Patient safety domains in primary healthcare: A systematic review

Background: Healthcare systems should ensure the provision of quality services to patients without harming them. However, the provision of services is occasionally accompanied by harm or complications, most of which are preventable. Most studies have focused on secondary healthcare rather than primary healthcare (PHC). Thus, this study aimed to identify various dimensions and components of patient safety in PHC worldwide. Methods: This systematic review study was conducted in November 2022 based on PRISMA reporting guidelines. Studies were retrieved from PubMed, Scopus, Cochrane Library, Web of Science, and EMBASE and searched for English documents using the keywords "patient safety" and "PHC" from 2000 to 2022. Finally, two reviewers extracted the data independently and analyzed using thematic content analysis. Results: Overall, 23 out of the initially 4937 identified articles were selected for the final analysis based on the inclusion and exclusion criteria. Most of these studies used a qualitative-quantitative approach (61.9%, seven studies for both), and 64% had been conducted in European countries. Eventually, five dimensions and 22 components were identified for patient safety in PHC, including management measures, quality management, resources and technology, documents, and patient-related factors. Conclusion: The patient safety dimensions and components identified in this research can help develop a clear definition of patient safety and its assessment standards and criteria in PHC. Considering that most previous studies on patient safety in PHC were conducted in European and developed countries, it is suggested that researchers conduct more studies in developing countries to fill this research gap

Comparison of intelligence quotient in children surviving leukemia who received different prophylactic central nervous system treatments

Background: Neurocognitive deficits and decrease in intelligence quotient (IQ) is one of the complication of prophylactic central nervous system (CNS) treatment in acute lymphoblastic leukemia (ALL) patients. In this study, we compare the IQ in survivors of ALL that were treated with different prophylactic CNS treatments. Materials and Methods : We compared 43 long-term survivors of ALL: 21 survivors with intrathecal methotrexate (IT MTX) as CNS prophylaxis, 22 with IT MTX+1800-2400 rads cranial irradiation and 20 healthy controls. The IQ was measured using the Raven′s test in these patients. Results: Raven′s test revealed significant differences in IQ between the survivors of ALL that were treated with IT MTX, IT MTX plus cranial irradiation and control group. There was no significant difference in the IQ with respect to sex, age and irradiation dose. Conclusion: We can that reveal that CNS prophylaxis treatment, especially the combined treatment, is associated with IQ score decline in ALL survivors. Therefore,a baseline and an annual assessment of their educational progress are suggested

Comparison of direct and indirect nursing care time in 8-hour and 12-hour shifts

AbstractIntroduction:  Nurses are the largest and one of the most important groups of health care providers. The quality of health care mostly depends on the quality of direct and indirect nursing care. Measuring the average nursing care time is an objective measure for assessing the quality of patient care.The goal of the present study was to compare the time being devoted to professional – nonprofessional activities by nurses in 8 hours and 12 hours working shift in Shahid Modarres teaching hospital in Tehran.Methods:  A descriptive- comparative study was conducted on 30 nurses (27 female, and 3 male) working in medical and surgical wards of Shahid Modarres teaching hospital in Tehran. The nurses were working 8 and 12 hours shifts and in rotating schedule. Data were collected by direct observation of nurses’ activities,using a checklist with list of direct, indirect and nonprofessional nursing activities. The reliability of the checklist was assured by calculating inter observers’ agreement (The duration of time which nurses spent for each activity was recorded. Data were analyzed using SPSS and Wilcoxon test.Results:  The findings of the present study revealed that, nurses working 8 hour shift duration, spent 64.99% of their time on professional and 35.3% on nonprofessional activities (41.21% on direct nursing care, 23.78% on indirect nursing care, 22.53% on personnel affairs and 12.5% on administrative activities). Nurses with 12 hour shift duration, spent 65.59% of their times on professional activities and 33.92% on nonprofessional activities (41.57% on direct healthcare, 24.02% on indirect healthcare, 20.94% on personnel affairs and 12.98% administrative activities).Conclusion:  Nurses working in both 8 and 12 hours shift spend most of their times for professional activities (direct and indirect healthcare) and devote less time to nonprofessional activities (administrative and personal affairs), and these activities are independent of their shift durationKeywords: Working shift, Nurse, Direct nursing care, Indirect nursing care, Teaching hospital REFERENCES Admi H Tzischinslcy O Epstein R et al (2008). Shift work in nursing: Is it really a risk factor for Nurses health and patients safety?. Nursing Economics. 26 (4)250-256 Farquharson B (2013). How much time do nurses actually spend on patient care? An analysis of real-time data across medical and surgical wards. Avaible at: https://www.rcn.org.uk/__data/assets/pdf_   file/0019/512146/2013_RCN_research_3.1.3.pdf French L (1977). The Personal Management Process.6rd ed. Boston: Houghton Mifflin Co.   Hagerty B, Spengler C.(1985). Work sampling analyzing nursing staff productivity. The Journal of Nursing Administration. 5(9) 13-20.     Heslop L Power R Cranwell K (2014) Building workforce capacity for complex care coordination: A function analysis of workflow activity. Heslopet al. Human Resources for Health2014,12:52. Avaiable at:http://www. human-resources-health.com/content/12/1/52 Josten DC (2003).The effects of extended work days on fatigue, health, performance and satisfaction in Nursing. Journal of Advanced Nursing.44(6) 643-652.     Kabiri F (1992) [ How nurses relate themselves to patients in the internal and cardiology wards of Tehran   university]. M.S Thesis. Faculty of Nursing and Midwifery Shahid Beheshti University of Medical Sciences. (Persian).   Liang Y, Chen W, Lee J & Huang L (2012). Nurse staffing, direct nursing care hours and patient mortality in Taiwan: the longitudinal analysis of hospital nurse staffing and patient outcome study BMC Health Services   Research 2012, 12:44 Medical Dictionnary (2014). Avaible At: http://medical-dictionary.thefreedictionary.com/indirect+care.       Accessed time: 9/24/2014.   Puente LM, Rabbino H (2003). Creating value with strategic resources. Avaiable At:http://www.iseesystems.   com/community/connector/Zine/SeptOct03/luz.html. Accessed time: 9/24/2014.   Rogers AE, Hwang WY, Scott LS, Aiken LH, Dinges DF(2004). The Working Hours of Hospital Staff Nurses And Patient Safety. Avaiable at:http://content.healthaffairs.org/content/23/4/202.full. Accessed time   9/24/2014. Rostamipoor A(1986).[ Assessment of nurses non professional activities in Tehran hospitals ] M.S Thesis.       Tarbiat Modarress university.(Persian).   Shams Azad M (1995).[ Comparison of nurses’ productive hours in various wards of educational hospital in   Tehran. M.S thesis. Shahid Beheshti University of Medical Sciences. (Persian).   Safari M (2002).[ Impact of touching group discussion technique to nurses on the quality of care for myocardial patients]. M.S thesis. Tarbiat Modarress University. [Persian]. 1393 راهب ،84 هرامش ،24 هرود / 50 ناراکمه و یسیئر ناروپ Telles SCR, & Castilho V.(2007). Staff cost in indirect nursing care at an intensive care unit. Rev Latino-am Enfermagem. 15(5) 1005-9 Thompson P (2009). Health care financial management. Health Management Journal.63(1) 76-82. Westbrook JI Duffield C Li L & Creswick NJ (2011) How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals, BMC Health Services Research 11:319. Avaible at: http://www.biomedcentral.com/1472-6963/11/319 Williams M (1977).Quanification of direct nursing care activities. Journal of Nursing Adminstration. 7(8)15-8, 49-51.

Vitamin D and bone minerals status in the long-term survivors of childhood acute lymphoblastic leukemia

Background: Low vitamin D and diminished bone minerals with the potential for fractures are one of the nonapparent late effects of acute lymphoblastic leukemia (ALL). Chemotherapy and radiation were known as two important risk factors. We evaluated these late effects in ALL survivors who were treated with chemotherapy or chemo plus cranial radiation therapy. Methods: In a case-control study, 33 of ALL survivors who were treated with chemotherapy (Group A), and 33 subjects who were treated with chemoplus cranial radiation (Group B) were compared against 33 matched age, sex, and pubertal stage of their healthy siblings (Group C). Standard anthropometric data were collected as well as Tanner staging for puberty, number of fractures since treatment, serum calcium (Ca), phosphorus (P), magnesium (Mg), alkaline phosphatase, parathyroid hormone, and 25-hydroxyvitamin D (25(OH) D). The independent t-test, one-way ANOVA, Chi-square test, and Tukey′s test were used to analyze the data. Results: The findings indicated that the mean serum levels of 25(OH) D in ALL survivors (i.e. Groups A and B) with age mean score of 11.2 years and 12.3 years, average treatment length: 3.25 years and average time after treatment completion: 4 years, was lower compared to the controls group (12.94 ± 6.69, 14.6 ± 8.1, 20.16 ± 10.83, respectively, P 0.05). Other clinical and laboratory parameters had no significant differences between the survivors and control. Vitamin D deficiency (<20 ng/ml) was observed in 27% of group A and 24% of group B and vitamin D insufficiency (20-30 ng/ml) in 72.7% and 69.6% survivors of Group A and B and 48.5% of controls group (P = 0.003). Conclusions: ALL treatment is associated with the increase in prevalence of vitamin D insufficiency in the childhood ALL survivors and since the low vitamin D level potentially increases the risk of low bone density, subsequent malignancies, and cardiovascular disease in the survivors, close follow-up of such patients are highly recommended to prevent the stated complications

Post transplant anaplastic large T-cell lymphoma

Post transplant lymphoproliferative disorders (PTLD) are a heterogeneous group of lymphoid proliferation that ranges from polyclonal hyperplasia to monoclonal malignant lym-phoma. We report a 13-year-old boy who was diagnosed with PTLD in February 2007 after 3 1/2 years of deceased renal transplantation. We treated him with an adapted ACVBP (doxorubicin, cyclo-phosphamide, vincristine, bleomycin and prednisone) regimen. He responded well to the chemo-therapy without deterioration of graft function

Langerhans cell histiocytosis following Hodgkin lymphoma: a case report from Iran

The occurrence of Langerhans Cell Histiocytosis (LCH) in a patient with lymphoma is an indication of a probable relationship between them. The two conditions have similarities both clinically and histopathologically. Occurrence of these two conditions in the same patient, particularly not simultaneously, is rare. According to different management and treatment of these conditions, exact histopathologic evaluation and even using immunohistochemistery (IHC) can prevent misdiagnosis. In this report, a 10 year old boy presented who afflicted with LCH 3 years after diagnosis and treatment of mixed cellularity Hodgkin lymphoma

Examining the care of noncommunicable diseases at the first level of providing services during the COVID-19 pandemic

Aim: Providing services for patients with noncommunicable diseases is one of the main responsibilities of health systems. During the COVID-19 pandemic, the care of these patients faced problems. This study investigates the ways of providing optimal care to patients during pandemics like COVID-19. Subject and methods: This study was conducted in 2021 in Tehran province using an analytical cross-sectional method. Six hundred participants were selected for the study. In order to examine the challenges and solutions for receiving services, a questionnaire was completed and its reliability and validity were checked; finally, a telephone interview was completed over a period of 3 months. Results: Among study participants, 68.2% were female, and the highest percentage was in the age group of 50–60 years. Fifty-four percent were illiterate or had primary education, 48.8% had diabetes, 42.8% had high blood pressure, and 8.3% had both diseases. Forty-three percent of the interviewees had not used health care services during the COVID-19 pandemic, the main reason for which was the fear of contracting COVID-19. The outbreak of coronavirus disease had affected the care of noncommunicable diseases for 63% of the interviewees. Conclusion: The fundamental need for changes in the health system was revealed by the COVID-19 pandemic. The need for flexibility in the health system will inevitably arise when similar cases occur, and policymakers and managers should consider necessary measures in this regard. The use of new technologies is one of the ways to replace traditional models

The metabolic syndrome in survivors of childhood acute lymphoblastic leukemia in Isfahan, Iran

&lt;ul&gt;&lt;li&gt;&lt;strong&gt;BACKGROUND&lt;/strong&gt;: To determine the prevalence of metabolic syndrome in survivors of childhood leukemia in Isfahan, Iran.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;METHODS&lt;/strong&gt;: During a 4-year period (2003 to 2007), 55 children (33 male and 22 female) diagnosed with ALL at Unit of Hematology/ Oncology, Department of Pediatrics, Isfahan University of Medical Science, were enrolled in this crosssectional study. Metabolic syndrome was defined using the modified version of Adult Treatment Panel (ATP III) criteria. Insulin resistance was defined based on the homeostasis model assessment index (HOMA-IR).&lt;/li&gt;&lt;li&gt;&lt;strong&gt;RESULTS&lt;/strong&gt;: The mean age of participates was 10.4 years (range 6-19 years) and the mean interval since completion of chemotherapy was 35 months. Twenty percent (11/55) of survivors (10 male, 1 female) met criteria for diagnosis of metabolic syndrome. Obesity was observed in one forth of patients and nearly 3/4 of obese patients had metabolic syndrome. High serum insulin levels were found in 16% of participants and in 63% of obese survivors. The mean insulin levels in survivors with metabolic syndrome was three-times more than those without (28.3 mu/l vs. 9.57 mu/l, p = 0.004). Insulin resistance was detected in 72.7% of survivors with metabolic syndrome and it was&amp;nbsp; ositively correlated with serum triglycerides (0.543, p &lt; 0.001), systolic and diastolic BP (0.348, p = 0.01 and 0.368, p = 006 respectively), insulin levels (0.914, p &lt; 0.001) and blood sugar (0.398, p = 003).&lt;/li&gt;&lt;li&gt;&lt;strong&gt;CONCLUSIONS&lt;/strong&gt;: The prevalence of metabolic syndrome in survivors of childhood leukemia in Iran is higher than developed countries. Nearly all of the obese patients had metabolic syndrome. Weight control and regular physical exercise are recommended to the survivors.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;KEYWORDS&lt;/strong&gt;: Acute lymphoblastic leukemia, metabolic syndrome, obesity, children.&lt;/li&gt;&lt;/ul&gt