Maternal near miss approach to evaluate quality of care in Alborz province, Iran.

OBJECTIVE: the maternal near miss approach has been developed by World Health Organization for assessing and improving the quality of care. This study aimed to examine the incidence, characteristics, and features of the care provided for maternal near-miss cases in public and private hospitals in Alborz province, Iran. METHODS: a cross sectional, facility-based study was conducted in all 13 public and private hospitals of Alborz province between April 2012 and December 2012. The World Health Organization near miss criteria were applied to gather and analyse the data, and indicators related to maternal near miss, access to and quality of maternal care. FINDINGS: 38,715 deliveries were assessed. There were 38,663 live births, 419 (1.08%) had potentially life-threatening conditions and 199 had severe maternal outcomes (SMO) (192 near miss cases and 7 maternal deaths). The maternal near-miss ratio was 4.97 cases per 1000 live births. The incidence of severe maternal outcome was 5.15 cases per 1000 live births. Severe mortality outcomes index within 12 hours of hospital stay from admission (SMO12) was 3.52%. The proportion of SMO12 cases from the total SMO cases was 99.5%. The Intensive Care Unit (ICU) admission rate among women with SMO was 72.7%, while the overall admission rate was 0.7%. Overall, hypertensive disorder was the most frequent condition among women with potentially life-threatening conditions and maternal near-miss cases. Cardiovascular dysfunction and respiratory dysfunction were the most prevalent dysfunctions among maternal near miss (MNM) cases and maternal death cases respectively. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the WHO maternal near miss criteria help to identify issues that may lead to life threatening conditions and can be used to monitor and improve the quality of care in maternity settings. Hypertensive disorders related to near miss conditions need more attention to prevent maternal severe outcomes in Alborz province. Most of the process indicators were not satisfactory. The WHO tool enables health managers to improve maternal health care.

The role of critical thinking skills and learning styles of university students in their academic performance.

INTRODUCTION: The Current world needs people who have a lot of different abilities such as cognition and application of different ways of thinking, research, problem solving, critical thinking skills and creativity. In addition to critical thinking, learning styles is another key factor which has an essential role in the process of problem solving. This study aimed to determine the relationship between learning styles and critical thinking of students and their academic performance in Alborz University of Medical Science. METHODS: This cross-correlation study was performed in 2012, on 216 students of Alborz University who were selected randomly by the stratified random sampling. The data was obtained via a three-part questionnaire included demographic data, Kolb standardized questionnaire of learning style and California critical thinking standardized questionnaire. The academic performance of the students was extracted by the school records. The validity of the instruments was determined in terms of content validity, and the reliability was gained through internal consistency methods. Cronbach's alpha coefficient was found to be 0.78 for the California critical thinking questionnaire. The Chi Square test, Independent t-test, one way ANOVA and Pearson correlation test were used to determine relationship between variables. The Package SPSS14 statistical software was used to analyze data with a significant level of p<0.05. RESULTS: Our findings indicated the significant difference of mean score in four learning style, suggesting university students with convergent learning style have better performance than other groups. Also learning style had a relationship with age, gender, field of study, semester and job. The results about the critical thinking of the students showed that the mean of deductive reasoning and evaluation skills were higher than that of other skills and analytical skills had the lowest mean and there was a positive significant relationship between the students' performance with inferential skill and the total score of critical thinking skills (p<0.05). Furthermore, evaluation skills and deductive reasoning had significant relationship. On the other hand, the mean total score of critical thinking had significant difference between different learning styles. CONCLUSION: The results of this study showed that the learning styles, critical thinking and academic performance are significantly associated with one another. Considering the growing importance of critical thinking in enhancing the professional competence of individuals, it's recommended to use teaching methods consistent with the learning style because it would be more effective in this context.