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Background & Aim: Exclusive breast feeding is highly recommended for children under six months and the best time for starting supplementary food is the end of sixth months. Inadequate feeding can lead to malnutrition. Since infants&apos supplementary feeding pattern is influenced highly by the socio-cultural status it is necessary to study the subject in diverse conditions. This study aimed to investigate supplementary feeding pattern in 6-12 months children referred to Ilam clinics in 2002.

Methods & Materials: In this study, 364 mothers with 6-12 months children were selected using convenient sampling method from 10 health care centers. Data were collected using a four-sectioned questionnaire including mothers and their babies demographic characteristics, feeding pattern (frequency, the type of milk), supplementary food (the age of onset and the type of the first supplementary food, the time of starting mixed foods, and the source of information about supplementary food) and mothers&apos performance about feeding with supplementary food. The questionnaire was filled via interview.

Results: Findings showed that the growth curve in 84.8% of babies was in the health road. About 38% of babies were the first child. In 50.9% of samples, supplementary food was started before 6 months of age and in 49.9% of the cases, it was started after 6 month old. Supplementary feeding accompanied with breast feeding in 83.5% of the infants. The most used supplementary food was rice mucilage (40.8% of the babies). The interval between starting one supplementary food and the other one was 3-4 days in 50.2% of the cases. Also 80.8% of samples started feeding in the amount of one spoon and increased it gradually. The majority of mothers (64%) did not add sugar, salt and spices in order to attract their babies. As well, 75.6% of samples used spoon and cup for feeding and 92.9% knew the safe time for keeping cooked food in the refrigerator. The source of information about supplementary feeding in 65.4% of mothers was health care providers and in 5% were books and booklets.

Conclusion: Findings indicated that more than half of mothers began supplementary feeding for their children before 6 months old without pursuing any accepted pattern. It seems that usual educational programs in Ilam were unable to answer all the problems aroused in this issue. Hence, educating mothers using other methods such as visual teaching material is recommended.

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  Background & Aim: The quality of clinical services is a major concern for healthcare systems throughout the world. Clinical Governance, a relatively new approach to improve quality of healthcare systems, plays a fundamental role in the establishment of primary healthcare strategies to provide high quality services. Moreover, regarding the importance of organizational culture as a powerful lever to improve organizational behavior, success of organizations in implementing strategies largely depends on the support receiving from organization. Accordingly the aim of this study was to examine the correlation between organizational culture with establishment of clinical governance in public hospitals in Rasht .

  Methods & Materials: A cross-sectional correlation study with structural equation modeling was used. All 152 nurses working in managerial positions participated in the study. Data were collected using Denison Organizational Culture questionnaire, and research-made questionnaire on clinical governance. Validity and reliability of questionnaire were confirmed. Data were analyzed using the Pearson correlation coefficient test and confirmatory factor analysis in the SPSS and LISREL . 

  Results: There was a significant positive relationship between clinical governance and all components of organizational culture (P< 120.01' type="#_x0000_t75"> ). Factor analysis showed the impactof organizational culture on successful establishment of clinical governance .

  Conclusion: Improvement of organizational culture leads to sustainable establishment of clinical governance through which quality of healthcare services improves. Managers of hospitals should pay attention to instituting appropriate organizational culture in order to establish clinical governance .

  

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Background & Aim: Sedation after coronary artery bypass graft surgery can prevent the side effects of the treatment. The purpose of this study was to determine the effect of controlled sedation based on the Richmond scale on the duration of mechanical ventilation and the changes of blood pressure in patients following coronary artery bypass graft surgery.
Methods & Materials: In a single blind randomized clinical trial (IRCT2017050517693N2) from June to August 2017, a convenience sample of 80 patients after coronary artery bypass graft surgery, hospitalized in the intensive care unit of Heshamat Center, Rasht, were selected and randomly allocated into two groups (each group=40). Sedative drug dose was determined using the Richmond agitation sedation scale in the intervention group and determined routinely (based on hemodynamic changes) in the control group. Pain as a confounding variable was evaluated using CPOT tool. Data were analyzed by descriptive statistics and Chi-square, Mann-Whitney, independent t-test and repeated measures ANOVA using the SPSS software version 22.
Results: The mean age of samples was 59.89±7.53 and 66.7% of them were male. There was a significant difference between two groups in the duration of mechanical ventilation (P<0.04), the changes of patients’ blood pressure (P<0.05), need for a vasopressor drug (P<0.05) until extubation and need for the first administration of sedatives (P<0.001).
Conclusion: Utilizing the Richmond tool can reduce the patient’s dependence on ventilator and changes in arterial pressure. Also, using this tool can prevent unnecessary and early administration of sedative and vasopressor drugs in patients.