review of medication errors in Iran: sources, underreporting reasons and preventive measures

Medication error [ME] is the most common preventable cause of adverse drug events which negatively affects patient safety. Inadequate, low-quality studies plus wide estimation variations in ME from developing countries including Iran, decreases the reliability of ME evaluations. To clarify sources, underreporting reasons and preventive measures of MEs, we reviewed Iran current available literature. We searched Scopus, WOS, PubMed, CINAHL, EBSCOHOST and Persian databases [IranMedex, and SID] up to October 2012. Two authors independently selected and one reviewed and extracted data. Results reported by more than 30% of studies considered as the most important topics. Finally 25 articles were included. All study designs were cross-sectional [except for two interventional studies] and in hospital settings. Nursing staff and students were the most observed populations. Individual factor, with "inadequate knowledge of medication" as its most frequent reason, were the mostly reported source of MEs. Fear and reporting process were two most important reporting barriers. The sense of being reprimanded and ignoring to report respectively were their most frequent factors. Anti-infectives were the most frequent drugs involved in MEs. Preventive measures were varied and reporting of their effectiveness was inconsistent. There are still many research gaps which need to be explored by further studies. Based on our findings, further researches may be focused on design, implementation, and evaluation of a ME reporting system as groundwork, assessing systems-related factors to ME alongside individual factors and evaluating the effectiveness of preventive measures for MEs in trials

Is supplementation efficacious in maintaining adequate plasma levels of vitamin A and E for thalassemic patients undergoing hematopoietic stem cell transplantation? a cross-sectional study

Thalassemia along with hematopoietic stem cell transplantation [HSCT] can lead to major oxidative stress. Vitamins A and E are antioxidants which protect membrane from lipid peroxidation. We sought to determine for the first time, whether vitamins A and E supplementation is efficacious in maintaining or increasing plasma level of these vitamins in thalassemic children undergoing HSCT. A cross-sectional study was performed on 50 children with beta-thalassemia major hospitalized for HSCT. Patients took a daily multivitamin. Plasma vitamins A and E levels were measured at four different times: on admission, HSCT day [day 0], day 7 and day 14 after HSCT. Plasma vitamin A and E were abnormal on admission in most patients [62.0% and 60.0% respectively]. Ratio of patient with normal to abnormal plasma level of the vitamins improved from baseline to a peak on day 7 then deteriorated afterward until day 14. There was an increasingly positive correlation between daily oral intake and plasma vitamin A at different times, but plasma vitamin E showed inverse correlation at first which tended towards no correlation subsequently. In multivariate analysis, supplementation significantly changed plasma level of vitamin A at different measurement time [P=0.001] within study subjects. But, plasma level of vitamin E showed no significant difference [P=0.2]. Our findings suggest that oral supplementation could have beneficial effects due to increasing plasma vitamin A level and preventing plasma vitamin E depletion

Efficacy of pregabalin in childhood refractory partial seizure

About one third of partial seizures are refractory to treatment. Several anticonvulsant drugs have entered the market in recent decades but concerns about intolerance, drug interactions, and the safety of the drug are notable. One of these new anticonvulsants is pregabalin, a safe drug with almost no interaction with other antiepileptic drugs. In this open label clinical trial study, pregabalin was used for evaluation of its efficacy on reducing seizure frequency in 29 children suffering from refractory partial seizures. Average daily and weekly seizure frequency of the patients was recorded during a 6-week period [baseline period]. Then, during a period of 2 weeks [titration period], pregabalin was started with a dose of 25-75 mg/d, using method of flexible dose, and was brought to maximum dose of drug that was intended in this study [450 mg/d] based on clinical response of the patients and seizure frequency. Then the patients were given the drug for 12 weeks and the average frequency of daily and weekly seizures were recorded again [treatment period]. Reduction in seizure frequency in this study was 36% and the responder rate or number of patients who gained more than 50% reduction in seizure frequency was 51.7%. This study showed that pregabalin can be used with safety and an acceptable efficacy in treatment of childhood refractory partial seizures

community assessment model appropriate for the Iranian community

Community assessment is one of the core competencies for public health professionals; mainly because it gives them a better understanding of the strengths and drawbacks of their jurisdictions. We planned to recognize an appropriate model that provides a conceptual framework for the Iranian community. This study was conducted in Tehran, during 2009-2010 and consisted of two parts: a review of the literature and qualitative interview with selected experts as well as focus group discussion with health field staff. These steps were done to develop a conceptual framework: planning for a steering committee, forming a working committee, re-viewing community assessment models and projects, preparing the proposed model draft, in-depth interview and focused group discussions with national experts, finalizing the draft, and preparing the final model. Three different models published and applied routinely in different contexts. The 2008 North Carolina Community Assessment model was used as a reference. Ten national and 18 international projects were compared to the reference and one and six projects were completely compatible with this model, respectively. Our final proposed model takes communities through eight steps to complete a collaborative community assessment: form a community assessment team, solicit community participation and gain inter-sectoral collaboration, establish a working committee, empower the community, collect and analyze community's primary and secondary statistics, solicit community input to select health priorities, evaluate the community assessment and develop the community assessment document, an develop the community action plans

Drug utilization evaluation of imipenem and intravenous ciprofloxacin in a teaching hospital

Drug Utilization Evaluation [DUE] studies are designed to assess drug usage appropriateness. We aim to evaluate the drug utilization of intravenous ciprofloxacin and imipenem, two of the broad spectrum antibiotics that consume a significant proportion of our hospitals' outlay, in different wards of a teaching hospital in Zabol. During a 5 months period [December 2010 to May 2011], 263 patients who received imipenem or intravenous ciprofloxacin were assigned to this study. Retrospective review of patient's records was carried out. Data were converted to Defined Daily Dose [DDD] and the ratio of prescribed daily dose per DDD was calculated. Among these records, 100 patients received either imipenem or ciprofloxacin. The ratio of prescribed daily dose to DDD was 1.5 for both antibiotics. Almost all patients received empiric therapy in both groups. Only 13 patients [26%] in ciprofloxacin group and 4 patients [8%] in imipenem group received their antibiotics consistent with American Hospital Formulary System [AHFS] mentioned indication. Baseline Blood Urea Nitrogen [BUN] and serum Creatinine were ordered for only 37 patients [74%] in both groups with 15 abnormal results but dose adjustment performed just in one case with decreased renal function. In conclusion, the majority of courses with both drugs were empirically selected and continued and required lab tests for drug monitoring and dose adjustments were not performed in most cases. Educational interventions, developing a local formulary and a strict antibiotic prescribing policy for example by prior approval by an infectious disease consultant can help significantly to overcome these problems

High prevalence of sleep problems in school- and preschool-aged children in Tehran: a population based study

Sleep problems are experienced by 25-30 percent of children and adolescents, regardless of age. The purpose of this study was to investigate if there is any relationship between gender or school entrance and sleep complaints. From June 2008 to May 2009 children aged 2 to 12 years were selected by clustered randomization of families. The Persian version of the BEARS questionnaire [Bedtime problems, Excessive sleepiness, Awakenings during the night, Regularity of sleep, Snoring] with five domains was filled out by general pediatricians. Prevalence of sleep complaints in each B-E-A-R-S category was calculated and compared for pre-school and school-age groups. BEARS questionnaire was completed for a total of 746 children [2-12 years old]; 325 in pre-school-age group [2-6 years old] [142 females [43.7%] and 183 males [56.3%]] and 421 in primary school-age group [7-12 years old] with the average age of 3.93 [ +/- 0.16] years and 9.63 [ +/- 0.16] years respectively. The most common screening problem in both groups was excessive daytime sleepiness [64.9% and 62.9% respectively]. Bedtime problems and also regularity and duration of sleep were significantly more prevalent in pre-school-age group [P<0.0002; odds ratio [OR] =1.98; 95% confidence interval [95%CI]: 1.98-4.20; and OR=2.00; 95%CI: 1.41- 2.84 respectively]. The difference between mean sleep duration between pre-school age and school-age groups was statistically significant [P<0.0001]. The current survey shows that different types of sleep problems are relatively high especially in the form of excessive daytime sleeping domain in preschool- and school-aged children. Bedtime problems and regularity problems were significantly more prevalent in pre-school-age group. School entrance seems to play a positive role for bedtime problems, and sleep-disordered breathing

Evaluation of Iranian pediatric specialists' attitude and knowledge regarding approach to patients with acute otitis media

The ministry of health and medical education of Iran and many other countries advice physicians to use this guideline for diagnosis and treatment of acute otitis media [AOM], but there is not any evaluation of effectiveness and obedience of this guideline, so the aim of this study was to evaluate the attitude of pediatricians, the most important group that interfere with these patients in treatment of acute otitis media. A total of 120 anonymous surveys were mailed to 120 pediatrician in Tehran [Iran] to evaluate pattern of diagnosis and treatment of AOM in these physicians. Age, gender, place of work, attitude of diagnosis and treatment were asked by anonymous survey. Sixty-two completed surveys were received, for a response rate of 51%. There was no significant difference between responders in these survey and scenarios, according to sex, age, practice setting, graduation year or the number of AOM patients visiting each month. Our study seems to add new insights to the previous literature on management of AOM according to guideline. We can assess the impact of guidelines on the usual practice of practitioners in evidenced-based management of AOM

Pathologic findings of Whipple pancreaticoduodenectomy: a 5-year review on 51 cases at Taleghani general hospital

The aim of this study was to comprehensively analyze histopathologic parameters of Whipple pancreaticoduodenectomy specimens at Taleghani general hospital pathology department. The Whipple procedure is performed for variety of tumors involving the head of the pancreas, ampulla of Vater, common bile duct, or duodenum. Records of all cases of Whipple pancreaticoduodenectomy between 2007 and 2011were retrospectively reviewed and pathological details of diagnosis and staging were extracted. A total of 51 patients underwent Whipple procedure during a 5-year period, including 37 males and 14 females. The average age was 57 years [18-82 years]. The most frequent presenting symptoms were jaundice and weight loss. Forty-four patients [86.3%] had malignant and 7 [13.7%] had benign lesions. Among malignant lesions, 27 [61.4%] were ampullary carcinomas, 12 [27.3%] were pancreatic carcinomas and 5 [11.4%] were cholangiocarcinomas. The pathological stage of most of the tumors was T3 [50%]; followed by T2 [29.5%], and T1 [15.9%]; only 4.5% were T4. Mean tumor size was 2.8 cm [0.2-7 cm]. Duodenal and common bile duct margins were tumor-free in most cases [95.5%]. The pancreatic margin was free in 81.8% of patients; this margin had not been evaluated in 5 patients. Nearly 38.6% of all tumors showed vascular invasion while 68.2% showed perineural invasion. The average number of dissected lymph nodes was 4 [range 1-15]; although in 25% of specimens, no lymph nodes had been found. Twelve specimens [35.3%] had lymph node metastases. The present study demonstrates that most of our patients are diagnosed with malignancy, at advanced stage, and further research is needed to develop practical methods for earlier diagnosis. The fact that 25% of specimens had no lymph nodes needs more consideration

Challenges and success factors in university mergers and academic integrations

There are different reasons for mergers among higher education institutes. In October 2010 the Iran University of Medical Sciences [IUMS] merged with two other medical universities in Tehran in this study, we aim to review the literature on academic integrations and university mergers to call the attention to challenges and reasons for the success or failure of university mergers. We searched for studies that pertained to university or college mergers, amalgamation, dissolution, or acquisition in the following databases. PubMed, Emerald, Web of Science, Scopus, and Ovid, without any limitations on country, language, or publication date. Two reviewers selected the search results in a joint meeting. We used content analysis methodology and held three sessions for consensus building on incomptabilities. We reviewed a total of 32 documents. The "merger" phenomenon attracted considerable attention worldwide from the 1970s until 1990s. The most important reasons for merging were to boost efficiency and effectiveness, deal with organizational fragmentation, broaden student access and implement equity strategies, increase government control on higher education systems, decentralization, and to establish larger organizations. Cultural incompatibility, different academic standards and geographical distance may prevent a merger in some countries, geographical distance has caused an increase in existing cultural, social, and academic tensions. The decision and process of a merger is a broad multi-dimensional change for an academic organization. Managers who are unaware of the fact that mergers are an evolutionary process with different stages may cause challenges and problems during organizational changes. Socio-cultural integration acts as an important stage in the post -merger process. It is possible for newly-formed schools, departments, and research centers to be evaluated as case studies in future research