ATTITUDES OF PHYSICIANS TOWARD PATIENT RIGHTS: A COMPARISON OF PATIENT RIGHTS IN IRAN WITH THOSE STATED IN THE BILL OF PATIENT RIGHTS
This study consisted of two parts: In the first part, a comparison was made between the laws, acts and codes related to patient rights in the I. R of Iran and the Bill of patient rights as based upon the American Hospital Association (AHA), the American Civil Liberties Union (ACLU) and the National League for Nursing (NLN) which has been recognized by a large number of countries and whose laws have been approved.
It was concluded that in Iranian laws, a comprehensive compiled collection named under the rubric of "Patient Rights" does not exist, but in various parts of the law, acts and regulations issued by the Ministry of Health and Medical Education (MHME) reference to this topic has been made. There are regulations on refusal of treatment, consent, counseling, mandatory treatment of emergency cases and invoices about costs for therapeutic services. Many laws deal with emergency cases and emphasize on the patient’s right to receive prompt treatment. The laws also clearly insist on the confidentiality of medical data, but it seems that they lack necessary details. Concerning the rights of refusing treatment, counseling, respectful care, and invoices about costs for treatment services, clear laws referring specifically to patient’s rights have been passed, but seem to lack necessary details. Concerning other patient’s rights, stated in the "Bill of Rights", the study did not encounter special laws in the collection of rights and regulations of the MHME. These comprise the right to select the method of treatment, the right to be informed about the purpose and reason for being transferred to another medical center, the right to know the contents of one’s own medical record, the right to know the name of the treating physician and the field in which he has specialized, the right to know whether the medical center is a teaching hospital or not, the right to know the names and specialties of all those involved in patient care, the right of patients who are unfamiliar with the local language to ask for a translator, the right of the patient to know his date of discharge from hospital and to be instructed about the treatment he has to undergo after discharge.
In the second part of the study, an opinion poll was held among physicians at the Shiraz University of Medical Sciences in Fars province, south of Iran about the patient’s rights. A questionnaire containing 35 questions was distributed to a randomly selected group of 67 physicians, including 40 specialists and 27 general practitioners. The results of the opinion poll indicated that with a few exceptions including the patient’s right to read his own medical record, the right to choose the method of treatment from the existing methods and the necessity for the medical center to use a translator in order to establish an effective contact with patients unfamiliar with the local language, all other rights of the patient must be confirmed by the treating physician. In addition, the participants in the opinion poll emphasized the necessity to pass a collection of patient’s rights in Iran.
Authors: M. Fesharaki , H.
Toufighi, M. Nematollahi
Source: Teb & Tazkieh. 2000; 36: 63.
PEMPHIGUS IN KHOUZESTAN: A STUDY OF 111 CASES
Pemphigus is an autoimmune disease characterized by intraepidermal cleavage. The aim of this study was to examine the clinical and epidemiologic features of this disease in Khouzestan Province, south-west Iran. All new cases of pemphigus admitted to the Department of Dermatology, Sina Hospital, Ahwaz University of Medical Sciences, from October 1990 to September 1999 were studied. The diagnosis of pemphigus was based on clinical and histological findings. Among the 2,358 patients, 111 (4.7%) were found to have pemphigus. The most common presentation was pemphigus vulgaris (81.98%), followed by pemphigus foliaceous (18.02%). Pemphigus was more common in women (62 of 111; 55.86%) than men (49 of 111; 44.14%). The mean age of all variants of pemphigus at the time of diagnosis was 42.5 years for both sexes. The time between the onset of illness and final diagnosis in pemphigus vulgaris and pemphigus foliaceous were 4 and 9 months, respectively. In pemphigus patients, the onset of lesions were from the mucous membranes (mainly oral cavity) and skin in 54.65% and 45.35% of cases, respectively. However, the onset of lesions were from the skin in the patients with pemphigus vulgaris. The mortality rate was 6.30%, higher in pemphigus foliaceous as compared to pemphigus vulgaris. This study showed that pemphigus is relatively common in the Khouzestan province as compared to other regions.
Author: R. Yaghoobi
Source: Iranian Journal of Dermatology.
2000; 3 (10): 50.
COMPARISON OF ORAL IVERMECTIN AND TOPICAL GAMMA BENZENE HEXACHLORIDE 1% IN THE TREATMENT OF SCABIES
Oral ivermectin has been recently introduced for the treatment of scabies. The objective of this clinical trial was to compare the efficacy and safety of oral ivermectin with topical gamma benzene hexachloride (GBH) 1% in the treatment of scabies. Fifty-eight cases were randomly assigned to two treatment groups. In the ivermectin group, patients received a single oral dose of the drug (200 µg/kg). In case of any signs of active disease, a second dose was administered one week later. All the patients in the GBH group received two topical applications of the drug, one week apart. The patients were visited after a period of 48 hours, 1 week, 2 weeks, and 4 weeks.
Of the 37 patients treated with ivermectin, 27 (73%) required a second dose one week later. In the 21 patients treated with GBH, 18 (85.7%) received two applications of GBH, and three cases (14.3%) were cured by an additional course of precipitated sulfur 6%. No serious side effects were seen in the eight groups. The mean time for the improvement of pruritus, the sense of well-being and healing of lesions, were all shorter with ivermectin than GBH, and the differences were statistically significant.
Although all of the patients treated with ivermectin or topical GBH were eventually cured, but the cure was faster with ivermectin than topical treatment.
Authors: M. Daneshpajooh, F.
Jafari, M. F. Sadri, M. Valikhani
Source: Iranian Journal of Dermatology.
2000; 3 (10): 3.
POS-TTRAUMATIC PERIPHERAL NERVE REPAIR
Different repair strategies exist for peripheral nerve injuries depending on the cause. After sectioning of the peripheral nerve following bullet collision, destructive damages can occur that escape detection after sectioning with sharp objects. In this article, it was attempted to discuss peripheral nerve injuries and their related treatment strategies. Of the total collected records of war-inflicted peripheral nerve injuries, only 2,629 were complete and suitable for analysis. In this respect, 369 records were related to the injuries of the brachial plexus, of which 249 cases had been followed up for a period of 5 years or more after surgical operation. In these patients shrapnel of mortar shells was the traumatizing object in more than 90% of the cases. The other cases were due to shock of explosives or direct straining of the plexus. With the exclusion of 4 cases, all were male. Also 39 cases had coexisting vascular injuries.
The applied treatment strategies included neurolysis, nerve grafting and end-to-end anastomosis. The results were categorized as "Good" if the force exceeded M3 and proprioception, pain, temperature and touch perception was present. The results of nerve grafting in the nerve roots and cords were promising and rated as good in 93% and 88% of the cases respectively. In the nerve trunks results were good in 5 of the 10 cases. Apparently in the brachial plexus, the treatment outcome of peripheral nerve injuries inflicted by warfare seems to be much more favorable than the conventional stretch injuries. For this reason, surgical interventions are recommended in such instances.
Authors: J. Gousheh, P. Mafi
Source: Iranian Journal of Plastic
Reconstruction Surgery. 1999; 2 (6): 3.
STREPTOCOCCAL INFECTION CARRIER-STATES IN THE SCHOOLS OF EAST TEHRAN
Streptococcal infections are one of the most common causes of bacterial infections in infants and children aged between 5 to 15 years. Group-A streptococci are the most common cause of acute pharyngitis.
This study was designed to evaluate the occurrence of carrier-states in streptococcal infections in school children of eastern Tehran from 1993 to 1994. Using sterile swabs, samples were obtained and cultured from the tonsils and pharynx. Out of the 747 cases evaluated (387 boys and 360 girls), 59.2% and 40.8% were elementary and middle school children, respectively. Also, it was seen that 88.5% (n=661) were positive for alpha-hemolytic streptococci, 7.4% (n=55) for non group-A streptococci, 2.7% (n=20) for beta-hemolytic group-A-streptococci and 1.4% (n=11) for staphylococci. Overall, 75 cases were positive for carrier-state group-A and non-A beta-hemolytic streptococci.
Author: M H. Soltanzadeh
Source: Teb & Tazkieh. 1999; 34: 46.
MULTIPLE ORGAN DYSFUNCTION SYNDROME AFTER SEPTIC SHOCK IN THE PEDIATRIC INTENSIVE CARE UNIT AT THE CHILDREN’S MEDICAL CENTER, TEHRAN
Multiple organ dysfunction syndrome (MODS) has been recognized as a clinical entity only in the past twenty years, primarily as a result of advances in technology, medical information and scientific research. This syndrome can occur after severe sepsis (septic shock), surgery, trauma and ischemia. Multiple organ failure (MOF) is the end stage of MODS in critically ill patients. Many systems such as the pulmonary, gastrointestinal, hepatic, renal and cardiovascular systems may be involved in this syndrome. When two or more organs are involved, the survival rate becomes progressively lower.
MOF is one of the main causes of death in patients admitted to intensive care units (ICUs). In recent years because of advanced life support, the morbidity and mortality due to this syndrome has diminished. MODS has generally been associated with severe sepsis/septic shock. Because of the importance of this issue, a study was conducted for a period of 3 years in the Pediatric Intensive Care Unit (PICU) of the Children’s Medical Center. A total of 2,260 patients were admitted during these years, out of which 86 had the criteria of septic shock. All had developed MODS which revealed 94% pulmonary, 90% renal, 74% hepatic and 83% hematologic and 95% cardiac involvement. According to sex, there was no difference in organ involvement.
The age of these patients ranged from 1 month to 10 years with a median age of 21 months. Hyponatremia, hypocalcemia and hyperglycemia were more prevalent in these patients. Only 16% of the blood cultures were positive. Unfortunately 84 patients (97%) expired. None of the two surviving patients had pulmonary involvement but due to the small number of these patients, it was not possible to conclude any relationship between organ involvement and the outcome of the patients.
Authors: M. Kadivar, S.
Kabgani , A. Kocharian
Source: Iranian Journal of Infectious
Disease and Tropical Medicine. 1999; 9: 7.