Clinical effectiveness of modified sequential organ failure assessment scoring system for predicting ICU indexing scores

Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of modified sequential organ failure assessment (MSOFA) scale to predict mortality and length of stay in intensive care unit patients respectively. Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit. All patients’ records who admitted to the intensive care unit of Kowsar Hospital, Semnan city (the capital of the province), Iran, in 2015 considered as the sample. Collecting data were done during 4 weeks in April and May 2016. The data collection tool was a demographic questionnaire and modified sequential organ failure assessment scale. Exclusion criteria included discharge in the first 24 hours after admission, the patient died a few hours after admission and incomplete information to complete the modified sequential organ failure assessment form. Results: The study of 105 patients' records of the intensive care unit showed that 45.7% of patients were died, 15.2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and receiver operating characteristic (ROC) curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0.635, CI= 0.527-0.743) and each unit increase in modified sequential organ failure assessment score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P= 0.001(. Also each unit increase in modified sequential organ failure assessment (MSOFA) score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P= 0.015(. Conclusion: The results of this study showed that the modified sequential organ failure assessment scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit

Clinical Effectiveness of Modified SOFA (MSOFA) scoring system for predicting mortality and length of stay in patients hospitalized in intensive care unit

Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of MSOFA scale to predict mortality and length of stay in ICU patients respectively. Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit of Kowsar Hospital of Semnan. The data collection tool was a demographic questionnaire and MSOFA scale. Finally, data were analyzed using SPSS version 16 by logistic regression and ROC curve. Results: The study of 105 patients' records of the intensive care unit in 2015 showed that 45/7% of patients were died, 15/2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and ROC curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0/635, CI= 0/527-0/743( and each unit increase in MSOFA score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P=0.001(. Also each unit increase in MSOFA score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P=0.015(. Conclusion: The results of this study showed that the MSOFA scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit

Vancomycin Utilization Review in Patients Undergoing Bone MarrowTransplantation

Background:  Infections  in  neutropenic  patients  are  considered  as  major  causes  of  mortality and the emergence of drug resistance. Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including Methicillin Resistant Staphylococcus Aureus (MRSA). In this study, we evaluated the appropriate utilization of this agent in bone marrow transplantation (BMT) patients. Methods: In a cross sectional study, all patients who received vancomycin in a seven months period at bone marrow transplantation research center in Shariati teaching hospital in Tehran, Iran, were entered to the study. Clinical and preclinical parameters such as serum creatinine, microbial culture, antibacterial sensitivity, WBC count and fever were collected and recorded for analysis. We also measured vancomycin trough level after administration of three doses. Results: Fifty one patients were entered in the study and reviewed in two adult BMT wards. The age range was 18 to 65 years. Most patients received allogenic versus autologous transplantation (56.9%, 43.1%). About 80% of the vancomycin used for the patients with febrile neutropenia was compatible with National Comprehensive Cancer Network (NCCN) guideline. 21.6% of patients received appropriate doses. Vancomycin trough serum concentration range was 15.0±11.9 μg/mL. Conclusion: Vancomycin is an antibiotic used to treat resistant gram-positive infections and must be prescribed by a specialist. Vancomycin wrong dosing or initiation prescribing with dose 1 gr/q12h increases the resistance and toxicity to drug, and cause an inappropriate response to the drug

Safe Handling of Cytotoxic Drugs and Risks of Occupational Exposure to Nursing Staffs

Background: Inherent toxicity of cytotoxic drugs is the basis for their potential adverse risks from occupational exposure to the nursing staff. In Iran, chemotherapy regimens are prescribed and administered according to the world updated protocols. But little is done regarding the protective standards in this field. Methods: An observational cross-sectional survey was conducted among nurses who work in three tertiary care teaching hospitals in Tehran, Iran in 2012. All participants worked in one of the hospital wards handling cytotoxic drugs (preparation and administration). A questionnaire was used for interviewing all subjects, and observing them preparing and administering the drugs. We examined all adverse effects associated with handling of antineoplastic drugs. Results: Totally 270 adverse reactions were reported. The most frequently reported adverse effects included headache and vertigo (40 cases), hair loss (36 cases), skin rashes and itching (31 cases), and burning sensation in eyes (31 cases). In all hospital wards, the standards were met in not more than 50% of the items. Conclusion: Monitoring the personnel who are directly involved in handling of cytotoxic drugs is of great importance. Furthermore, educating the personnel in the field of standards of cytotoxic drugs handling could increase the nursing staff’s knowledge regarding these drugs’ adverse reactions

Expectations of Health Care Professionals Regarding the Services

Background: The provision of accurate and timely drug information to health care professionals is an important mechanism to promote safe and effective drug therapy for patients. World’s Drug and Poison Information Centers (DPICs) are mainly affiliated to hospitals, rather rarely with faculties of pharmacy or with faculties of medicine and other related organizations. Methods: Data was collected from a questionnaire which was distributed among 400 health care providers in April 2009. Data were analyzed using SPSS software (version 17). Results: Medical reference books and drug information textbooks (36.7%) and expert colleagues (29.7%) were the “most commonly” used drug information resources. In addition, 77.8% of respondents “almost never” use DPICs. About 77% of respondents were non- acquainted with these centers’ activities. Five expectations were considered ‘very important’ by respondents: Provide information on IV drugs incompatibilities (74%), Provide drug interaction information (70.1%), Provide new drugs information (56.5%), Education/training of health care professionals regarding rational drug therapy and prevention of medication errors (54.9%), Providing information on dosage forms of drugs available in Iran (53.5%). Conclusion: Being non acquaintance with services of DPIC centers can be considered as the most important reason of not using them. Considering “announcement of availability of drugs in pharmacy” as one of the activities of DPICs, shows that the health care professionals are not acquainted with real services of these centers. It shows an urgent need for culture building activities to introduce them to these centers services

Evaluation of Community Pharmacists’ Knowledge, Attitude and Practice towards Good Pharmacy Practice in Iran.

Background: The principles of pharmaceutical care are embedded in the concept of Good Pharmacy Practice (GPP). GPP is poorly applied in community pharmacies not only in Asian countries, but even in United States and Europe. The present study was undertaken to evaluate the knowledge, attitude and practice of the community pharmacists in Iran, regarding GPP. Methods: A total of 794 pharmacists were evaluated with a reliable and validated KAP (Knowledge, Attitude, and Practice) questionnaire regarding GPP in September 2008. Results: The most important finding in the present study was the pharmacists’ low knowledge (Mean= 13.42) and practice (Mean= 29.85) level about GPP, while their attitude towards this subject was at a high level (Mean= 74.83). Increase in their knowledge of good pharmacy practice aligned with an increase in their attitudes towards this issue. Also increase in our pharmacists’ knowledge and attitude aligned with an increase in quality of their practice. Conclusion: The  current  practice  of  Iranian  community  pharmacists  needs  further improvement. National pharmaceutical organizations should organize educational programs for the community pharmacists to equip them for their main role in communitypractice: promoting rational drug use