Proactive risk assessment of the laboratory management process inGhaem Hospital, Mashhad (2013)

Laboratory errors may occur in every stage of laboratory management process and lead to a considerable harm to inpatients. This study was aim to investigate the Proactive risk assessment of the laboratory management process in Ghaem Hospital, Mashhad (2013). This was a descriptive research that quantitatively and qualitatively analyzed some failure modes and effects. In order to classify the modes of failure and effective causes of them and also determining the improvement strategies, we have used "nursing error management association", "Eindhoven" and "theory of inventive problem solving" models respectively. In 5 steps of laboratory management process which is conducted on17 listed sub-processes, on average 59 error modes in each ward was identified. 18.7% of error modes were identified as high risk errors (hazard score ≥ 8). Most of error causes were related to human factors (42.7%).In addition, 31.6% of preventive measures were assigned in human resources management strategy group and 16.9% in team work group. The Healthcare Failure Mode and Effect Analysis method was very efficient in identifying failure modes, determining causes which impact each failure mode, and proposing improvement strategies for laboratory management processes of Ghaem Department.

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Evaluation of correlation between lifestyle

AbstractObjectives:  Cardiovascular diseases are the leading cause of 17’000’000 worldwide deaths annually. If the current trends continue, the number of deaths will increase to 25’000’000 by the year 2020. Lifestyle contributes to many chronic diseases such as coronary heart diseas. The aim of this study was to examine the correlation between lifestyle and ischemic heart disease.Methods:  This case-control study was carried out in Damavand sevvom sha’ban hospital. The sample of the study consisted of 65 cases (patients suffering from coronary artery disease) and 65 healthy controls. Data were collected by three questionnaires: General Health Questionnaire(GHQ), FFQ (Food Frequency Questionnaire) and physical activity questionnaire . These questionnaires were completed by interviewing the participants. Data were analyzed by SPSS software.Results:  There was a significant correlation between Age, Marital status, Smoking, Physical activity, diet and Mental health and ischemic heart disease.Conclusion:  Insufficient physical activity, high fat and low fiber diet, inappropriate mental status were risk factors and major causes of in heart ischemia incidence.Key words: Heart Ischemia, Life Style, Physical Activity, Diet, Mental Heath. REFERENCES Ahmadvand AR. Jamshidi AR. and et al (2002). [Translation of Health World Report of 2002]. Tehran:   Avicenna Institute. (Persian)   American Heart Association (AHA) (2001). Heart and Stroke Facts. New York: American Heart Publication.. Aminbashi M. (1999). [Prevalence of Risk Factors for Coronary Artery Disease Patients Under 50 Hospitalized in Zahedan Khatamolanbia Heart Hospital]. MS Tehsis. Zahedan Medical Sciences University in 1373-77   year. (Persian)   Azizi F. (2001). (Sugar & Lipid in People of Tehran). Metabolism & Endocrinology Researches Center of Shahid Beheshti Medical Sciences University. (Persian) Azizi F. Hatami H. Janghorbani M. (2000)[ Epidemiology and Control of Common Diseases in Iran]. No. 1. Tehran: Eshtiyagh. (Persian) Baecke JA. Burema J. and Frijters JE. (1982) A short questionnaire for the measurement of habitual physical   activity in epidemiological studies. The American Journal of Clinical Nutrition. 36(5)936-42. http://ajcn. nutrition. org/content/36/5/936. short Bastanhagh MH Nematipoor E. et al.. (1994). [The Results of Tehran People Blood Pressure Research Plan]. Tehran University of Medical Sciences Heart Research Center. (Persian)   Benchimol D. et al. (2000). Short and long-term risk factors for sudden death in patient with stable angina.       International Journal of Cardiology. 76(2-3)147-56.   Butler JT. (2001). Principle of Health Education and Health Promotion. 3rd ed. United States: Wads Worth   Press.   Dwivedi S. Dwivedi G. Chaturvedi A et al(2000). Coronary artery disease in the young: Heredo familial or   faulty life style or both. Journal of Indian Academy of Clinical Medicine. 3(1) 221-5. Eaker ED. Abbot RD. Kannel WB. (1989). Frequency of uncomplicated angina pectoris in type A compared       with type B persons. The Framingham. Study. Am J Cordial. 63(15)1042-5.   نشر ه دانشکده پرستاری و ماما ی لب يهمكسبا ء ل تبا ا گين كب يهطسربا ب /  53 ر ق س د ب ز ی ی ا   Fauci A S Braunwald E Kasper D L et al (2008) Harrison ‘s Principles of International Medicine. New York: McGraw Hill. Goldberg DP. Hillier VF. (1979). A scaled version of the general health questionnaire. Psychological Medicine. 9(1)139-45. Garber CE. (1997). The benefits of physical activity on coronary heart disease and coronary heart disease risk factors in women. United States. Women’s Health Issues. 7 (1)17-23. Hashemifard T. (2003). [Sustainability of Health Education on Quality of Life in Patients with Open Heart Surgery in Shahid Rajaei Heart Hospital]. MS Thesis. Tarbiat Modarres University. (Persian) International Cardiovascular Disease Statistics (1998). Biostatistician Fact Sheet. American Heart Association. Jenkins CD. (1983). Psychological and Behavioral Factors. Prevention of Coronary Heart Disease. KimiagarKS. Ghaffarpour M. Houshiar-Rad M. et al. (1998). Food consumption pattern in the Islamic Republic of Iran and its relation to coronary heart disease. Eastern Mediterranean Health Journal. 4(3) 539-47. Malcolm JA. Dobson AJ. (1989) Marriage is associated with a lower risk of ischemic heart disease in Men. The   Medical Journal Of Australia. 151(4)185-8 Moher M. (1995). Evidence of the Effectiveness of Intervention for Secondary Prevention and Treatment of       Coronary Heart Disease in Primary Care. Oxford: Anglia and Oxford Regional Heart Authority. Mohammad Noorbala AA. (1999). [Plan Reviews in health and disease]. Tehran: Health Department/Medical Sciences       Researches Center.. (Persian)   Mohebbi S. Sharifirad. GHR. Matlabi M. (2006). [The relation of physical activity in middle age and cardiovascular problems in old age in retired people in Isfahan]. Ofogh Danesh; The journal of Gonabad Facility of Medical Sciences & Health Services. 12 (3) P57-64. (Persian) World Health Organization (WHO). Fighting Heart Disease and Stroke. 17 March 2002. available at:http: //www. Who. Into / world – health (22 march 2002). World Health Organization. (1999). The World Health Report. Geneva.