A Comparative Assessment of Patient Safety Culture between Iranian Selected Hospitals and Agency for Healthcare Research and Quality (AHRQ) Report

Establishing a culture of patient safety can be effective in reducing the incidence of medical errors and solving concerns of safety inadequacy in health systems. The purpose of this study was to assess the culture of patient safety in the selected hospitals, and compare the results with published reports of AHRQ. This study was approved by the Ethical Committee of BPUMS. The subjects signed the informed consent form to participle in the study. Confidentiality was maintained throughout the study reports. Cross-sectional study was conducted in 2012;the study sample was composed of 364 staffs working at two selected hospitals affiliated to Bushehr University of Medical Sciences. Hospital Survey on Patient Safety Culture was used to collect data. Descriptive statistical analysis was used to analyze the data. No reports of events in both studied hospitals and benchmark were accounted for the most of the reported errors, although this indicator in studied hospitals was nearly 23% higher than that of the benchmark report. The highest patient safety grade in studied hospitals and benchmark was “acceptable” and “very good”, respectively. The highest percentage of positive response to patient safety dimension was organization learning and then teamwork within units in studied hospitals. Teamwork within units also was the highest average percent in benchmark report. Non-punitive response to errors had the lowest positive percentage of participant responses in both studies. To achieve the patient safety culture, we do not need to blame individual and apply punitive approach when errors occur. This makes person accept responsibility for their actions honestly and report errors in a timely manner to prevent reoccurrence of similar errors.

Health care staffs’ perception of patient safety culture in hospital settings and factors of importance for this

Many hospital patients are affected by adverse events. Managers are important when improving safety. The perception of patient safety culture varies among health care staff. Health care staff (n = 1023) working in medical, surgical or mixed medical-surgical health care divisions answered the 51 items (14 dimensions) Swedish Hospital Survey on Patient Safety Culture (S-HSOPSC). Respondents with a managerial function scored higher than non-managers for 11 of 14 dimensions, indicating patient safety culture strengths for a majority of dimensions. Enrolled nurses and staff with experience > 10 years also scored high for several dimensions. The 12 dimensions and sample characteristics explained 49% and 26% of the variance for the outcome dimensions Overall Perceptions of Safety and Frequency of Incident Reporting, respectively. RNs, ENs and physicians have different views on patient safety culture. Hospital Management Support and Organisational Learning is some important factors influencing patient safety culture. Bridging the gap in health care staff’s perceptions of safety in order to improve patient safety is of utmost importance. Managers have the responsibility to foster patient safety culture at their workplace and can thus benefit from results when improving safety for patients.

Pericarditis in Cardiology at a Regional Hospital

Introduction: Pericarditis is an inflammation of the pericardium with or without pericardial fluid effusion. Its prevalence is difficult to determine given the many forms that are not symptomatic. In Africa, its prevalence was 6.3% in Gabon in 2020 and 7.2% in Mali in 2022. In Europe, an Italian study estimates the incidence of acute pericarditis at 27.7 cases per 100,000 people per year. In another study conducted in Finland over a period of 9 years, the incidence of pericarditis requiring hospitalisation was 3.32 cases per 100,000 people per year. The aim of our study was to describe the clinical and paraclinical characteristics of pericarditis observed in the cardiology department of the regional hospital in Mali. Methodology: This was a single centre cross-sectional study from 30 January 2018 to 30 June 2020 in the cardiology department of the Ségou regional hospital. All consenting patients, regardless of age or sex hospitalised in the department for pericarditis confirmed on cardiac ultrasound were included. Data were collected using an individual patient follow-up form recording sociodemographic, clinical, biological, electrocardiographic and echocardiographic data, as well as the course of the disease. Results: Out of 879 patients hospitalized, the hospital frequency was 7.28%. Females predominated, with a sex ratio of 0.42. More than half the patients were aged 45 or younger (59.4%). The mean age of patients was 41.8 ± 18.1 years. Cardiovascular risk factors were dominated by hypertension and smoking (46.9% and 12.5% respectively). The reasons for consultation were dyspnoea (84.3%), chest pain (54.7%), cough (71.9%) and fever (34.4%). Physical signs included muffled heart sounds (76.6%), tachycardia (70.3%), pericardial friction (17.2%) and signs of peripheral stasis in 53.1% of cases. We observed elevated C-reactive protein (CRP) in 57.8% of cases, hypercreatininaemia in 37.5% and positive HIV serology in 3.1%. The major radiographic signs were cardiomegaly in 82.8% and pleural effusion in 37.5%. On electrocardiogram (ECG), 51.6% of patients had a repolarisation disorder and sinus tachycardia;34.4% had QRS microvoltage. Echocardiography revealed tamponade in 1.6% and pericardial effusion in 100%. The effusion was very large in 17.3% of cases. The pericardial fluid was citrine yellow in 18.8%, serosanguineous in 9.4% and haemorrhagic in 7.8%. The aetiology of the pericarditis was idiopathic in 42.1% and secondary to HIV in 3.1%. Transudative fluid was observed in 16.5% of cases. The outcome was generally favourable, with 92.2% of cases cured, but 1.6% with persistent effusion, 3.1% with recurrence, and 3.1% with mortality.

Primary Non-Hodgkin’s Malignant Lymphoma of the Uterus at the Reference Hospital of Maradi/Niger: A Case Report

Malignant non-Hodgkins lymphoma (MHNL) of the uterus is uncommon. We report a case diagnosed on the basis of histologic and immunohistochemical studies of a hysterectomy specimen induced by a very painful pelvic mass in a 50-year-old patient with no previous history of the disease. It was classified as Ann Arbor IV Bb after imaging, given the medullary infiltration and signs of clinical and biological evolutivity: the patient had received two courses of chemotherapy, CHOP protocol. She died 23 days after the second treatment due to a hypertensive crisis.

Four Dimensions of Integrating Chinese Culture Into College English Teaching From the Perspective of Tyler’s Basic Principles

Integrating Chinese culture into college English can not only enhance students’humanities literacy and cultivate their cultural confidence,but also facilitate the inheritance and international dissemination of Chinese culture.Taking Tyler’s curriculum framework as the starting point,this paper analyzes some factors that affect the integration of Chinese culture into the college English teaching and proposes some strategies for the integration of Chinese culture into college English teaching by innovating teaching objectives,enriching teaching contents,transforming modes of course delivery,and reconstructing the assessment system.

L'Hospital法则的新证明

法则是求不定式极限的常用、有效的方法。文章利用Stolz定理和Heine归结原则,上、下极限,Newton-Leibniz公式三种方法证明了L'Hospital法则。启发人们在改造《高等数学》和《数学分析》教材体系上产生新的思路,同时作为以上几个定理的直接应用,解决了一类比原来更为广泛的利用导数求极限的问题.

Cultures and Subcultures

A cross-cultural analysis of an extract of the book Lost in Translation is provided in the essay. Definitions of culture and subculture are discussed and different theories from Hofstede and Schwartz are referred to in order to validate the analysis.

Simplified three-dimensional culture system for long-term expansion of embryonic stem cells

AIM: To devise a simplified and efficient method for long-term culture and maintenance of embryonic stem cells requiring less frequent passaging. METHODS: Mouse embryonic stem cells(ESCs) labeled with enhanced yellow fluorescent protein were cultured in three-dimensional(3-D) self-assembling scaffolds and compared with traditional two-dimentional(2-D) culture techniques requiring mouse embryonic fibroblast feeder layers or leukemia inhibitory factor. 3-D scaffolds encapsulating ESCs were prepared by mixing ESCs with polyethylene glycol tetra-acrylate(PEG-4-Acr) and thiolfunctionalized dextran(Dex-SH). Distribution of ESCs in 3-D was monitored by confocal microscopy. Viability and proliferation of encapsulated cells during long-term culture were determined by propidium iodide as well as direct cell counts and PrestoB lue(PB) assays. Genetic expression of pluripotency markers(Oct4, Nanog, Klf4, and Sox2) in ESCs grown under 2-D and 3-D cultureconditions was examined by quantitative real-time polymerase chain reaction. Protein expression of selected stemness markers was determined by two different methods, immunofluorescence staining(Oct4 and Nanog) and western blot analysis(Oct4, Nanog, and Klf4). Pluripotency of 3-D scaffold grown ESCs was analyzed by in vivo teratoma assay and in vitro differentiation via embryoid bodies into cells of all three germ layers. RESULTS: Self-assembling scaffolds encapsulating ESCs for 3-D culture without the loss of cell viability were prepared by mixing PEG-4-Acr and Dex-SH(1:1 v/v) to a final concentration of 5%(w/v). Scaffold integrity was dependent on the degree of thiol substitution of Dex-SH and cell concentration. Scaffolds prepared using Dex-SH with 7.5% and 33% thiol substitution and incubated in culture medium maintained their integrity for 11 and 13 d without cells and 22 ± 5 d and 37 ± 5 d with cells, respectively. ESCs formed compact colonies, which progressively increased in size over time due to cell proliferation as determined by confocal microscopy and PB staining. 3-D scaffold cultured ESCs expressed significantly higher levels(P < 0.01) of Oct4, Nanog, and Kl4, showing a 2.8, 3.0 and 1.8 fold increase, respectively, in comparison to 2-D grown cells. A similar increase in the protein expression levels of Oct4, Nanog, and Klf4 was observed in 3-D grown ESCs. However, when 3-D cultured ESCs were subsequently passaged in 2-D culture conditions, the level of these pluripotent markers was reduced to normal levels. 3-D grown ESCs produced teratomas and yielded cells of all three germ layers, expressing brachyury(mesoderm), NCAM(ectoderm), and GATA4(endoderm) markers. Furthermore, these cells differentiated into osteogenic, chondrogenic, myogenic, and neural lineages expressing Col1, Col2, Myog, and Nestin, respectively. CONCLUSION: This novel 3-D culture system demonstrated long-term maintenance of mouse ESCs without the routine passaging and manipulation necessary for traditional 2-D cell propagation.

Intensify standardized therapy for esophageal and stomach cancer in tumor hospitals

INTRODUCTIONCancer treatment situation in tumor hospitals inChina has its own unique characteristics which arenot found in other parts of the world. Because ofthe huge population and high incidence rates ofesophageal and stomach cancer[1-5], the number ofcancer patients waiting for admission isinconceivably large.

Establishment of the Culture Technique o f Pulmonary Vascular Pericytes and Its Identification in Rats

Summary: In order to study the cellular origin of muscularization in non muscular arterioles of the lung, the pulmonary vascular pericytes culture was established. The terminal lung tissue of the rat was taken out and minced. Then 0.5 % of type Ⅳ collagenase solution was added for digestion and the microvascular segments were obtained by screening. The targeted cells were cultured by “selective conditioned media”. Under phase contrast microscope, the cultured cells were large in size with ragged margin and numerous pseudopodia, which imparted tubule like structure. There was no contact inhibition in growing cells, so multiple layers developed. When they were confluent, there were morphologically no “hillock and dale” growth pattern as in smooth muscle cells or “weave like” pattern as in fibroblasts. The ultrastructure of cultured cells showed numerous digital processes, moderate amount of rough and smooth endoplasmic reticulum, rich Golgi's apparatus, microfilaments, few lysosomes without myofilaments and dense bodies. Immunohistochemical staining revealed that the cultured pericytes had same kind of cellular skeletal protein, α SM actin, like smooth muscle cells. The cultured cells also exhibited positive reaction to CD 34 antigen and S 100 antigen, which were negative in smooth muscle cells and fibroblasts. The cell growth pattern, ultrastructure and immunological phenotype suggested that the cultured cells had characteristics of vascular pericytes. Pericytes are one of the components of microvascular cells, and the establishment of in vitro culture technique of pericytes is of significance for further exploration of the muscularization of non muscular arterioles in lung and the mechanism of structural remodeling of pulmonary vessels.

Clinical presentation and endoscopic management of Dieulafoy's lesions in an urban community hospital

AIM:To identify rates of occurrence,common clinical and endoscopic features,and to review the outcome of endoscopic management of Dieulafoy's lesions in the upper gastrointestinal (GI) tract in an urban community hospital setting. METHODS:Endoscopic data from esophagogastroduo denoscopies (EGDs),done at Wyckoff Heights Medical Center,Brooklyn,NY between 2000 and 2006 were reviewed to identify patients with Dieulafoy's lesions. Demographic data,medical history,examination findings,lab data,endoscopic findings and details of therapy for patients treated for Dieulafoy's lesions were reviewed retrospectively. RESULTS:Dieulafoy's lesions were documented to be the cause of bleeding in approximately 1% of patients presenting with upper gastrointestinal bleeding,while they were detected in only 2 patients when the indications for EGDs were different from active GI bleeding. When we analyzed EGDs performed in patients above age 65 years presenting with gastrointestinal bleeding,prevalence of Dieulafoy's lesions approached 10 percent. The most common location of the lesion was the body of stomach (7),followed by the cardia (4) and the esophagus (2). One patient had this lesion in the fundus and one patient in the duodenal apex. All patients were initially treated endoscopically with epinephrine injection,in eight cases heater probe was applied following epinephrine and endoscopic clips were applied in two cases. All but one of the patients did well in near and intermediate term follow-up (average follow-up period of 18 mo). One patient died of multi-organ failure during the same hospital stay. Average length hospital stay was 7 d.CONCLUSION:Community hospital gastroenterologists and endoscopists should be aware that Dieulafoy's lesions are an uncommon cause of upper GI bleeding among elderly patients. Early accurate diagnosis through emergent endoscopy and endoscopic therapy,especially in patients with multiple co-morbid conditions,can be very effective and life saving.

Quality of care delivered to hospitalized inflammatory bowel disease patients

Hospitalized patients with inflammatory bowel disease(IBD)are at high risk for morbidity,mortality,and health care utilization costs.While the literature on trends in hospitalization rates for this disease is conflicting,there does appear to be significant variation in the delivery of care to this complex group,which may be a marker of suboptimal quality of care.There is a need for improvement in identifying patients at risk for hospitalization in an effort to reduce admissions.Moreover,appropriate screening for a number of hospital acquired complications such as venous thromboembolism and Clostridium difficile infection is suboptimal.This review discusses areas of inpatient care for IBD patients that are in need of improvement and outlines a number of potential quality improvement initiatives such as payfor-performance models,quality improvement frameworks,and healthcare information technology.

Impact of vitamin D on the hospitalization rate of Crohn's disease patients seen at a tertiary care center

AIM To study the association between vitamin D level and hospitalization rate in Crohn's disease(CD) patients.METHODS We designed a retrospective cohort study using adult patients(> 19 years) with CD followed for at least one year at our inflammatory bowel disease center. Vitamin D levels were divided into: low mean vitamin D level(< 30 ng/m L) vs appropriate mean vitamin D level(30-100 ng/m L). Generalized Poisson Regression Models(GPR) for Rate Data were used to estimate partially adjusted and fully adjusted incidence rate ratios(IRR) of hospitalization among CD patients. We also examined IRRs for vitamin D level as a continuous variable.RESULTS Of the 880 CD patients, 196 patients with vitamin D level during the observation period were included. Partially adjusted model demonstrated that CD patients with a low mean vitamin D level were almost twice more likely to be admitted(IRR = 1.76, 95%CI: 1.38-2.24) compared to those with an appropriate vitamin D level. The fully adjusted model confirmed this association(IRR = 1.44, 95%CI: 1.11-1.87). Partially adjusted model with vitamin D level as a continuous variable demonstrated,higher mean vitamin D level was associated with a 3% lower likelihood of admission with every unit(ng/m L) rise in mean vitamin D level(IRR = 0.97, 95%CI: 0.96-0.98). The fully adjusted model confirmed this association(IRR = 0.98, 95%CI: 0.97-0.99). CONCLUSION Normal or adequate vitamin D stores may be protective in the clinical course of CD. However, this role needs to be further characterized and understood.

Feminism, Patriarchy and Culture Dominance ——A review to "The Woman Warrior

The Woman Warrior" is an influential book in the 20th century making a thunder of voice in the world to accuse the stereotype of patriarchy and racism, which also shows the Chinese Americans’ difficulty of being edged to the cultural cliff. This article analyses the content and the style of the novel to see inside what the writer wants to express and to figure out the real reason of the inequality between sexes and reveal the truth of the western culture dominance. Feminism, Patriarchy and culture are the main factors considered in the article.

On Characteristics and Cultures of the Hakka's Enclosed Houses in South Jiangxi Province

General situation and distribution of round houses of the Hakka in south Jiangxi were introduced, such architectural styles as enclosed house with a square yard (kouzi wei, in the shape of 口), enclosed house with a yard of three transverse and one longitudinal constructions (guozi wei, in the shape of 国), and enclosed house with a round house in its yard (tao wei) were taken to analyze features of the Hakka's enclosed houses. It was highlighted that the Hakka's enclosed houses in south Jiangxi has diversified architectural styles and outstanding defensive and living functions. Construction art and religious culture shown by the enclosed houses were interpreted, and the branch of Han people with unique dialects, cultures, folk customs and emotional attitudes was proposed as a miniature of the culture in south Jiangxi. Moreover, it was stressed that more attention of the public and more efforts for the protection should be given to the Hakka's cultures in south Jiangxi, carriers of the locals' history over the past thousands of years.

A Study of Pearl Buck’s Translation View of Cultural Symbiosis

Based on the theory of cultural symbiosis put forward by Mr.Zhang Liwen,this paper summarizes the translation view of cultural symbiosis,and uses it to explain the relevant characteristics of the Noble laureate Pearl Buck’s English translation of All Men Are Brothers.This paper,through laying out Buck’s cultural harmony value full in her translated work,probes into the connotation,manifestation,and enlightenment of Pearl Buck’s idea of a harmonious symbiosis of Chinese and Western cultures.

Rural Tourism, Shanxi Merchants’ Culture and New Rural Construction of Socialism

Rural tourism was a new form of tourism gradually emerging in China in recent years. It satisfied urban residents' pursuit of nature and had a promising market prospect. New rural construction of socialism was an important historical task in the process of economic and social development of China at present and in future period. New rural construction was the important basis of rural tourism development and meanwhile rural tourism development could promote new rural construction. Shanxi Merchant's Culture of Xi Village in Jinzhong City was a kind of excellent rural tourism resource. Developing rural tourism was one of the effective ways to promote new rural construction of socialism in Xi Village.

Cross-Cultural Adjustment and Coping:U.S.Students in Taiwan Residents Higher Education

The aim of this study was to investigate the adjustment problems of students from the United States enrolled in universities in the East,specifically in Taiwan,their problems related to cultural adaptation,and the process of adjustment to student life in Taiwan.Under investigation were cultural adjustment and coping skills as these students transitioned from West to East.Qualitative data were collected from interviews with participants and faculty members as well as participant observations.Results indicated that U.S.students found their own ways to acclimate to their new academic setting as well as to social relations,cross-cultural issues,and the linguistic environment in Taiwan to achieve effective adaptation.They made changes in themselves to cope with all situations they encountered.This study provides suggestions for international students abroad in Taiwan,for the Taiwan Residents government,and for universities or colleges in terms of what they should offer to current and future international students.

The Rise of Aesthetic Anthropology in the Marginal Culture

At the turn of the century, the development of aesthetics encounters severe challenges and is trapped in a crisis. To get out of it, it is necessary to dig deeper in the study of aesthetics. The fact that the marginal areas＇ cultural heritage, agricultural culture, industrial culture and post-industrial culture often coexist in a harmonious way in a nation or the same area attracts the attention of aesthetic anthropologists. The paper mainly analyzes the constructive relationship between the culture of marginal areas and aesthetic anthropology, and discusses how to establish a relationship between them with the help of the development model of Yunnan＇s marginal culture.

Effects of aminoguanidine on nitric oxide production induced by inflammatory cytokines and endotoxin in cultured rat hepatocytes

AIM: To study the effects of aminoguanidine (AG) and two L-arginine analogues N(omega)-nitro-L-arginine methyl ester (L-NAME) and N(omega)-nitro-L-arginine (L-NNA) on nitric oxide (NO) production induced by cytokines (TNF-alpha, IL-1 beta, and IFN-gamma) and bacterial lipopolysaccharide (LPS) mixture (CM) in the cultured rat hepatocytes, and examine their mechanisms action. METHODS: Rat hepatocytes were incubated with AG, L-NAME, L-NNA, Actinomycin D (ActD) and dexamethasone in a medium containing CM (LPS plus TNF-alpha, IL-1 beta, and IFN-gamma) for 24h. NO production in the cultured supernatant was measured with the Griess reaction. Intracellular cGMP level was detected with radioimmunoassy. RESULTS: NO production was markedly blocked by AG and L-NAME in a dose-dependent manner under inflammatory stimuli condition triggered by CM in vitro. The rate of the maximum inhibitory effects of L-NAME (38.9%) was less potent than that obtained with AG(53.7%, P 【 0.05). There was no significant difference between the inhibitory effects of AG and two L-arginine analogues on intracellular cGMP accumulation in rat cultured hepatocytes. Non-specific NOS expression inhibitor dexamethasone (DEX)and iNOS mRNA transcriptional inhibitor ActD also significantly inhibited CM-induced NO production. AG(0.1 mmol x L(-1)) and ActD (0.2 ng x L(-1)) were equipotent in decreasing NO production induced by inflammatory stimuli in vitro, and both effects were more potent than that induced by non-selectivity NOS activity inhibitor L-NAME (0.1 mmol x L(-1)) under similar stimuli conditions (P【0.01). CONCLUSION: AG is a potent selective inhibitor of inducible isoform of NOS,and the mechanism of action may be not only competitive inhibition in the substrate level, but also the gene expression level in rat hepatocytes.