Frequency of errors in nursing and associated factors in the cases referred to the Mortality Committee in Shahrekord University of Medical Sciences during 2006-2012

زمینه و هدف: شناسایی خطاهای پرستاری و ارتقاء امنیت بیماران امری حیاتی است. با توجه به اینکه خطا در عرصه ارائه خدمات پرستاری، پدیده ای آسیب رسان و در برخی موارد غیرقابل جبران است، لذا این مطالعه با هدف تعیین فراوانی خطاهای پرستاری و فاکتورهای مرتبط با آن در پرونده های ارجاعی به کمیته مرگ و میر انجام شد. روش بررسی: در این مطالعه توصیفی، کلیه پرونده های ارجاعی به کمیته مرگ و میر استان چهارمحال و بختیاری مورد بررسی قرار گرفت و از پرونده هایی که پرستار به عنوان مقصر شناخته شده بود اطلاعاتی شامل: سن و جنس، نوع بستری، محل ارجاع، بخش بستری و علت بستری بیمار وجنس، سنوات خدمت، بخش محل خدمت، مقطع تحصیلی، شیفت کاری پرستار و نوع خطای مرتکب شده توسط پرستار مورد بررسی قرار گرفت. داده ها با استفاده از آمار توصیفی(فراوانی) و تحلیلی(آزمون دقیق فیشر) مورد تجزیه و تحلیل قرار گرفت. یافته ها: از 400 پرونده های ارجاعی به کمیته مرگ و میر دانشگاه علوم پزشکی شهرکرد از سال 1385 تا نیمه اول سال 1391 حدود 50 خطای پرستاری روی داده که 44 آن ها مربوط به عدم اطلاع به موقع به پزشک و 36 درصد مربوط به مشکلات در ثبت گزارش پرستاری بود. نتیجه گیری: با توجه به اینکه از بین بردن خطاهای کاری به صورت صد در صد امکان پذیر نمی باشد، بنابراین با کاهش حجم کاری، افزایش تعداد پرستار، سیستم نظارتی دقیق و آموزش تا حدودی می توان میزان خطاهای پرستاری را کاهش داد

Across‐vendor standardization of semi‐LASER for single‐voxel MRS at 3T

The semi‐adiabatic localization by adiabatic selective refocusing (sLASER) sequence provides single‐shot full intensity signal with clean localization and minimal chemical shift displacement error and was recommended by the international MRS Consensus Group as the preferred localization sequence at high‐ and ultra‐high fields. Across‐vendor standardization of the sLASER sequence at 3 tesla has been challenging due to the B1 requirements of the adiabatic inversion pulses and maximum B1 limitations on some platforms. The aims of this study were to design a short‐echo sLASER sequence that can be executed within a B1 limit of 15 μT by taking advantage of gradient‐modulated RF pulses, to implement it on three major platforms and to evaluate the between‐vendor reproducibility of its perfomance with phantoms and in vivo. In addition, voxel‐based first and second order B0 shimming and voxel‐based B1 adjustments of RF pulses were implemented on all platforms. Amongst the gradient‐modulated pulses considered (GOIA, FOCI and BASSI), GOIA‐WURST was identified as the optimal refocusing pulse that provides good voxel selection within a maximum B1 of 15 μT based on localization efficiency, contamination error and ripple artifacts of the inversion profile. An sLASER sequence (30 ms echo time) that incorporates VAPOR water suppression and 3D outer volume suppression was implemented with identical parameters (RF pulse type and duration, spoiler gradients and inter‐pulse delays) on GE, Philips and Siemens and generated identical spectra on the GE ‘Braino’ phantom between vendors. High‐quality spectra were consistently obtained in multiple regions (cerebellar white matter, hippocampus, pons, posterior cingulate cortex and putamen) in the human brain across vendors (5 subjects scanned per vendor per region; mean signal‐to‐noise ratio [less than] 33; mean water linewidth between 6.5 Hz to 11.4 Hz). The harmonized sLASER protocol is expected to produce high reproducibility of MRS across sites thereby allowing large multi‐site studies with clinical cohorts

Compact ultrafast orthogonal acceleration time-of-flight mass spectrometer for on-line gas analysis by electron impact ionization and soft single photon ionization using an electron beam pumped rare gas excimer lamp as VUV-light source.

Orthogonal acceleration time-of-flight mass spectrometers (oaTOFMS), which are exhibiting a pulsed orthogonal extraction of ion bunches into the TOF mass analyzer from a continuous primary ion beam, are well-suited for continuous ionization methods such as electron impact ionization (EI). Recently an electron beam pumped rare gas excimer lamp (EBEL) was introduced, which emits intensive vacuum UV (VUV) radiation at, e.g., 126 nm (argon excimer) and is well suited as the light source for soft single photon ionization (SPI) of organic molecules. In this paper, a new compact oaTOFMS system which allows switching between SPI, using VUV-light from an EBEL-light source, and conventional EI is described. With the oaTOFMS system, EBEL-SPI and EI mass spectral transients can be recorded at very high repetition rates (up to 100 kHz), enabling high duty cycles and therefore good detection efficiencies. By using a transient recorder card with the capability to perform on-board accumulation of the oaTOF transients, final mass spectra with a dynamic range of 106 can be saved to the hard disk at a rate of 10 Hz. As it is possible to change the ionization modes (EI and SPI) rapidly, a comprehensive monitoring of complex gases with highly dynamic compositions, such as cigarette smoke, is possible. In this context, the EI based mass spectra address the bulk composition (compounds such as water, oxygen, carbon dioxide, etc. in the up to percentage concentration range) as well as some inorganic trace gases such as argon, sulfur dioxide, etc. down to the low ppm level. The EBEL-SPI mass spectra on the other hand are revealing the organic composition down to the lower ppb concentration range

Nursing: An evolutionary concept analysis

Background & Aim: More clarification of the concept of nursing helps to review policies, standards, codes of ethics, professional values and nursing roles. The purpose of this study was to analyze nursing concept using Rodgers evolutionary method. Materials & Methods: With employing a rigorous evolutionary concept analysis approach, the concept of nursing was examined. After an extensive search, about 6706 articles were found; 43 articles and 6 related books published in English from 1980 were reviewed vigorously. Then data about the nursing concept was analyzed using evolutionary concept analysis approach. Results: The definition of attributes, antecedents, as well as consequences of nursing was performed through concept analysis. Core attributes (the goal of nursing, nursing scope, dimensions, practice and interventions, roles, audience, and professional values) were studied. The antecedents of nursing include getting a degree and nursing qualification, standards, and ethical codes. In addition, it led to health promotion. Care was an interchangeable concept of nursing. Missed and individualized nursing care, advanced nursing practice, holism and health improvement were obtained as nursing related concepts. Conclusion: Recognition of main attributes boundaries and professional differences in health care context prevents perplexity in nursing and leads to professional development and self-confidence

Evolved gas analysis by single photon ionization-mass spectrometry.

The applicability of thermogravimetry (TG) coupled to single photon ionization time-of-flight mass spectrometry (TG-SPI-TOFMS) for evolved gas analysis (EGA) of coffee is demonstrated in this study. Coffee is a chemically well-known complex food product of large scientific and commercial interest. The roasting process of single green coffee beans (Arabica, Robusta) was simulated in the TG-SPI-TOFMS device, and the chemical composition of the evolved roasting gases was monitored on-line. Additionally, roasted and ground coffee powders of different types and brands as well as instant coffee were successfully investigated. For example, the diterpenes cafestol and kahweol can be detected among many other roasting products. These compounds can be of particular interest for quality control of coffee. It is shown that kahweol can be used as a tracer compound to discriminate arabica coffee species from robusta species

Evolved gas analysis (EGA) in TG and DSC with single photon ionisation mass spectrometry (SPI-MS: Molecular organic signatures from pyrolysis of soft and hard wood, coal, crude oil and ABS polymer.

A combined thermogravimetry/differential scanning calorimetry device (TG/DSC) was coupled to single photon ionisation mass spectrometry (SPI-MS) for evolved gas analysis (EGA). Single photon ionisation (SPI) was performed with a new type of VUV light source, the so called electron beam pumped rare gas excimer lamp (EBEL). SPI does not fragment molecules upon the ionisation process. Thus the molecular mass signature of the evolving gases from thermal composition of carbonaceous material can be directly on-line recorded. In this work the thermo-analytical data and the SPI-MS information on the released organics is presented and discussed for various samples. Namely biomass (soft and hard wood), fossil fuel (crude oil and coal) as well as a complex polymer (ABS) are investigated. The general potential of hyphenating thermal analysis and soft photo ionisation mass spectrometry (EBEL-SPI-MS) for fundamental and applied research and material analysis is discussed

Evolution of volatile flavor compounds during roasting of nut seeds by thermogravimetry coupled to fast cycling optical heating gas chromatography-mass spectrometry with electron- and photoionization.

Online multidimensional evolved gas analysis was conducted during the roasting of nuts using fast-cycling optical heating gas chromatography (OHGC) coupled to mass spectrometry with electron ionization and soft single photon ionization (OHGC-EI/SPI-MS). SPI is a semi-selective soft ionization method for organic compounds that produces mainly molecular ions, whereas EI is a hard ionization method that results in fragmentation. Ionization was either done exclusively by one of these methods or both were used alternately. Roasting of the nuts (almonds, Brazil nuts, cashews, peanuts, hazelnuts, pecans, pine nuts, and walnuts) was simulated in a thermal analysis (TA) device at a roasting temperature of 170 °C. The TA device was directly coupled to the OHGC-EI/SPI-MS for quasi-real-time analysis. Multidimensional analysis was possible with a temporal resolution of 1 min. Good chromatographic separation, constant sampling repetition rates, and constant retention times (RTs) were obtained. Peak assignment was performed using the molecular mass information obtained from SPI-MS, the characteristic fragmentation patterns from EI-MS, and the OHGC RTs. The gases that evolved during roasting of each type of nut were monitored online using the TA-OHGC-MS setup. Aldehydes, furans, and pyrazines were detected as flavor compounds. Changes in the compositions of the evolved gases during the roasting process were evaluated. The TA-OHGC-MS method could separate isobaric and isomeric compounds

Investigation of sulfur and selenium vapors with thermal analysis – single photon ionization mass spectrometry.

The vapors of elemental sulfur and selenium exhibit a complex molecular composition, the characterization of these vapors is still a challenge. In this study, we developed a thermal-analysis – single-photon-ionization time-of-flight mass spectrometry system with Skimmer® interface (TA-Skimmer-SPI-TOFMS) and tested its applicabilitiy for the elucidation of the composition of sulfur and selenium vapor. For this purpose, soft ionization is crucial, since the ionization energies of the species are between 8 and 10 eV. The non-fragmenting ionization of the molecules is also demonstrated, by separating the GC-measurable-species with gas chromatography. We realized it by coupling the same photon source used in the thermal analytical measurements with a gas chromatography – mass spectrometry device.   The analyte transmission to the MS is strongly limited by the vapor pressure of the substances within the sample. One possibility to overcome this issue and enable the in situ measurement of even low volatile compounds without any wall contact between the thermal balance and the ion source of the MS is a STA-MS with a Skimmer® interface. We modified the original Skimmer® STA-MS system (Netzch Gerätebau, Selb, Germany) by replacing the quadrupole mass analyzer with a single-photon-ionization time-of-flight mass spectrometer. The advantages of a fast modern time-of-flight mass analyzer are fast scan rates and increased sensitivity [1]. During evolved gas analysis, usually electron ionization (EI) with standard kinetic electron energy of 70 eV is applied. Due to the high excess energy compared to the ionization energies of the analytes, fragment peaks are dominating EI mass spectra. The application of SPI allows soft ionization and fragmentation of the molecules is mostly avoided. Vacuum-ultraviolet (VUV) photons for SPI are generated by a deuterium lamp (Hamamatsu Photonics, Hamamatsu City, Japan).   Sulfur and selenium vapor consist of molecules with 2-8 atoms in temperature- and pressure-dependent equilibria. By using the mass spectrometric traces, the composition of the evolving vapors can be calculated (Data for sulfur is depicted in Fig. 1).   Another aspect of this study was to confirm that sulfur and selenium species are not fragmented during the ionization process in TA-Skimmer-SPI-TOFMS device. We performed it with gas chromatography – mass spectrometry (GC-MS). The same deuterium lamp as in the Skimmer® system was applied