IntroductionImproving quality of maternal care as well as patients' safety are two important issues in health-care service. Therefore, this study aimed to assess the culture of patient safety at maternity units.MethodsThis cross-sectional study was conducted among staffs working at maternity units in seven hospitals of Ilam city, Iran. The staffs included in this study were gynecologists and midwifes working in different positions including matron, supervisors, head of departments and staffs. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC).ResultsThis study indicated that 59.1% of participants reported fair level of overall perceptions of safety and 67.1% declared that no event was reported during the past 12 months. The most positively perceived dimension of safety culture was teamwork within departments in view of managers (79.41) and personnel (81.10). However, the least positively perceived dimensions of safety culture was staffing levels.ConclusionThe current study revealed areas of strength (teamwork within departments) and weakness (staffing, punitive responses to error) among managers and personnel. In addition, we found that staffs in Ilam's hospitals accept the patient safety culture in maternity units, but, still are far away from excellent culture of patient safety. Therefore, it is necessary to promote culture of patient's safety among professions working in the maternity units of Ilam's hospitals.
Purpose: The effectiveness of an Internet-based guided self-help cognitivebehavioral therapy (I-GSH-CBT) was assessed in alleviating childbirth fear (CBF), depression, anxiety, and stress of pregnant women during the first delivery. Design and Methods: In a quasi-experimental study, pregnant women in the intervention group used the I-GSH-CBT program during pregnancy. The Wijma Delivery Expectancy/Experience Questionnaire, and the Depression, Anxiety, and Stress Scale 42-item (DASS-42) questionnaires were used to collect the psychometric data. Findings: Implementing the I-GSH-CBT significantly reduced CBF, DASS-42 scores, and cesarean section preference.
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BackgroundAt the 1994 International Conference on Population and Development (ICPD), held in Cairo, the global community agreed to the goal of achieving universal access to sexual and reproductive health (SRH) and rights by 2015. This research explores the accelerators and decelerators of achieving universal access to the sexual and reproductive health targets and accordingly makes some suggestions.MethodWe have critically reviewed the latest national reports and extracted the background data on each SRH indicator. The key stakeholders, both national and international, were visited and interviewed at two sites. A total of 55 in-depth interviews were conducted with religious leaders, policy-makers, senior managers, senior academics, and health care managers. Six focus-group discussions were also held among health care providers. The study was qualitative in nature.ResultsObstacles on the road to achieving universal access to SRH can be viewed from two perspectives. One gap exists between current achievements and the targets. The other gap arises due to age, marital status, and residency status. The most recently observed trends in the indicators of the universal access to SRH shows that the achievements in the “unmet need for family planning” have been poor. Unmet need for family planning could directly be translated to unwanted pregnancies and unwanted childbirths; the former calls for sexual education to underserved people, including adolescents; and the latter calls for access to safe abortion. Local religious leaders have not actively attended international goal-setting programs. Therefore, they usually do not presume a positive attitude towards these goals. Such negative attitudes seem to be the most important factors hindering the progress towards universal access to SRH. Lack of international donors to fund for SRH programs is also another barrier. In national levels both state and the society are interactively playing their roles. We have used a cascade model for presenting the barriers at the state levels from the strategic planning to implementation. Social factors are to be considered as a background for other factors at all stages.ConclusionAccelerating universal access to SRH requires adequate funding, firm political commitment, creative programming, and the involvement of diverse actors, including faith-based, civil society, and private sector partners.
Background. Low adherence of pregnant women to the content of prenatal care guidelines (PCGs) is one of the most significant issues in obstetrics.Objective. This study aimed to improve the well-being of the mother and fetus by preventing maternal and neonatal complications using the adherence to antenatal care (ANC). Patients and methods. An integrated retrospective-prospective longitudinal study with participating 604 pregnant women was carried out in the Iranian community. A valid researcher-made tool was used to implement this three-stage research approach. The results of demographic and obstetric characteristics, the adequacy of adherence to PCGS, and pregnancy outcomes were analyzed using multivariate logistic regression to assess the compliance of women with pregnancy outcomes. Results. 71.36% of the total population had a complete adherence (≥ 80%) to the PCGs. The women with higher education levels substantially showed more adherence to this healthcare program guideline (p = 0.0001). In relation to pregnancy outcomes, there was a significant relationship between women's adherence to PCGs and neonatal complications (p < 0.05). Conclusion.The assessment of PCGs content was successful in evaluating ANC quality. The complete adherence to first ANC guidelines could efficiently promote neonatal outcomes, whereas it showed no effect on maternal outcomes. SOMMARIOBackground. La scarsa aderenza delle donne incinta al contenuto delle linee guida per l'assistenza prenatale (PCG) è una delle questioni più significative dell'ostetricia. Obiettivo. Questo studio mira a migliorare il benessere della madre e del feto, prevenendo le complicazioni materne e neonatali con l'aderenza alla cura prenatale (ANC). Pazienti e metodi. Nella comunità iraniana è stato condotto uno studio longitudinale retrospettivo/prospettivo integrato con 604 donne incinta partecipanti. Per implementare in tre fasi questo approccio di ricerca è stato utilizzato un valido strumento per ricercatori. I risultati delle caratteristiche demografiche e ostetriche, l'adeguatezza dell'aderenza al PCGS e gli esiti della gravidanza sono stati analizzati utilizzando la regressione logistica multivariata, al fine di valutare la conformità delle donne agli esiti della gravidanza. Risultati. Il 71,36% della popolazione totale ha avuto una completa aderenza (80%) ai PCG. Le donne con livelli di istruzione superiore hanno mostrato sostanzialmente una maggiore aderenza a questa linea guida del programma sanitario (p -0,0001). Per quanto riguarda gli esiti della gravidanza, c'è stata una relazione significativa tra l'aderenza delle donne ai PCG e le complicazioni neonatic (p < 0,05). Conclusione. La valutazione dei contenuti dei PCG è risultata efficace per la valutazione della qualità dell'ANC. La completa adesione dell'ANC alle prime linee guida potrebbe promuovere efficientemente i risultati neonatali, mentre non ha mostrato alcun effetto sui risultati materni.
Background: A respiratory tract infection (RTI) is considered as one of the commonest public health problem dealt with in primary care. Objective: To evaluate the prescribing pattern of antibiotics, drug interactions involved and their rationality in the management of respiratory tract infection. Methods: The study was conducted in 180 RTI patients admitted in Sagar Hospital, Bengaluru. The study was a prospective, observational study. The information collected was based on inpatient case record and documented in the predesigned patient profile form. The data was analyzed and assessed using Micromedex 2.0, Medscape and www.drugs.com. Results: A total of 180 patients were included as per inclusion and exclusion criteria, out of which 98(54.4%) were male and the mean (SD) age of the patients was 58(14.3) years. Majority of patients had hypertension 77(26.22%) as co-morbidity followed by diabetes mellitus 64(21.89%). Among 180 cases, 42(23.33%) cases were diagnosed with URTI in which 7(16.66%) patients had sinusitis, 5(11.9%) had tonsillitis, 8(19.04%) had common cold, 2(4.76%) had pharyngitis and 19(45.23%) had unspecified URTI. In study population 134(74.44%) cases were diagnosed with LRTI in which 7(5.22%) were acute bronchitis, 40(29.85%) were bronchitis, 2(1.49%) were broncholithiasis, 29(21.64%) were pneumonia and 56(41.80) were unspecified LRTI. 4(2.23%) cases were diagnosed with both URTI and LRTI. In current study a total of 322 Antibiotics were prescribed among which most commonly used is Piperacillin+ Tazobactam 88(27.32%) followed by Clarithromycin 52(16.14%). The most offending drug in major, moderate and minor drug interactions was clarithromycin 111(79.28%), clarithromycin 65(51.58%) and Piperacillin + Tazobactam 23(56.09%) respectively. Conclusion: This study concluded the prudent use of antibiotics will diminish the burden of multi-drug resistance and thereby providing better patient management.
Removal of leukocytes from blood products is the most effective means for elimination of undesirable side effects and prevention of possible reactions in recipients. Micro-fibrous mats are currently used for removal of leukocytes from blood. In this study, samples of electrospun nano-fibrous mats were produced. The performance of the produced electrospun nano-fibrous mats as means of leukocytes removal from fresh whole blood was both evaluated and compared with that of commercially available micro-fibrous mats. In order to produce the samples, polyacrylonitrile (PAN) nano-fibrous mats were made under different electrospinning conditions. Mean fiber diameter, pore characterization and surface roughness of the PAN nano-fibrous mats were determined using image processing technique. In order to evaluate the surface tension of the fabricated mats, water contact angle was measured. The leukocyte removal performance, erythrocytes recovery percent and hemolysis rate of the nano-fibrous mats were compared. The effectiveness of nano-fibrous mats in removing leukocyte was established using both scanning electron microscope and optical microscope. Results showed that for given weight, the fabricated nano-fibrous mats were not only more efficient but also more cost-effective than their commercial counterparts. Results confirmed that changes in mean fiber diameter, the number of layer and weight of each layer in the absence of any chemical reaction or physical surface modification, the fabricated nano-fibrous mats were able to remove 5-log of leukocytes. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 1759-1769, 2018.
Background: Although extensive Mother-friendly Hospital initiatives have been improved the quality of maternity care in Iran, recent national reports have been indicated that obstetrics errors are still common. The current study aimed to assess safety attitude in the maternity care units of public hospitals in a region with high rate of maternal death in Iran. Materials and Methods: Data was collected from 314 midwives, specialist and also managers working in all public hospitals in 2016. The Cronbach's alpha coefficient was used to analyze psychometric features of the Safety Attitudes Questionnaire (SAQ). Results: 86.2% of the participants (n = 314) completed the questionnaire. Results showed that lower scores in teamwork, safety climate and also job satisfaction subcomponents. The working conditions and stress recognition had the highest negative scores. There was a significant relationship between the following subcomponents and work load: teamwork (r = −0.416, P-value = 0.05), stress recognition (r = 0.40, P-value = 0.05) and also working conditions (r = 0.421; P-value = 0.02). The score of midwives was significantly lower than specialists regarding job satisfaction (P-value = 0.014), working conditions (P-value = 0.02) and also the overall safety attitude score (P-value = 0.001). About 63% of respondents reported no error during the last year. The mean of error reporting during the last year significantly increased among specialists compared to midwives (P-value = 0.001). Conclusion: Maternity care units in the region with high maternal death have been faced with many intangible barriers related to safety attitude such as poor teamwork climate, working condition and also poor stress recognition. It is now needed to promote supportive environment for midwives and also strengthening staff cohesion 387through guiding the strategic direction of current maternity risk management system in creating open and just culture, improving leadership behaviors among senior managers and also addressing poor staffing levels.
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