Soheila Mojdeh’s research while affiliated with Isfahan University of Medical Sciences and other places

Introduction and purpose: Falling of instruments is seen as a major problem and defect in the most surgical procedures. Instruments' fall leads to increase in operating time, surgical flow disruptions, more cost and possible damage to surgical instruments. Due to the efficiency of magnetic drapes and the maintenance of instruments in the field o f surgery, some o f Instruments' fall and its adverse effects on the operating room efficiency are prevented. Thus, this study was undertaken to investigate the effect of magnetic drapes on the falling of instruments during neurosurgical, general, gynecological, orthopedic and urological operations. Materials and Methods: After making and testing the magnetic drape, the clinical data were recorded by intra-operative observation using a Self Administered checklist in two groups of control and intervention during 200 neu-rosurgical, general, gynecological, orthopedic and urolog-ical procedures. Results: The results of this study showed that the frequency of instruments fall in the intervention group significantly decreased (P <0.05). Conclusion: Falling of instruments frequently occur in the operating room and have a major effect on surgery flow and resource utilization. Thorough documentation of in-traoperative falling of instruments provides a basis for the development of solutions for improving operating room efficiency. According to the results of present study, it can be concluded that magnetic drape had a significant effect on reducing the falling of instruments during neurosur-gical, general, gynecological, orthopedic and urological procedures. So, designing and manufacturing magnetic drape is recommended for the safety and comfort of surgical team members and the removal of additional cost. Investigando el efecto del uso de la protección magnética en la prevención de caídas durante la cirugía en el Centro educativo de Alzahra Medical en Isfahan en 2017 Resumen Abstract Introducción y propósito: la caída de los instrumentos es vista como un problema y defecto importante en la mayoría de los procedimientos quirúrgicos. La caída de los instrumentos aumenta el tiempo de operación, las interrupciones del flujo quirúrgico, más costos y posibles daños a los instrumentos quirúrgicos. Debido a la eficien-cia de las cortinas magnéticas y al mantenimiento de los instrumentos en el campo de la cirugía, se evitan algu-nas caídas de los instrumentos y sus efectos adversos en la eficiencia de la sala de operaciones. Por lo tanto, este estudio se realizó para investigar el efecto de las corti-nas magnéticas en la caída de los instrumentos durante operaciones neuroquirúrgicas, generales, ginecológicas, ortopédicas y urológicas. Materiales y métodos: Después de realizar y probar la capa magnética, los datos clínicos se registraron mediante observación intraoperatoria utilizando una lista de verifi-cación auto administrada en dos grupos de control e in-tervención durante 200 procedimientos neuroquirúrgicos, generales, ginecológicos, ortopédicos y urológicos. Resultados: Los resultados de este estudio mostraron que la frecuencia de los instrumentos en el grupo de in-tervención disminuyó significativamente (P <0.05). Conclusión: la caída de los instrumentos ocurre con fre-cuencia en la sala de operaciones y tiene un efecto impor-tante en el flujo de la cirugía y la utilización de recursos. La documentación exhaustiva de la caída intraoperatoria 285 Revista Latinoamericana de Hipertensión. Vol. 14-Nº 4, 2019 www.revhipertension.com de instrumentos proporciona una base para el desarrollo de soluciones para mejorar la eficiencia de la sala de opera-ciones. De acuerdo con los resultados del presente estudio, se puede concluir que la caída magnética tuvo un efecto significativo en la reducción de la caída de los instrumen-tos durante procedimientos neuroquirúrgicos, generales, ginecológicos, ortopédicos y urológicos. Por lo tanto, se recomienda el diseño y la fabricación de cortinas magnéti-cas para la seguridad y la comodidad de los miembros del equipo quirúrgico y la eliminación de costos adicionales. Palabras clave: Aparatos quirúrgicos, quirófano, caída, magnéticos, drapeados. ithin each operating room (OR) suite, there are many instruments used by the surgical team members. And then the falling of instrument seems to be a common incident and also a deterrent to most of the surgery. This issue is very important, which can have short and long-term effects, leading to surgical flow disruption , the imposition of additional time and costs, and the shortening the longevity of instruments. Surgical instrument fall as an interruption factor may affect negatively the surgical team's ability to remain fully engaged mentally during a case. Also, the noise caused by the moving or falling of the surgical instrument leads to distraction of the surgical team. Surgical team members should give their full attention to carrying out duties performed during critical phases 2. As mentioned by Wiegmann, surgical flow disruptions related to resource accessibility accounted for the remaining 8% of the observed events during 31 nonemergency cardiovascular operation 3. Joshi and colleagues reported an average delay of 5.7 min after the fall of the surgical instrument 4. As a result of prolonging the procedure, the patient is placed at a higher risk of infection or other serious complications. In addition, other surgeries may be subsequently delayed, and time wasted on the part of the surgeon and other hospital staff. Harders and colleagues found that the second most commonly recorded reason for delay in the operating room, after patient clinical condition, was the availability of instruments 6. During surgery, contaminated instruments should be properly and completely removed from blood or tissue in the sterile field. On the other hand, the instrument dropped to the floor remains there until the completion of the surgery. Blood and foreign matter that are not removed or are allowed to dry and harden may become trapped in jaw serrations, between scissor blades, or in box locks, making final cleaning more difficult and the sterilization or disinfection process ineffective. It can cause instruments to become stiff and eventually break. Surgical instruments are a major financial investment in every surgical facility, and processes should be in place to protect this investment. The life of a surgical instrument is dependent upon the way it is used and the care it receives. It is a responsibility for the surgical team and the operating room staff. Instruments should be handled carefully and gently to avoid possible damage caused by their becoming tangled, dented, and misaligned. During and after surgery they should be placed in an appropriate place to prevent them from falling 7. Surgeons, assistants and scrub nurses work very closely together handling the same instruments in a confined space during surgery 8. Consequently, one of the factors influencing the incidence of instruments fall is communication in the operating room. In recent research, verbal and non-verbal exchanges in the operating room (OR) have been evaluated; commands are delayed, incomplete, or not received at all, and frequently left unresolved 9. Firth-Cozens found that 31% of all communications in the operative procedures represent failures, a third of which had a negative impact on the patient 10. Halverson and colleagues claimed that 36% of communication errors were related to instrument utilization 11. Generally, there are three phases related to the use of the instruments. First, the request for a tool has to be handled, then the tool is used, and finally it is disposed of 1,2. An error in any of these phases can be considered as a disruption to the surgical flow. In other words, the tool request was not properly interpreted or holding the required tool was not conducted properly e.g., it was mishandled or dropped on ground 12. Because the most fallen surgical instruments include Hemostats, needle holders, Scissors and Forceps, also the majority of surgical instruments are stainless steel and stainless steel can be magnetically absorbent, therefore, the use of magnetic instrument holder will improve the efficiency and safety of the transfer of tools to the surgeon when they are needed. Thus, this study was undertaken to investigate the effect of magnetic drapes on the falling of instruments during neurosurgical, general, gynecological, orthopedic and urological operations 3,4. his experimental paper is divided into two section. Firstly, Intra-operative observation of operative procedures was performed by first author over two week periods. Surgical cases were distributed across all days of the week, times within the day, surgical specialty, and surgeon within each specialty. A similar sampling scheme was used for observation in order to make a main checklist and record data sheet for two control and intervention group during study. A combination of recorded observations was used to introduce the basic checklist and categorize falling events. The topics of the self-administered checklist were classified into 6 catego

Introduction The incidence of gastric ulcers in patients with abdominal stoma is high and affects the quality of patients’ life. Aim To evaluate the effect of Adib herbal ointment containing chamomile rose, black nightshade origin versus Comfeel and Conveen ointments on the skin of abdominal stoma. Material and methods This is a clinical study in which the volunteers were stoma patients. Study group consisted of 52 qualified subjects, 26 were included in the experimental group and 26 in the control group. A 2-part questionnaire was used for the data collection. The 1st part was demographic information. The 2nd part of the data collection was evaluated according to the pressure ulcer scale for healing (PUSH) tool, which used for examining skin ulcers around the stoma. P ≤ 0.05 was considered as a significant. Results and discussion The results of the Mann–Whitney test showed that between the mean score of the total score of the wound before intervention (P = 0.92) and on the 3rd day (P = 0.476), 6th (P = 0.222), 9th (P = 0.11) and 12th (P = 0.418), there was no significant difference between the control and test groups. Also, the Friedman test (intra-group) also showed that between the mean score of the total score of the wound before the intervention and the 3rd, 6th, 9th and 12th days in the control group (P = 0.0001) and in the experimental group (P = 0.0001) There was a significant statistical difference. Conclusions Based on the study, Adib herbal ointment could be recommended for the treatment of stoma to the skin as an herbal product as other common treatments.

Falling of instruments is seen as a major problem and defect in the most surgical procedures that leads to an increase in operating time, surgical flow disruptions, more cost and possible damage to surgical instruments. The aim of this study was to analyze and compare statistically the incidence of accidental fall of instruments during neurosurgical, general, gynecological, orthopedic and urological operations. In this cross-sectional study, the prevalence of steel surgical instruments downfall during 100 open surgical operations was recorded. The data were recorded by intra operative observation using a self administered checklist which were confirmed. Data were then analyzed by SPSS software version 18 and descriptive tests. A total of 55 instruments falling were recorded. The results of this study showed that the most frequent number of instruments falls was in supine position and abdominal region. The causes of instruments' fall in control (49.1%) was related most commonly to time that the tools were left on the side of the patient body at a reachable region and ignoring instruments dropped on the floor (80%) was the most common condition after falling surgical instruments in both groups. Documentation of intra operative falling of instruments provides a basis for the development of solutions for improving operating room efficiency.

Background: The aim of this study was to compare the body image in two groups of patients with obesity, undergoing gastric bypass surgery and Sleeve gastrectomy. Methods: This descriptive study was performed on 126 morbid obese patients (two groups of 63), who underwent gastric bypass and Sleeve gastrectomy procedures from January 2017 to October 2017 at Alzahra Medical Training Center in Isfahan, Iran. Body image of all patients was assessed preoperatively and 6 months after the surgery using Multidimensional Body Self-Relation Questionnaire. All data were analyzed using SPSS software. Findings: Paired t test indicated that the mean of total body image score increased significantly in both groups after the surgery (P < 0.01); but independent t test showed that there was no significant difference between the two groups at baseline (P = 0.62), was well as 6 months after the surgery (P = 0.62). Conclusion: The mean total body image score was significantly improved at 6 months postoperatively. But in long term, following more weight loss and flabby or loose skin, their body image would change or decrease consequently. Therefore, it is recommended to follow up these patients in a longer periods.