Subject(s)
Anti-Bacterial Agents/therapeutic use , Fever/drug therapy , Neoplasms/complications , Neutropenia/drug therapy , Adult , Aged , Australia , Drug Therapy , Female , Fever/chemically induced , Humans , Male , Middle Aged , Neoplasms/drug therapy , Neutropenia/chemically induced , Outpatients , Risk Assessment , Severity of Illness Index , Tertiary Care CentersABSTRACT
BACKGROUND: Despite good contraceptive coverage rates, recent studies in Iran have shown an alarmingly high incidence of unplanned pregnancy. OBJECTIVE: To determine factors affecting quality of family planning services, a cross-sectional study was performed from June to August 2006 on women visiting urban Primary Health Care clinics in a provincial capital in western Iran. The primary focus of the study was on provider-client interaction. METHOD: We used a slightly edited version of a UNICEF checklist and a convenient sampling method to assess quality of care in 396 visits to the family planning sections at 25 delivery points. RESULTS: Poor performance was observed notably in Counselling and Choice of method sections. In logistic regression analysis, the following factors were found to be associated with higher quality of care: provider experience [OR (odds ratio)=1.9, CI(0.95) (confidence interval)=1.2-3.0], low provider education (OR=6.7, CI(0.95)=4.0-10.8), smaller workload at the clinic (OR=3.7, CI(0.95)=2.0-6.7), and 'new client' status (OR=4.2, CI(0.95)=2.6-6.7). CONCLUSION: This study identified the issues of counselling and information exchange as the quality domains in serious need of improvement; these areas are expected to be the focus of future training programmes for care providers. Also, priority should be given to devising effective supervision mechanisms and on-the-job training of senior nursing and midwifery graduates to make them more competent in delivering basic family planning services.
Subject(s)
Family Planning Services/standards , Cross-Sectional Studies , Family Planning Services/methods , Family Planning Services/organization & administration , Female , Health Care Surveys , Health Personnel/education , Humans , Iran , Pregnancy , Pregnancy, Unplanned , Professional-Patient Relations , Quality of Health CareABSTRACT
Healthcare workers and medical students are at risk of exposure to blood-borne viruses such as HBV, HCV HIV, etc. Here we report the results of a survey of the frequency and causes of cutaneous blood exposure accidents (CBEA) among medical students. Anonymous questionnaires were randomly distributed to 200 interns in their second year of internship in hospitals affiliated to Tehran University of Medical Sciences. A definite exposure was defined as injury by a sharp object causing obvious bleeding, whereas a possible exposure was defined as subtle or superficial injury due to contact with a contaminated instrument or needle but without bleeding, or contamination of an existing wound with blood or other body fluids. One hundred eighty-four subjects (92% of the original sample) responded to the questionnaire. We recorded 121 definite exposures and 259 possible exposures over a mean time interval of 14 months. Needles were the most common objects (41% of exposure episodes) causing CBEAs, while phlebotomy and suturing were the hospital procedures that accounted for the highest percentage of exposure episodes (30 and 28 percent, respectively). Only a minority of students regularly observed basic safety measures (wearing gloves, not recapping used needles and proper disposal of sharp objects). Considering the high incidence of blood exposure in medical interns at Tehran University of Medical Sciences and the ensuing risk of blood-borne infections, the subjects are likely to develop such infections during their internship period.
