تاثیر استفاده از چک لیست بر بهبود کیفیت شرح حال گیری بیماران ترومایی

Introduction: To date, no study with a proper sample size has been done to evaluate the efficiency of using pre-designed checklists in history taking of trauma patients in Iran. Therefore, the present study was designed to evaluate the pre-designed checklist’s effects on the quality of history taking in trauma patients referred to the emergency department (ED). Methods: In the present prospective cross-sectional study, data of the trauma patients presented to the ED were recorded either with or without using a checklist, randomly. The designed checklist consisted of personal data, trauma mechanism, wound characteristics and trauma severity, severity and location of injuries, and the patient’s diagnostic and therapeutic plans. The quality of data gathering in each evaluated item was divided into 3 groups of complete recording, incomplete recording, and not recorded. Data recording quality was compared between the 2 groups using chi square or exact Fisher’s test. In all analyses, p < 0.05 was defined as significance level. Results: In the preset study, patient data were gathered without using a checklist in 795 and using a checklist in 384 cases. Complete and accurate data recording in all items was more frequent in the group that had used the checklist (p < 0.001). Recording injury location without using a checklist was complete in only 20.8% of the cases. This rate increased to 95.6% when the checklist was used. In addition, complete and accurate recording of the diagnostic plan increased from 9% to 72.8%, and complete and accurate recording of the therapeutic plan raised from 14% to 68.7%. The improvements in data recording quality was significant in all cases. Conclusion: It seems that using pre-designed checklists for history taking in trauma patients, leads to a significant increase in quality of data recording and history taking. مقدمه: تاکنون مطالعه ای با حجم نمونه قابل قبول به منظور کارایی استفاده از چک لیست های از پیش طراحی شده در جمع آوری داده های پزشکی بر بالین بیماران ترومایی در کشور انجام نشده است. بر این مبنا مطالعه حاضر با هدف بررسی تاثیر استفاده از چک لیست از پیش طراحی شده بر کیفیت ثبت شرح حال بیماران ترومایی مراجعه کننده به بخش اورژانس طراحی شد. روش کار: در مطالعه مقطعی آینده نگر حاضر ثبت داده های بیماران ترومایی مراجعه کننده به بخش اورژانس به صورت تصادفی به دو روش استفاده از چک لیست و بدون استفاده از آن انجام پذیرفت. چک لیست طراحی شده حاوی قسمت های اطلاعات فردی، مکانیسم تروما، عمق تشریحی و شدت تروما، اندازه ضایعات، محل ضایعات و برنامه تشخیصی و درمانی بیمار بود. وضعیت تکمیل داده ها در هر یک از آیتم های مورد بررسی به سه طبقه ثبت کامل، ثبت ناقص و عدم ثبت تقسیم گردید. مقایسه وضعیت تکمیل داده ها بین دو گروه، با استفاده از آزمون کای دو یا تست دقیق فیشر انجام شد. در تمامی آنالیزها 05/0>p به عنوان سطح معنی داری تعریف شد. يافته ها: در پژوهش حاضر داده های 795 بیمار بدون استفاده از فرم و 384 بیمار با استفاده از آن جمع آوری شد. ثبت کامل و دقیق داده ها در تمامی آیتم های مورد مطالعه در گروه استفاده کننده از چک لیست بیشتر بود (001/0>p). ثبت محل ضایعه بدون استفاده از فرم تنها در 8/20 درصد موارد به طور صحیح و کامل ثبت شد. این میزان با استفاده از فرم به 6/95 درصد افزایش یافت. همچنین ثبت کامل و دقیق برنامه تشخیصی از 9 درصد به 8/72 درصد و ثبت کامل و دقیق برنامه درمانی از 14 درصد به 7/68 درصد رسید. این بهبود در وضعیت ثبت داده بیماران در تمامی موارد معنی دار بود. نتيجه گيری: به نظر می رسد استفاده از چک لیست های از پیش طراحی شده در جمع آوری اطلاعات بالینی بیماران ترومایی، باعث بهبود چشمگیر ثبت داده ها و کیفیت شرح حال گیری می گردد

Evaluating the Quality of Multiple Trauma Patient Records in the Emergency Department of Imam Khomeini Hospital in Urmia

مقدمه: شیوه صحیح تکمیل پرونده ها تاثیر قابل توجهی در کاهش میزان خطای پزشکی داشته و باعث تشخیص صحیح و درمان به موقع بیماران می شود. پرونده پزشکی منبع مهم اطلاعاتی در مورد بیمار، بیماری، عملکرد پزشک و تشخیص و درمان صحیح وی می باشد. این مطالعه با هدف بررسی کیفیت شرح حال پرونده بیماران ترومایی مراجعه کننده به اورژانس بیمارستان امام خمینی (ره) ارومیه انجام شده است. روش کار: در یک مطالعه مقطعی، پرونده بالینی بیماران ترومایی مراجعه کننده به بخش اورژانس بيمارستان امام خميني (ره) شهرستان ارومیه طی آبان ماه سال 1392 با هدف بررسی میزان و کیفیت تکمیل پرونده ها مورد بررسی قرار گرفت.  پرونده بالینی کلیه بیماران از نظر ثبت دقیق مکانیسم تروما؛ اندازه، محل و عمق تشریحی ضایعات جلدی؛ ثبت علائم حیاتی؛ برنامه تشخیصی و  درمانی مورد ارزیابی و استخراج اطلاعات قرار گرفت. بر اساس سیستم تقسیم بندی و امتیاز دهی لیکرت، کیفیت ثبت اطلاعات به سه وضعیت ثبت نشده، ثبت شده با کیفیت مطلوب و ثبت شده با کیفیت نامطلوب تقسیم بندی شد. اطلاعات مذکور در نهایت با استفاده از نرم افزار SPSS نسخه 21 مورد تجزیه و تحلیل آماری قرار گرفت. يافته ها: در این پژوهش پرونده 795 بیمار ترومایی بستری شده در بخش اورژانس مورد مطالعه و بررسی قرار گرفت (66/7 مرد). بیشترین میزان ثبت کامل اطلاعات مربوط به مکانیسم تروما (92/5 درصد) و کمترین آن مربوط به برنامه تشخیصی (9 درصد) بود. بیشترین میزان ثبت ناقص اطلاعات نیز به ترتیب مربوط به محل ضایعات حاصل از تروما (7/71 درصد)، تعداد ضایعات (34 درصد) و عمق تشریحی و شدت تروما (34 درصد) بود. بیشترین موارد عدم ثبت اطلاعات مربوط به برنامه تشخیصی(91 درصد) گزارش گردید. در 142 (17/8 درصد) پرونده فقط 1 مورد، در 241 (30/3 درصد) پرونده 2 مورد و در 277 (34/8 درصد) پرونده 3 مورد از آیتم ها ناقص ثبت شده بود و ثبت اطلاعات در 135 (16/9 درصد) پرونده در تمامی موارد ناقص بود. در کل در 82 درصد پرونده ها یک تا چند نقص در ثبت موارد مورد نظر وجود داشت. نتيجه گيری: بر اساس یافته های مطالعه حاضر، وضعیت و کیفیت ثبت اطلاعات مربوط به بیماران ترومایی در واحد اورژانس مورد مطالعه در سطح چندان مطلوبی قرار نداشت. بطوریکه بیشترین میزان ثبت ناقص اطلاعات مربوط به محل ضایعات حاصل ازتروما و بیشترین میزان عدم ثبت اطلاعات مربوط به برنامه تشخیصی بود.Introduction: Medical profile is an important source of data regarding the patient, the illness, the doctor’s performance and leads to adequate diagnosis and treatment. Filling out medical profiles correctly, greatly decreases medical errors and leads to accurate diagnosis and proper treatment of the patients. This study aims to evaluate the quality of the patient records of trauma patients admitted to the emergency department of Emam Khomeini Hospital, Urmia, Iran. Methods: In a cross-sectional study, the medical profiles of trauma patients admitted to the emergency department of Emam Khomeini Hospital, Urmia, Iran in November 2013 were evaluated aiming to determine the quality of filling the profiles. All the patients’ medical profiles were evaluated regarding accurate recording of trauma mechanism; size, site of injuries; vital signs recordings; diagnostic and treatment plan. Based on the Likert scale, the quality of data recording was rated as: not recorded, recorded with high quality, recorded with low quality. The data were statistically analyzed using SPSS 21. Results: In this study, 795 profiles were studied and evaluated (66.7% male). The most accurate data recording belonged to mechanism of trauma (92.5%) and the least accurate data recording belonged to diagnostic plan (9%). The highest frequency of incomplete data belonged to the site of injuries caused by trauma (71.7%), the number of injuries (34%) and anatomical depth and severity of trauma (34%). Most cases of missing data belonged to diagnostic plan (91%). In 142 (17.8%) profiles only 1, in 241 (30.3%) profiles 2, and in 277 (34.8%) profiles 3 categories were incomplete and data recording in 135 (16.9%) profiles were incomplete in all categories. In total, 82% of the profiles had 1 or more incomplete categories. Conclusion: Based on the results of this study, the quality of data recordings of trauma patients admitted to the studied emergency department was not satisfying. The highest rate of incomplete data belonged to the site of injury caused by trauma and the highest rate of missing data belonged to diagnostic plan.

Aerodynamic analysis of backward swept in HAWT rotor blades using CFD

The aerodynamical design of backward swept for a horizontal axis wind turbine blade has been carried out to produce more power at higher wind velocities. The backward sweep is added by tilting the blade toward the air flow direction. Computational Fluid Dynamics (CFD) calculations were used for solving the conservation equations in one outer stationary reference frame and one inner rotating reference frame, where the blades and grids were fixed in reference to the rotating frame. The blade structure was validated using Reynolds Averaged Navier-Stokes (RANS) solver in a test case by the National Renewable Energy Laboratory (NREL) VI blades results. Simulation results show considerable agreement with the NREL measurements. Standard K-ε turbulence model was chosen for simulations and for the backward swept design process. A sample backward sweep design was applied to the blades of a Horizontal Axis Wind Turbine (HAWT) rotor, and it is obtained that although at the lower wind velocities the output power and the axial thrust of the rotor decrease, at the higher wind velocities the output power increases while the axial thrust decreases. The swept blades have shown about 30 percent increase in output power and about 12 percent decrease in thrust at the wind speed of 14 m/s

The Effect of Using a Checklist on Quality Improvement of History Taking from Trauma Patients

Introduction: To date, no study with a proper sample size has been done to evaluate the efficiency of using pre-designed checklists in history taking of trauma patients in Iran. Therefore, the present study was designed to evaluate the pre-designed checklist’s effects on the quality of history taking in trauma patients referred to the emergency department (ED). Methods: In the present prospective cross-sectional study, data of the trauma patients presented to the ED were recorded either with or without using a checklist, randomly. The designed checklist consisted of personal data, trauma mechanism, wound characteristics and trauma severity, severity and location of injuries, and the patient’s diagnostic and therapeutic plans. The quality of data gathering in each evaluated item was divided into 3 groups of complete recording, incomplete recording, and not recorded. Data recording quality was compared between the 2 groups using chi square or exact Fisher’s test. In all analyses, p &lt; 0.05 was defined as significance level. Results: In the preset study, patient data were gathered without using a checklist in 795 and using a checklist in 384 cases. Complete and accurate data recording in all items was more frequent in the group that had used the checklist (p &lt; 0.001). Recording injury location without using a checklist was complete in only 20.8% of the cases. This rate increased to 95.6% when the checklist was used. In addition, complete and accurate recording of the diagnostic plan increased from 9% to 72.8%, and complete and accurate recording of the therapeutic plan raised from 14% to 68.7%. The improvements in data recording quality was significant in all cases. Conclusion: It seems that using pre-designed checklists for history taking in trauma patients, leads to a significant increase in quality of data recording and history taking.</table

Substance Abuse Poisoning Registry development Based on Lessons Learned from a Pilot Implementation

Introduction: Substance abuse has been recognized as a national problem in which poisoning with pharmaceutical drugs, opioids and alcohols is a common problem in Iran. Due to the lack of a comprehensive information system related to Substance abuse, despite the systematic information in health services, and to achieve this goal, the purpose of this research was to develop a registry system for substance abuse poisoning in - Urmia University of Medical Sciences. Material and Methods: This research is a practical development study that was done in 4 phases. In the first phase, minimum data set (MDS) of the system were determined. In the second phase, the registration system was designed. The third phase includes the implementation of the system, and finally, the system was evaluated by QUIS questionnaire. Results: A total of 58 data elements in 6 classes were recognized as essential for this system from the point of view of experts. The system was implemented on the ASP.NET platform using C# language and SQL Server database in the poisoning department of Taleghani Hospital in Urmia. The evaluation of usability of the system showed score obtained in the 6 main categories were in set of terms of the system 8.52, screen 8.36, ability to learn 8.8, overall functionality 8.04, user interface 7.98, and the overall interaction is 7.73 respectively. Conclusion: Considering the capabilities of the system for registering poisonings caused by drug abuse, it seems necessary to implement this system in the form of a national network, in order to make the necessary interventions to control drug abuse while using resources efficiently

Aerodynamic Analysis of Backward Swept in HAWT Rotor Blades Using CFD

The aerodynamical design of backward swept for a horizontal axis wind turbine blade has been carried out to produce more power at higher wind velocities. The backward sweep is added by tilting the blade toward the air flow direction. Computational Fluid Dynamics (CFD) calculations were used for solving the conservation equations in one outer stationary reference frame and one inner rotating reference frame, where the blades and grids were fixed in reference to the rotating frame. The blade structure was validated using Reynolds Averaged Navier-Stokes (RANS) solver in a test case by the National Renewable Energy Laboratory (NREL) VI blades results. Simulation results show considerable agreement with the NREL measurements. Standard K-ε turbulence model was chosen for simulations and for the backward swept design process. A sample backward sweep design was applied to the blades of a Horizontal Axis Wind Turbine (HAWT) rotor, and it is obtained that although at the lower wind velocities the output power and the axial thrust of the rotor decrease, at the higher wind velocities the output power increases while the axial thrust decreases. The swept blades have shown about 30 percent increase in output power and about 12 percent decrease in thrust at the wind speed of 14 m/s