[Evaluation of an awareness of clinical information systems among the staff of medical records departments of hospitals affiliated to the Tehran university of medical sciences, 2011]

The information gathered in hospitals for clinical services is massive and management of this dispersed information is very complicated, however, necessary for medical centers. Considering the computer capabilities, clinical information systems are very useful and efficient in achieving the management goals in medical centers. This study was conducted for evaluating different applications of clinical information systems and staff awareness of Medical Records Department. This study was conducted in two-steps: In the first step, the available resources during 2000-2011 were studied. In the second step, awareness of clinical information systems among Medical Record Department's staff of Tehran University of Medical Sciences hospitals has been evaluated. The validity of the questions raised in questionnaire was confirmed by the expert panel and its reliability was determined to be 80% by test-retest coefficient. The collected data was analyzed using MS Excel 2007 software. The clinical information system consists of different parts and a variety of applications including: clinical documentation, making decision, management of medicine, radiology, laboratory, etc. There are barriers such as financial, behavioral and technical issues to employ these systems. The results obtained from the second part showed that the average of staff awareness of clinical information systems was 49%. Considering the numerous benefits of clinical information systems, using it for supplying information on clinical centers is an inevitable necessity. Selecting a proper system, training users, and paying attention to the factors affecting their implementation in hospitals play a key role in its clinical effectiveness and widespread use of clinical information systems

Delayed fracture of a PFM Nit-occlud Flex coil after transcatheter occlusion of patent ductus arteriosus

We report the fracture of a 4x4 Nit-Occlud pfm coil in a child with patent ductus arteriosus [PDA], bicuspid aortic valve, and coarctation, detected three years after deployment without any adverse consequent. This report emphasizes the importance of adherence to the user guidelincs of the company for the implementation of the device and also shows the significance of lateral chest X-ray in the follow-up of patients after the occlusion of the PDA, particularly in the case of using smaller-sized, frail pfm coils for the detection of coil fracture

Assessment of the results of secundum atrial septal defect closure by two surgery [right thoracotomy] and intervention [transcatheter amplatzer septal occluder]

Secondary atrial septal defect is one of the most common congenital heart diseases, and treatment is required in cases of large defects. The aim of this study was to assess the short-term results of secundum atrial septal defect closure by two surgery [right thoracotomy] and intervention [transcatheter Amplatzer septal occluder]. This is a descriptive study on 25 patients treated by one of the two above-mentioned methods at our center between 2004 and 2007. The patients underwent clinical and diagnostic examinations both before and after treatment such as chest X-ray, electrocardiography, echocardiography, catheterization, and angiography. The outcome and results were thereafter assessed and compared. The study population was comprised of 20 [80%] females and 5 [20%] males. The patients were divided into two groups: 17 [68%] patients were treated by intervention and 8 [32%] by right thoracotomy. The intervention group had a mean age of 12 years [ +/- 6years] and the surgery group 11 years [ +/- 4 years]. The average size of the defect was approximately 15 mm, which was similar in both groups. The average duration of hospital stay in the intervention group was significantly shorter than that of the surgery group, and the average cost of treatment in the intervention group was slightly less than the surgery group. One of the patients in the surgery group needed blood transfusion, and one of the patients in the intervention group suffered from Amplatzer embolization to the left ventricle, necessitating the extraction of the device through open heart surgery. One of the patients in the surgery group had a residual defect in the atrial septum, which was not significant. In light of the results of this study, it seems that in appropriately selected patients, the closure of the atrial septal defect via the interventional method is comparable to surgery

Inverted left atrial appendage: a cause of left ventricular inflow obstruction

When a new left atrial mass is discovered by means of echocardiography, the differential diagnosis is usually between thrombus, vegetation, and tumor. In the past decade, however, the physicians were able to document another cause. Our aim is to introduce a case of postoperative inverted left atrial appendage which caused left ventricular inflow obstruction requiring reoperation. We report a 4- year old boy who had inverted left atrial appendage after atrial septal defect repair. He showed signs and symptoms of pulmonary edema postoperatively. We assessed him by echocardiography and discovered a mass in his left atrium necessitating re-operation. The surgeon found and restored inverted left atrial appendage intra-operatively. Because inverted left atrial appendage can cause severe and occasionally life threatening complications, we believe intraoperative transesophageal echocardiography is highly essential to diagnose this pathology and to avoid restorative reoperation

[Comparison between echocardiography finding and cardiac catheterization data in diagnosis of pulmonary hypertension]

Pulmonary hypertension [PHT] is a common accompaniment of many congenital cardiac lesions. Cardiac catheterization is the gold standard method for confirming the diagnosis of PHT and for guiding management. Doppler ultrasound also can be used non-invasively to estimate the pulmonary artery pressure. We reviewed the clinical history, examination and echocardiogram of 84 patients [male=50, female=34] [mean age = 4.2 Y [3m-15y] who underwent cardiac catheterization for their congenital heart problem in our pediatric cardiology ward [Mar 2001-Apr 2002]. The patients were divided into pulmonary hypertension [PHT] group and normal pulmonary artery pressure [NPAP] group according to the results of catheterization. PHT was diagnosed in 40 patients [47%] by catheterization compared with 42 patients [50%] by echocardiography. Mean age of PHT groups was 3.38 years [3 months to 4 years] by 24 male [60%]; and 5.5y [8-15] by 26 male [59%] in NPAP group. The sensitivity and specificity of echocardiography in diagnosis of PHT was 100% and 95% respectively. The positive predictive value of echo cardiography was 95% and the negative predictive value was 100%. These results indicate similar diagnostic power by echocardiography and catheterization in identifying pulmonary hypertension

[Pulmonary arterio-venous fistula cases in Shaheed Rajayee Heart Hospital during 30 years [1974 - 2003]]

Pulmonary arteriovenous fistula [PAVF] is a rare cyanotic disease. Until 1942 when the first surgery was performed for PAVF, there was not any treatment option available for this disease. In 1977, the first embolotherapy for PAVF was carried out and today, this procedure is the treatment of choice for PAVF. There has been no report of PAVF patients from Iran so far. In a retrospective study, all PAVF cases who had been hospitalized since the inauguration of the center were identified, and data regarding demographic information, symptoms, signs, complications, paraclinical studies, treatment complications and results, and long-term follow-up were gathered and analyzed. Our patients comprised 11 cases and had a lower mean age [16 years] compared with previous large studies. We found that the lower referral rate of non-Tehranian adult patients to our center, as compared to non-Tehranian pediatric patients, might have been responsible for the observed difference. Other statistically significant differences were lower prevalence of chronic headaches [9%] and higher rate of polycythemia [70%] in our patients compared with other studies. The first PAVF surgery had been performed in 1991 and the first embolotherapy in 2001 at our center. After 2001, no PAVF patient had been referred for fistula surgery. PAVF is a rare and interesting disease. Embolization has opened new horizons into the treatment of PAVF