A review on patient safety

Background: Patient Safety Events (PSEs) are important preventable issues with high morbidity and mortality rates, imposing high costs and the occurrence of legal and social problems in societies. Therefore, having a prevention program is very important for it. In this study, we have selected the most common and important errors and provide simple preventive measures for users.   Methods: In this review study, to obtain information associated to patient safety prevention, we used the scientific reliable literatures, registered in US National Library of Medicine/National Institutes of Health (PubMed), Google Scholar and Scopus data banks.   Results: Simple preventive measures for prevention of mistakes due to misidentification (nominal similarities, displacement of the patients, switching the newborns, etc.), miscommunication (improper communications, patient disrespect, misinterpretations due to language differences, giving bad news, etc.), misinterpretations, irrational administration and use of drugs (inappropriate medication, for the wrong patient, with wrong amount, via the wrong way, and for the wrong duration), incompatible blood transfusion, mistakes in anesthesia, surgeries and other procedures, medical complications due to PSEs (Health care associated infections, trauma and fall, thrombophlebitis and thromboembolism, bed sores, suicide, violence, and mismanagement of the hospital affaires were extracted and suggested to the hospital authorities.   Conclusion: We have extracted numerous suggested preventive measures from the accomplished studies for prevention of unpleasant patient safety related events in the hospitals

Effects of mustard gas on immune system of exposed Iranian people: a review of conducted studies

     Exposure to high dosages of sulfur mustard (SM) can cause bone marrow depression, immune system suppression, impairment of the immune functions, and eventually results in diseases due to secondary immune disorders. In this article, we have studied the effects of this poison on Iranian veterans by analysis of related published studies. In a systematic search, the effects of SM gas on Iranian victims were reviewed. We used known international medical databases such as   ISI, Medline, Scopus and Iranian databases such as Iranmedex and Irandoc. About 350 published articles were assessed. Among them, 43 articles were related to immunologic field. No special evaluation was conducted on the quality of the reviewed manuscripts and the credit of journal was considered sufficient. In accomplished studies conducted on Iranian people, both cellular and humoral immunity were affected. The reported changes were as follows:  increasing the number of inflammatory cells in chronic phase which indicates ongoing active alveolitis, neutrophils (in chronic bronchitis), eosinophils, CRP titer, RF titer, IgG (especially in asthmatic patterns) ,IgM , Ig E, IL-6, TFG-beta1target protein in bronchoalveolar lavage fluid, and decreasing the number of leukocytes , lymphocytes, natural killer cells (NKCs), IL-8and IL-6 in blood. Eventually, in reported changes, chemo taxis factors, plasma opsonins and  nitroblue tetrazolium (NBT) test were normal. In sever and prolonged exposure to mustard gas, the immune system would be suppressed. Therefore, the victims should be monitored for infections and even cancers

The impact of industrial wastewater on some of the morphological and physiologhical characteristics of Cyperus alternifolius, Chrysopogon zizanioide and Aloe vera

The increase of the entry of industrial effluents containing various types of heavy metals into water and soil leads to the ever-increasing spread of environmental problems. Therefore, it is necessary to find less expensive solutions to reduce the pollution. In this regard, in order to compare the effect of the removal of heavy elements on some of the morphological and physiological characteristics of C. alternifolius, Ch. zizanioides and Aloe vera plants, an experiment was conducted in the form of a randomized complete block design with three replications for 14 months at the University of Guilan. The results showed that under the treatment of industrial wastewater, the metal accumulation indices (MAI) of zinc, chromium, lead, copper, manganese, nickel, magnesium were higher in Ch. zizanioides and Aloe vera than those in C. alternifolius. In all three studied plants, the indices of root length, shoot length, total biomass and tolerance index (TI) had a significant decrease compared with those in the control plants, and Ch. zizanioides and A. vera plants had the lowest percentage of decrease. In addition, other investigated components including absorption index (UI), total soluble sugar, total phenol content, total flavonoid, total anthocyanin, total tannin, and DPPH free radical inhibition percentage increased in all three plants under industrial wastewater treatment. The highest percentage of increase in all investigated components, except DPPH free radical inhibition percentage, was observed in Ch. zizanioides. In general, it can be said that in terms of MAI and morphological and physiological characteristics, Ch. zizanioides and A. vera were more successful than the C. alternifolius. Therefore, it is recommended to plant the studied plants in the order of priority (Ch. zizanioides ˃ A. vera ˃ C. alternifolius) in soils contaminated with industrial effluents, in order to remediate the soil

A Post-Marketing Surveillance Study to Evaluate the Safety Profile of AlvotereⓇ (Docetaxel) in Iranian Patients Diagnosed with Different Types of Cancers Receiving Chemotherapy

Background Docetaxel is a clinically well established antimitotic chemotherapy medication. Labeled docetaxel indications are breast cancer, gastric cancer, head and neck cancer, non–small cell lung cancer, and prostate cancer. Objective This is a Phase IV study to evaluate the safety profile of docetaxel (Alvotere; NanoAlvand, Iran) in Iranian patients diagnosed with different types of cancers receiving chemotherapy regimens with docetaxel. Methods Patients who received Alvotere as a part of their chemotherapy regimen were enrolled in this Phase IV, observational, multicenter, open-label study. Alvotere was administrated as a single agent or in combination with other chemotherapy agents. Safety parameters in each cycle were assessed, and the related data were recorded in booklets. Findings A total of 411 patients with different types of cancers were enrolled from 25 centers in Iran. The most common malignancies among participants were breast cancer (49.88%), followed by gastric cancer (22.63%). Participants’ mean age was 53.33 years, and the mean total dose used in each cycle was 132 mg. According to the results, 341 patients experienced at least 1 adverse event, that the most common was alopecia (41.12%). In total, 92 (22.38%) patients had at least 1 adverse event of grade 3 or 4, and 25 (6.08%) patients showed 54 serious adverse events, which the causality assessment for all was possibly related to Alvotere. There was a significant difference between men and women in the incidence of skin and subcutaneous tissue disorders (55.63% in women vs 41.73% in men; P = 0.009). Also, the incidence of gastrointestinal disorders, nervous system disorders, skin and subcutaneous tissue disorders, hepatic enzymes increase, and fluid retention was significantly higher (P < 0.05) in patients receiving anthracyclines in their chemotherapy regimens. Conclusions The findings of this open-label, observational, multicenter, postmarketing surveillance showed that Alvotere appears to have an acceptable safety profile in Iranian cancer patients receiving chemotherapeutic regimens. (Curr Ther Res Clin Exp. 2022; 82:XXX–XXX) © 2022 Elsevier HS Journals, Inc

Paraclinical findings in Iranian veterans exposed to sulfur mustard gas: A literature review

Objective: Sulfur mustard (SM) causes various systemic disturbances in human beings. This study aimed to assess paraclinical changes caused by exposure to SM gas in Iranian veterans during the war between Iraq and Iran. Methods: A literature review was carried out in international and national medical databases including ISI, Medline, Scopus, Iranmedex and Irandoc. Both Farsi and English literature were searched. Results: Search of the literature yielded 422 medical articles related to SM poisoning. Among them, 30 relevant articles were thoroughly reviewed. The most important reported complications were leukopenia, neutropenia, lymphopenia, eosinophilia, thrombocytopenia, increased bleeding time, positive C-reactive protein (CRP), rheumatoid factor (RF), antinuclear antibody (ANA), decreased T helper cells, natural killer cells, IL6, and IL8 levels, elevation of serum immunoglobulins, decreased levels of T3, T4 and cortisol, increased level of adrenocorticotropic hormone (ACTH), proteinuria, hematuria, and elevated liver enzymes. Also, there were some changes in chest assessments. Conclusions: SM causes profound systemic complications in victims, even years after exposure. The paraclinical changes can be observed in hematology, immune system, biochemistry, hormonal profile and some imaging studies

Iraq-Iran chemical war: calendar, mortality and morbidity

Objectives: To review the calendar, mortality and morbidity of Iraq-Iran chemical war among Iranians based on researchers’ reports. Methods: We used national and international databanks such as PubMed, ISI, Scopus, Irandoc and Iranmedex and studied 350 articles related to chemical agents and their effects on different organs. The main criteria for qualification of articles were relevancy orientation and being published in approved medical journals. Results: The Iraqi army invaded to west and southwest Iran using chemical weapons such as nerve agents (NAs) and sulfur mustard (SM). Most victims were civilians including women and children. These attacks had imposed more than 150 types of diseases and complications on Iranians and the frequency of death was 2%-3%. Most reports were about respiratory problems and a few were in the domain of socio-economic damages. Conclusion: At present, 25 years after the end of war, the victims are faced with different complications induced by chemical agents and it is estimated that they will be continuously troubled by these problems in future. Key words: Chemical warfare; Wounds and injuries; Iran; Ira

Students’ Benefit Rate from Morning Report Sessions and Its Related Factors in Tehran University of Medical Sciences

Introduction: Morning report along with clinical rounds and ambulatory teaching are three common, useful and valuable methods (Gold Standards) in clinical education. This program has some characteristics and standards that, when properly applied, will play an effective role in students’ clinical learning. The main aim of this study is to determine the characteristics of morning report sessions in internal medicine wards affiliated to Tehran University of Medical Sciences, and also to assess students’ view points on the benefit and satisfaction from the content of these programs and the related factors. Methods: In this cross- sectional study, the structural characteristics of morning report sessions and the students’ rate of benefit from their content were investigated in year 2010. A sample 300 internship and clerkship medical students were asked to fill out a researcher- made questionnaire. The validity and reliability were confirmed by experts and the calculation of Cronbach’s alpha respectively. Results: The structural characteristics of the sessions were as follows: The average starting time of the sessions was at 8 a.m., the average duration of sessions was one hour, the average number of meetings was 5 times a week, the patient presenter in most cases was an intern, the cases presented were complicated and difficult ones, the average number of cases presented in each session was three, the average time for presenting each case was 20 minutes. Air conditioning, temperature, lighting, and sound quality were favorable. Faculty members usually sat in the front row and with their back to the audience. The main audience at the sessions were not defined and usually the experts of other fields such as pharmacists, nutritionists , pathologists or radiologists were absent. Total benefit rate according to the students was: 55 people (18.3%) high, 152 people (50.7%) moderate and 93 people (31%) low. There was a significant correlation between their benefit rate and most of the structural parameters of morning report sessions (P<0/005). Conclusion: Despite the structural conformity of the morning report sessions in internal medicine wards of Tehran University of Medical Sciences with those in most similar studies, some more efforts should be spent on promoting the students’ satisfaction

Integration of Medical Education in Medical Services: A Cross Sectional Study

Ministry of health and Medical Education (MOH&amp;amp;ME) with the goals of attaining the comprehensive self sufficiency in medical fields and accountability of universities to public health needs were established in Iran in 1985. After that, ministry moved one step towards the integration of medical education into the health services in 1994. A dilemma about returning the system into the prior situation was increased in 2002, during which the parliament tried to change the situation toward disintegration. We have studied the attitudes of key academic persons regarding the segregation of medical universities (MOH&amp;amp;ME establishment) and "Integration" of medical education into the health delivery system. A descriptive, cross sectional and correlation study was conducted on 556 universities staffs in 11 universities throughout the country. We applied a questionnaire with 28 questions on 5 axes. The analytical test used in this study was Pearson chi-square. The most understudied staffs, agreed with Integration philosophy. They believed that, although it seems the quality of medical education has declined, but some effective factors such as increasing admitted students, irregular increasing of universities and self controlling of educational hospitals, deficit of educational budget and other reasons were the main effective causes in this declining of quality, and most of them believed that the reintegration of MOH&amp;amp;ME into the ministry of sciences organization will not benefit for the country. This study has presented some reasons of proposed declining the quality of medical education and some suggestions for development of present system

Long-term effects of mustard gas on respiratory system of Iranian veterans after Iraq-Iran war: a review

【Abstract】To review long-term respiratory effects of mustard gas on Iranian veterans having undergone Iraq-Iran war. Electronic databases of Scopus, Medline, ISI, IranMedex, and Irandoc sites were searched. We accepted articles published in scientific journals as a quality criterion. The main pathogenic factors are free radical mediators. Preva-lence of pulmonary involvement is approximately 42.5%. The most common complaints are cough and dyspnea. Major respiratory complications are chronic obstructive pulmo-nary disease, bronchiectasis, and asthma. Spirometry re-sults can reveal restrictive and obstructive pulmonary disease. Plain chest X-ray does not help in about 50% of lung diseases. High-resolution CT of the lung is the best modality for diagnostic assessment of parenchymal lung and bronchi. There is no definite curative treatment for mus-tard lung. The effective treatment regimens consist of oxy-gen administration, use of vaporized moist air, respiratory physiotherapy, administration of mucolytic agents, bronchodilators, corticosteroids, and long-acting beta-2 agonists, antioxidants, surfactant, magnesium ions, thera-peutic bronchoscopy, laser therapy, placement of respira-tory stents, early tracheostomy in laryngospasm, and ulti-mately lung transplantation. High-resolution CT of the lung is the most accurate modality for the evaluation of the lung parenchyma and bronchi. The treatment efficacy of patients exposed to mustard gas depends on patient conditions (acute or chronic, upper or lower respiratory tract involvement). There are various treatment protocols, but unfortunately none of them is definitely curable. Key words: Lung injury; Chemical warfare; Mustard ga