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Hospital Practices and Research
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  This is an Open Access Journal Open Access journal
ISSN (Print) 2476-390X - ISSN (Online) 2476-3918
Published by Baqiyatallah University of Medical Sciences Homepage  [4 journals]
  • Audit of Minimally Invasive Hysterectomy Rates: A Canadian Retrospective
           Cross-Sectional ...

    • Abstract: Background: Minimally invasive hysterectomy is generally preferable to abdominal hysterectomy. The technicity index (TI) is the proportion of hysterectomies performed by minimally invasive surgery. Many centers globally have started to audit local TI as a quality indicator, but only a handful have published their results to help define international standards of care. Objective: In this study, TI was examined in Winnipeg and Canada to determine consistency between local and national patterns of practice, audit expected changes, and contribute to the growing body of literature defining international standards of care. Methods: A retrospective cross-sectional database review of hysterectomies performed in the Winnipeg Regional Health Authority (WRHA) from 2008 to 2015 was conducted. Mixed effects linear regression models were generated primarily to analyze TI and account for surgeon and hospital characteristics. The Canadian Institute for Health Information (CIHI) database was accessed to estimate the average national TI from 2009 to 2014. One-sample t tests compared annual WRHA and CIHI TI. Results: In Winnipeg, 1363±32 hysterectomies were performed annually for all indications with an average TI of 34% independent of time (P=0.09). The CIHI database recorded approximately 27 000 hysterectomies annually with increasing TI (41%-52%, 3.5±1.8%/year, P=0.025). WRHA TI differed from national TI every year (P<2.2x10-16). Conclusion: Over the study period, WRHA TI was below the Canadian average and static despite national increases. The importance of local audits to identify underperformance and stimulate initiatives for quality improvement is highlighted in this study.
      PubDate: Wed, 31 Jan 2018 20:30:00 +010
  • Sickness absenteeism of Healthcare Workers in a Teaching Hospital

    • Abstract: Background: Absence from work for health reasons is known as “sickness absenteeism”. Frequent sick leave is a major concern to any organization, especially hospitals. Objective: This study analyzed the extent and causes of sickness absenteeism in a teaching hospital and evaluated its corelation with demographic and occupational factors. Methods: In a cross-sectional study, data was extracted from computerized records regarding sickness absenteeism of healthcare workers (HCWs) in the Occupational Health Department of a teaching hospital in Tehran. Studied variables included demographic characteristics, occupational factors, and causes of sickness absenteeism. The sickness absence rate (SAR) and absence frequency rate (AFR) in the study period were calculated. Chi-square and Mann-Whitney tests were used for the comparison of categorical and quantitative variables, respectively. Results: In the current study, SAR and AFR were 0.011 and 0.68, respectively. Job type was the only factor that had a significant correlation with sickness absenteeism. The major disease-causing sicknesses were flu (21%) and musculoskeletal disorders (18.9%). Conclusion: A significant relationship was found between the nursing group and sickness absence episodes. Flu, musculoskeletal disorders, and infectious diseases were the most frequent causes of sickness absence. Based on these findings, it can be concluded that factors such as availability of the flu vaccine and providing principles of personal protection and infection control can reduce sickness absence due to infectious disease.
      PubDate: Wed, 31 Jan 2018 20:30:00 +010
  • Knowledge, Attitude, and Contraceptive Preferences Among Postpartum Women
           in Izzi, Ezza South, ...

    • Abstract: Background: The fertility rate is high and the contraceptive prevalence rate is very low in Nigeria. Thus, women in Nigeria are exposed to the dangers of unwanted and unplanned pregnancies. Objective: The current study aimed to determine the levels of knowledge, attitudes, and contraceptive preferences among couples in selected health facilities in Ebonyi State so as to recommend a package of intervention to increase contraception uptake. Methods: This cross-sectional descriptive quantitative study used questionnaires administered by the researchers themselves among 128 postpartum women who were current users of contraceptive methods in Izzi, Ezza South, and Ikwo local government areas of Ebonyi State, Nigeria from January 1, 2016 to June 30, 2017. Informed consent was obtained from participants. Data was analyzed using SPSS version 20. Simple percentages were used to report categorical variables. Results: The study results showed that most of the respondents (49%) had a secondary education, were aged above 20 years, and were mainly employed as civil servants with an average monthly income of $47.20. About 69% had less than 5 living children. Most respondents knew about contraception as a means of delaying pregnancy or limiting the number of children (37%) and recommended its use for family/society (46%). The most commonly used contraceptive methods were implants and injectable ones, while the IUD was the least preferred. Both implants and injectable contraceptives were recommended by friends and believed to be highly effective. Conclusion: The current study showed that knowledge and positive attitude of participants towards family planning was high, comparable to studies in other parts of the world. Further research on determinants of postpartum use of family planning methods among this population is recommended.
      PubDate: Wed, 31 Jan 2018 20:30:00 +010
  • Medical Errors Disclosure: Is It Good or Bad'

    • Abstract: Background: In the treatment and health process, there are a lot of dangers to patients, and the increased number of medical errors is one of the most important circumstances of this process. Objective: The present research purposed to decrease medical errors through disclosure of them in hospitals of Tehran University of Medical Sciences. Methods: This qualitative-quantitative study included a population of 232 individuals, selected through targeted non-random selection, who were somehow connected with medical errors made in hospitals affiliated with Tehran University of Medical Sciences. The triangulation technique was utilized to collect data. Data was analyzed using the factor analysis technique. After the effective factors were determined, their internal correlation was determined through regression correlation. Results: Disclosure is made up of organizational culture, the factors related to the patient, the factors related to the presenter, the factors involved in the error, structural factors, and disclosure situation indexes, and is an effective factor in managing the medical errors in hospitals of Tehran University of Medical Sciences. Disclosure increases the immunity of patients. Conclusion: Disclosure is an effective factor in managing the medical errors that occur at hospitals affiliated with Tehran University of Medical Sciences. It is essential that managers identify the effective factors in disclosure and take steps to apply a suitable disclosure system to decrease errors.
      PubDate: Wed, 31 Jan 2018 20:30:00 +010
  • Prevalence of Dissociative Experiences in Those Referred to Emergency
           Psychiatric Centers After ...

    • Abstract: Background: Dissociation is a symptom that can be related to traumatic childhood events. Dissociation in some cases is categorized in a distinct subgroup from other psychiatric disorders. Objective: The purpose of this study was to investigate the prevalence of dissociative experiences in patients who have attempted suicide and who have referred to an emergency psychiatric center. Methods: This was a cross-sectional epidemiological study in which dissociative experiences were evaluated in 98 patients who referred to Ibn Sina and Hafez hospitals after attempting suicide. In addition to determining the prevalence of these experiences, the relation between the symptoms and variables such as sex, age, marital status, education and suicide risk was determined. Results: There was a significant difference in the level of disappointment between married and single patients (P = 0.047). The mean disappointment score for the overall population was 11.92, which is in the normal range. There was no significant relationship between the dissociation score and level of disappointment (P = 0.933). The prevalence of dissociative experiences was found to decrease as the age of the patients increased (P = 0.006). There was no significant difference between the rate of suicide as reflected in the measurement of disappointment and dissociative symptoms. There was no significant relationship between DES score and other variables. Conclusion: One cause of psychological pressure in deciding to attempt suicide is family conflict. Many individuals who attempt suicide did not have a thought-out desire to take their lives, but attempted it impulsively in response to a periodic stressor.
      PubDate: Wed, 31 Jan 2018 20:30:00 +010
  • Preventing Traumatic Urinary Catheter Insertion Through a Computerized
           Ordering System: ...

    • Abstract: Background: Iatrogenic urethral injury is a well-known risk of urinary catheter insertion. Associated morbidities include stricture formation, catheter associated infection, risk for instrumentation, and extended length of stay. Yet, insufficient attention is paid to its prevention. Objective: This study aimed to assess the effectiveness of a computerized ordering system in reducing iatrogenic urethral injuries in men at high risk for iatrogenic urethral injury from traumatic catheterization. Methods: A pre-post study was performed to assess the impact of a computerized ordering system that recommended a 16 Fr Coudé-tip catheter be used instead of the standard 16 Fr Foley catheter for men at high risk for difficult catheter insertion. The intervention was implemented in October 2012. The rates of traumatic and non-traumatic insertion consults were compared between the pre-intervention (10/1/2010-09/30/2011) and post-intervention (10/1/2012-9/30/2013) time periods. Results: The results showed that 78.5% of patients with iatrogenic urethral injury possessed at least one identified risk factor for difficult catheterization. There was no significant difference in frequency of traumatic or non-traumatic insertion consults between the pre- and post-intervention cohorts. Conclusion: The current study highlights the possibility of preventing traumatic insertions by targeting men at high risk for iatrogenic injury. Without a simultaneous plan for improving catheter placement awareness and training, any change in the ordering process is unlikely to succeed on its own.
      PubDate: Wed, 31 Jan 2018 20:30:00 +010
  • Steroid Cell Tumor of Ovary Diagnosed After Delivery; Case Report

    • Abstract: Introduction: Steroid cell tumors (SCTs) constitute less than 0.1% of all ovarian tumors. They are divided into 3 categories according to cell of origin: Stromal Luteoma arising from stromal cells of the ovary, Leydig cell tumor arising from Leydig cells, and SCT not otherwise specified (NOS) when the origin of the tumor is not defined. Case Presentation: Herein is presented a case of SCT diagnosed one month after a caesarian section delivery of a female fetus with ambiguous genitalia. The patient was admitted to the emergency department with the findings of acute abdomen, and surgery was performed under emergency conditions. The patient had virilization and hoarsening of the voice before surgery. Intraoperatively, a 21-cm ovarian mass was detected and resected with unilateral salpingo-oophorectomy. Conclusion: A histopathological examination of the tumor showed a tumor with cystic degeneration, necrosis, hemorrhage, and tumoral embolism. The pathological examination revealed ovarian SCT. Virilization was resolved immediately after the surgery. In women with virilization who give birth to a fetus with ambiguous genitalia, SCTs should be kept in mind.
      PubDate: Wed, 31 Jan 2018 20:30:00 +010
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Heriot-Watt University
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