Use of clinical guidelines: perspectives from clinicians in paediatric and maternity hospitals in Kabul, Afghanistan

This study explored the perceived value, role and reported use of clinical guidelines by clinicians in urban paediatric and maternity hospital settings, and the effect of current implementation strategies on clinician attitudes, knowledge and behaviour. A total of 63 clinicians from 7 paediatric and maternity hospitals in Kabul, Afghanistan participated in structured focus groups; content analysis methodology was used for identification and analysis of key themes. Seven sets of guidelines, protocols or standards were identified [including 5 WHO-endorsed guidelines]. However, most are failing to achieve high levels of use. Factors associated with guideline use included: clinician involvement in guideline development; multidisciplinary training; demonstrable results; and positive clinician perceptions regarding guideline quality and contextual appropriateness. Implementation activities should fulfil 3 major objectives: promote guideline awareness and access; stimulate motivation among clinical guideline users; and actively facilitate adherence to guidelines

[Change in sex ratio among newborn rats in response to potassium supplements]

Affecting the female reproductive organ and the layers around the oocyst, some ration ions could facilitate the penetration of sperm with specific chromosome type and change the sex ratio in mammal infants. The purpose of the present study was to evaluate the effect of potassium supplement on the sex ratio in rat. The percentage of moisture, ash, crude fat and protein, sodium, potassium, calcium, and energy was measured in the ration of rats. In one gestation period, the male and female pups from 32 female and 8 male adult rats were counted as control group. In experimental group, potassium citrate [36% potassium] was used in control group ration to raise the level of potassium from 0.35% to 0.8% and 12 female and 3 male adult rats were fed with that ration in two gestation periods. The number of male and female pups in both groups was counted at the age of three days. Sex ratio in both groups was compared using chi-square test [SPSS, Ver. 11.5]. The ration of control group had 90% dry matter, 8% ash, 4.1% crude fat, 21.6% crude protein, 70.8% total digestible nutrients [TDN], 0.4% calcium, 0.3% potassium and 0.1% sodium. The ratio of male pups in the rats were fed with potassium supplement [1.52, 100 male and 66 female pups] was higher [p=0.03] compared to the control group [0.94, 115 male and 122 female pups]. Raising the level of potassium in food ration can increase the number of male pups over 10% in each gestation

[ methods used for evaluation of health information systems in Iran]

Introduction: With the vast implementation of health information systems, continuous evaluation of these systems, seems to have a key role in the quality improvement of health care provided to patients. The aim of the study was to assess the studies conducted to evaluate health information systems in Iran

Methods: This was a review in which all papers relevant to the research objective were retrieved from SID, Magiran and Iran medex databases, from April 2001 to September 2012. There were 36 out of 727 articles retrieved and then selected as relevant for review by the authors

Results: Questionnaires were used to evaluate the systems in 50 percent of the studies. Questionnaires were distributed among study population in 42 percent of the studies. In 50 percent of the studies the information was collected by means of interviews, observations and the review of patients' documents and records. With the exception of one study, all studies used quantitative methods and were summative

Conclusion: Evaluation tools and methods are required for developing and optimizing information systems. Although various evaluation studies have been conducted in Iran, only a limited number of evaluation tools and methods are used

[ comparison of fracture resistance of zirconia copings made with CAD/CAM technology and slip casting technique]

Statement of Problem: Zirconia has been introduced as an appropriate structure for fabricating metal free copings. A major advantage of such restorations is esthetic concerns; however, due to its high strength, zirconia can also be used in posterior areas. One of the recent methods of making these restorations is CAD/CAM machines

Purpose: This study aimed to evaluate the fracture resistance of zirconia copings fabricated by two methods, CAD/CAM and slip casting

Materials and Method: 32 brass dies were fabricated for this study and divided into two groups of 16 dies each. Zirconia copings were made by CAD/CAM machine for one group and by slip casting method for the other. The copings were cemented to dies by a resin-modified glass ionomer [GC plus]. A hardened steel ball with a diameter of 5 mm was used to apply the load to the copings in the long axis of the dies at a crosshead speed of 0.5 mm/min. Then the amount of force needed to fracture each coping was recorded. Independent Sample T-test was used to compare the two groups

Results: The average of fracture resistance for the CAD/CAM group was 1411+/- 424 N and for the slip cast group it was 1542+/-412 N, having no significant difference [p > 0.05]

Conclusion: Zirconia copings made by CAD/CAM and slip casting methods have no significant difference in fracture resistance

Outcomes of ventricular septal defect repair in various anomalies: a single institute experience and literature review

This is a single institute retrospective study [from 2007 to 2008] to evaluate how patient related factors [age, weight] and type of anatomical location of ventricular septal defect [VSD] could affect the outcome of surgery. Patients with any diagnosis who had undergone ventricular septal defect repair [a total of 25 patients] from 2007 till early 2008 at our center were evaluated retrospectively for factors which might be responsible for developing residual ventricular septal defects and heart block. Data were analyzed through univariate and multivariate analysis. There was 2 deaths among 252 patients [0.8%]. The incidence of postoperative residual ventricular septal defect was 28.2% +/- 2.8* [71 of 252], but only 3 of them [4.2%] needed reoperation. Neither patch material [p=0.572], nor type [p=0.349] or size [p=0.599] of ventricular septal defect had any effect on this complication. The mean age and weight of patients who had residual ventricular septal defect compared to those who did not were not significantly different, although they were somewhat lower [4.7 +/- 0.7 vs. 5.2 +/- 0.4 years, p=0.537; and 15.4 +/- 1.7 vs. 17.9 +/- 1.1 kg, p=0.222, respectively]. There were five patients [2.05] with postoperative complete heart block [CHB] and again this was independent of the patients' age, weight and surgical approach [transatrial or transventricular]. Patients with history of previous Blalock-Taussig [BT] shunt proved to have postoperative bleeding more commonly [13%, 6 of 46 patients] than patients who had not [3.4%, or 7 of 206 patients, p=0.009]. Also in patients with a history of BT shunt compared to those without it, postoperative pericardial effusion [6.5% versus 1.5%, P=0.04] and pneumonia [4.35 versus 0.5%, P=0.025] were more common. It seems that for VSD repair, there are no limitations such as wight or age to proceed with the definitive surgery. Also the incidence of complications is independent of the type of anomaly or approaches for closing the defect. Finally, BT shunt has its own complications which are neither rare nor minor, so it is advisable to proceed with the definitive surgery at the first time to avoid the complications associated with BT shunt

[Study on the quality and comparing of the compost produced by Khomain and Tehran compost factories]

Over than 70% of solid wastes is consisted of food wastes with high putrecibility in Iran. Due to this regard, construction of composting factories for sanitary disposal or fertilizer production from solid wastes was very appreciated in our country. The objective of this research was to study on the quality and comparing of the compost produced by Khomain and Tehran compost factories. This study was accomplished on the compost produce from Khomain and Tehran compost factories about 9 months. For investigation of chemical qualities of these materials, some indexes such as percentage of organic materials, carbon, nitrogen, phosphorus, potash and heavy metals consists of lead, cadmium, mercury and chromium were measured. Microbial quality of these compost materials were defined by assessing of the amounts of coliforms bacteria, salmonella bacteria and parasites ova. The average amounts of some indexes in compost of Khomain and Tehran were been: organic materials% [37.77, 29.80], carbon%[22.14, 18.12], nitrogen% [2.08, 1.6], lead [229.6, 59.44 ppm], and chromium [70.2, 19.75], respectively. The microbial quality of these compost samples were agreement with class B of USEPA guidelines. This study showed that quality of organic materials percent in Tehran's samples was better than Khomain's samples, but these indexes on these samples were lower than the grade No.2 of compost. The percentage of carbon, nitrogen and potash in these samples were desirable but, phosphorus amount were not in sufficient. The heavy metals especially lead and chromium in Tehran's samples were higher than Khomain's samples, but these samples were usually in agreement with guidelines of compost. Due to the defined microbial qualities, these samples could be used as well as amendment agents for poor soil

[Comparing the factors related to the effective clinical teaching from faculty members' and students' points of view]

Teaching and learning are interdependent in educational process. Teaching effectiveness, therefore, is to be investigated both from teachers' and learners' viewpoints in order to achieve a better education. This study was conducted to determine and compare the factors related to effective clinical education from teachers' and students' viewpoints in School Of Nursing and Midwifery in Isfahan University of Medical Sciences. In this descriptive cross-sectional study, the population under the study was 53 faculty members and 118 senior students selected through purposeful sampling. The research environment consisted of teachers' offices, hospitals, and clinical centers affiliated to Isfahan University of Medical Sciences. The data gathering tool was a researcher made questionnaire consisted of two parts of demographic feAutres and factors related to clinical education which contained 5 general areas of individual feAutres of the learner, clinical teacher, clinical environment, educational planning, and clinical evaluation. Questions related to each of these areas were scored based on a five point Scale. The questionnaires were distributed anonymously and gathered after one week. The data was analyzed by SPSS software. Mean of the scores in areas of factors related to the individual feAutres of the learner, clinical teacher, clinical environment, and educational planning were above 4 and only in the area of clinical evaluation it was 3.95 +/- 0.81 out of the total score 5. T-test results for four before mentioned areas were 0.46, 0.45, 0.53, and, 1.39, respectively and it was 0.38 for evaluation area which revealed no significant difference. Regarding the agreement of faculty members and students on the importance of these factors in clinical education, it is recommended to apply all these factors in order to promote the quality of clinical education

Coagulopathy after spider bites in a six-year-old boy: case report

Spider bites are common in most parts of the world. In some areas, where snake or scorpion bites are common, spider bites may not be considered a significant problem by the general public and those who have been bitten by spiders may not go to a hospital. However, significant problems are observed in the victims of certain species of spiders including: widow spider [of the genus Latrodectus], including the black widow and brown spiders [of the genus Loxosceles], such as the brown recluse. We report a six-year-old boy, admitted to the hospital two weeks after suffering a spider bite. The patient presented with a severe nose bleed, ecchymosis and purpura, as well as anemia, indicating a clotting disorder. Laboratory results revealed abnormal values for prothrombin time [PT] > 50 sec, partial thromboplastin time [PTT] > 120 min and fibrinogen = 0 mg/dl, whereas factor VIII was normal according to a mixing study, with a normal platelet count of 350,000/micro l. The patient was managed with fresh frozen plasma every 12 h, and was discharged one week after hospital admission. At present, the patient is well with more normal laboratory results one month after treatment: PT = 13.4 sec, PTT = 34 sec, fibrinogen = 105 mg/dl. Although spider bites are uncommon in Iran, severe systemic reactions may occur in the pediatric population requiring admission to the pediatric intensive care unit. These systemic reactions may include hemolytic anemia coagulopathy and renal failure

Hydrocortisone in post-dural puncture headache

Headache after spinal anesthesia is a common complication is patients undergoing this procedure. In this study we evaluated the efficacy of intravenous hydrocortisone in the treatment of headache after spinal anesthesia in women who have undergone cesarean section. Sixty patients with headache after spinal anesthesia were included. Patients randomly allocated into two groups, 30 patients received only conventional therapy [complete bed rest, hydration, acetaminophen and pethidine]. Other 30 patients received conventional therapy plus intravenous hydrocortisone [200 mg first, then 100 mg TID for 48 hours]. Mean [ +/- SD] of headache intensity at 0, 6, 24, and 48 hours after beginning of treatment was measured using visual analog scale. There was no significant difference in headache intensity between two groups before beginning of treatment. After 6 hours, the mean of headache intensity in 30 patients treated conventionally was 6.63 [ +/- 1.35] while it was 2.77 [ +/- 1.07] in other patients received intravenous hydrocortisone too [p <0.001]. After 24 hours, mean headache intensity was 3.87 [ +/- 1.63] in conventionally treated group versus 0.73 [ +/- 0.74] in hydrocortisone group [p <0.001]. After 48 hours, mean headache intensity was 1.87 [ +/- 0.93] in conventionally treated group versus 0.63 [ +/- 0.61] in hydrocortisone group [p = 0.001]. This study showed the therapeutic effects of intravenous hydrocortisone in reducing headache after spinal anesthesia in women who underwent cesarean section. Its mechanism of action is yet to be determined