Quality of working life on residents working in hospitals

BACKGROUND

Residents play an important role in the delivery of hospital care. They regularly work overnight, in emergency situations and with workload and stress which can affect their performance and quality of working life (QWL). This study explores the QWL and its contributory factors in residents working at hospitals affiliated with Tehran University of Medical Sciences (TUMS), Tehran, Iran.

METHODS

Medline was searched to identify questionnaires for measuring QWL in healthcare professionals and these questionnaires were used to design a comprehensive questionnaire for measuring residents QWL. Face and content validity of the questionnaire were examined by 7 experts. The questionnaire then was completed twice with one-week interval by 14 residents to assess the intera-rater reliability. Then 310 questionnaires were distributed among residents working at different specialties in 7 hospitals affiliated to TUMS including a large general hospital, two medium general hospitals and four small single specialty hospitals. Statistical analyses were performed by SPSS.

RESULTS

Totally, 263 residents (84%) completed the questionnaire. The quality of working life was very well in 18%, well in 32%, moderate in 31%, low in 14% and very low in 5% of residents. Pediatric residents had the highest and urology and internal medicine residents had the lowest quality of working life.

CONCLUSION

The QWL is high in the majority of residents, but the QWL is still not desirable in a significant proportion of them. The questionnaire used in this study is reliable and valid. The residents' QWL still need improvement.

The Effect of Service Quality on Patient loyalty: a Study of Private Hospitals in Tehran, Iran

BACKGROUND

Service quality is perceived as an important factor for developing patient's loyalty. The aim of this study was to determine the hospital service quality from the patients' viewpoints and the relative importance of quality dimensions in predicting the patient's loyalty.

METHODS

A cross-sectional study was conducted in 2010. The study sample was composed of 943 patients selected from eight private general hospitals in Tehran. The survey instrument was a questionnaire included 24 items about the service quality and 3 items about the patient's loyalty. Exploratory factor analysis was employed to extracting the dimensions of service quality. Also, regression analysis was performed to determining the relative importance of the service quality dimensions in predicting the patient's loyalty.

RESULT

The mean score of service quality and patient's loyalty was 3.99 and 4.16 out of 5, respectively. About 29% of the loyalty variance was explained by the service quality dimensions. Four quality dimensions (Costing, Process Quality, Interaction Quality and Environment Quality) were found to be key determinants of the patient's loyalty in the private hospitals of Tehran.

CONCLUSION

The patients' experience in relation to the private hospitals' services has strong impact on the outcome variables like willingness to return to the same hospital and reuse its services or recommend them to others. The relationship between the service quality and patient's loyalty proves the strategic importance of improving the service quality for dragging and retaining patients and expanding the market share.

The Psychometric Properties of the Farsi Version of "Hospital Survey on Patient Safety Culture" In Iran's Hospitals

BACKGROUND

If you want to start a long journey towards patient safety, you should create a good culture of patient safety among employees alongside structural interventions. The first step in doing so is the assessment of current culture in the organization using different tools. One of the most commonly used instruments of measuring patient safety culture is Hospital Survey of Patient Safety culture (HSOPS). The aim of this study was to assess the validity and reliability of Farsi version of this questionnaire for the first time in Iran's hospitals.

METHODS

We purposefully selected four hospitals out of seven general Tehran University of Medical Sciences affiliated hospitals. Then a 420 sample of staff of these hospitals were taken randomly. Staff was asked to complete the questionnaire. Confirmative factor analysis, correlation coefficient, Cronbach's alpha were employed in statistical analyses.

RESULTS

Factor loadings for almost all questions were acceptable. Factors jointly explained 77.8% of the variance in the responses. The Cronbach's alpha coefficient was between 0.57 and 0.8. The study revealed that over 70% of employees were working at their hospitals more than 40 hours a week and also more than half of the employees were not reporting errors.

CONCLUSION

Farsi version of HSOPS with 12 dimensions and 42 questions is a valid and reliable questionnaire to measure patient safety culture for the first time in Iran hospitals. This tool will be helpful in tracking improvements and in heightening awareness on patient safety culture in Iran.

Primary anaplastic large cell lymphoma of trachea with subcutaneous emphysema and progressive dyspnea

Primary anaplastic large cell lymphoma of the trachea is a rare tumor. Common complaints are dyspnea and cough that could mimic a partially refractory asthma in some cases. We report a 16-year-old female with an anaplastic large cell lymphoma (null cell type) in which tracheal involvement was presented with life-threatening airway obstruction and subcutaneous emphysema. After debulking the tumor by endobronchial curettage, the patient was treated with chemotherapy followed by local radiotherapy. She had no evidence of local or distant recurrence after 25 months. Primary anaplastic large cell lymphoma of the trachea is a rare life-threatening disease. Nevertheless, this condition has a good prognosis if diagnosed immediately and treated with chemotherapy and radiotherapy.

Patients' length of stay in women hospital and its associated clinical and non-clinical factors, tehran, iran

BACKGROUND

Length of Stay (LOS) is an appropriate hospital indicator to evaluate hospital resource utilization rate, efficiency, and quality of services delivered. In this survey, we aimed to study hospital LOS and determine its association with clinical and non-clinical factors in Women Hospital in Tehran.

METHODS

In this cross-sectional study, we reviewed all 3421 charts of patients admitted in Oncology, Surgery and Obstetrics units in 2008. We used a data collection sheet and conducted interviews to collect the following data: distance from living area, medical insurance coverage types, admission and discharge months, days and times, inpatient units, final diagnoses and the number of diagnostic tests.

RESULTS

The overall median of the LOS in the studied hospital was 50.8 hours. The medians were 48.5, 54.4, and 94.2 hours in the Obstetrics, Surgical and Oncology units, respectively. Results showed that the associated factors with the LOS were patient admissions on Thursdays, admitting by residents, the number of performed diagnostic tests (p<0.001), suffering from neoplastic diseases (p=0.005) and spouse jobs.

CONCLUSION

Among the associated factors, policy makers and managers can only change the admission days and the number of diagnostic tests to decrease the LOS. Further researches are needed to find other factors associated with LOS.

Incidence rate of ovarian cancer in Iran in comparison with developed countries

BACKGROUND

Ovarian cancer is one of the most common gynecologic malignancies. The present study was designed to compare age-standardized incidence rate (ASR) of ovarian cancer in Iran with that in Australia and some other developed countries.

MATERIALS AND METHODS

Data from the Cancer Registry Program of Iran, as a base, were compared with the cancer registry reports of surveillance, epidemiology and end results program in the USA, considering the population of the USA in the year 2000 as the standard population.

RESULTS

In all the age groups, ASR of ovarian cancer was much lower in Iran. Overall rates of ovarian cancer in Iran and the USA were 3.9 and 16.2 per 100,000, respectively.

CONCLUSION

Age-standardized ovarian cancer rate in Iran was much lower in comparison with high incidence areas in the world. Encouraging oral contraceptive use and reduction in fat intake may be effective in decreasing the rate of ovarian cancer or keeping its rate constant in Iran.

Eight years of lung transplantation: experience of the National Research Institute of Tuberculosis and Lung Diseases

BACKGROUND

Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Iran, the first single-lung transplantation was performed in the year 2000, more than 3 decades after the first successful procedure in the world, and the first double-lung transplantation was performed in the year 2006.

OBJECTIVE

To describe our 8-year experience in lung transplantation.

PATIENTS AND METHODS

During 8 years, we performed 24 lung transplantation procedures. Underlying lung diseases were pulmonary fibrosis in 16 patients (66.6%); chronic obstructive pulmonary disease in 2 (8.3%); bronchiectasis in 5, including 2 patients with cystic fibrosis (20.8%), and alveolar microlithiasis in 1 (4.16%). Data for all patients were collected and analyzed. Procedures were carried out using standardized methods. The induction suppression regimen consisted of cyclosporine and methylprednisolone. Maintenance immunosuppression drugs were cyclosporine and mycophenolate mofetil, and tapering dosage of prednisolone. Patients were followed up with physical examinations, 3 times a week, as well as and cycle ergometry 3 times a week and spirometry and laboratory tests once a week and chest radiography per needed for up to 3 months posttransplantation.

RESULTS

The longest survival time was 7.2 years, in a 60-year-old patient with idiopathic pulmonary fibrosis. Fourteen patients died, 8 as a result of hemodynamic instability and/or hemorrhage, 1 as a result of bone and fat emboli, 3 after cessation of drug and 2 of them after infection.

CONCLUSION

Although lung transplantation is a complex procedure it can be performed in developing countries such as Iran.

Comparison between Intravenous and Intramuscular Administration of Prostaglandin E2 on Management of Missed Abortion

BACKGROUND

To compare the efficacy of two routes of prostaglandin E2 administration (Intravenous and Intramuscular) for treatment of missed abortion this study was conducted. Regarding the pilot cases of missed abortion admitted for termination of pregnancy intravenous administration of PGE2 that had higher efficacy compare to intramuscular route, investigators designed this study.

METHODS

In a randomized clinical trail, 50 women with confirmed missed abortion received 250-500 μg prostaglandins E2 either intravenously or intramuscularly. Evacuation time set from drug injection to complete empting of uterus. Complete uterine evacuation was defined as empting of uterus from pregnancy materials without the need for surgical intervention and partial evacuation defined as incomplete empting of uterus that need further surgical management. Data were analyzed using SPSS, version 13. All the data extracted with a checklist and compare by descriptive statistics and X2 and t-tests.

RESULTS

There was no statistically difference between the results of two administration routes. The mean of evacuation time in intravenous administration routes was significantly lower in compare to intramuscular administration routes (P< 0.5). There was no statistically significant difference in the demographic data in two groups.

CONCLUSION

There was no preference between two administration routes except for evacuation time that occurred more rapidly in intravenous administration of PG E2.

Nondestructive room-temperature adsorption of 2,4,6-tri(2'-thienyl)-1,3,5-triazine on a Si-B interface: high-resolution STM imaging and molecular modeling

Organic nanostructures on semiconductors are currently investigated but the surfaces are known to interact strongly with molecules. To reduce the molecule-surface interaction, we used the Si(111)-B square root 3 x square root 3R30 degrees . Deposition of isolated 2,4,6-tri(2'-thienyl)-1,3,5-triazine, was achieved at room temperature without modification of their pi skeleton. This fascinating arrangement, observed by STM, has been validated by full density functional theory computations onto the entire system. The theoretical results give a clear explanation for the specific adsorption sites of molecules on the substrate.

Characterization of single wall carbon nanotubes by means of rare gas adsorption

Based on the formalisms of Langmuir and Fowler, theoretical adsorption isotherms are calculated for different bundle geometries of single wall carbon nanotubes in a triangular lattice. The authors show the dependence of the adsorption properties on the nanotube diameter and on the specific morphology of the bundles they constitute. The authors demonstrate how isotherm curve analysis can help to experimentally determine what kinds of tubes form a given bundle and the ratio of open to closed tubes in a sample having undergone a complete or incomplete opening protocol. In spite of the model's simplicity, quite satisfactory agreement is observed between experiments and the authors' calculations.

[The biochemical diagnosis of Gaucher disease]

Gaucher disease is a disease of overload lyosomale which we often met since a score of years. Since 1980 we had to answer several requests for diagnosis of this metabolic disease. Requests emanating primarily from paediatric services. Twelve cases were confirmed within sight of measurement of the intra-leucocytic activity of the beta-glucocerebrosidase, enzyme intervening in the catabolism of the sphingolipides. We report here our experiment in the biochemical diagnosis of Gaucher disease by showing mainly the variability and the extreme heterogeneity of the activity of the beta-glucosidasic during practised measurements. In addition, we expose the problems of diagnosis etiologic which certain patients raise in front of the discordances between the measured enzymatic activity and clinical signs of the disease of left-handed person. In addition, we develop the biological parameters useful to proportion for the monitoring of the treatment which is finally available in our country.

Influence of molecular adsorption on the dielectric properties of a single wall nanotube: A model sensor

Recent measurements of the resonance frequency of a copper disk covered with carbon nanotube bundles have shown characteristic resonance shifts during exposure with various gas molecules. The shifts were interpreted as the change of the dielectric permittivity of the system forming the sensor due to the electric properties of the adsorbed molecules. Starting from a simplified sensor model formed by one single wall nanotube, we develop a self-consistent approach to describe the variation of the linear dielectric susceptibility of the tube at the atomic scale when molecules are adsorbed at its external surface. The sensitivity of this model sensor is tested as a function of the apolar or polar nature of the admolecules, their adsorption geometry, their concentration, and the characteristics of the tube (length, diameter,...). The comparison with data on dielectric constant changes vs adsorption, coming from measurements of the resonance frequency shifts, displays striking agreement for most of the molecular species considered.

EMA-EP regimen, as firstline multiple agent chemotherapy in high-risk GTT patients (stage II-IV)

Multiple agent chemotherapy in high-risk metastatic gestational trophoblastic tumor patients is a problem for any medical team. In this study, EMA-EP chemotherapy (etoposide, methotrexate, actinomycin, and cisplatinum) was evaluated as firstline chemotherapy to manage high-risk GTT metastatic patients. Seventeen high-risk metastatic patients, including 14 without and 3 with brain metastasis, who were candidates to firstline multiple agent chemotherapy between April 2000 and March 2003 in Vali-e-Asr hospital took part in a prospective study under EMA-EP regimen. EMA-EP was prescribed in two periods: EMA in two consecutive days in week 1 and EP in 1 day in the following week with a week interval between these two (each cycle was repeated every 2 weeks). In brain metastasis group, patients got high-dose medication (methotrexate) together with brain radiotherapy. Remission, toxicity, full dose tolerance, and recurrences of patients were evaluated. Median age of patients was 30 (15-49), and they received 100 courses of chemotherapy including 75 low-dose courses and 25 high-dose courses. 71% of courses were done in full dosage (83% in low dose and 36% in high dose). The most common cause for dosage reduction was leukopenia. Two patients did not complete the regimen, one due to hypersensitivity and the other due to fever and leukopenia leading to death. All others, who received complete courses, achieved remission. In the group without brain metastasis, one case of recurrence was observed. Grade 3 anemia, grade 3 and 4 leukopenia, and grade 3 and 4 thrombocytopenia were observed in 3, 12, and 3% of patients, respectively. In current study, EMA-EP regimen in patients with high-risk metastatic GTN patients (with or without brain metastasis) lead to remission in all patients who completed the treatment courses.

[Surgery for diaphragmatic palsy]

Diaphragmatic palsy leads to a permanent ascension of one or both hemi-diaphragms with highly variable functional impact. The underlying mechanisms can be divided into two main categories: neurological or muscular disorder leading to peripheral dysfunction; defective or non-transmitted central command causing central dysfunction. A complete morphological and functional work-up is required to determine the circumstances leading to diaphragmatic palsy and the uni- or bilateral nature of the paralysis. The entire phreno-diaphragmatic transmission chain from the cranium to the diaphragmatic muscle must be analyzed to search for a local cause. Function tests are used to examine central command and transmission, function of the phrenic nerve, and the capacity of the diaphragmatic muscle to generate sufficient pressure for efficacious ventilation. Once indirect causes of diaphragmatic ascension (independent of the phreno-diaphragmatic system) have been ruled out, surgery may be proposed for symptomatic, permanent and irreversible diaphragmatic paralysis. A tension procedure may be sufficient in the event of eventration with or without phrenic palsy. For well-selected patients with central paralysis due to supraspinal lesions with intact nerves and muscles, implantation of a phrenic pacemaker may be helpful to eliminate positive pressure mechanical ventilation and restore more physiological respiration.

EMA-EP regimen, as firstline multiple agent chemotherapy in high-risk GTT patients (stage II–IV)

Multiple agent chemotherapy in high-risk metastatic gestational trophoblastic tumor patients is a problem for any medical team. In this study, EMA-EP chemotherapy (etoposide, methotrexate, actinomycin, and cisplatinum) was evaluated as firstline chemotherapy to manage high-risk GTT metastatic patients. Seventeen high-risk metastatic patients, including 14 without and 3 with brain metastasis, who were candidates to firstline multiple agent chemotherapy between April 2000 and March 2003 in Vali-e-Asr hospital took part in a prospective study under EMA-EP regimen. EMA-EP was prescribed in two periods: EMA in two consecutive days in week 1 and EP in 1 day in the following week with a week interval between these two (each cycle was repeated every 2 weeks). In brain metastasis group, patients got high-dose medication (methotrexate) together with brain radiotherapy. Remission, toxicity, full dose tolerance, and recurrences of patients were evaluated. Median age of patients was 30 (15–49), and they received 100 courses of chemotherapy including 75 low-dose courses and 25 high-dose courses. 71% of courses were done in full dosage (83% in low dose and 36% in high dose). The most common cause for dosage reduction was leukopenia. Two patients did not complete the regimen, one due to hypersensitivity and the other due to fever and leukopenia leading to death. All others, who received complete courses, achieved remission. In the group without brain metastasis, one case of recurrence was observed. Grade 3 anemia, grade 3 and 4 leukopenia, and grade 3 and 4 thrombocytopenia were observed in 3, 12, and 3% of patients, respectively. In current study, EMA-EP regimen in patients with high-risk metastatic GTN patients (with or without brain metastasis) lead to remission in all patients who completed the treatment courses.

Cloning and characterization of rainbow trout (Oncorhynchus mykiss) somatolactin cDNA and its expression in pituitary and nonpituitary tissues

A cDNA clone encoding rainbow trout (Oncorhynchus mykiss) somatolactin (rtSL) has been isolated from a rainbow trout pituitary cDNA library. This 2329-bp cDNA clone includes a very short 7-bp 5'-untranslated region, a coding region of 702 bp, and a long 3'-untranslated region of 1620 bp. The deduced amino acid sequence of rtSL shows a polypeptide of 233 amino acid residues which consists of a 24-amino-acid putative signal peptide followed by a 209-amino-acid mature polypeptide. This mature polypeptide has a molecular weight of 24 kDa. The rtSL shares 99% amino acid identity with chum salmon SL (csSL) and approximately 53-77% amino acid identity with SLs in other fishes, including the 7 conserved cysteine residues. Although a glycosylation site has been identified in SL of other fish species, none is observed in rtSL polypeptide. The level of rtSL mRNA in a single pituitary gland was determined by RNA blot hybridization. Results showed that levels of SL mRNA in pituitary glands of 2-year-old fish were 4- to 7-fold higher than those of 1-year-old fish. The tissue distribution of SL gene expression in adult fish was determined by reverse transcription-polymerase chain reaction (RT-PCR) and DNA blot hybridization. In addition to the pituitary gland, SL mRNA was detected in all tissues examined including brain, gill, heart, kidney, liver, skeleton muscle, spleen, ovary, testis, and immature oocytes. The extrapituitary expression of the SL gene was also detected in embryos and fry. The PCR products which contained the region coding for mature SL from heart and kidney were cloned and characterized. Nucleotide sequence analysis showed that the SL mRNAs in heart and kidney were identical to that in the pituitary gland. These results suggest that, although the pituitary gland is the predominant tissue for producing SL, it is not the only tissue that SL gene is expressed in, and the extrapituitary expression of rtSL gene starts from very early developmental stages.