A novel framework for human factors analysis and classification system for medical errors (HFACS-MES)-A Delphi study and causality analysis

The healthcare system (HCS) is one of the most crucial and essential systems for humanity. Currently, supplying the patients' safety and preventing the medical adverse events (MAEs) in HCS is a global issue. Human and organizational factors (HOFs) are the primary causes of MAEs. However, there are limited analytical methods to investigate the role of these factors in medical errors (MEs). The aim of present study was to introduce a new and applicable framework for the causation of MAEs based on the original HFACS. In this descriptive-analytical study, HOFs related to MEs were initially extracted through a comprehensive literature review. Subsequently, a Delphi study was employed to develop a new human factors analysis and classification system for medical errors (HFACS-MEs) framework. To validate this framework in the causation and analysis of MEs, 180 MAEs were analyzed by using HFACS-MEs. The results showed that the new HFACS-MEs model comprised 5 causal levels and 25 causal categories. The most significant changes in HFACS-MEs compared to the original HFACS included adding a fifth causal level, named "extra-organizational issues", adding the causal categories "management of change" (MOC) and "patient safety culture" (PSC) to fourth causal level", adding "patient-related factors (PRF)" and "task elements" to second causal level and finally, appending "situational violations" to first causal level. Causality analyses among categories in the HFACS-MEs framework showed that the new added causal level (extra-organizational issues) have statistically significant relationships with causal factors of lower levels (Φc≤0.41, p-value≤0.038). Other new causal category including MOC, PSC, PRF and situational violations significantly influenced by the causal categories of higher levels and had an statistically significant effect on the lower-level causal categories (Φc>0.2, p-value<0.05). The framework developed in this study serves as a valuable tool in identifying the causes and causal pathways of MAEs, facilitating a comprehensive analysis of the human factors that significantly impact patient safety within HCS.

Application of "Human Factor Analysis and Classification System" (HFACS) Model to the Prevention of Medical Errors and Adverse Events: A Systematic Review

Hospitals, as one of most important subsectors in human societies, are responsible for providing safe and effective medical services to clients. But sometimes these hospitals are the source of injury and death in patients by creating medical errors. In this systematic review study, the application of human factor analysis and classification system (HFACS) method in the classification of medical errors was investigated. Major electronic databases including Scopus, Web of Science, and MEDLINE were searched. All studies that investigated the application of HFACS method for coding, causation, and classification of medical errors and adverse events conducted from 2001 until February 2021 were included. A total of 108 articles were found. Due to duplication, 18 studies were removed from the review list. After reading the titles and abstracts, 50 of these publications were excluded because they had objectives different from this review. The remaining 40 publications were retrieved for further assessment. Of these, 28 publications were excluded because it did not meet the inclusion criteria. Finally, 12 articles remained for the final systematic review. We found that in 65% of the selected studies, preconditions for unsafe acts have been the major causal level of medical errors and adverse events. In the majority of the studies, communication and coordination, adverse mental states, physical environment, crew resource management, and technological environment have also been recognized as the most important causal categories in this study. As a result, to prevent medical errors and adverse events, the main focus should be on controlling the preconditions for unsafe acts including personnel factors, operator conditions, and environmental factors.

Mental workload profile and its relationship with presenteeism, absenteeism and job performance among surgeons: The mediating role of occupational fatigue

Introduction

Surgeons are one of the most significant jobs in the health care system that plays an important role in the patients' health promotion and their treatment. In the current study, the effect of mental workload on the work performance of surgeons was tested by considering the mediating effect of fatigue on this relationship.

Method

This study was done analytically on 165 surgeons working in the operating rooms of hospitals in Iran. To determine of mental workload, the SURG-TLX method was used. The job performance was measured using the short version of the job performance questionnaire provided by the World Health Organization (WHO-HPQ), and accordingly relative presenteeism, relative absenteeism and job performance variables were calculated. The Swedish Occupational Fatigue Inventory (SOFI) questionnaire was used to determine occupational fatigue. A conceptual model was built to determine the direct and indirect relationship between mental workload and job performance, and the mediating effect of occupational fatigue on the relationship between mental workload and job performance was tested using structural equation modeling (SEM).

Results

Out of 165 distributed questionnaires, 140 questionnaires were completed and delivered to the researchers (85% response rate). The mean ± standard deviations of mental workload, fatigue, and work performance were 16.57 ± 5.83, 6.32 ± 2.86, and 0.65 ± 0.28, respectively. The results of model fit indexes revealed that all indexes are within the acceptable range. Regarding this model, the direct effect of mental workload on job performance was not significant (β = -0.21; p = 0.072). A significant positive relationship was observed between mental workload and fatigue (β = 0.36; p < 0.001). The direct effect of fatigue on job performance was also the opposite and statistically significant (β = -0.39; p < 0.001). Finally, results indicated that the effect of mental workload on work performance mediated by occupational fatigue.

Conclusion

Surgeons suffer a high level of mental workload during their work, and this factor can have a negative effect on surgeons' job performance. The effect of mental workload on job performance in surgeons can be detected, directly and indirectly, through the mediating effect of occupational fatigue. Improving the mental and physical conditions of the work environment can reduce occupational fatigue and improve surgeons' job performance.

Investigation of Correlation Result of NORDIC Questionnaire (wrist & hand) with DASH Questionnaire

Introduction: Work-related musculoskeletal disorders occur predominantly in the upper limbs and cause disability. When it comes to the perception of people for their abilities, Questionnaires are useful and valuable tools. Questionnaires can be used to measure the symptoms of disease and disability. We decided to evaluate the correlation result of the NORDIC questionnaire (wrist & hand) with the DASH questionnaire. Materials and Methods: The study was a descriptive-analytic and cross-sectional one and was carried out among 82 female assembly workers. To evaluate the correlation result of the NORDIC questionnaire (wrist & hand) with the DASH questionnaire, chi squire and spearman have been used. Data analysis was carried out by using SPSS 20. It is noteworthy to mention that a P-value <0.05 was considered significant. Results: In this study, the results of the DASH questionnaire with the studied variables were similar to the results of the NORDIC questionnaire (wrist & hand). Moreover, in the majority of questions, there was a significant relationship between the two questionnaires (P value <0.05). The average score of DASH was obtained at 19.65 ± 14.85 and 65.9% of the people had a mild upper limb. Moreover, 76.8% of the participants had distress in the wrists area, among which, 46.3% had mild discomfort. Conclusion: According to the results the DASH questionnaire is a useful tool for industrial and occupational issues. Therefore, due to the high relationship between the two questionnaires, the DASH questionnaire could be used instead of the Nordic Questionnaire (Wrist and Hand).  

The Effect of Sleep Quality and Mental Fatigue on the Learning Rate of Shift Workers with Fast Shift Work Rotation

Background

Modern industrial societies are always prone to errors and accidents due to complex devices, multitasking, and shift work jobs. Therefore, behavioral tests in learning and memory are necessary to evaluate employees' perceptions to examine the brain's information processing and the physiological and psychological aspects of memory disorders.

Materials and Methods

In this study, the effect of fast shift rotation, sleep quality, and mental fatigue on individuals' learning and memory was investigated using a maze device. Participants were divided into two groups (regular daytime workers and shift workers). The quality of sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), and the rate of mental fatigue was evaluated using a checklist published by the Japan Industrial Safety and Health Association.

Results

Learning time and the number of learning errors at the beginning and end of the morning shifts and night shifts had a significant relationship (P value <0.0001). However, there was no meaningful relationship between sleep quality and time and the number of learning errors in day workers and shift workers.

Conclusion

The results indicated that although shift workers experience rapid shift rotation, they are still exposed to this circadian sleep change's side effects such as general physical fatigue, sensory-neurological fatigue, poor perceived sleep quality, daily dysfunction, difficulty in learning, and memory. They show a significant difference compared to people working on a regular workday.

Investigating the Combined Effects of Heat and Light Color Temperature on Precision and Speed in Female Students in Laboratory Conditions

Background & Aims of the Study: Cognitive functions, such as precision and speed, significantly affect human errors and incidents. The temperature of light color and heat can impact cognitive functions. Therefore, the present study examined the effect of heat and color temperature on the speed and precision of work in the laboratory. Materials and Methods: This study was conducted on 10 female students in the Laboratory of Atmospheric Medical School of Isfahan University of Medical Sciences in Isfahan City, Iran. Piron v-vibrometer and precision and target vibrometer devices were used to measure accuracy and speed. The test was held in 4 turns, each time for 1 hour. The first turn, 22°C, and color temperature 3000°K, the second turn 22°C and color temperature 6000°K, the third turn 36°C and color temperature 3000°K and the fourth turn 36°C and color temperature 6000°K, adjusted. Results: Based on the obtained results, precision measurement with precision and target vibrometer was significant in two cases with a color temperature of 3000 and temperatures of 22°C and 36°C (P<0.05); thus, with increasing temperature, the frequency of errors enhanced, and consequently the precision decreased. Furthermore, the speed measurement with the precision and target and Piron v-vibrometer in color temperature state 6000 and temperatures of 22°C and 36°C and the color temperature of 3000 and temperatures 22°C and 36°C were significant (P<0.05). In other words, with increasing temperature, the time of work decreased, and as a result, the speed of work increased, and in other cases, no significant relationship was observed (P>0.05). Conclusion: In general, the present study results indicated that the precision of work at 36°C is less than exposure to 22°C; the speed of work is higher, and changing the color temperature of light has no significant effect on increasing the precision of work. Therefore, it is suggested to use control strategies to reduce the temperature in environments with temperatures higher than comfort.

Urate-induced epigenetic modifications in myeloid cells

OBJECTIVES

Hyperuricemia is a metabolic condition central to gout pathogenesis. Urate exposure primes human monocytes towards a higher capacity to produce and release IL-1β. In this study, we assessed the epigenetic processes associated to urate-mediated hyper-responsiveness.

METHODS

Freshly isolated human peripheral blood mononuclear cells or enriched monocytes were pre-treated with solubilized urate and stimulated with LPS with or without monosodium urate (MSU) crystals. Cytokine production was determined by ELISA. Histone epigenetic marks were assessed by sequencing immunoprecipitated chromatin. Mice were injected intraarticularly with MSU crystals and palmitate after inhibition of uricase and urate administration in the presence or absence of methylthioadenosine. DNA methylation was assessed by methylation array in whole blood of 76 participants with normouricemia or hyperuricemia.

RESULTS

High concentrations of urate enhanced the inflammatory response in vitro in human cells and in vivo in mice, and broad-spectrum methylation inhibitors reversed this effect. Assessment of histone 3 lysine 4 trimethylation (H3K4me3) and histone 3 lysine 27 acetylation (H3K27ac) revealed differences in urate-primed monocytes compared to controls. Differentially methylated regions (e.g. HLA-G, IFITM3, PRKAB2) were found in people with hyperuricemia compared to normouricemia in genes relevant for inflammatory cytokine signaling.

CONCLUSION

Urate alters the epigenetic landscape in selected human monocytes or whole blood of people with hyperuricemia compared to normouricemia. Both histone modifications and DNA methylation show differences depending on urate exposure. Subject to replication and validation, epigenetic changes in myeloid cells may be a therapeutic target in gout.

Comparing the Effectiveness of Three Ergonomic Risk Assessment Methods-RULA, LUBA, and NERPA-to Predict the Upper Extremity Musculoskeletal Disorders

Background:

Musculoskeletal disorders are a major problem in all jobs. Several methods are available for assessing the exposure to risk factors associated with musculoskeletal disorders. This study is aimed at comparing three different ergonomic risk assessment methods—rapid upper limb assessment (RULA), loading on the upper body assessment (LUBA), and new ergonomic posture assessment (NERPA) method—to predict upper extremity musculoskeletal disorders.

Materials and Methods:

The study was conducted on 210 workers from three different industries including pharmaceutical, automotive, and assembly in the Isfahan province. A Nordic questionnaire was used for determining the levels of musculoskeletal disorders. Then, selected postures were evaluated with RULA, LUBA, and NERPA methods. Finally, data were analyzed with Kolmogorov–Smirnov test to check the normality distribution of data, Spearman's correlation test to investigate the correlation between the assessed levels with musculoskeletal disorders, and Wilcoxon test to identify significant differences between the values with SPSS version 16.

Results:

Wilcoxon test revealed a significant difference between the values related to NERPA and RULA (P < 0.001), whereas no significant relation between LUBA and RULA was shown by this test (P = 0.914). The correlation coefficients of the musculoskeletal disorders' level with RULA level, NERPA level, and LUBA level were 0.74, 0.73, and 0.69, respectively.

Conclusion:

Low-risk levels in NERPA, medium-risk levels in LUBA, and high-risk levels in RULA are evaluated better. The results showed that RULA was the best method for assessing musculoskeletal disorders among the three methods.

A survey of the relationship between work schedule and its effect on the fatigue of rescue personnel in Isfahan with a standard method of CIS202

CONTEXT

Fatigue is a factor that can have negative effects on family life, social relationship and work. Work schedule is one of the affective factors on personnel's fatigue in different jobs. In this study, the work schedule and its effect on rescue personnel in Isfahan are explored.

AIMS

The purpose of this study was to investigate the relationship between work schedules and fatigue among rescue personnel.

SETTINGS AND DESIGN

This study is periodical and has been conducted on 72 employees of rescue personnel in Isfahan.

MATERIALS AND METHODS

Random sampling was done and the primary data that was collected through fatigue assessment questionnaire after being conducted as a pilot study on 10% of samples were collected to confirm the validity of this study. Finally, the data was given to SPSS11.5 software and were analyzed by descriptive statistics and linear digression.

RESULTS

The results showed that from the statistical point of view some parts of work schedules like work hours satisfaction, resting time and work order on total fatigue are effective in linear and inverse way but the item "predictibility of work conditions" does not have a meaningful relationship with total fatigue. Furthermore, the results showed that there is a meaningful and inverse relationship with work hours, resting time and work order with mental fatigue and also the work schedule has a meaningful, linear and inverse relation with mental fatigue and total fatigue.

CONCLUSIONS

By increasing the satisfaction of working hours, increasing resting time and also with an increase of work order the total fatigue of rescue personnel will decrease.

The effect of three ergonomics interventions on body posture and musculoskeletal disorders among stuff of Isfahan Province Gas Company

BACKGROUND

Prevalence of work-related musculoskeletal disorders (WMSDs) is high among computer users. The study investigates the effect of three ergonomic interventions on the incidence of musculoskeletal disorders among the staff of Isfahan Province Gas Company, including training, sport, and installation of software.

MATERIALS AND METHODS

The study was performed in the summer of 2013 on 75 (52 men, 23 women) Isfahan Province Gas Company employees in three phases (phase 1: Evaluation of present situation, phase 2: Performing interventions, and phase 3: Re-evaluation). Participants were divided into three groups (training, exercise, and software). The Nordic Musculoskeletal Questionnaire (NMQ) and rapid upper limb assessment (RULA) were used. Data collected were analyzed using SPSS software and McNemar test, t-test, and Chi-square test.

RESULTS

Based on the evaluations, there was a decrease in musculoskeletal symptoms among the trained group participants after they received the training. McNemar test showed that the lower rate of pain in low back, neck, knee, and wrist was significant (P < 0.05). The results obtained from the RULA method for evaluation of posture showed an average 25 points decrease in the right side of the body and 20 points decrease in the left side of the body in the group subjected to training. Based on t-test, the decrease was significant.

CONCLUSION

The study demonstrated that majority of the participants accepted interventions, which indicates that most of the people were unsatisfied with the work settings and seeking improvement at the workplace. Overall, the findings show that training, chair adjustment, and arrangement in workplace could decrease musculoskeletal disorders.

Job strain (demands and control model) as a predictor of cardiovascular risk factors among petrochemical personnel

BACKGROUND

One of the practical models for the assessment of stressful working conditions due to job strain is job demand and control model, which explains how physical and psychological adverse consequences, including cardiovascular risk factors can be established due to high work demands (the amount of workload, in addition to time limitations to complete that work) and low control of the worker on his/her work (lack of decision making) in the workplace. The aim of this study was to investigate how certain cardiovascular risk factors (including body mass index [BMI], heart rate, blood pressure, cholesterol and smoking) and the job demand and job control are related to each other.

MATERIALS AND METHODS

This prospective cohort study was conducted on 500 workers of the petrochemical industry in south of Iran, 2009. The study population was selected using simple random statistical method. They completed job demand and control questionnaire. The cardiovascular risk factors data was extracted from the workers hygiene profiles. Chi-square (χ (2)) test and hypothesis test (η) were used to assess the possible relationship between different quantified variables, individual demographic and cardiovascular risk factors.

RESULTS

The results of this study revealed that a significant relationship can be found between job demand control model and cardiovascular risk factors. Chi-square test result for the heart rate showed the highest (χ (2) = 145.078) relationship, the corresponding results for smoking and BMI were χ (2) = 85.652 and χ (2) = 30.941, respectively. Subsequently, hypothesis testing results for cholesterol and hypertension was 0.469 and 0.684, respectively.

DISCUSSION

Job strain is likely to be associated with an increased risk of cardiovascular risk factors among male staff in a petrochemical company in Iran. The parameters illustrated in the Job demands and control model can act as acceptable predictors for the probability of job stress occurrence followed by showing a high trend of CVD risk factors.

Relationship between mental workload and musculoskeletal disorders among Alzahra Hospital nurses

BACKGROUND

Musculoskeletal disorders (MSDs) are a serious problem among the nursing staff. Mental workload is the major cause of MSDs among nursing staff. The aim of this study was to investigate the mental workload dimensions and their association with MSDs among nurses of Alzahra Hospital, affiliated to Isfahan University of Medical Sciences.

MATERIALS AND METHODS

This descriptive cross-sectional study was conducted on 247 randomly selected nurses who worked in the Alzahra Hospital in Isfahan, Iran in the summer of 2013. The Persian version of National Aeronautics and Space Administration Task Load Index (NASA-TLX) (measuring mental load) specialized questionnaire and Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used for data collection. Data were collected and analyzed by Pearson correlation coefficient and Spearman correlation coefficient tests in SPSS 20.

RESULTS

Pearson and Spearman correlation tests showed a significant association between the nurses' MSDs and the dimensions of workload frustration, total workload, temporal demand, effort, and physical demand (r = 0.304, 0.277, 0.277, 0.216, and 0.211, respectively). However, there was no significant association between the nurses' MSDs and the dimensions of workload performance and mental demand (P > 0.05).

CONCLUSIONS

The nurses' frustration had a direct correlation with MSDs. This shows that stress is an inseparable component in hospital workplace. Thus, reduction of stress in nursing workplace should be one of the main priorities of hospital managers.

Study of the relationship between the aerobic capacity (VO2 max) and the rating of perceived exertion based on the measurement of heart beat in the metal industries Esfahan

BACKGROUND AND OBJECTIVE

To establish a balance between work (physical exercise) and human beings, the aerobic capacity (VO2 max) could be used as a measure. Additionally, the subjective and physiological assessment could be applied as one of the methods for assessing physical exercise. The most commonly used tools for the assessment of fatigue during physical exercise include the Borg scale Rating of perceived Exertion (RPE) in relation to subjective symptoms and heart rate (HR) in relation to physiological symptoms. The study is aimed to investigate the relationship between the aerobic capacity and the RPE based on the measurement of heat rate (HR) of workers from the Metal Industries of Isfahan.

MATERIALS AND METHODS

The subjects were 200 male workers from metal components manufacturers in Isfahan selected by using random sampling based on statistic method. The subjects were examined by using ergometer in accordance with A strand 6 minutes cycle test protocol. Furthermore, the subjects were asked to rate their status based on the Borg rating scale at the end of each minute. Additionally, their heat rates were monitored and recorded automatically at the end of each minutes.

RESULTS

Statistical analysis showed that there was a significant relationship between the RPE and the aerobic capacity (VO2 max) (r = -0.904, P < 0.05). The results illustrated that there was a stronger correlation between HR and VO2 max (r = 0.991, P < 0.001). The regression analysis of the quadratic equation also indicated that there was also a significant relationship between the VO2 max and HR.

CONCLUSIONS

The results indicated that there was a strong relationship between the RPE and VO2 max, as well as a greater correlation between HR and VO2 max. Therefore, the HR could be used as a Prediction measure to estimate VO2 max.

Hepatoprotective effects of zataria multiflora ethanolic extract on liver toxicity induced by cyclophosphamide in mice

Although cyclophosphamide (CP), an alkylating agent, has been extensively used in chemotherapy, it possesses a wide spectrum of adverse effects including hepatotoxicity. This study was aimed to evaluate the protective effects of Zataria multiflora against hepatic damage induced by CP in mice.Mice were orally (gavages) pretreated with the ethanolic extract aerial parts of Zataria at doses of 50, 100, 200, or 400 mg/kg for 7 consecutive days before a single intraperitoneal injection of 200 mg/kg CP. After 24 h, animals were anesthetized, blood samples and hepatic tissues were collected and used for biochemical and histological examination.Serum levels of hepatic markers were significantly increased after only CP treated animals but restored in Zataria pretreated groups. A single dose of CP administration also markedly induced abnormality in the levels of several biomarkers associated with oxidative stress in liver tissues homogenates. However, pretreatment with Zataria significantly inhibited the abnormality of antioxidant enzymes defense system in the liver tissues. In addition, histopathological studies proved that CP causes damage to the liver, and this was evidenced by the induced dilated and congested sinusoidal space, lymphocytic infiltration between hepatocytes, portal space with moderate to severe inflammation and necrotic hepatocyte with absence of nuclei. Zataria effectively protected animals against CP-induced hepatic tissue damages.Our results reveal that Zataria produces a potent hepatoprotective role and could be a potent candidate to use concomitantly as a supplement agent against hepatotoxicity of CP for the patients undergoing chemotherapy.

Effects of work-related stress on work ability index among refinery workers

INTRODUCTION

Work-related stress is one of the basic problems in industrial also top 10 work-related health problems and it is increasingly implicated in the development a number of problems such as cardiovascular disease, musculoskeletal diseases, early retirement to employees. On the other hand, early retirement to employees from the workplace has increased on the problems of today's industries. Hereof, improving work ability is one of the most effective ways to enhance the ability and preventing disability and early retirement. The aim of This study is determine the relationship between job stress score and work ability index (WAI) at the refinery workers.

MATERIALS AND METHODS

This is a cross-sectional study in which 171 workers from a refinery in isfahan in 2012 who were working in different occupational groups participated. Based on appropriate assignment sampling, 33 office workers, 69 operational workers, and 69 maintenance workers, respectively, were invited to participate in this study. Two questionnaires including work related-stress and WAI were filled in. Finally, the information was analyzed using the SPSS-20 and statistic tests namely, analysis of covariance Kruskal-Wallis test. Pearson correlation coefficient, ANOVA and t-test.

RESULTS

Data analysis revealed that 86% and 14% of participants had moderate and severe stress respectively. Average score of stress and standard deviation was 158.7 ± 17.3 that was in extreme stress range. Average score and standard deviation of WAI questionnaire were 37.18 and 3.86 respectively. That placed in a good range. Pearson correlation coefficient showed that WAI score had significant reversed relationship with a score of stress.

CONCLUSION

According to the results, mean stress score among refinery worker was high and one fator that affect work abiity was high stress, hence training on communication skills and safe working environment in order to decreses stress, enhance the work ability of workers.

Investigating the predictive of risk-taking attitudes and behaviors among Iranian drivers

BACKGROUND

World Health Organization findings shows that up to year 2020 the number of fatality due to driving accidents will increases up to 65%, which is 80% is in developing countries. Iran has one of the highest rates of road traffic accident mortality rate in the world.

MATERIALS AND METHODS

The cross-sectional study was carried out in the center and west of Iran upon 540 ordinary and taxi drivers who were driving regularly from bus terminals and the travel agencies to other cities. Data collection tool is a questionnaire that measuring driving risk taking by two items of risky driving behaviors and risk taking attitudes.

FINDINGS

The results of this study showed that the averages of risk driving behaviors scores were higher than the average of risk taking attitudes scores. The results of logistic regression test showed that the risky driving behaviors can be a predictor of driving accidents due to individuals' risk taking (P = 0.014). Among all these variables, attitude toward rule violations and speeding, aggressive driving and violation of the road laws respectively are important predictive of drivers' risk taking (P < 0.0010).

DISCUSSION AND CONCLUSION

Although attitude toward risk taking has been located at a low level by different ways, a desired result was not obtained from the reduction of those high risky behaviors; in fact, high-rate of accidents and traffic incidence in Iran indicates this matter well.

Survival after 131I-labeled lipiodol therapy for hepatocellular carcinoma

This study investigated the efficacy of 131iod- ine-labeled lipiodol (1311-lipiodol) as a palliative therapy, evaluated overall survival (OS) across Barcelona Clinic Liver Cancer (BCLC) stages, and determined the main prognostic factors influencing OS in patients with hepatocellular carcinoma (HCC). Patients, methods: We retrospectively analyzed 57 (44 men; mean age, 65.7 years; mean activity per session, 1.6 GBq; mean cumulative activity in patients with >1 sessions, 3.9 GBq) HCC patients who underwent 1311-lipiodol therapy. A majority of patients exhibited Child-Pugh class B (53.6%) disease and a good Eastern Cooperative Oncology Group performance status (0-1; 72%). Multinodular disease was observed in 87.7% patients, bilobar disease in 73%, and portal vein occlusion (PVO) in 54%. Furthermore, 21.1% patients were staged as BCLC B and 59.6 % as BCLC C. All patients were followed until death. Results: The median OS was 6.4 months, which varied significantly with disease stage (median OS for BCLC A, B, C, and D was 29.4, 12.0, 4.6, and 2.7 months, respectively; p = 0.009); Child-Pugh score and class; presence of ascites, PVO, or extrahepatic disease; largest lesion size; favourable treatment response; international normalized ratio, baseline albumin and alpha-fetopro- tein levels. Patients with a Child-Pugh A liver disease had a longer OS. Conclusion: Currently, different treatment modalities for HCC include radioembolization, transarterial chemoemboliz- ation, and systemic therapy with sorafenib; however, 1311-lipiodol therapy remains a feasible alternative for patients without a favourable response to other therapies, particularly for patients with Child-Pugh A liver cirrhosis.

Residual activity after radioembolization of liver tumours with 90Y resin microspheres

The actual number of resin microspheres is approximately 30-60 times higher than glass microspheres per 3 GBq vial. Thus, radioembolization (RE) with resin microspheres exerts an embolization effect besides the radiation effect. This embolization effect can occasionally cause early back flow of the microspheres before application of the entire calculated dose. To avoid these adverse side effects, RE has to be terminated at an earlier time point. Measurement of the residual activity in the delivery box, which includes the v-vial, tube and catheter, to calculate the achieved target dose is often challenging. The aim of the current study was to establish a post-RE measurement method comparable to the glass microspheres method without unnecessary radiation exposure to the staff and risk of contamination. Methods: Two different measurements were performed. First, total radioactivity in the shipping vial was measured in an ion chamber and then it was put in the delivery box and the radiation was measured from a 30 cm distance from the centre of the box with a dosimeter. The required radioactivity was then transferred to the v-vial, and the shipping vial was measured again. After that, the v-vial was measured from the same distance from the centre of the box with dosimeter. Results: Altogether 62 times the shipping vial with different activities were measured with a significant positive correlation between the amount of the activity measured in the iron chamber and the radiation dose, measured with dosimeter (r2 = 0.98; p < 0.001). There was also a strong positive correlation between these measurements of the v-vial (r2 = 0.98; p < 0.001). Conclusion: With measurement of the residual activity in the delivery box using a dosimeter the percentage of the whole injected activity can be easily calculated. This facilitates the calculation of the actual, achieved target and non-target dose in those cases, where therapy had to be stopped because of eminent flow reversal or obstruction.

Validation of a questionnaire for heat strain evaluation in women workers

INTRODUCTION

Physiological, anthropometrical and thermal perceptual are the most important factors affecting thermoregulation of men and women in workplaces. The purpose of this study was determining the validity of a questionnaire method for assessing women's heat strain in workplaces.

METHODS

This cross-sectional study was carried out on 96 healthy women. Data were continuously collected over a period of 3 months (July-September) in 2012. Mean ± (SD) of age was found to be 31.5 ± 7.48 years, of height 1.61 ± 0.05 m, of weight 61.55 ± 10.35 kg, and of body mass index 23.52 ± 3.75 kg/m(2) in different workplaces. Heart rate and oral temperature were measured by heart rate monitoring and a medical digital thermometer, respectively. Subjects completed a draft questionnaire about the effective factors in the onset of heat strain. After collecting the questionnaires, the data were analyzed by applying Cronbach'sa calculation, factor analysis method, Pearson correlation and receiver operator characteristic curves using the SPSS 18 software.

RESULTS

The value for Cronbach's α was found to be 0.68. The factor analysis method on items of draft questionnaire extracted three subscale (16 variables) which they explained 63.6% of the variance. According to the results of receiver operator characteristic curve analysis, the cut-off questionnaire score for separating people with heat strain from people with no heat strain was obtained to be 17.

CONCLUSIONS

The results of this research indicated that this quantitative questionnaire has an acceptable reliability and validity, and a cut-off point. Therefore it could be used in the preliminary screening of heat strain in women in warm workplaces, when other heat stress evaluation methods are not available.

Evaluation of the effect of noise on the rate of errors and speed of work by the ergonomic test of two-hand co-ordination

BACKGROUND

Among the most important and effective factors affecting the efficiency of the human workforce are accuracy, promptness, and ability. In the context of promoting levels and quality of productivity, the aim of this study was to investigate the effects of exposure to noise on the rate of errors, speed of work, and capability in performing manual activities.

METHODS

This experimental study was conducted on 96 students (52 female and 44 male) of the Isfahan Medical Science University with the average and standard deviations of age, height, and weight of 22.81 (3.04) years, 171.67 (8.51) cm, and 65.05 (13.13) kg, respectively. Sampling was conducted with a randomized block design. Along with controlling for intervening factors, a combination of sound pressure levels [65 dB (A), 85 dB (A), and 95 dB (A)] and exposure times (0, 20, and 40) were used for evaluation of precision and speed of action of the participants, in the ergonomic test of two-hand coordination. Data was analyzed by SPSS18 software using a descriptive and analytical statistical method by analysis of covariance (ANCOVA) repeated measures.

RESULTS

The results of this study showed that increasing sound pressure level from 65 to 95 dB in network 'A' increased the speed of work (P < 0.05). Increase in the exposure time (0 to 40 min of exposure) and gender showed no significant differences statistically in speed of work (P > 0.05). Male participants got annoyed from the noise more than females. Also, increase in sound pressure level increased the rate of error (P < 0.05).

CONCLUSIONS

According to the results of this research, increasing the sound pressure level decreased efficiency and increased the errors and in exposure to sounds less than 85 dB in the beginning, the efficiency decreased initially and then increased in a mild slope.

Precise Evaluation of Anthropometric 2D Software Processing of Hand in Comparison with Direct Method

Various studies carried out on different photo anthropometry, but each one had some deficiencies which during the years they have been resolved. The objective of this paper is to test the efficiency of two-dimensional image processing software in photo anthropometry of hand. In this applied research, 204 office workers and industrial workers were selected. Their hands were measured by manual with photo anthropometric methods. In this study, designing the "Hand Photo Anthropometry Set," we tried to fix the angle and distance of the camera in all of the photos. Thus, some of the common mistakes in photo anthropometric method got controlled. The taken photos were analyzed by Digimizer software, version 4.1.1.0 and Digital Caliper (Model: Mitutoyo Corp., Tokyo, Japan) was used via manual method. t-test statistical test on data revealed that there is no significant difference between the manual and photo anthropometric results (P > 0.05) and the correlation coefficients for hand dimensions are similar in both methods illustrated in the range of 0.71-0.95. The statistical analyses showed that photo anthropometry can be replaced with manual methods. Furthermore, it can provide a great help to develop an anthropometric database for work gloves manufacturers. Since the hand anthropometry is a necessary input for tool design, this survey can be used to determine the percentiles of workers' hands.

The analysis of health research system evaluation in medical sciences universities

BACKGROUND

Based on Iran by 2025 defined vision, we must to receive the first grade of science position in south western Asian region. Thus we need to have a comprehensive evaluation program.

METHODS

A comprehensive WHO Health Research System Analysis (HRSA)- based evaluation system was developed to evaluate the HRS in Iran. This article has explored the results of the five-year evaluation (2003-2008) and aims to introduce this method to other developing countries. Here we explore the results of research performance evaluation from 2002 to 2010 and by comparing the results with previous available information, we reveal the probable role of this method in research promotion and proposed approach to facilitate and expedite achieving the prospects for goals of health research based on the visions of Iran by 2025.

RESULTS

All of the indicators of stewardship and capacity building axes are received to their predefined levels. Moreover all of the medical science university research policies are based on their strategic plannings which are extracted from national visions of Iran by 2025. Most of the predefined goals in knowledge production domain had a significant grow trend but for more growth for commitments they should be closely follow.

CONCLUSION

We developed an HRS-based comprehensive evaluation program to our national vision as well as our regional and international research competition.

A Study on Work Ability Index and Physical Work Capacity on the Base of Fax Equation VO(2) Max in Male Nursing Hospital Staff in Isfahan, Iran

BACKGROUND

The purpose of this research is to establish the ability of employees by work ability index (WAI), physical work capacity (PWC), and finding the correlation between them. Establishing the PWC index with attention to WAI values for the purpose of saving in costs and time of PWC measurements is another aim of this project.

METHODS

The present research is an analytic cross-sectional and one-trail study. The study population consists of 228 randomly selected registered nurses from hospitals in Isfahan (Iran). The WAI and PWC were established through WAI questionnaire and Fax equation and by using ergometer bicycle, respectively. The resulting data were analyzed using SPSS 16 software.

RESULTS

Average WAI and PWC among the study population were 38.25±4.4 and 4.45±0.7, respectively. Pearson test results showed no significant correlation between PWC and WAI in different age groups (r=0.3 and P>0.05). Multiple linear regression analysis showed that the variables of age and diagnosed diseases were the most effective factors of WAI (β=0.18 and P>0.05). Pearson test revealed a significant correlation between the number of diagnosed diseases and PWC index in age groups of 40-49 years.

CONCLUSION

Average WAI in this research, like other studies on similar jobs is in the acceptable level of >36. Work ability index and PWC index in different age groups did not show a significant correlation and this suggests that there are essential discrepancies in work ability evaluations made by each index and it is not possible to predict PWC index using WAI values. Given the PWC results and the level of nursing staff's activity (low, medium) the WAI is a suitable instrument to establish the professionals' abilities. This study revealed that 27.6% of individuals were subject to medium-low work ability risk (WAI<37), which was 1.8 times that of Finland's professional health Institute, which could be caused by shift working and increased working hours.

Evaluation of Work-related Psychosocial and Ergonomics Factors in Relation to Low Back Discomfort in Emergency Unit Nurses

BACKGROUND AND AIM

High prevalence of low back pain is one of the most common problems among nurses. The aim of this study was to evaluate the relation of the intensity of low back discomfort to two low back pain contributor factors (Ergonomics risk factors and psychosocial factors).

METHODS

This cross-sectional survey was conducted on 120 emergency unit nurses in Esfahan. Job content, ergonomics hazards and nordic questionnaire were used in that order for daily assessment of Psychosocial and Ergonomics factors and the intensity of low back discomfort. Nurses were questioned during a 5-week period, at the end of each shift work. The final results were analyzed with SPSS software18/PASW by using Spearman, Mann-Whitney and Kolmogorov-Smirnove test.

RESULTS

There was a significant relationship between work demand, job content, social support and intensity of low back discomfort (P value <0.05). But, there was not any link between intensity of low back discomfort and job control. Also, there was significant relationship between intensity of low back discomfort and ergonomics risk factors.

CONCLUSION

This study showed an indirect relationship between the intensity of low back discomfort and social support. This study also confirmed a direct relationship between the intensity of low back discomfort and work demand, job content, ergonomics factors (Awkward Postures (rotating and bending), manual patient handling and repetitiveness, standing continuously more than 30 min). So, to decrease work related low back discomfort, psychosocial factors should be attended in addition to ergonomics factors.

Health research evaluation and its role on knowledge production

BACKGROUND

Knowledge production and evaluation are two important functions of health research system (HRS). In this article, we aimed to reveal the correlation between evaluation of health research organizations and health knowledge production promotion.

METHODS

A comprehensive evaluation system was developed to evaluate the academic performance of national medical science universities on an annual basis. It assess following domains; stewardship, capacity building and knowledge production. Measurable indicators for each domain were assigned, a 'research profile' for each department was provided. In this study, we compared the results of annually national Health Research System evaluation findings during 2005-2008.

RESULTS

The number of scientific articles has been increased from 4672 to 8816 during 2005 to 2008. It is mentionable that, the number of articles which has been published in indexed data bases has risen too. This fact could be related to directed policy for more international publication of scientific articles from Iran. The proportion of total articles to the number of academic members was 1.14 in 2008, comparing to 0.84 in 2005. It means that this proportion have increased about twice (0.7 Vs 0.45) during mentioned time. Moreover, other scientific products such as authored books based on domestic researches and cited articles in textbooks have increased according to special attention to knowledge production by policy makers.

CONCLUSION

We conclude that Health System Research evaluation could be used as a mean for implementing policies and promoting knowledge production.

Diospyros lotus L. fruit extract protects G6PD-deficient erythrocytes from hemolytic injury in vitro and in vivo: prevention of favism disorder

OBJECTIVE

The aim of this study was to evaluate the protective effect of Diospyros lotus L. fruit extract against the hemolytic damage induced by Vicia faba beans extract in both G6PD enzyme-deficient human and rat erythrocyte in vitro and in vivo.

MATERIALS AND METHODS

In the former model, venous blood samples were obtained from five subjects with known G6PD deficiency and erythrocyte hemolysis induced by Vicia faba L. bean extract was asessed spectrophotometrically in the presence and absence of Diospyros lotus L. fruits extract. In the in vivo model, G6PD-deficient rats (induced by intraperitoneal injection of dehydroepiandrosterone for 35 days) pre-treated with different doses of Diospyros lotus L. (500, 750, 1000, and 1500 mg/kg, p.o for 7 days) were challenged with Vicia faba beans extract and the protective effect of the fruit extract against hemolysis was evaluated as above.

RESULTS AND CONCLUSIONS

The results have shown that Diospyros lotus L. fruits extract has antioxidant activity that may protect against hemolytic damage induced by Vicia faba bean extract in both G6PD-deficient human and rat erythrocytes. The study gives a scientific basis for the efficacy of the fruit extract as used in Iran. The fact that this was shown in human erythrocytes in vitro is significant and provides a rationale for further testing in vivo in G6PD-deficient human populations.

The radiotracer (99m)Tc-MIBI is not genotoxic for human peripheral blood lymphocytes at diagnostic radioactive dose

The radiotracer technetium-99m methoxyisobutyl isonitrile ((99m)Tc-MIBI) has been widely used for myocardial blood flow imaging. We investigated the genotoxicity of (99m)Tc-MIBI in cultured human lymphocytes at the same concentration used in patients. Radioactivity doses were determined in whole blood at 5 min post-injection of 20 mCi (99m)Tc-MIBI in patients. Subsequently, whole blood of human volunteers was incubated with 1, 2.3, 4 or 8 microCi (99m)Tc-MIBI. After a 30-min incubation, the lymphocytes were stimulated with a mitogen to assay for micronuclei in cytokinesis-blocked binucleated cells. The frequency of micronuclei in samples treated with this radiopharmaceutical up to 2-fold (8 microCi) the concentration of (99m)Tc-MIBI normally found in the blood of patients was not more than in control lymphocyte cultures. We concluded that there is no increased induction of micronuclei in lymphocytes incubated with (99m)Tc-MIBI at the radioactivity doses used for diagnostic purposes.

Safety Cultural Assessment among Management, Supervisory and Worker Groups in a Tar Refinery Plant

BACKGROUND

This study investigated the relationship between people's attitudes towards the safety culture and comparing its perceptions among three levels of refinery Personnel: top management, supervisory staff and frontline workers by conducting safety culture survey.

METHODS

A questionnaire comprising general information and 59-safety attitude statement were distributed among 237 workers, 53 supervisors and 12 managers in Isfahan Tar Refinery in Iran.

RESULTS

The 10 testable factors, including organizational and management commitment to safety and communication, Rule breaking, Training and competence, Pressure for production and safety, Communication, Personal involvement in health and safety, Accident/Incidents/Near misses, Organizational/management commitment to health and safety, Supervisors/Immediate bosses/Line managers, Health and safety procedures/Instructions/rules, Workforce view on state of safety culture, have high inter-correlations and the three groups of respondents hold quite different attitudes regarding safety culture.

CONCLUSION

These findings can give invaluable indication to the managers to have better understanding of safety culture in this industry.

Application of a hazard and operability study method to hazard evaluation of a chemical unit of the power station

BACKGROUND

The aim of this study was to identify the hazards, evaluate their risk factors and determine the measure for promotion of the process and reduction of accidents in the chemical unit of the power station.

METHODS

In this case and qualitative study, HAZOP technique was used to recognize the hazards and problems of operations on the chemical section at power station. Totally, 126 deviations were documented with various causes and consequences.

RESULTS

Ranking and evaluation of identified risks indicate that the majority of deviations were categorized as "acceptable" and less than half of that were "unacceptable". The highest calculated risk level (1B) related to both the interruption of acid entry to the discharge pumps and an increased density of the acid. About 27% of the deviations had the lowest risk level (4B).

CONCLUSION

The identification of hazards by HAZOP indicates that it could, systemically, assess and criticize the process of consumption or production of acid and alkali in the chemical unit of power plant.

Escherichia coli, Shigella and Salmonella species in acute diarrhoea in Hamedan, Islamic Republic of Iran

This study investigated the frequency of Escherichia col, Shigella and Salmonella species in stool specimens from patients with diarrhoea presenting to health centres in Hamedan province, Islamic Republic of Iran. From 144 samples, Shigella strains were isolated in 17 cases (11.8%): 10 Sh. flexneri, 3 Sh. sonnei, 2 Sh. boydii and 2 untyped strains. No Salmonella strains were isolated. Using molecular diagnostic methods, diarrheogenic E. coli were detected in 37 cases (25.7%), the majority were enterotoxigenic (ETEC) (22 cases) and Shiga toxin-producing (STEC) strains (15 cases). In 14 cases (9.7%) there was co-infection.

Unusual presentation of vitamin A intoxication

A 10.5-year-old boy was admitted to hospital because of a focal motor seizure. He had suffered from impaired attention span and emotional instability from the age of 6 years. From the age of 5 years he received daily a multivitamin preparation containing 5,000 IU vitamin A. The cause of his symptoms was found to be vitamin A intoxication, with an unusual acute presentation of microscopic hematuria, electroencephalographic abnormalities, and convulsions.