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ABSTRACT: Medication dosing errors are frequent in neonatal wards. In an Iranian neonatal ward, a 7.5 months study was designed in three periods to compare the effect of Computerized Physician Order Entry (CPOE) without and with decision support functionalities in reducing non-intercepted medication dosing errors in antibiotics and anticonvulsants. Before intervention (Period 1), error rate was 53%, which did not significantly change after the implementation of CPOE without decision support (Period 2). However, errors were significantly reduced to 34% after that the decision support was added to the CPOE (Period 3; P < 0.001). Dose errors were more often intercepted than frequency errors. Over-dose was the most frequent type of medication errors and curtailed-interval was the least. Transcription errors did not reduce after the CPOE implementation. Physicians ignored alerts when they could not understand why they appeared. A suggestion is to add explanations about these reasons to increase physicians' compliance with the system's recommendations.
Journal of Medical Systems 02/2011; 35(1):25-37. · 1.13 Impact Factor
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ABSTRACT: A single-mode tapered fiber optic biosensor was utilized for real-time monitoring of the Escherichia coli (E. coli K-12) growth in an aqueous medium. The applied fiber tapers were fabricated using heat-pulling method with waist diameter and length of 6-7μm and 3mm, respectively. The bacteria were immobilized on the tapered surface using Poly-l-Lysine. By providing the proper condition, bacterial population growth on the tapered surface increases the average surface density of the cells and consequently the refractive index (RI) of the tapered region would increase. The adsorption of the cells on the tapered fiber leads to changes in the optical characteristics of the taper. This affects the evanescent field leading to changes in optical throughput. The bacterial growth rate was monitored at room temperature by transmission of a 1558.17nm distributed feedback (DFB) laser through the tapered fiber. At the same condition, after determining the growth rate of E. coli by means of colony counting method, we compared the results with that obtained from the fiber sensor measurements. This novel sensing method, promises new application such as rapid analysis of the presence of bacteria.
Journal of photochemistry and photobiology. B, Biology 12/2010; 101(3):313-20. · 1.87 Impact Factor
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ABSTRACT: Despite the significant effect of computerized physician order entry (CPOE) in reducing nonintercepted medication errors among neonatal inpatients, only a minority of hospitals have successfully implemented such systems. Physicians' resistance and users' frustration seem to be two of the most important barriers. One solution might be to involve nurses in the order entry process to reduce physicians' data entry workload and resistance. However, the effect of this collaborative order entry method in reducing medication errors should be compared with a strictly physician order entry method.
To investigate whether a collaborative order entry method consisting of nurse order entry (NOE) followed by physician verification and countersignature is as effective as a strictly physician order entry (POE) method in reducing nonintercepted dose and frequency medication errors in the neonatal ward of an Iranian teaching hospital.
A four-month prospective study was designed with two equal periods. During the first period POE was used and during the second period NOE was used. In both methods, a warning appeared when the dose or frequency of the prescribed medication was incorrect that suggested the appropriate dosage to the physicians. Physicians' responses to the warnings were recorded in a database and subsequently analyzed. Relevant paper-based and electronic medical records were reviewed to increase credibility.
Medication prescribing for 158 neonates was studied. The rate of nonintercepted medication errors during the NOE period was 40% lower than during the POE period (rate ratio 0.60; 95% confidence interval [CI] .50, .71;P < .001). During the POE period, 80% of nonintercepted errors occurred at the prescription stage, while during the NOE period, 60% of nonintercepted errors occurred in that stage. Prescription errors decreased from 10.3% during the POE period to 4.6% during the NOE period (P < .001), and the number of warnings with which physicians complied increased from 44% to 68% respectively (P < .001). Meanwhile, transcription errors showed a nonsignificant increase from the POE period to the NOE period. The median error per patient was reduced from 2 during the POE period to 0 during the NOE period (P = .005). Underdose and curtailed and prolonged interval errors were significantly reduced from the POE period to the NOE period. The rate of nonintercepted overdose errors remained constant between the two periods. However, the severity of overdose errors was lower in the NOE period (P = .02).
NOE can increase physicians' compliance with warnings and recommended dose and frequency and reduce nonintercepted medication dosing errors in the neonatal ward as effectively as POE or even better. In settings where there is major physician resistance to implementation of CPOE, and nurses are willing to participate in the order entry and are capable of doing so, NOE may be considered a beneficial alternative order entry method.
Journal of Medical Internet Research 01/2010; 12(1):e5. · 4.41 Impact Factor
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ABSTRACT: In recent years, the theory that on-line clinical decision support systems can improve patients' safety among hospitalised individuals has gained greater acceptance. However, the feasibility of implementing such a system in a middle or low-income country has rarely been studied. Understanding the current prescription process and a proper needs assessment of prescribers can act as the key to successful implementation.
The aim of this study was to explore physicians' opinions on the current prescription process, and the expected benefits and perceived obstacles to employ Computerised Physician Order Entry in an Iranian teaching hospital.
Initially, the interview guideline was developed through focus group discussions with eight experts. Then semi-structured interviews were held with 19 prescribers. After verbatim transcription, inductive thematic analysis was performed on empirical data. Forty hours of on-looker observations were performed in different wards to explore the current prescription process.
The current prescription process was identified as a physician-centred, top-down, model, where prescribers were found to mostly rely on their memories as well as being overconfident. Some errors may occur during different paper-based registrations, transcriptions and transfers. Physician opinions on Computerised Physician Order Entry were categorised into expected benefits and perceived obstacles. Confidentiality issues, reduction of medication errors and educational benefits were identified as three themes in the expected benefits category. High cost, social and cultural barriers, data entry time and problems with technical support emerged as four themes in the perceived obstacles category.
The current prescription process has a high possibility of medication errors. Although there are different barriers confronting the implementation and continuation of Computerised Physician Order Entry in Iranian hospitals, physicians have a willingness to use them if these systems provide significant benefits. A pilot study in a limited setting and a comprehensive analysis of health outcomes and economic indicators should be performed, to assess the merits of introducing Computerised Physician Order Entry with decision support capabilities in Iran.
International Journal of Medical Informatics 09/2008; 78(3):199-207. · 2.41 Impact Factor
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ABSTRACT: The medical record is used to document patient's medical history, illnesses and treatment procedures. The information inside is useful when all needed information is documented properly. Medical care providers in Iran have complained of low quality of Medical Records. This study was designed to evaluate the quality of the Medical Records at the university hospital in Tabriz, Iran.
In order to get a background of the quality of documentation, 300 Medical Records were randomly selected among all hospitalized patient during September 23, 2003 and September 22, 2004. Documentation of all records was evaluated using checklists. Then, in order to combine objective data with subjective, 10 physicians and 10 nurses who were involved in documentation of Medical Records were randomly selected and interviewed using two semi structured guidelines.
Almost all 300 Medical Records had problems in terms of quality of documentation. There was no record in which all information was documented correctly and compatible with the official format in Medical Records provided by Ministry of Health and Medical Education. Interviewees believed that poor handwriting, missing of sheets and imperfect documentation are major problems of the Paper-based Medical Records, and the main reason was believed to be high workload of both physicians and nurses.
The Medical Records are expected to be complete and accurate. Our study has unveiled that the Medical Records are not documented properly in the university hospital where the Medical Records are also used for educational purposes. Such incomplete Medical Records are not reliable resources for medical care too. Some influencing factors external to the structure of the Medical Records (i.e. human factors and work conditions) are involved.
BMC Public Health 02/2008; 8:139. · 2.00 Impact Factor
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ABSTRACT: Satureja Khuzestanica is an endemic plant of Iran that is widely distributed in the southern part of the country. It is famous for its medical uses as an analgesic and antiseptic in folk medicine. The present study was designed to explore the toxicological and pharmacological effects of essential oil of Satureja Khuzestanica (SKEO) in vivo.
The intraperitoneal LD50 of SKEO was determined. Teratogenicity was determined by administration of SKEO at doses of 500, 1000 and 1500 ppm to pregnant rats during days 6 to 015 of gestation. FRAP and TBARS assays were used to determine total antioxidant power and lipid peroxidation respectively. Diabetes and hyperlipidemia were induced by administration of streptozocin and lipid regimen in rats. SKEO (1000 ppm) was administered in drinking water for 10 days.
SKEO is not lethal up to a dose of 2 g kg-1 in rats. In the teratogenicity test, dams of the treated group were active and did not show any signs of toxicity. A significant increase in the number of implantation and live fetuses were observed with SKEO (500 and 1000 ppm) in comparison to the control group. SKEO treatment decreased the normal blood lipid peroxidation level and increased total antioxidant power. Significant decreases in fasting blood glucose and triglyceride levels were observed with SKEO in diabetic and antihyperlipidemic rats respectively.
This preliminary study indicates the safety and interesting stimulatory effect of SKEO on reproduction. The antioxidant properties of SKEO may explain its antidiabetic and triglyceride-lowering effects.
Medical science monitor: international medical journal of experimental and clinical research 10/2003; 9(9):BR331-5. · 1.70 Impact Factor
