Journal of

Background and Aim: Acinetobacters are opportunistic pathogens and one of the important agents of nosocomial infections that causes many infections like septicemia and  pneumonia. For resistance to antibiotics acinetobacters are mentioned as a healthcare system complications and are transmitted by the hands of healthcare workers. This research has performed in order to determine prevalence and antibiotic susceptibility of isolated acinetobacters from blood cultures.

Material and methods: This study was  performed during a nine months period in  shariati hospital. All 750  positive  blood cultures were distinguished and prevalence of acinetobacter and antibiotic susceptibility of isolated acinetobacters were determined  using disk diffusion agar method. Data were analyzed using SPSS software .

Results: According to our findings,133 blood cultures were positive for acinetoloacters(17.7% of cases). The most observed cases were isolated  from emergency ward of hospital (65.5%). Antibiogram  results  using  ciprofloxacin ,cotrimoxasol,gentamicin, ceftazidime, amikacine, tobramicine and ceftriaxone, showed maximum  sensitivity to ciprofloxacine(91%) and  cotrimoxazole (57.5%) and  maximum  resistance to ceftriaxone respectively.

Discussion and Conclusion: Because the most acinetobacter  isolation was from emergency ward of hospital, it seems that a part of such infections is more due to contamination than real infection. Therefore it is  recommended  that a prospective cohort study considering standard  and sterile conditions  during  sampling , by  considering  patients clinical features  has to  be performed.

Background and Aim: Managers today work in a dynamic environment. Their role in creating quality is  essential. Today paying attention to the quality of goods and services is the first Paiority in heath care organizations which is in with contact  peoples lives. Total Quality Management has undergone vast changes in health care management. The aim of this study is  to determine the top (chief) and middle managers knowledge and attitude on the feasibility of applying Total Quality Management in hospitals of Tehran University of Medical Science in 2009.

Materials and Methods: This is a descriptive - analytic research. The study population consists of top and middle mangers of Tehran University of Medical Science in 2009. For data gathering , we have used a  questionnaire  which consisted of 46 questions. We assessed its validity by expert team and its reliability by subsample method (CI95%). Then the data were analyzed by SPSS  software. The descriptive results(consist of mean, median, mode, std deviation, variance, range, maximum and minimum) and analytical results(consist of  bivariate and Pearson tests) were obtained.

Results: The total mean of the top and middle managers knowledge for TQM is  73.24% and is in good range. The total mean of the top and middle managers attitude about TQM is 79.76% and is good and near to excellent range.There is a meaningful relation between top and middle managers knowledge and attitude  for TQM. In total the coordination of the top and middle managers ideas for TQM is near to the each other and is good to applying it in hospitals.

Discussion and Conclusion: Total Quality Management is a new idea that is vital for organizations, especially for hospitals. Results of this survey show that top and middle managers knowledge and attitude are in good range but it needs promotion and continual teaching because when the knowledge and attitude change, the behavior of this managers also change and finally the behavior of all the employees in hospital will change. Also the goals of TQM  that are the consent of the patients, employees and society and high quality of services will be acceptable and remain for promotion of good health in the society.

Background and Aim: Information Technologies (ITs) has become a significant resource for dissemination of information and resulted to an increase of health knowledge in communities. With attention to patient - centered approach this study was done to determine knowledge of inpatients about ITs.

Materials and Methods: A descriptive - cross-sectional study was done on 461 inpatient in Kashan University of Medical Sciences hospital's with a reliable (spearman Brown, r =0.83) and valid (face and content) questionnaire in two section, demographic information and study objects. Data gathering was done with interview then analyzed by SPSS and descriptive analysis.

Results: %42.1 and %26.7 of participants had knowledge about computer and the Internet relatively. %41.9 of them had the Internet access. 86.3% and 88.3% relatively would be interested to access and get medical records and their information. They intended to get test (%85.7), refill her/his prescription (79%), get appointment (%76.4), consult with physicians (%80), and get information about diets (80%) through ITs.

Discussion  and Conclusion: It seems ITs attitude in inpatients is relatively good. Providing their information needs especially about prescription order and diets from CD or the Internet by hospital sites and introducing good medical sites to patient were recommended.

Background and Aim: The present study was designed to compare the cell death, circulating levels of tumor necrosis factor-α and tumor necrosis factor type-I receptor in Iranian patients with sepsis and normal controls.

Materials and methods: Twenty-two patients with sepsis were included in this study. After blood collection, the serum circulating levels of TNF- and TNFRI measured with ELISA kits. The PBMCs isolated from blood samples and proportion of apoptotic cells measured by flowcytometry at the time of blood draws (0 time) and after 24-h incubation. PBMCs incubated at 37°C in culture (spontaneous apoptosis) and in the presence of rTNF that is capable of inducing apoptosis in activated T cells expressing the TNF family of receptors.

Results: PBMCs obtained from the patients showed significantly higher (P<0.001) proportion of apoptotic cells than PBMCs of controls at 0 time, indicated that a higher fraction of PBMCs were undergoing apoptosis in vivo in patients but not in controls. After 24-h incubation, spontaneous ex vivo apoptosis of PBMCs was nearly as high as that of TNF-  induced apoptosis, indicating that activated T cells had been preprogrammed in vivo to die.

Discussion and Conclusion: The circulating levels of both TNF- and TNFRI showed significantly higher in patients (P<0.001) than controls and this increase is proportional (r=0.908) in both indicating that TNFRI may have a protective effect in the early stage of sepsis.

Background and Aim: Analysis of efficiency in hospitals, as the most expensive operating unit of the health system, is very important. This costly unit has several departments that one of them is medical records. This study is trying to analyze the efficiency of medical records department for the enhancement of using medical records facilities.

Materials and Methods: In this study, technical, scale and managerial efficiency of medical records department has been studied by data envelopment analysis method, and assuming the scale efficiency variable and the input axis. Information used in this study was the input variables (number of technician personnel and lower and Master of Science personnel and higher), output variables (number of emergency and outpatient and inpatient medical records and the number of filing unit visitors to respond) during 2007-2009.

Results: The average technical efficiency of medical records departments is 84 percent, that indicates there is at least 16 percent capacity for an increase in performance. Average of management and scale Performance in units during the 3 years of study are 95 and 89 percent respectively. Most input surplus is relevant to technician and lower personnel. The average performance of these units in general hospitals is 80 percent and in specialized activities is 92 percent.

Discussion and Conclusion: Relationship between studied indicators in this study with performance medical records departments showed that using such as employee personnel with undergraduate degrees and higher and educated in medical records filed, the use of managers with enough experience in this department and more use of computer systems for unit activities can fill 16 percent capacity of performance improvement in these units.

Background and Aim: The production of science is the key element of program to achieve sustainable development. Currently, the most important characteristic to produce knowledge is the number of document indexed from scientific journals in databases that do bibliometry and Scientometrics study. The aim of this study is evaluation of scientific production of Iranian medical domain based on the document indexed form scientific journal in chosen database, between 2005-2009.

Materials and Methods: Analytical- descriptive method and bibliometry analytic was adapted. The study population includes all scientific journals that was published in English and indexed in WOS and Scopus until of the time of this study. Data collection tool was check list that was made by researchers & complete by referring and direct observation in WOS and Scopus databases. Data was analyzed by SPSS and other statistical methods.

Results: Showed that from 44 journals title that studied, 18 titles was indexed in WOS and 20 titles was indexed in Scopus. The number of records and citation, according to the review with passing year, has been rising. Maximum number of documents and citations are related to the final years. Number of records in the Scopus database is more than WOS, but the differences in not significant (P- value = 0/186).

Discussion and Concoction: Journals visibility in the medical science filed in review databases in not desirable. Less than 50 percent of scientific journals were indexed in databases. Between the years studied, the scientific production of medical area of the country has been growing but to reach the proper situation, more effort is required.

Background and Aim: The benefits of a unique computerized medical records and communication equipments is utilized to collect, storage, process, extract and relate to patient care information and management information. If this utilization is in accordance with the needs of managers and staff of medical records, many of the nation's health system problems will be dissolved. Information systems in health supply system by compiling, analyzing and publishing data provide utilization of information improve the health of the society. The purpose of this study is to investigate the process of clinical information systems in general hospitals of Tehran University of Medical Sciences based on available clinical information system in these hospitals.

Materials and Methods: This descriptive study is an application study that conducted in order to determine the process of clinical information system in general hospitals of Tehran University of Medical Sciences based on available clinical information in these hospitals. The required data have been collected by a valid and reliable questionnaire. Descriptive statistics were used to analyze data.

Results: With regard to the current condition and the importance of survey of the process of clinical information system in the studied hospitals, the authors provided the desired checklist in general hospitals with studying the related system in America, Australia and England countries, on the basis of country requirements in the form of clinical information system processes. We studied clinical information system processes in departments of admission, filling and retrieving, statistical and coding and also soft wares in this department.

Discussion and Conclusion: It is necessary to create a coordinated and integrated clinical information system with suitable process and empower experts in the field of proper use of data with regard to the position of information system in each organization and its fundamental role in the adoption of accurate policies. We found that relative frequency of clinical information system processes is more than 60% in this department and clinical information system elements was observed 75% in all the departments except admission.

Background and Aim: Patients' needs should be acknowledged properly in order to enable hospitals to take responsibility for their expenses. In this study, patients' satisfaction is assessed in various fields which are key elements of hospitals assessment program.

Materials and Methods: In this cross-sectional study, 120 consecutive patients which are randomly selected from Hospitals affiliated to Tehran University of Medical Sciences (TUMS) were enrolled. A questionnaire was completed for their demographic, occupational, insurance status and their satisfaction of clinical services, nutrition, hospital environment and hospital facilities.

Results: The age range of participants were11 to 80 years old 61.9% were females and 38.1% were males. Overall, 78.1% were satisfied in respect to hospitals general status while there were significant differences considering satisfaction in hospital environment and facilities, clinical services and nutrition among recruited hospitals.

Discussion and Conclusion: A strong correlation between the index of hospital environment and patients' satisfaction signifies further enhancements of hospital environment which could potentially increase patients' satisfaction. Also, the relationship between patients well being and satisfaction indicates health care staff role should be emphasized for patients' appreciation. Consequently, hospital administration should focus on current unsatisfied sections to improve health care quality.

Background and Aim: Homogeneity and Oneness is the feature of abstracting. These can't be achieved, without adherence to guidelines and international standards. The purpose of this study is evaluation of compliance abstracts of Persian-language journals of Tehran University of Medical Sciences, with ISO 214 & Vancouver's group guideline, in year 2009.

Materials and Methods: Survey-descriptive method was adapted. The study sample included all full-text journal Reviews in English Persian language belonging to Tehran University of Medical Sciences. These journals were significant in TUMS website to date (30/2/2009). Total 100 abstracts from the latest issue of the journal articles for instance, were randomly selected. The data collected through two control lists separately, reflecting the standards of ISO 214 and instructions group in Vancouver for abstract writing. The data were analyzed by software and statistical techniques.

Results: The average overall rate of compliance with ISO standards Review is 85/37 percent (SD 24/93 percent), and group instructions Vancouver is 84/44 percent (SD 24/36). Review of the "express findings" had the most and the "sub results presented" had minimum compliance with ISO standards. The "keyword existence" and "noted the findings" had the most and the "being derived from the headings keywords subject had "minimum compliance with the instructions in Vancouver group.

Discussion and Conclusion: The abstract compliance with ISO 214 and Vancouver instruction was desirable. More comply from ISO 214 in "results presented" and Vancouver group instruction in, keywords subject in medicine seems to be required.

Background and Aim: Females were reported to have significantly lower hematocrit (Hct), which might be the cause of increased need for blood transfusion. The goal of this study is to determine risk factors affecting blood transfusion in patients undergoing coronary artery bypass graft procedure related to gender

Materials and Methods: A cross sectional review of 500 (306 males and 194 females) ASA physical status I or Il patients undergoing bypass procedures with saphenous vein graft performed over a one year period were included in this study. The conducting of anesthesia was standardized. For each patient, we recorded the gender, age, body weight, height, body surface area (BSA), and duration of surgery. Hematocrit levels prior to surgery and the end of surgery were recorded. Packed red blood cell (PRBC) administration and use of fresh frozen plasma (FFP) and platelets were noted. Differences between the data for female and male patients were evaluated using Student's t-test, Chi-square test and using regression analysis.

Results: Approximately 57.2 % (111) female and only 39.9% (121) male patients received PRBCs. On average, females received 1. 6 units of PRBCs intraoperatively and 2. 6 units of PRBCs during the entire hospital stay, while the males received 1.1 units and 1.8 units for similar periods (P=0.0001). When females and males were compared within the same subgroups for age, body surface area (BSA), duration of surgery, and preoperative Hct, etc. ...had a significant correlation with age, postoperative Hct and BSA in females but had a significant correlation with preoperative Hct, preoperative PRBC and duration of surgery in males (P<0.05). Multiple logistic regression analysis showed that the probability of a patient receiving or not receiving PRBC transfusion is significantly influenced by preoperative Hct, postoperative Hct, duration of surgery, preoperative PRBC mass, and gender.

Discussion and Conclusion: Gender is an independent essential determinant of blood transfusion in CABG patients, and may interact with BSA, preoperative Hct, duration of surgery and other factors in determining the probability of transfusion.

Background and Aim: The study of organizational culture as a managerial tools, is necessary in health care organizations. Hospital administrators should compare present with desired hospitals' organizational culture continuously. This research is aimed to compare the present with desired organizational culture as administrators' view in Tehran University of Medical Sciences' Hospitals.

Materials and Methods: A Cross - Sectional' descriptive and analytical study was conducted among 15 Tehran University of Medical Sciences' Hospitals administrators by a questionnaire including demographic information and 30 questions which determined the approach of TUMS hospitals administrators about current and appropriate organizational culture components. Before the main study, validity and reliability of the questionnaire was performed. The data was collected by SPSS version 15 software and analyzed by Chi-square, Pearson and T tests.

Results: The result of this study showed that leadership was the most and control was the least organizational culture components which observed in present condition.

Discussion and Conclussion: As TUMS hospital administrators' view, all of the hospitals organizational culture components, exception control and communication patterns, are not observed in current status. There is a significant difference between current and appropriate hospital organizational culture components as the administrator's view which impressed on the hospital management system. Therefore, the hospitals administrators are required to do strategic planning to optimize the hospitals organizational cultures.

Background and Aim: Tobacco use is a major contributor to deaths from chronic diseases, one which begins during adolescence. The aim of this study was estimate the smoking prevalence and examines the determinants of smoking behavior among high school students in Jahrom, Iran.

Materials and Methods: This study is a cross-sectional survey that was done in Spring, 2007 in Jahrom. Students were selected by multistage sampling. An anonymous, valid, reliable, self administered questionnaire was filled in by all selected students presented at the day of the survey. Chi-square, student - t and logistic regression test was used to examine the determinants of smoking behavior.

Results: The prevalence of smoking among high school and pre-college students was 9.4% and 12.7% respectively. 53% of high school and 88% of pre-college students received cigarette their first time from their friends. The most powerful determinant of smoking among students of both school levels was sex.

Discussion and Conclusion: Effective smoking prevention programmers should take into account the dominant influence of peers and family members and also its focuss on the age of onset and maintenance of smoking behavior.

Background and Aim: Given The importance of patient satisfaction levels of health care is an effective role in planning health services management system. This study aimed to assess patient satisfaction of hospital services and related factors was designed in Baharloo study Hospital.

Materials and Methods: This is a cross sectional. The data is collected by questionnaire and interview and after completing the questionnaire based on the number of samples required in this study, the information was collected into the computer and analyzed. The study statistical society was 320 patients hospitalized in all different parts of the hospital in the second six months of 1387 were selected in the form of the random sampling . To measure the patient satisfaction used satisfaction questionnaire with six demographic questions and 20 satisfaction terms. Questionnaires was given to the patients by trained persons (non-medical staff) in the last session of therapy.In young patients the questionnaire was completed by the patients family or friend and about cases with illiteracy or low literacy the questionaire was completed by Trained questioners.Listen.

Results: Satisfaction including satisfaction levels was as follows: heat and cooling systems (44.8%)- facilities (48.3%) - Food Quality (44.8%) - daily clothes and sheets change(41.6%)- Sanitation and hygience (48.3%) - room lighting ( 56%) - the speed of filing reception files(58.6%)- Nurse attitude (55.2) - time presence of clinical nurses on the patient's bedside (58.6%) - appropriate communication with sick relatives (55.2%). Highest level of patient satisfaction was as follows: satisfaction of nurse time presence on the patient's bedside (58.6) - the speed of filing reception files and the patient good guidance by receptionist(58.6%) and room lighting (58%).

Discussion and Conclusion: The largest percentage of patient dissatisfaction was regarding facilities of rooms, food quality and daily clothes and sheet change(24.1%).

Background and Aim: APL is a Prevalent leukemia that Approximately included 5-10% of patients with acute myeloblastic leukemia. ATRA and recently arsenic is used for treatment. ATRA leadsto resistance to treatment and arsenic is toxic in high doses.AZT induce cell death in different ways. The purpose of this study was Assessment of effect of AZT, a telomerase inhibitor, on NB4 cell line (APL cell line) to reduce toxic effect of high dose arsenic.

Materials and Methods: In this study, viability and metabolic activityof NB4 cells, treated by different concentrations of AZT(50,100,200 µM), was assessed by trypan blue dye method and MTT assay respectively.

Results: Treated cells with AZT=50,100,200µM showed decreased viability, both in dose-dependent and time-dependent through trypan blue dye method and decreased cell metabolic activity by MTT assay.

Discussion and Conclusion: Considering that AZT is able to induce apoptosis and decrease cell activity, it seems AZT is a suitable drug for inhibiting the growth of tumor cells.

Background and Aim: MicroRNAs (miRNA) are small noncoding RNA molecules that transcribed by RNA polymerase II. After biogenesis, these molecules act by incorporation into the RNA-induced silencing complex (RISC). MiRNAs are involved in multiple physiological and pathological processes such as proliferation, differentiation, apoptosis and cancer.
Recently several studies reported down regulation of mir-150 during erythropoesis. Since hemoglobin expression is valuable indicator of erythroid differentiation we evaluated the mir-150 downregulation effect on alpha chain expression by Quantitative RT-PCR.

Materials and Methods: K562cells were grown in RPMI1640 in standard condition. K562 cells were transfected by microRNA 150 Inhibitor using transfection kit .Mir-150 downregulation was confirmed by miRNA Real time PCR, followed by Q-RT-PCR to investigate the alpha chain expression changes.

Results: By relative QRT-PCR the alpha chain expression was increased 10 folds in comparison to untransfected and scramble cells. Furthermore, the differences were statistically significant (P<0.05)

Conclusion: Elevation of alpha chain expression in our study showed that mir-150 downregulation has a crucial role in erythroid differentiation and can introduce as a novel marker in alpha thalassemia. Further researches to find out the detail mechanism and miRNAs genes target could improve our knowledge about miRNAs potential in management of diseases and their applications in gene therapy and regenerative medicine.

Background and Aim: In any country, one of the fundamental goals of health policymakers is to facilitate the people's access to treatment and health care services. Therefore, the aim of this study was to identify factors that influence recievers' access to delivered services in urban health care services.

Materials and Methods: We performed this descriptive and cross sectional study in year 2008. We used the multi-stage sampling method for selecting 57 staffs of urban health care centers as statistical samples. The valid and reliable questionnaire for gathering data was designed. Data was analyzed by SPSS 2 version 13 software.

Results: Our findings indicate that mean scores of individual, geographical, financial and structural factor was 2.29 (61.4% with high impact), 2.42 (57.9% with high impact), 2.27 (56.1% with high impact) and 2.58 (86% with high impact), respectively. (Our mean score range was 0 to 3).

Conclusion: According to the assessment of employee's viewpoint of Urban Health Care Centers, all of four individual, geographical, financial and structural factors had high influence on person's access to health care services in Urban Health Care Centers. Consequently this study has presented suggestions (according to the findings) for improving access to delivered services in urban health care centers.

Background and Aim: The balance between ROS generation and antioxidant activity is critical to the pathogenesis of oxidative stress related disorders. In this study the prooxidant - antioxidant balance and its correlation with lipid profile and uric acid was determined to evaluate the PAB as a prognostic factor for CAD.

Materials and Methods: Seventy - two patients and sixty eight healthy volunteers were enrolled in this study. The values of PAB were determined by using standard solutions and ELISA method.
Triglyceride, total cholesterol, LDL- cholesterol, HDL - cholesterol and uric acid were measured by enzymatic method.

Results: The PAB values of CAD patients and control group were 70.01±3.36 (HK unit) and 66.40 ± 2.84 (HK unit) respectively. There was no significant difference between PAB values among the two groups (P= 0.41). There was no significant difference between uric acid levels among the two groups (P= 0.46). There was a significant correlation between the uric acid values among patients and healthy volunteers and PAB values (P <0.01). There was a significant correlation between the TG, values among patients and healthy volunteers and PAB values (P<0.05).

Conclusion: This study showed oxidative stress could be used as a significant risk predictor in the coronary artery disease patient

Background and Aim: Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia. APL is characterized by a balanced reciprocal translocation between chromosomes 15 and 17, t(517)). Important therapeutic strategies for this disease are ATRA and Arsenic trioxide. To eliminate tumor cells with arsenic, high dose of arsenic is needed. But high dose is toxic for normal tissue. The purpose of this study is Assessment of effect of low dose of arsenic trioxide in combination with AZT on NB4 cell line (APL cell line) to reduce toxic effect of high dose arsenic.

Materials and Methods: In this study after NB4 cell line culture and proliferation, the cells treated with low dose of arsenic trioxide(0.5µM) in combination with different doses of AZT(50, 100, 200 µM) and then viability and metabolic activity was assessed by try pan blue and MTT assay respectively.

Results: Low dose of arsenic (0.5µm) alone and in combination with dose of 50µm of AZT has little effect on viability and metabolic activity but in combination with higher dose of AZT has significant effect on viability and metabolic activity and both viability and metabolic activity significantly reduced.

Conclusion: Different apoptosis- induced mechanisms cause apoptosis by arsenic and AZT. Since some of these mechanisms between AZT and arsenic are similar, so maybe these similar mechanisms cause synergic effect and significant reduction of viability and metabolic activity in combination of these two drugs.

Background and Aim: Prevalence of anabolic steroids (ASs) consumption among bodybuilders has increased progressively. Therefore, the purpose of this study was to evaluate the effect of ASs consumption on C-reactive protein (CRP) in bodybuilders.

Materials and Methods: Sixty healthy men (age: 24/1± 9/1yr weight: 77±10 kg and height: 172±12 cm) participated in the study voluntarily. These subjects were selected from three groups. First group (FG) was bodybuilders who consumed ASs (n=20), second group (SG) was bodybuilders who did not consume ASs (n=20) and third group (TG) were untrained subjects as control (n=20). Blood samples were collected in fasting state (12 hours) at 09:00 for CRP assessment. Strength and volume of the forearm, pectoral major and femur muscles were measured via 1RM test and muscle circumstances, respectively. Speed was assessed by 30m speed test. Analysis of variance test and LSD post-hoc test was used.

Results: FG had significantly greater blood CRP (P<0/05) compared to other groups. However, differences between SG and TG were not significant. Muscle strength, and forearm and femur circumstances were greater in FG than other groups. Furthermore, this was greater in SG than TG. But chest circumstance was greater in FG and SG than TG only. There were no significant differences in speed between groups.

Conclusion: ASs consumption for muscle strength and volume improvement in bodybuilders is accompanied by higher level of CRP (as a cardiovascular risk factor).

Background and Aim: Waiting time is one of the factors affecting patient satisfaction of service quality which is offered. In This Study waiting times referred to some clinics like Shahid Dastani integrated clinical training center, treatment and researching center like Shariati Hospital was performed.

Materials and Methods: Six sigma model in four stages together with qualitative and quantitative methods was used in this study. The study population consisted of the all patient referred to specialist clinics like Shahid Dastani during every week. We selected 10% of all patients as a sample size referred to specialist clinics (n= 266). Data were collected by interviewing and filling the checklists using a stopwatch. Measured waiting times were registered in a blank form. Data entry and analysis were performed using SPSS.

Results: Mean and standard deviation of waiting time were 121± 33.73 minutes. The most important processes from referred entrance to leaving the physician's office consisted of comprehensive workflow processes, overall workflow, times forming, funds, medical records, previous bloom times, refunds and discount at all costs, and complaints.

Conclusion: The first three factors of prolonged time form health care providers and referees view are simultaneous increase in the number of referees, physicians being on time and shortage of doctors. This collection extends the time of giving services by clinice, providing human resources and modifying the physical spaces wich were some of recommendations to reduce waiting times.