Journal of

 Background and Aim:To assess of human force and population's programming at high level, is very important that we know rates and characteristics of population. Growth of population has direct relationship with fertility rate of women in community. To control of population and arrive to index of N.R.R.(Net reproduction rate) equal to one ,each family must be has one or tow children .Thus ,in families that they have more over tow children, we must be search about factors affected and attempt to reduce of population's growth , until arrive to a stationary population.

Materials and Methods: The cross-sectional study upon 500 women that are married and have 45 years old and more in Bushehr. Tow-stage random sampling was used in this study. First, Bushehr divided into 23 hypothesis blocks of 1000 households and thus, 20 points from each of blocks were selected by chance. Also, from each of 20 pointes, 25 families were selected by chance. In this study, a questionnaire was used for collecting of data, that questioners were asked of chief of households. The data was analyzed with SPSS package version 13. To find relationship between variables together and with response variable , was used kendall's tau test and chi-square for trend test. The multiple-logistic regression was used to find factors affected on parity progression ratios.

Results: In this study 181 persons(36.2%) of women had illiterate, 229 persons(45.8%) had primary education and 90 persons(18%) of them had high and more education .The age of the first marriage of 456 persons(91.2 %)  of women were under 25 years old and the age of the first pregnancy of 196(39.2 %) of them were under 20 years old. Probability of arrive to the first child in Bushehr was equal 0.98,and probability of arrive to second, thirst and fourth children was equal 0.92,0.81 and 0.72 respectively. This study shows that the factor like the age of the first marriage of women has a negative effect on PPR (parity progression ratio) from zero to one child, and the factors like the women's education and having a dead child have a positive effect on it. The results indicate that the factor like having a dead child has increasing effect on PPR from one to tow children, and the factors like the women's education, the age of the first pregnancy and marriage have a decreasing effect on it. In this research it is observed that having a dead child has a positive effect on PPR from tow to three children, and the factors like the age of the first pregnancy and marriage, education of women and their husbands have a negative effect on PPR from tow to three children. Also it is observed that sexually and having a dead child has increasing effect on PPR from three to four children, and the factors like, the women's education, job and education of husband , and the age of the first pregnancy of  women have decreasing effect on PPR from three to four children.

Conclusion: The results indicate that probability of arrive to third and fourth children are high. Thus it is show the controlling of family planning in Bushehr dose not good carry out within families belong lately decades.

Background and Aim: Systematized Nomenclature of Medicine systems are the important supportive for electronic health record in registration and retrieval of data. Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) is the most comprehensive language and then the consistency of exchanged data across health care providers and finally the high effectiveness of health care.

Materials and Methods : This research is a descriptive - comparative study and has been done in certain time section. Ideally , it have been used the descriptive - comparative method for studying of selective countries.

Results : Findings of this study show that American and England countries have accepted the SNOMED CT with application in all clinical activities and Australia country is evaluating this system and is using older versions of SNOMED only in pathologic applications now. Study shows that SNOMED CT structure is complex and based of concept (clinical concept) and contains two fundamental parts : 1) content of SNOMED CT core (concepts , descriptions and relations) that are always constant 2) content of out of SNOMED CT core (mappings or relation with systems and local extensions) that according to health and management needs and native terms of country are different. Such a structure executes in different software applications.

Conclusion : SNOMED CT structure in America and England countries has been compared and with attention to similarities (content of SNOMED CT core) and differences (content of out of SNOMED CT core : cross mappings and local extensions) , a basic SNOMED CT structure has been provided for Iran. Because of SNOMED CT in Australia is under development, researcher has studied its evolution and execution process in this country and has provided an appropriate structural pattern for Iran.

Conflict management is a kind of management which could be administered the organization with the best ways and create balance between organization and staffs and  eliminates the conflict. Generally , conflict management is the process of conflict roles recognition between intergroups and intragroups and use of conflict techniques for eliminate or simulate conflict for organizational effectiveness.
This research is aimed to introduce conflict management and how to use its strategies to modify this phenomenon.
This research shows that organizational conflict have both instructive and destructive results. Managers should use conflict management in every organization. Most conflict management strategy used to control conflict is collaboration between managers and staffs. Conflict management has important role to make managers successful . Although, a minimum of conflict is appropriate in every organization but no managers agree with anarchism in his organization

Background and Aim : Myeloproliferative neoplasms are clonal and heterogeneous disorders of hematopoietic stem cells lead to increase of one or more cell lines in the blood. Recently, the acquired mutation JAK2 V617F has been described in the majority of patients with myeloproliferative neoplasms (MPNs).This mutation is characterized by a G to T transverse at nucleotide 1849 in exon 12 of the JAK2 gene, located on the chromosome 9p, leading to a substitution of valine to phenylalanine at amino acid position 617 in the JAK2 protein. The aim of this study was to assess the prevalence of JAK2 mutation in MPN patients.

Materials and Methods: In this experimental study we evaluated JAK2 mutation in 58 patients with MPNs by simple randomized sampling. The mutation was detected by ARMS-PCR in patients.

Results: The JAK2 V617F mutation was detected in 86.6% (26/30) of patients with polycythemia Vera, 46.6% (7/15) of patients with essential thrombocythemia and 61.5% (8/13) of patients with idiopathic myelofibrosis. Polycythemia Vera patients carrying the mutation displayed a higher levels of WBC (p=0.03) and 61.5% (16/26) of these patients were females. The differences in other groups were not significant. The mutation was confirmed by sequencing.

Conclusions: Our Results show similarity with other studies. Thus, ARMS-PCR can be applied as differential diagnosis test for detection of JAK2 mutation in suspected patients with MPNs.

Background and Aim: The risk of infectious diseases in laboratory's personnel is high and several factors can increase these risk. Some of these factors are general, such as burning (with stray acid and base) and electric shock hazards. Which are not exclusive for laboratories. In other hand some several risk factors such as burning liquids are exclusive for laboratories. And there is limited information available about them.

Materials and Methods: This cross-sectional study was designed to evaluate accidental exposures of all laboratories personnel of Teaching Hospitals of Tehran University of Medical Sciences during 2004- 2005. We selected 416 laboratories personnel's in 15 different teaching hospitably TUMS for our study. The data were collected using a questionnaire and SPSS software was applied for data analysis.

Results:There was no significant association between accidental exposures with gender (p=0.51), educational level (p=0.11) and age (0.09) of laboratories personnel. But, accidental exposures were lower among those who had job experience between 5 to 10 years (p<0.05) compare to less than 5 years or more than 10 years job experience.

Conclusions:Although age, gender and educational level of laboratories personnel did not influence their exposure to laboratory's accidents, little or extensive job experience may increase accidental exposures among them. 

Background and Aim: Occupational diseases are certain types of diseases that have been caused by special jobs and subject to special circumstances. There are several factors that can intensify these diseases. Various countries have indicated that they have played an effective role in decreasing exposures and its economic costs and attracting optimal resources through establishment of a comprehensive information system for occupational diseases with a appropriate structure. Health improvement is considered as the first aim of the health system which requires a comprehensive, complete and integrated information system on occupational disease.

Materials and Methods: This is a descriptive Comparative study which was conducted in 2008 during which information systems in countries such as US, Finland, France and Iran have been studied based on their objectives and structures. Main instrument of this research was articles, books, magazines, valid internet sites in English language. Then, the gathered data were classified and analyzed.

Results: All the three selected countries had an electronic information system and database in the field of occupational disease. In Finland, data of occupational diseases as well as their damages are kept in separate databases while US lacks a comprehensive system. There are countless systems in these countries in this field. In France, supervision on laboratories is a priority. In Iran, there is no certain comprehensive system for registering diseases.

Discussion and Conclusion: All of these countries have the same objectives. Structure of occupational diseases information system, in Finland, is more comprehensive. Iran lacks such a system, so it is recommended to make use of the experiences of other countries and establish electronic comprehensive disease system in this country.

Background and Aim: The JAK2 is an acquired mutation that is observed in majority of patients with classical Philadelphia-negative Myeloproliferative neoplasms that include polycythemia vera (PV), essential thrombocythemia (ET), primary myelofibrosis (PMF). This acquired mutation is characterized by a G to T transversion at nucleotide 1849 in exon 12 of the JAK2 gene, leading to a substitution of valine to phenylalanine at amino acid position 617(V617F) of the JAK2 protein, and result in constitutive JAK2 activation that promotes hypersensitivity to growth factors and cytokines.

Materials and Methods: In this study we evaluated RNA from 58 patients with MPNs and statistical analysis was done with mann whitney test. The mutation detected by AS-PCR. In addition, 3 samples were sequenced in Mille gen company.

Results: 46 patients:86.6%(26/30) of those with polycythemia vera, 53.3% (8/15) of those with essential thrombocythemia,61.5% (8/13) of those with idiopathic myelofibrosis polycythemia vera patient carrying the mutation displayed higher levels of WBC (p=0.03). on the other hand,16 out of 26 JAK2V617F positive patients were female there is a demonstrate correlation between the presence of a mutant allele and female gender. The difference in other groups were not significant.

Discussion and Conclusion: The JAK2V617F mutation has been detected in the vast majority of patients with polycythmia vera (65-95%) and in a lower frequency in patients with essential thrombocythemia (23-57%), idiopathic myelofibrosis (23-57%) and chronic myeloid leukemia 19% (3/16 CML Ph-). Detection of the mutation is helpful in differential diagnosis, prognosis, and prediction of therapeutic response.

Background and Aim: The main goal of each hospital - like all health care sectors - is protecting and increasing the health level in orsig country. The important role of human resources in hospitals is appropriate strategic decisions making for fast environmental changes and shows the need of staff participation. Nurses as a one of the biggest parts of hospital staff need to participate much more in strategic decision making in hospitals. This article is aimed to measure the level of nurses' participation in strategic decisions making.  

Materials and Methods: This research is descriptive - analytic. Total nurses of Shariati hospital were 577 nurses of which 175 nurses were selected and studied.The gathering information instrument was questionnaire adapted from Dustdar thesis. This questionnaire contained 35,5 - choice questions set by Likert basis. Project's data was analyzed with SPSS software in % 95 confidence levels and statistical specifications like mean, standard error,correlation and non parametric tests were used.

Results: According to the results obtained, there are meaningful relation between staff participation in strategic decision making and: marriage situation (PV=0.01), Decision Directing (PV=0.0), culture of participation (PV=0.00), organization maturity (PV=0.00) and risk tolerance (PV=0.01)  

Conclusions: It has been observed that nurse participation in strategic decision making in Shariati hospital is in "low" position (participation mean score: 28.52 from 100). So an administrator effort for spreading culture of participation to owner's process is something that should be paid attention more than before.

Background and Aim: Electronic learning system is a new educational process which designed upon basis of computerized technology, multimedia and processors. It has several potentials and contexts.
To do comparative study and utilizing of successful electronic learning in developed countries could help us to develop this new process in Iran's Universities of  Medical Sciences.

Materials and Methods: This research is developed descriptive comparative study in 2007 - 2008 by using of developed countries universities websites information and 62 references and keywords such as Electronic Educations,Medical Sciences Courses,Commutation Technology, Comparative Study and University in the field of electronic medical sciences. Then, the findings will compare with each developed countries universities and Iran's Universities of Medical Sciences.

Results: The results showed that Manchester and Dekin University have much experience in developing of electronic learning. The Students should be assessed by attendance, online and blended in developed universities.
Degree based courses are only present in South - Africa University, meanwhile single courses and training are present in other universities. Electronic health sciences courses and training are developed much more in compressive with others.

Discussion and Conclusion: The studied universities are different in history of construction, student assessment type, homework presence type, registration procedures, electronic medical education type with each other.
Iran's Universities of Medical Sciences, electronic education have several deficiencies in comparison with developed countries universities. We suggest appropriate technological and cultural infrastructure and use's skill improvement to develop this process in our country's universities of Medical sciences.

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: The operating room is one of the main units in a hospital, where the most important phase of treatment is performed. Due to the physical properties, use of gases, and different electric devices in the operating room, the safety of both the patients and the staff should be considered carefully. This study aims to estimate the safety standards of the operating rooms in ‎Tehran University Hospitals and to provide solutions to the existing problems.

Materials and Methods: This is a descriptive, cross-sectional study conducted in the operating rooms of TUMS hospitals. The research instrument was a checklist used by interviewers while observing the place. The safety standards were studied in terms of physical environment, protection against fire‎, personnel safety, patients' safety, and infection control. The data were analyzed by SPSS software.

Results: The overall safety of the operating rooms of TUMS hospitals was found to be 84.9 percent. The figures for infection control and personnel safety, however, were lower.

Conclusion: The operating rooms of Tehran University of Medical Sciences hospitals were studied in terms of five safety standards. Considering the physical environment, fire protection, and patient safety, they were quite safe but as to infection control they were relatively safe. However, they were found to be unsafe regarding the safety of their staff. Tehran Heart Center with an overall safety of 97.5% for its operating rooms can be considered as a model for the other TUMS treatment centers.

Background and Aim: Medicine as a strategic commodity and basic needs of the most people in the country is important. According to the necessary recognition correct pattern of drug use, this study is conducted to measure the pattern of drug use among Ardabil city families.

Materials and Methods: A cross -sectional descriptive study was conducted on 1000 randomly selected families from Ardabil city in 2010. Necessary information was gathered by interviewing one of the oldest people in the family. Collected data was analyzed using descriptive statistical methods in SPSS.16 software.

Results: 485(48.5%) of study people were female and rest of them were male. The mean age of samples was 41.6(SD=14.1). From all families 22% uses the drugs in home for curing diseases by self diagnosis. 10.9% of them do not respond to doctors non medical advice and prefer the doctor to prescribe drugs otherwise they refer to another doctor.

Conclusion: Results showed that the drug use behavior between Ardabil city families was inappropriate and decreasing irrational use of drugs by providing necessary information to people regarding optimal use of medicine was necessary.

Background and Aim: Internal Evaluation is a process of providing evaluative-descriptive information based on the value and significance of educational objectives, operations and results to direct decisions, responses, information and research processes.

Materials and Methods: In this research, studying the opinions of faculty members, students, and graduates, the educational system of Medical Laboratory Sciences Department at Tehran University of Medical Sciences (TUMS) was evaluated in the year 2010. The aim the study was to remodel and adjust the educational system with the society's needs and to promote the educational quality. The employed method was a cross-sectional, descriptive one and consisted of 10 procedural steps in eight sections dealing with the evaluated factors such as faculty members and students, and the satisfaction expressed by students.

Results: The results of the study showed that the average of the eight investigated sections was 70.6% for the Department of Medical Laboratory Sciences, which can be interpreted as desirable.

Conclusion: Internal evaluation can be considered as one of the best methods of improving the quality of education in the faculty of Allied Health Sciences School

Background and Aim: Nowadays, because of the intense competition between nutrition consultants and rapid changes in patients' demands for nutrition counseling, application of the concepts such as "Entrepreneurial Opportunities Recognition" in this field seems unavoidable. One of the most commonly used methods for recognition of entrepreneurial opportunities is "Strategic Analysis of External Environment". Present survey has been conducted in order to study the impact of nutrition consultants' educational level on their strategic analysis about entrepreneurial opportunities.

Materials and Methods: This analytical survey was implemented based on the data (nutrition consultants' educational levels and their responses regarding the supply and demand for nutrition counseling services) which was collected during a previous study entitled ((Analysis of supply and demand trends in the field of diabetes nutrition counseling: A basic step towards identifying the entrepreneurial opportunities for nutrition consultants)). Also, ((Spearman's correlation test)) and ((GLM multivariate test)) were performed for the analysis of aforementioned data.

Results: Both statistical tests showed that nutrition consultants' educational levels (including 1- Bachelor of Science and 2- Master of Science and PhD) had significant relationship with two-thirds of their comments.

Conclusion: Nutrition consultants' educational level has a relative impact on their strategic analysis about the entrepreneurial opportunities.

Background and Aim: Staphylococcus aureus(SA) may cause infection in all body organs. Many personnel and patients in hospitals may become carriers of this species. The aim of this study was to investigate relative frequency of SA and its resistance to Methicillin.

Materials and Methods: A couple of swabs were taken from nose and nails of 151 personnels working in operation room of Shahid Sadoughi Hospital in Yazd. Samples were inoculated into Mannitol salt agar medium and S. aureus colonies were antibiogramed to determine the rate of resistance to methicillin. Statistical analyses were performed by chi-square and Fishers' exact test.

Results: Overall prevalence of SA was 35.09%(19.2% and 15.9% in noses and nails, respectively). Prevalence of methicillin-resistant SA(MRSA) was 11.92%(5.3% and 6.6% in noses and nails, respectively). Surgeons had the highest, and workers the lowest prevalence of nasal SA carrier rate. In contrast, the nails of servants had the highest, and surgeons the lowest SA carrier rate. No significant difference was found between carrier rate and age, sex and duration of employment. But a meaningful relation was found between type of job and MRSA in both noses and nails. All of the MRSA isolates were sensitive to vancomycin.

Conclusion: Since employees of operation room are continuously working with patients undergone operation, screening both the personnel and patients to determine the rate of carriage, preventing transfusions of fore mentioned bacterium is necessary and highly recommended.

Background and Aim: Assessment of hospital performance increases responsiveness and efficiency of limited resources. One of the most useful models of hospital performance assessment is Pabon-Lasso, a graphical model that determines the relative performance of hospitals using three indicators: Bed Occupancy Rate Bed Turnover and Average Length of Stay. The present study aims to compare the performance of Lorestan University of Medical Sciences (LUMS) hospitals using the above-mentioned tools.

Materials and Methods: In this descriptive cross-sectional study, fourteen LUMS hospitals were selected through census. The data-gathering instrument was the standard data form verified by the Ministry of Health and Medical Education. Bed Occupancy Rate, Average Length of Stay, and Bed Turnover Rate were calculated and Pabon-Lasso graph was drawn using SPSS 15.

Results: The average length of stay, bed occupancy, and bed turnover rates turned out to be 3/21 days, 53/07% and 95/54, respectively. Five hospitals were in Zone III, indicating a satisfactory level of efficiency. Four hospitals demonstrated inefficiency and underutilization of resources by falling into Zone I. Three hospitals were placed n Zone II. And two hospitals were in Zone IV.

Conclusion: Among 14 studied hospitals, just 5 were considered as efficient. Therefore, it is necessary that policy-makers develop solutions to improve the performance of other hospitals and distribute health resources appropriately.

Background and Aim: Achievement-based evaluation is an important part of the educational planning process, in which learners are screened besides, it helps teachers in their self-evaluation. The purpose of present study is to survey the methods through which laboratory sciences students were evaluated by their professors at Tehran University of Medical Sciences(TUMS) in the academic year 2009-2010.

Materials and Methods: In this cross-sectional study, the population consisted of the faculty members who teach laboratory sciences courses. Data collection instrument was a researcher-made questionnaire. The collected data were analyzed to describe all evaluation methods using tables and necessary distribution frequencies. Then, the results were compared with those of Medical Planning Council resolutions.

Results: The results show that mid-term exams were used for the evaluation of students in 35% of all theoretical and practical courses. Besides, of the evaluation methods used, multiple-choice questions occupied the first rank(70%) among the methods normally employed.

Conclusion: According to the results, routine evaluation of undergraduate students of laboratory sciences at the Paramedical Faculty of Tehran University of Medical sciences not only conformed to the ratifications of the Supreme Council of Medical Planning, but also was done more extensively and with a higher degree of consistency in the academic year 2009-2010.

Background and Aim: Regarding the importance of communicators' presence in health programs and the fact that in recent years, we have witnessed a decrease in their cooperation or a cut in their relationship with the headquarters. This qualitative study was performed to clarify communicators and instructors' administrative-recreational experiences in breaking off with the headquarters.

Materials and Methods: This qualitative study was carried out on 60 healthcare communicators, 20 ex- communicators and 35 instructors selected through purposive sampling. The data were collected using focus discussion groups and semi-structured interviews with the participants. For data analysis, qualitative content analysis was employed.

Results: The findings of data analysis revealed two main levels: recreational and administrative. The key themes of the former included medical facilities, gifts, employment, futurism and camp and of the latter consisted of credit resources, instructors' conditions, organizational posts and orientation.

Conclusion: Expressing what is expected from communicators when selecting them can play a significant role in keeping them up with their jobs. Holding meetings between authorities and communicators' representatives to discuss their problems and present solutions, holding reward ceremonies, preparing the grounds for attracting financial resources to support communicators' programs, appreciating them and enhancing the communicators and instructors' academic level, and creating organizational posts for instructors can be effective in maintaining their presence and enhancing health communicators' program.

  Background and Aim: Family physician is the core in the world efforts for quality improvement, cost effectiveness, and equity in the health care systems. The main purpose of this present study was to investigate situation of the family physician program and identify referral route in this program in six pilot cities in Khuzestan province .

  Materials and Methods: A cross-sectional descriptive study was conducted in 2011. Pre-designed checklists were used for collecting data. In this study, 15 healthcare team in six pilot cities for family physician program in Khuzestan province were examined and their specified referral levels for each city was investigated and compared with the national instruction to identify current gaps.

  Results: The least number of staff belonged to nutrition, nurses and physicions respectively. In the second referral level cities, Specialists did not welcome the program . In Mahshar, a second level city, five specialists have been registered to family physician program. In the third level, 28/5 percent of specialist were enrolled in this program.

  Conclusion : It seems that it is necessary to facilitate patient access to physicians under contract with family physician program and referral system in second and third levels. Therefore, establishing a motivation system for attracting specialist and improving their maintenance situation can also be beneficial.

Background and Aim: Clinical laboratories, due to their succeptibility to potential risks, are priorities in all activities concerning safety issues in hospitals.
Total Quality Management (TQM) is a model considered by WHO for clinical laboratories safety development. This study aimed to assess how safety standards were followed at the clinical laboratories of hospitals affiliated with Tehran University of Medical Sciences (TUMS) based on TQM safety regulations.

Materials and Methods: This descriptive study was conducted on a research population including TUMS hospitals clinical laboratories in 2012. For data collection, census was applied and sampling was not considered. The data gathering instrument was a checklist measuring seven safety components based on TQM. The validity of the instrument was determined through content validation, and Cronbach alpha was calculated to be 0.82. For the analysis of the results, descriptive statistics including frequency percentage of scores was employed.

Results: The safety of research population turned out to be suitable in terms of four factors: designing, existence of general safety items, conducting standard safety activities, and safe disposal of laboratory wastes. Besides, implementation of safety programs and increase in employees’ knowledge to cope with accidents were relatively acceptable. The emergency evacuation program, however, was estimated as poor.

Conclusion: The studied laboratories enjoy relatively safe conditions, but imperfect implementation of safety protocols can endanger safety conditions. Therefore, it is necessary to take the required correcting measures to ensure full safety in clinical labs.