ارائه یک الگو برای سیستم ملی طبقه بندی اقدامات پزشکی ایران

مقدمه:مدیران اطلاعات بهداشتی، اطلاعات مربوط به مراقبت و درمان را بر اساس سیستم های طبقه بندی اقدامات پزشکی طبقه بندی نموده و براساس اطلاعات طبقه بندی شده گزارشات آماری را تهیه و تحلیل می نمایند . امروزه مراقبت بهداشتی با کیفیت مطلوب بدون وجود یک سیستم طبقه بندی اقدامات پزشکی کامل و کارآمد امکانپذیر نخواهد بود . با استفادهد از این سیستم نتایج عملیات مراقبت در پرونده بیمار به صورت کدهای استاندارد ثبت می شود . این کدها اساس تحلیل اطلاعات برای پرسنل درمانی ، پژوهشگران ، سیاستگذاران و برنامه ریزان بهداشتی است. با توجه به اینکه در حال حاضر در کشور ما یک سیتم طبقه بندی اقدامات که بتواند نیازهای کدگذاران را برآورده کند وجود ندارد، ضرورت ارائه یک الگو مناسب احساس گردیده است. روش بررسی : این تحقیق به صورت یک مطالعه مقطعی ـ مقایسه ای در سال های 82-1381 به منظور ارائه یک الگوی مناسب برای سیستم ملی طبقه بندی اقداماتی پزشکی کشورمان انجام شده است . ابزار گردآوری داده های این پژوهش کتاب ها ، نشریات ، پایان نامه های موجود در کتابخانه ، اینترنت و پست الکترونیکی بوده است . در این پژوهش با مطالعه سیر پیدایش و تکامل ، ساختار ، سازمان ایجادکننده ، مزایا و محدودیت ها و استانداردهای به کار رفته در طراحی سیستم های طبقه بندی اقدامات به زبان انگلیسی و یک الگو برای سیستم ملی طبقه بندی اقدامات پزشکی کشورمان پیشنهاد شد. الگوی پیشنهادی طی دو مرحله به روش دلفی آزمون شده است . سرانجام پس از تحلیل نتایج آزمون ، الگویی مناسب برای سیستم ملی طبقه بندی اقدامات کشورمان ارائه گردیده است . یافته ها : نتایج مطالعه سیستم های ملی طبقه بندی اقدامات نگاشته شده به زبان انگلیسی همراه سیستم های موجود در کشورمان به طور مقایسه ای آورده شده است . همچنین الگوی نهایی در پنج محور اصلی به طور مبسوط تشریح گردیده است. به طور خلاصه می توان چند محوری بودن ، امکان گسترش سیستم بدون تغییر در ساختار آن ، وسعت بیشتر ، در نظر گرفتن راهنمای فارسی کدگذاری اقدامات ، وجود توصیف گرهای مورد نیاز ، استاندارد بودن و تنظیم فصول بر اساس نوع اقدام یا مداخله از مزیت های الگوی ارائه شده در مقایسه با سیستم های اقدامات موجود کشور دانست : نتیجه گیری : الگوی ارائه شده برای سیتسم ملی طبقه بندی اقدامات کشورمان در مقایسه با سیستم ملی طبقه بندی کشورهای انگلیسی زبان بیانگر آن است که این الگو بیشتر منطبق بر سیستم ملی طبقه بندی اقدامات کشورهای اروپای شمالی است. به دلیل نوپا بودن سیستم ملی طبقه بندی اقدامات پزشکی کشورمان و امکان نادیده گرفتن برخی اقدامات ، کدهایی برای موارد طبقه بندی نشده پیش بینی گردید

A nurse-led intervention improves detection and management of AKI in Malawi

BACKGROUND: Acute kidney injury is common and has significant impact on mortality and morbidity. There is a global drive to improve the lack of knowledge and understanding surrounding the recognition, diagnosis and management of patients with AKI in resource poor healthcare systems. OBJECTIVES: We propose a nurse‐led education programme to medical and nursing staff of the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, will improve the overall care and understanding of patients with AKI that will still be effective 3 months later. METHODS: This was a three phase, prospective interventional pilot study which evaluated base line knowledge and clinical practice amongst healthcare workers, provided a comprehensive combination nurse‐led class room and ward based teaching programme and evaluated the change in knowledge and clinical management of patients in the high dependency areas of the hospital immediately, and 3 months, after the teaching intervention. RESULTS: The nurse‐led intervention significantly improved the healthcare workers attitudes towards detecting or managing patients with suspected AKI (p < 0.0001). There were also significant improvements in the completion of fluid charts and recording of urine output (p < 0.0001), corner stones of AKI management. Knowledge and clinical intervention was still present three months later. There was however little change in the understanding that AKI could be a significant clinical problem in QECH and that it may have a major impact on mortality and working practice and this needs to be addressed in future teaching programmes. CONCLUSIONS: A low cost, nurse‐led AKI educational intervention improved the knowledge and management of AKI at QECH, which was still evident 3 months later

Incidence, aetiology and outcome of community-acquired acute kidney injury in medical admissions in Malawi

BACKGROUND: Epidemiological data on Acute Kidney Injury (AKI) from low-income countries is sparse. The aim of this study was to establish the incidence, severity, aetiology, and outcomes of community-acquired AKI in Malawi. METHODS: We conducted a prospective observational study of general medical admissions to a tertiary hospital in Blantyre between 27(th) April and 17(th) July 2015. All patients were screened on admission with a serum creatinine; those with creatinine above laboratory reference range were managed by the nephrology team. Hospital outcome was recorded in all patients. RESULTS: Eight hundred ninety-two patients were included; 188 (21 · 1%) had kidney disease on admission, including 153 (17 · 2%) with AKI (median age 41 years; 58 · 8% HIV seropositive). 60 · 8% of AKI was stage 3. The primary causes of AKI were sepsis and hypovolaemia in 133 (86 · 9%) cases, most commonly gastroenteritis (n = 29; 19 · 0%) and tuberculosis (n = 18; 11 · 8%). AKI was multifactorial in 117 (76 · 5%) patients; nephrotoxins were implicated in 110 (71 · 9%). Inpatient mortality was 44 · 4% in patients with AKI and 13 · 9% if no kidney disease (p <0.0001). 63 · 2% of patients who recovered kidney function left hospital with persistent kidney injury. CONCLUSION: AKI incidence is 17 · 2% in medical admissions in Malawi, the majority is severe, and AKI leads to significantly increased in-hospital mortality. The predominant causes are infection and toxin related, both potentially avoidable and treatable relatively simply. Effective interventions are urgently required to reduce preventable young deaths from AKI in this part of the world. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-017-0446-4) contains supplementary material, which is available to authorized users

Diagnostic performance of a point-of-care saliva urea nitrogen dipstick to screen for kidney disease in low-resource settings where serum creatinine is unavailable.

Kidney disease is prevalent in low-resource settings worldwide, but tests for its diagnosis are often unavailable. The saliva urea nitrogen (SUN) dipstick is a laboratory and electricity independent tool, which may be used for the detection of kidney disease. We investigated the feasibility and performance of its use in diagnosing kidney disease in community settings in Africa. Adult patients at increased risk of kidney disease presenting to three community health centres, a rural district hospital and a central hospital in Malawi were recruited between October 2016 and September 2017. Patients underwent concurrent SUN and creatinine testing at enrolment, and at 1 week, 1 month, 3 months and 6 months thereafter. Of 710 patients who presented at increased risk of kidney disease, 655 (92.3%) underwent SUN testing at enrolment, and were included (aged 38 (29-52) years, 367 (56%) female and 333 (50.8%) with HIV). Kidney disease was present in 482 (73.6%) patients and 1479 SUN measurements were made overall. Estimated glomerular filtration rate (eGFR) correlated with SUN (r=-0.39; p&lt;0.0001). The area under the receiver operating characteristics curve was 0.61 for presenting SUN to detect acute or chronic kidney disease, and 0.87 to detect severe (eGFR &lt;15 mL/min/1.73 m2) kidney disease (p&lt;0.0001; sensitivity 82.3%, specificity 81.8%, test accuracy 81.8%). In-hospital mortality was greater if enrolment SUN was elevated (&gt;test pad #1) compared with patients with non-elevated SUN (p&lt;0.0001; HR 3.3 (95% CI 1.7 to 6.1). SUN, measured by dipstick, is feasible and may be used to screen for kidney disease in low resource settings where creatinine tests are unavailable