[Barriers to clinical governance administration from point of view of managers and nurses]

Introduction: clinical governance is a framework in which the organization providing clinical services is accountable for continuing improvement of quality of clinical service excellence

Objective: this study aimed to determine obstacles of clinical governance administration from view point of managers and nurses in hospitals affiliated to Jahrom University of Medical Sciences

Methods: this is a cross-sectional study conducted on 280 nurses and 20 managers selected by census method. Data were gathered by a researcher made questionnaire, consisting of 48 items in 7 domains of clinical governance. Questionnaire validity was done by face and content determination style and its reliability was established through Test-retest method and Spearman test [r=0.73]. Data were analyzed by descriptive statistics

Results: clinical audit and personnel management had the most negative effect in clinical governance administration from participants' viewpoint. From all questions "inattention to personnel job satisfaction" in "personnel management" domain had the most negative effect

Conclusion: according to importance of clinical governance administration, such research results should be considered by health managers

[Does traumatic uncontrolled blood loss require intensive hydration therapy?]

Hemorrhage in trauma is important and replacement of the blood loss is one of the ways which may reduce the number of mortalities. We decided to study the use of hypersaline serum in comparison with normal saline serum and not prescribing blowing serum in caring animal simulation model of uncontrolled hemorrhagic shock following trauma. The assessment of 3% hyper saline serum application compared with saline normal serum and not prescribing blowing serum in caring animal simulation model of hemorrhagic shock in trauma. The animal lab investigation and the grant of this animal trial was provided by AJA University of medical science. The goats were sedated with Ketamine and Diazepam. The tracheostomy was done on the goat and was ventilated with protable ventilator. Continuous blood pressure and electrocardiogram monitoring was positioned. Animals were cut and blood volume was measured. The bleeding was not being controlled and after 300-350 ml of bleeding, the goats were randomized into 3 groups; those treated with normal saline 20ml/kg [n=10], hypersaline 3% 6ml/kg [n=10] and no fluid resuscitation [n=10]. Data related to the duration of survival, volume of lost blood, blood pressure and metabolic acidosis were gathered and analyzed. Blood volume loss in normal saline group, hypersaline group and no volume resuscitation group was 1139ml, 1551ml, 600ml respectively. The mortality rate significantly increased using hypersaline. Also, blood acidosis increased and hemoglobin decreased significantly while using normal and hypersaline serum vs. no fluid resuscitation. Resuscitation with normal saline or hypersaline can increase blood loss during a hemorrhagic shock and do not improve survival

[Postoperative analgesia after laminectomy with dexamethasone: intravenous versus epidural injection]

Background: according to sever pain of laminectomy operation, this double blind clinical trial study was done for accompany postoperative analgrsia with preoperative IV dexamethasone and postoperative epidural dexamethasone in patients

Materials and methods: two 45 patients groups that candidated for elective laminectomy under general anesthesia, according to double blind clinical trial study were randomly divided into two groups, one group received preoperative IV dexamethasone and second group received postoperative epidural dexamethasone and then data were gathered, analyzed with Chi - square and Mann-Whitney U and T-Student tests by spss software

Results: two groups were similar with demographic parameres as age, weigh and sex[p>0.05]. In the postoperative epidural dexamethasone severity of postoperative pain was lower [p<0.05]. The time of free pain period in the postoperative epidural dexamethasone group was longer [p<0.05]

Conclusion: usage of postoperative epidural dexamethasone in laminectomy operation can decrease of severity of pain and cause longer free pain period in patients