An investigation into the effects of quality improvement method on patients' satisfaction: a semi experimental research in Iran

Today, to increase effectiveness is a Strategy for success of organizations and their viability. In health care organization not only service cost- effectiveness is a major problem for productivity and organizational management but also customer-centred is in first priority. Because of these reasons, most of health organization trend to patient satisfaction for their viability. If complex process implemented for viability without attention to patient satisfaction, this is no success result. The FOCUS PDCA process is a new strategy for effectiveness of service quality. To this reason, the recent research done and its objective is to assess effect of FOCUS PDCA process strategy on patient satisfaction in surgery units of hospitals affiliated to Tehran Medical University. This research is a semi experimental with non- equivalent design. The sample was all of patients who hospitalized in two selected surgery units. Self-report was method of data gathering. Patient satisfaction assessed with questionnaire in pre and posttest. Then manipulation implemented as post-operation care process selected. Modelling and opportunity statement Diagrams prepared and improvement team organized. Flow process, convergences and cause- effect charts used to prepare list of items to be improved. Executive program was written. This include personnel training, standard implementation, election and training of quality control nurses (Q.C Ns), daily QC of caring and providing appropriate feed back to personnel, forming group session for determining corrective actions. Then after 1 month patient satisfaction was assessed. Statistical analysis shows this process increase patient satisfaction and it leads to care effectiveness. The findings of the pre-intervention phase indicated that the satisfaction level had been low in both groups and it is not significantly different in the two groups (P> 0.05). There was a significant difference before and after following intervention in the case study group (P>0.0001). FOCUS PDCA is effective method for access to various objectives especially patient satisfaction. it is suggested other researcher assess effects of this strategy for other indexes and total care process effectiveness.     

Sulfur mustard-induced poikiloderma: a case report

Sulfur mustard (SM) is a potent chemical warfare agent that was widely used during the First World War and the Iran-Iraq conflict. This vesicant agent causes several acute and chronic effects on the skin, eye, and respiratory system. We report the case of a 41-year-old man who was injured with SM in Iraq chemical attack in 1988. After exposure, he developed severe skin blisters on his upper trunk, dorsum of hands, and genitalia. Based on several clinical observations, such as atrophy, pigmentation, and vascular changes on genitalia with relevant findings in histopathological studies, persistent pigmentation, and damaged skin appendix in hand lesions, a diagnosis of "SM-induced poikiloderma" was postulated. The absence of any complication on the palmar aspect of hands is another remarkable finding in presented case, which suggests a plausible role of the palms as a vector for transporting SM to other sites of the skin.     

Relative fractional anisotropy value using DTI: Can it help as a prognostic tool in anticipating the recovery of stroke patients?

Objective

To evaluate the use of diffusion tensor imaging (DTI) and fractional anisotropy (FA) as prognostic tools in anticipating the recovery of stroke patients.

Effect of oral contraceptives on balance in women: A randomized controlled trial

Objective

To detect the effect of combined oral contraceptive pills (COC) on dynamic postural balance in healthy middle aged women.

The T657C polymorphism on the SYCP3 gene is associated with recurrent pregnancy loss

SYCP3 (Sinaptonemal complex protein 3) plays a critical role in pairing and recombination of homologous chromosomes in meiosis 1. It has been shown that lack of this gene leads to infertility in male and weakened fertility in female mice. In a case–control study, we investigated the SYCP3T657C polymorphism in the genome of 100 Iranian women with recurrent pregnancy losses of unknown causes as well as 100 control samples of normal fertile women having at least one healthy child. The general aim of our study was to determine whether there is a relationship between genetic changes in the SYCP3 gene and recurrent pregnancy loss in human or not. Frequency of the heterozygous genotype and mutated allele C were significantly higher in women with recurrent pregnancy losses (P-value < 0.005). Our findings suggest that the T657C polymorphism of the SYCP3 gene is possibly associated with recurrent pregnancy loss of unknown cause in human.     

Gastric secretions affected by esophageal distention in the rat

Background  The effect of esophageal distention (ED) on gastric motility has been well documented, but only a few investigations have been carried out about the effect of ED on gastric secretions. The aim of this study was to investigate the effect of ED on gastric acid and pepsin secretions and the mechanisms involved. Methods  Male adult Wistar rats (200–240 g) were anesthetized by urethane [1.2 g/kg, intraperitoneally (i.p.)] and underwent tracheostomy and laparotomy. A catheter was inserted in the stomach through the duodenum for gastric washout and distention followed by the esophageal distention by a balloon (0.3 ml, 10 min). Gastric acid secretion was stimulated by gastric distension (1.5 ml/100 g body weight), pentagastrin (20 μg/kg, i.p.), or insulin (0.6 IU/kg, i.p.). Pepsin secretion was stimulated by carbachol (20 μg/kg, i.p.). Effects of cervical vagotomy and reserpine (1 mg/kg, i.p.) were also investigated. Results  Gastric distention-, pentagastrin-, and insulin-stimulated gastric acid secretion was reduced by esophageal distention (P < 0.001, P < 0.05, and P < 0.05, respectively). Carbachol-induced pepsin secretion was also attenuated by esophageal distention (P < 0.05). Cervical vagotomy abolished the inhibitory effect of ED on pentagastrin-induced gastric acid secretion. In reserpinized rats, ED reduced the basal gastric acid secretion (P < 0.05). Conclusions  These results indicate that the vagus nerves are involved in the inhibitory effect of esophageal distension on gastric secretory function.     

Screen-detected malignant breast lesions diagnosed following benign (B2) or normal (B1) needle core biopsy diagnoses

Breast needle core biopsy (NCB) is now a standard diagnostic procedure in the triple assessment of screen detected breast lesions. However, unlike fine needle aspiration (FNA) cytology, information on the miss rate including false-negative diagnoses (FN) of malignancy (benign ‘B2’ or normal ‘B1’ NCB with a malignant outcome) is limited.MethodsA large series of NCBs (121, 742) performed over an 8-year period has been studied to assess the frequency and causes of missing a malignant diagnosis on NCB and to evaluate their impact on patients’ management in the screening service.ResultsDuring the period of this study, 50,691 were diagnosed as B2 and 9599 were diagnosed as B1. Of those, 779 B2 and 919 B1 were diagnosed as malignant on the subsequent surgical specimens, respectively, giving a FN rate of 3.0%. However when year of diagnosis was taken into consideration, we found that during the period 1999–2001, the FN rate for B2 was 2.7% while the miss rate for B1 was 4.0%. This showed marked improvement over time to reach a figure of 0.5% and 0.5% for B2 and B1, respectively, during the period 2005–2007. On detailed review of cases from a single screening region diagnosed during the last 3 years (2005–2008), 14 cases (0.17% of all NCBs) with malignant surgery were diagnosed as B2 (seven cases; FN rate 0.19%) and B1 (seven cases; B1 biopsy rate from cancer 0.19%). In these cases, NCB was unsatisfactory, there was a discrepancy between radiological abnormalities and histological findings with recommendation for excision or suspicious/malignant cytological diagnosis on concurrent FNA material. Therefore, our results indicate that the malignancy miss rate on NCB is rare and FN NCB diagnoses had no impact on patient management.