative review study was carried out in 2013 by searching Google, Google Scholar, Scientific Information Database (SID), Irandoc, Magiran and PubMed sites using keywords combination of demographic factors, violence, aggression, hospital and Iran. The aim of study was to search for all studies about the prevalence of violence and related demographic factors in hospitals of Iran that finally 17 appropriate and consistent studies were selected. According to the results, violence in hospitals of Iran was more verbally and physically, and in general men were the main attackers and victims of violence. Age, work experience and low level of education can also be as effective factors to increase the violence. Considering this fact that some factors such as poor working conditions with lack of manpower to care for many patients and long waiting time has caused aggression, and therefore to reduce and prevent violence, better human resource planning using experienced and patient staff to interact with clients and increasing the number of employees for better care and staff training in coping with violence, anger management and appropriate and respectful communication with patients and families are suggested.
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Performance-based financing inlow-and middle-income countries
p. 6
Mubashir Zafar
DOI
:10.4103/2347-9019.135341
The "pay-for-performance" (P4P) tool has been used in low and middle-income countries in order to improve the performance of health-care providers. It helps to improve the quality of care and efficiency but has a drawback that it has a focus on a single condition and do not reflect the complexity of caring for patients with multiple conditions. To assess the impact of P4P on utilization of health service and quality of care in low- and middle- income countries. Different documents, papers, reports and literature were searched to assess the impact P4P on utilization and quality of health services and used Google search engine for this purpose. Analysis of the papers and project documents from 2002 to 2012 was conducted. The P4P schemes range from very large national programs to localized pilots and has been successfully implemented in post-conflict/fragile areas. Pay for performance model implemented in Dera ghazi Kahn district in Pakistan through free of cost vouchers given to pregnant women for antenatal checkup and transport facilities. The facility based deliveries increased from 20 to 90%. In Morocco, P4P model implemented through paid to the physicians for quality of care, screening of cervical cancer increased from 1.7 to 5.3% and hemoglobin A1c increases from 0.2 to 2.1%. Pay for performance increase the utilization of health services and quality of health services but it is constrained by certain challenges such as immature non-governmental international organizations (NGO) service sector with weak managerial and technical capacity, conditional cash transfers to households in countries with a large proportion of the population considered poor.
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ORIGINAL ARTICLES
Utilization assessment of radiology information system: Solution to patient safety improvement
p. 15
Ahmad Reza Raeisi, Asghar Ehteshami, Mahtab Kasai, Mohamadreza Yusofi
DOI
:10.4103/2347-9019.135345
Introduction:
Radiology Information System is responsible for information management tasks typically including readout, storage, analysis and information optional searching. It is generally responsible for administrative and clinical information management tasks in the radiology department. Quality RIS can support software applications in other department such as nuclear medicine, imaging centers, radiation therapy, and endoscopy.
Methods:
This is an applied cross-sectional study assessing utilization of radiology information system in 12 academic hospitals. The study checklist includes 94 items assessing Radiology Information System input, process and output. Its content and constructed validity were confirmed by research literature and experts opinion. The collected data were analyzed Using SPSS software V. 14.
Results:
The results indicated that hospital Radiology Information Systems compliance with input, process and output criteria were 54.9%, 55.2% and 37.7%, respectively. The results also showed that the mean input, process, output compliance level in fully electronic and semi electronic radiology information systems were 61% and 44%, respectively.
Conclusions:
Hospitals with electronically integrated radiology information systems had a more favorable position than other hospitals. They had quality medical staff, were able to provide comprehensive care and services to patients and other consumers and improve patient safety. To achieve their full potentials and close the exiting gaps adoption of international standards is essential and necessary.
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Surveying the crises interaction with the emphasis on earthquake crisis using SWOT method: A case study on district 22, Tehran metropolis
p. 22
Seyed Mahdi Hashemi, Amir Mahmoudzadeh, Fariba Yousefi
DOI
:10.4103/2347-9019.135348
Introduction:
Earthquake is a natural phenomenon when occurs on its own does not necessarily have undesirable and unpleasant results. But what causes it to be a 'disaster' is the damage and harmful consequences arising from lack of preparation to confront and deal with this natural phenomenon.
Materials and Methods:
Tehran metropolitan area of about 1500 square kilometers is located in the central and the southern slopes of the Alborz Mountain. Tehran with a population of over 12 million people, not only is the most populous city in Iran, but also is the political, economic, social and cultural center in the Islamic Republic of Iran. Probability of an earthquake in Tehran metropolis is a very strong assumption, so in order to reduce the consequences of this disaster a study ought to be carefully done to finally being able to consider a strategic model for controlling the outcomes of earthquakes and the results of their interactions. In this regard, this study aims at investigating the interaction of crises, with emphasis on earthquake crisis using the Strengths Weaknesses Opportunities and Threats (SWOT) method in a case study of district 22, Tehran metropolis. In this regard, an extensive study has been done on the faults and structural status, demographic, urban fabric, etc. Method used in this research is the SWOT.
Conclusions:
Of the results of this research, the abundancy of gardens and green areas can be noted as a strong point so that these spaces can play a special role in crisis management.
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The survey of degree of observance of positive patient identification standards in university hospital
p. 30
Asadollah Shams, Vahideh Rostami, Marzieh Javadi
DOI
:10.4103/2347-9019.135352
Context:
Misidentification of patients is a common problem that many hospitals face on daily basis and is one of the resulting causes of medical errors and medical malpractices. Ensuring correct patient identification prior to any medical intervention is necessary at all times.
Aims:
The present study was conducted to assess the degree of observance of correct patient identification standards in One of the biggest teaching hospitals university hospital.
Subjects and Methods:
The present descriptive study was carried out cross-sectional in autumn of 2013, in One of the biggest teaching hospitals university hospital. Data were collected by a valid and reliable researcher who made checklist through observation (documents and patient identification process) and through interview with 150 patient and staff that were randomly selected. The data was analyzed using Statistical Package for the Social Sciences (SPSS) statistical software and descriptive statistical methods. Results: The results of the present study indicated that correct patient identification process when prescribing medication with a mean score of 85.7% was evaluated 'good'. The correct patient identification process before blood transfusion (73.5%), the general principles associated with the correct patient identification process (71%), correct patient identification during laboratory (70.7%) and correct patient identification before imaging (50%) were evaluated average in studied hospital. Correct patient identification before surgery and correct infants identification process with score of 43.7%, 45%, respectively were evaluated 'poor'. Overall, hospital in the implementation of the principles associated patient safety identification process with a mean score of 62.8 was evaluated 'average'.
Conclusions:
Given that the importance of patient identification process in patient safety and considering that patient safety is the required infrastructure for clinical governance and accreditation program. Thus, the use of proper patient identification systems should be placed at the head of the patient safety program.
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The share of adverse events from patients' complaints: A case study
p. 34
Alireza Jabbari, Elahe Khorasani, Marzieh Jafarian Jazi, Maryam Mofid, Raja Mardani
DOI
:10.4103/2347-9019.135354
Introduction:
Adverse events are among the important challenges that health systems in all countries are grappling with and they are attempting to minimize them and reduce the damages caused by them. In the meantime, complainant is expressing dissatisfaction, which needs the accountability and auditing. Only a small proportion of dissatisfaction with the Health Care System is reflected in complaints. This paper aims at investigating the proportion of adverse events in the complaints of individuals referring to the Deputy of Treatment of an Iranian Province, which is the authority to respond the complaints from the real and legal people, who are health services providers.
Materials and Methods:
This is a cross-sectional retrospective descriptive research. The population of the study has been the cases of complaints referring to the Deputy of Treatment in 2012. All the registered cases have been studied. For data collection, we used extended checklists of the Deputy of Treatment in which their face and content validity have been approved by the experts. Data was extracted from the files and it was described using the frequency distribution table in Excel.
Results:
The findings showed that in 2012, 587 cases of complaint were submitted to the Deputy of Treatment, of which 504 cases (85/86%) were related to the first six months of the year and 83 cases (14/14%) were for the second half of the year. Most complaints from individuals were about the "physician", and from the healthservice providers have been related to the "hospital". The results of the study also indicated that the care processes have been the major subject of the complaints.
Conclusion:
According to the findings of the research, adverse events have been ranked as the third reason for complaints. Failure to provide appropriate and correct treatment has been the most common in interpreting adverse events. Since most of the errors and malpractices are revealed after the patient or his family's complaint, investigation of the complaints referred to the regulatory systems of health service areas by revealing frequency of errors and occurred malpractices, and also by providing appropriate and effective solutions can reduce adverse events and provide the consumers of health services with more satisfaction.
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Prevalence of multi, extensively and pan drug resistant uropathogens among the women patients visiting a tertiary care hospital in central India
p. 38
Trupti Bajpai, Ganesh S Bhatambare, Maneesha Pandey, Meena Varma
DOI
:10.4103/2347-9019.135357
Background:
The escalation of drug resistance among the uropathogens poses a global threat. The indiscriminate, inadequate and the irrational usage of antimicrobials have contributed to the emergence of resistant strains, which may turn out to be a leading cause for the morbidity and mortality in the developing countries.
Aims:
The aim of the study was to provide an outlook on the prevalence of drug resistance among the isolated uropathogens.
Subjects and Methods:
The present study was carried out in the department of Microbiology of a teaching tertiary care hospital from July 2013 to September 2013. A total of 314 urine samples were tested, out of which 115 samples were culture positive. All the uropathogenic isolates were identified up to species level by conventional methods. Antibiotic sensitivity testing was done through disc diffusion method and all interpretations were done in accordance with the Clinical and Laboratory Standards Institute (CLSI)-2013 guidelines. Simultaneously, the extended-spectrum beta-lactamases (ESBL), Amp C and carbapenemase production mechanisms were also detected among the various isolates. Antibiotic resistance profile of the various Gram negative isolates was evaluated and the percentage prevalence of multi drug resistant(MDR), extensively drug resistant(XDR) and pan drug resistant(PDR) isolates was determined.
Results:
Out of the 314 urine samples tested, 120 isolates were detected among which 91 isolates were Gram negative bacilli. Among the 91 Gram negative isolates, 69 (75.8%) were MDR, 11 (12%) were XDR whereas 2 (2.1%) were PDR isolates.
Conclusions:
Before prescribing an empirical anti microbial therapy, an in depth knowledge of the etiology, the predisposing factors, the culture positivity and the continued evaluation of the susceptibility patterns of the uropathogens to the traditional as well as new antimicrobials is essential to avoid irrational drug usage and to ascertain the optimal prophylactic therapy.
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Hospital safety index (HSI) analysis in confronting disasters: A case study from Iran
p. 44
Katayoun Jahangiri, Yasamin O Izadkhah, Azam Lari
DOI
:10.4103/2347-9019.135368
Background:
The ability of hospitals to continue functioning without interruption in disaster situations is a matter of life and death. The Hospital Safety Index (HSI) provides an overview of the probability of a hospital or healthcare facility to remain operational in emergency situations.
Aims:
This study has been performed in one of the hospitals associated with Social Security Organization in Tehran in order to assess the HSI in disasters. HSI helps authorities to quickly determine where interventions can improve safety.
Materials and Methods:
In this applied study, both qualitative and quantitative methods were used.
Settings and Design:
A specialized hospital in Tehran was studied regarding its structural, nonstructural and functional aspects using the World Health Organization/Pan American Health Organization (WHO/PAHO) standard checklists. Various wards and personnel of the hospital were included in this study.
Statistical Analysis Used:
Different types of hazards were analyzed, which are related to the location of the hospital. For determining the amount of risk in different wards, the occurring probability of each risk was scored based on the section status, previous records and events according to the Likert scale in one of the 4 levels and the total scores was considered as the section risk amount. Afterward, among each sections with similar tasks (administrative, financial, managerial and professional, supportive, clinical, surgery room and intensive care unit, emergency unit, and inpatient sections), the least and most amount of risk were clarified with regard to the following scores. Regarding the total scores, the minimum risk amount was 17 and the maximum was 68 in each section. If the total score was less than 17, no risk (safe), 17-34 low risk, 35-52 moderate risk, and in case of 53-70, the high risk was considered for that section.
Results:
According to the results, the final Hospital Safety Index score places this hospital in category "C" among three existing classifications of safety, which means that the hospital's current safety levels are inadequate to protect the lives of patients and hospital staff during and after a disaster.
Conclusions:
Urgent intervention measures and rapid assessment will give decision-makers a starting point to identify priorities in order to reduce risk and vulnerability in hospitals and health care facilities.
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Should area, population and sample selection for gas disaster studies be a multidisciplinary approach: Experiences from Bhopal MIC disaster
p. 50
Brajendra Mishra, AN Seth
DOI
:10.4103/2347-9019.135371
Inroduction:
Following methyl isocyanate (MIC) leak disaster in December 1984, epidemiological studies on health consequences among the affected population were started. The area, population and sample selection for these studies were mainly based on the mortality/morbidity experienced 72 hrs post-disaster or longer by the people living in affected area spread over in 36 wards. Designs for these studies were mainly cross-sectional or prospective. Very soon criticism to the method of area and sample selection started appearing in peer reviewed journals. Some scientists suggested alternative/improved methods for area/sample selection. In few studies, distance/exposure dose versus affect models were also developed and found to be more accurate. Authors decided to review the study design of Epidemiological studies conducted on Bhopal along with other gas disasters; two natural and two manmade have to occur during 1952-1986, for influence of non- epidemiological factors like terrain, meteorology contributed in precipitation of the disasters and the methodology used in area/population and sample selection.
Materials and Methods:
Field visits and Secondary data review: Authors visited Bhopal gas affected area many times in past and reviewed on other gas disasters.
Results:
Authors observed that area population and sample selection exercises can be strengthened by utilization of existing information on non-epidemiological factors contributing to disaster and information generated by other disciplines. It is concluded that in gas disaster epidemiological studies area, population and sample section should have multidisciplinary approach rather than being based on mortality morbidity indices or prevalence of effect rather than prevalence of the cause.
Recommendations:
Authors also recommend some steps to be considered before planning epidemiological studies on gas disasters in future.
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Sending the important signals by internet with Feature extraction capability (Telemedicine)
p. 56
Moslem Begol, Milad Janghorban Lariche, Sepide Iranfar
DOI
:10.4103/2347-9019.135375
Background:
Several research have been done on telemedicine in recent years and this science has been used as a tool for the diagnosis and treatment of diseases. In this article, attention was drawn on a software for sending the important signals of patient to the doctors.In addition to research on telemedicine the Lab view software is used in this project and data send to the doctor by the internet or net with respect to the special standards.
Materials and Methods:
Data have been sent to the computer (target) by the intermediate hardware and after processing the filtering levels and turning data to 'Threaded Mode for doctor' in the doctor's computer.
Result:
There is a place for received information as 'Feature extraction' that has extracted all of the doctor's parameters after computing by this.
Conclusion:
This project is Implemented in the Basic mode, and certainly the continuation of it will be Cause the Acceptable results in the telemedicine world.
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CASE REPORT
Inter-sectoral interaction in oil spill incident: Zayande Rood case study
p. 62
Golrokh Atighechian, Katayoun Jahangiri, Mohammad Reza Maleki
DOI
:10.4103/2347-9019.135378
Five years ago, due to driver bulldozer recklessness, Isfahan-Omidiyeh Oil Pipeline was broken and the extensive oil spill was happening in ZayandehRood, and the surrounding land and the river was polluted. After the incident, the drinking water of some cities was completely cut off for 48 hours. This study was done to present a successful example of inter-sectoral cooperation and interaction for the management of an environmental disaster. This is an applied research that was carried out in five stages. First, a review of the literature was done about oil spill in water resources. Second, the incident was reviewed by existing documents. In the third stage, through interviews with those responsible or involved in incident management, information identifying the roles, responsibilities and interventions and finally content analysis was used to analyze data and design interactive models for oil spill management. Results In response to the incident, widespread acts were done by Governor, Office of Water and Waste Water, The Environmental Protection Agency, Isfahan University of Medical Sciences. The Fire and Safety Services, oil companies and other organizations were responsible for cleaning the area and preventing entry of crude oil, dewatering and water treatment facilities. After cleaning the river and carrying out the necessary tests, water treatment carried out in compliance with relevant standards. Also by coordination in Isfahan province, side problems of water cut were reduced to a minimum. One of the most persistent and dangerous pollution of water resources is oil pollution. This type of pollution is a threat to ground water resources and surface water resources. To reduce the risks of oil spills, prediction and identification of black spots and actions that lead to the occurrence of such events are essential. The inter-sectoral interaction and collaboration between organizations involved in the pre-disaster should be considered.
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SHORT COMMUNICATION
Incorporating private health sector in tuberculosis control activities in India: An overview
p. 69
Saurabh R Shrivastava, Prateek S Shrivastava, Jegadeesh Ramasamy
DOI
:10.4103/2347-9019.135379
Tuberculosis (TB) has been acknowledged as the leading public health disease of an infectious nature. In the global vision to extend the gamut of services to the community, the primary strategy is to involve and engage all health care providers in the Revised National TB Control Program (RNTCP) to have an epidemiological impact on the magnitude of the disease. RNTCP has proposed ten different schemes for encouraging the involvement of NGOs and private providers namely Advocacy, communication, and social mobilization; Sputum collection center; Sputum pick-up and transport; Designated microscopy cum treatment centre; Laboratory technician; Culture and drug sensitivity testing; Treatment adherence; Slum scheme; Tuberculosis unit; and TB-HIV scheme, so that the services available under the program reach even those remote rural / tribal areas where there are no public sector health care establishments. To conclude, roping in all private sector health care providers / establishments in the program under the public-private partnerships schemes with active supervision by RNTCP program managers cannot only contribute optimally for the betterment of the program but also ensuring universal access to TB care.
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© International Journal of Health System and Disaster Management | Published by Wolters Kluwer -
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Online since 15 Oct, 2013