Showing 31 results for Afshar
M Afshar , E Tahery , D Alasty ,
Volume 55, Issue 6 (1 1997)
Abstract
Organochlorine pesticides are a group of persistant compounds which have been used for a long time. Due to their stability, some of them such as DDT, BHC and their derivatives are still used in the areas with malaria epidemic condition, hence the chance of food contamination always exists. The present survey demonstrated that human milk is one of the best indicator substances in monitoring the environment and human body contamination by organochlorine compounds. We studied the level of residues in the milk of nursing mothers who could be exposed to these compounds through food chain in their contaminated environment. In this investigation, we collected 40 samples from the nursing mothers of two hospitals located in the north and south of Tehran. Detection was carried out by Gas chromatography (GC) with 3% OV17 column and Ni63 ECD (Electron Capture Detector). Reference substances were obtained from WHO. Results are discussed in the text.
M Afshar, H Hoseinian Moghadam,
Volume 59, Issue 6 (11-2001)
Abstract
One method of drug smuggling is body packing or body stuffing, placement of narcotics (opium, heroin, hashish, …) inside intestinal tract for transfer from city to city or country to country. Estimating of the methods for transferring, content of packets, packaging, cause of death and results of diagnostic and therapeutic methods can effectively decrease the number of body packer and law execution. This study is case series by randomized sampling. Several parameters such as sex, age, marital status, addiction, job, level of education, type of opioids and their weight and number of packets, result of abdominal X-ray, surgery needs, were collected from April 1999 to December 2000. Through this period of time, 32 male smuggler who had swallowed drug packets were detained. The average age was 41 years (max=62, min=20). The minimum weight of the opium carried by this smugglers was below 20 gram and maximum weight was 1000 grams (median=360 grams). The minimum number of packets were one packet and maximum number of packets were 54 (median=10 packets). In 84 percent of body smugglers the content of packets was opium, 13 percent was heroin and 3 percent was hashish. From the cases, 81 percent of smugglers were addicts themselves. Death occurred in 7 cases from which 3 were after surgery.
Ziaee V, Kordi R, Alizadeh R, Afsharjoo Hr, Yunessian M, Halabchi F ,
Volume 60, Issue 3 (14 2002)
Abstract
Background: To determine the incidence and risk factors of acute mountain sickness (A - AMS) in pilgrims. Although it is well known that western trekkers suffer from acute mountain sickness (AMS) in other mountains, not much is documented about the incidence of AMS in the Damavand Mountains, Iranian population that go to high altitude and its related contributing factors.
Materials and Methods: The design was a cross sectional study. During six weeks (in summer 2000) a population of 459 pilgrims was studied. The period of the study was six weeks in summer AMS symptoms, were assessed by an extensively used standard questionnaier (Lake Louise), applied at 2900 m, after than arrive at 4200 m above sea level, and during descent from summit Damavand (at 4200 m) at Damavand in Iran Alborz Mountain.
Results: The overall incidence of A.M.S. was 60.8 percent. Climbers had 13-71 years and 67.8 percent of the study population was men. Men did not differ significantly higher rate of AMS from women. The incidence being increased in those who residence at an altitude below 600 m, climbed fast, amateur climbers, a previous AMS experience or high altitude illness, a history of AMS at ascent to Damavand and ascent time at night (6pm-6am). It was weakly dependent to rate of ascent (from 2800 m up 4200 m less that 4 hours) and sleep in 4200 m. The incidence of AMS was unrelated to sex, age, body mass index (BMI), height, weight, smoking, to the load carried and knapsack and spent more than 15 hours in shelter (at 4200 m). So it was independent of rate of ascent in the higher altitude (from 4200 m to 5671 m), speed of descent and family history of AMS.
Conclusions: Data show a strong relation between experiences mountaineer, history of AMS, ascent time at night and the incidence of acute mountain sickness in 459 climbers studied at high altitudes that didn’t report previously.
Sj Shah Taheri , M Afshar , M Majedi Far , J Nasl Saraji ,
Volume 63, Issue 1 (5 2005)
Abstract
Background: Nowadays, aromatic hydrocarbons such as benzene, toluene, and xylene are extensively used in the different environments and industries, causing adverse effects on individuals who are being exposed occupationally and environmentally to these hazardous compounds. In this study, occupational exposure to xylene in workers, employing at pathology wards of hospitals belonging to the Qazvin University of Medical Sciences have been investigated.
Materials and Methods: Methyl Hiporic Acid (MHA) as a main metabolite of xylene in urine was used to evaluate the workers exposure to this chemical. The urine samples were taken from all 30 workers from 4 hospitals, i.e. Kosar, Shahid Rajaei, Booali and Qods. Through this study, 30 administrative employees were also selected as control group. The direct DBA colorimetric method was used to measure MHA in the workers urine.
Results: The results obtained from this study showed that, there were significant differences between MHA and working days, type of jobs, and length of exposure time. This study also showed that, there were no significant differences between urinary MHA concentration and sex, age, and smoking habit.
Conclusion: Through this study, it was also clearly obtained that, xylene exposure can not affect on the total and direct serum bilirobin in the workers blood. Finally, it is worth mentioning that, although this study showed no acute exposure to xylene in hospitals pathology wards, the effect of chronic exposure to such compound cannot be ignored, therefore protecting workers against like these organic solvents are strongly recommended as their TLVs are considerably being reduced during these years
Torkaman M, Afsharpeyman Sh, Khalili Matinzadeh Z, Amirsalary S, Kavehmanesh Z, Hashemi S.a,
Volume 64, Issue 10 (2 2006)
Abstract
Background: Jaundice is a common and benign problem in neonatal period. Several therapeutic procedures for decreasing of serum bilirubin level has been recommended. phototherapy is most common them. Our goal Form this study is the evaluation of serum therapy effects in decreasing of serum bilirubin concentration in icteric infants that are treated with phototherapy.
Methods: This is a prospective clinical trial in Najmeih Hospital in 2002. In this study 80 term icteric infants with bilirubin level greater than 17 mg/dl were randomized in two groups, both groups underwent phototherapy and in the case group intravenous fluid supplementation was added. There were no significant differences in the mean gestational age, birth weight, hemoglobin, and also in total serum bilirubin level at admission in the two groups.
Results: There were no significant differences in the mean rate of of serum bilirubin level decline during first 24 and 48 hours of hospitalization and also the time of bilirubin decreasing to less than 15 mg/dl and the length of hospitalization in two groups.
Conclution: Our study showed intravenous fluid supplementation could be limited to special cases of neonatal icter such as moderate to severe dehydration.
Mirsalehian.a, Nakhjavani.f, Peymani.a, Jabalameli.f, Mirafshar.s M, Hamidian.m,
Volume 65, Issue 1 (5 2008)
Abstract
Background: The incidence of ESBL producing species have been steadily increased in
recent years, resulting in limitation of infection control issues and therapeutic
options.The purpose of this study was to evaluate prevalence of Enterobacteriaceae and
also assess epidemiology ESBL producing strains isolated from patients admitted in
ICUs.
Methods: A total of one hundred fifty isolates were collected from urine, sputum, blood,
wound and other clinical samples from patient admitted in ICU and then were identified
by biochemical tests .All of the samples were screened by DAD method according to The
NCCLS Guideline. The species that met NCCLS screening criteria was further tested for
Clavulanic Acid effect by confirmatory method.
Results: A total of one hundred fifty isolates,133(89.3%) were found to be resistant at
least on of the indicators cephalosporin tested according to NCCLS Guideline.
121(80.6%) of the isolates were resistant to all the indicators tested .89(59.3) isolateds
were confirmed as ESBL producers. The number of isolates ESBL producing was as
follow: Klebsiella pneumoniae 33 (76.74%), E.coli 20 (60.60%), Enterobacter cloacae 8
(47.05%), Citrobacter diversus 6 (54.54%), Enterobacter aerogenes 7 (53.84%),
Citrobacter freundii 4 (40%), Klebsiella oxytoca 6 (62.5%), Proteus mirabilis 4 (50%),
Serratia marcescens 2 (40%), Proteus Volgaris 0%.All of the isolates sensitive to
imipenem.
Conclusion: The present study shows high prevalence of ESBL producing
Enterobacteriaceae from patients admitted in ICU .The increased rate of these species in
most cases due to the administration of inadequate and irrational antimicrobial therapy
.To overcome this problem, it needs to develop new antimicrobial agents, limiting the
Unnecessary Use of antimicrobial and increasing compliance with infection control
issues.
Afsharpaiman Sh, Mamishi S,
Volume 66, Issue 3 (2 2008)
Abstract
Background: Early diagnosis of bacteremia and its complications is the most important part of care and management of the patients. The utility of polymerase chain reaction (PCR) techniques have been shown to identify pathogens in less and more optimal time. The aim of our study was to evaluate prevalence of bacteremia using universal PCR in febrile patients admitted in Pediatric Medical Center comparing other routine methods like blood culture.
Methods: One hundred febrile children suspected to septicemia who were admitted in Pediatric Medical Center, were included. From all patients whole blood samples were obtained for blood culture and PCR.
Results: Of all patients, 65% were 3 to 36 months old. The frequency of male and female patients was 45 and 55, respectively. The prior oral and parental antibiotic therapy had been taken for 45 and 12 patients. The mean temperature of body was 38.98±0.57 at presenting time. Twelve patients were positive blood culture. Nineteen patients had positive PCR test which consisted of 11 patients with positive blood culture. The severity of fever and laboratory findings such as WBC, ESR, and CRP had no significant difference between patients with positive and negative blood culture and PCR.
Conclusion: universal PCR technique is more sensitive and specific than conventional blood culture and other methods to diagnose bacterial infection.
Mirsalehian A, Jabalameli F, Mirafshar Sm, Bazarjani F, Gorjipor A, Goli H.r,
Volume 66, Issue 6 (5 2008)
Abstract
Comparing Intensity Elicited Maximum Reflex Amplitude Between Noise Induced Hearing Loss & Acoustic Trauma at 1kHZ, Contralaterally, and Investigate Relationship Between Amplitude and Hearing Impairment
Noorbakhsh S, Shekarabi M, Kalbasi Z, Tabatabaei A, Tonekaboni H, Afsharkhas L, Vafaei-Shahi M,
Volume 68, Issue 5 (6 2010)
Abstract
Background: M. pneumoniae infection in children is usual and diagnosis of its neurologic complications for rapid treatment is very important. To compare the CSF- M. pneumoniae antibody level between febrile children with acute neurologic signs (Menigoencephalitis, Guillan Barre Syndrome (GBS), Transverse myelitis, Ataxia and so on) with unaffected ones.
Methods: A cross sectional/ case control study in pediatric wards of Rasoul-e-Akram & Mofid hospitals (2007-2009) was done. The amount of Specific M. pneumoniae IgG (ELISA) antibody level determined in CSF of 55 cases and in 10 controls. Chi square values (CI 95%, p< 0.05) calculated for all categorical variables. Sensitivity specificity Positive Predictive Value (PPV) Negative Predictive Value (NPV) of CSF antibody level determined by using the Area under the ROC Curve.
Results: Cases (n= 55) aged between five month to 13 years with mean age of 3.84±3.43 years. Area Under Curve (AUC) in ROC was 0.876 (%95 CI, 0.78- 0.96 p< 0.0001). Cut off level for antibody was 0.0025 with 73% sensitivity 90% specificity 100% PPV 28.8% NPV. CSF antibody level had significant difference between cases and controls [0.08± 0.26 Versus 0.001± 0.001 p: 0.02] It had poor agreement between cases and controls (Kappa= 0.27). Lowest amount seen in cases with aseptic meningitis highest amount observed in cases with GBS and cases with focal neurologic signs.
Conclusion: The presence of very low amount (0.0025) of M. pneumoniae antibody in CSF of febrile children with acute neurologic signs had 70% sensitivity and 90% specificity 100% PPV but had low (28.8%) NPV. M. pneumoniae would be a rare cause in cases with aseptic meningitis. Finding the M. pneumoniae-DNAs in CSF are not so frequent (2%) but in high suspicious cases adding this test to determining the CSF antibody level might be helpful.
Karbasi-Afshar R, Shahmari A, Shafighi N, Saburi A,
Volume 70, Issue 6 (5 2012)
Abstract
Background: Various therapeutic protocols have been recommended for treating dyslipidemia, particularly in patients with coronary artery disease. The purpose of this study was to assess the efficacy of statin use with or without fenofibrate on echocardiographic findings of patients with coronary artery disease and dyslipidemia.
Methods: This clinical trial was conducted on 124 patients with coronary artery disease and dyslipidemia in Baqiyatallah Hospital in Tehran, Iran during 2008 to 2010. The first group of patients (64) received simvastatin (20 mg) and fenofibrate (200 mg) with low lipid diet and exercise while the second group (60) only received simvastatin with low lipid diet and exercise for one year.
Results: The mean age of the participants was 54.3±6.5 years. The first group showed significant changes in lipid profile and left ventricular ejection fraction (LVEF), (P<0.05). Left ventricular diastolic function parameters showed no significant changes in both groups upon 12 months of treatment.
Conclusion: The results of this study show, one-year treatment by simvastatin and fenofibrate can be effective on lipid profiles, and improve LVEF with resultant positive effect on heart function.
Reza Karbasi-Afshar , Reza Noroozian , Ayat Shahmari , Amin Saburi ,
Volume 71, Issue 3 (June 2013)
Abstract
Background: Sympathetic complex of over-activation kidneys is one of the main causes of primary hypertension (HTN). We aimed to assess the efficacy and safety of sympathectomy using 5Fr mariner catheter ablation on patients with refractory hypertension.
Methods: In this prospective cohort study, patients who received three or more anti-hypertensive medications with 160mmHg systolic blood pressure (BP) or more were randomly included and divided into 2 groups. Cases in the first group were undergone to renal denervation and the second group was treated by previous antihypertensive medications. Both groups were followed for six month by assessing BP and adverse effects.
Results: One hundred and seventeenth patients (54%) out of 212 screened patients were included in the first group (renal denervation) and 95 patients as the second group. The mean of BP changes in the first group was 35/15 mmHg with standard deviation of 22/11mmHg. (P<0.001) in the second group, the mean changes of BP was not statistically significant. (5/0mmHg± 22/11, P=0.79 for systolic BP and P=0.96 for diastolic BP). 92% of 117 patients in the first group had a favorable BP decrease, which was defined as a 20mmHg or more decrease in BP, in comparison with 15% of 95 patients as controls (P=0.001). There was no observed complication after denervation in the first group.
Conclusion: It seems that the sympathetic renal denervation can be an effective and safe method for treatment of refractory hypertensive patients indeed of routine medications although further studies with longer follow up duration and more cases are suggested for confirming this issue.
Shahla Afsharpaiman , Amir Skandari , Zareian Jahromi Maryam , Shokoofeh Radfar , Shahnaz Shirbazoo , Susan Amirsalari , Mohammad Torkaman ,
Volume 72, Issue 2 (May 2014)
Abstract
Background: Toxoplasma gondii, is a mandatory intracellular protozoa, that many people worldwide are infected with. In children, the infection enters central nervous system and leads to inflammation of the gray matter. Autism, is a complex develop-mental disorder, altering social communication, with unknown origin. Neuropathologi-cal changes in autism are the same as those occurred in brain toxoplasmosis. The objective of this survey was to evaluate positive serology of toxoplasma gondii, in autistic children.
Methods: This case-control study was done on 3-12 years old children, referring to the neurology and psychiatry sub-special clinics of Baqiyatallah hospital and also autistic children of Omid-e Asr and Navid-e Asr general rehabilitation centers in Tehran, Iran. The study performed at 2012-2013. Forty autistic children were placed in the case group and 40 children, suffering from no neuropsychiatric disease or other ones, were placed in the control group. A folder, containing demographic data, type of the disor-der, onset of diagnosis and child characteristics at birth, such as time of birth (preterm/ term) fulfilled for each child. Sampling was done with 5 ml blood, for determining IgM and IgG antibody levels against toxoplasma gondii, using ELISA method. Data ana-lyzed by the software SPSS ver. 17 and descriptive and analytic analysis were done, us-ing central and dispersion indexes and also chi-Square test.
Results: The autistic group contained 34 boys and 6 girls (85 and 15 percent respectively), with the average age of 6 (±2.71) years old [minimum of 2.33 and maximum of 12]. The average age at the time of diagnosis was 4.01 (±1.87) years old. 87. The non-autistic group contained 17 boys and 23 girls (42.5 and 57.5 percent respectively), with the average age of 5.67 (±3.09) years old [minimum of two and maximum of 12]. IgM and IgG serology of all autistic children were negative, while in non-autistic group, 2.5 percent (1 child) were positive and 97.5 percent (39 ones) were negative. There were no statistically significant difference among these two groups according to the serology results.
(P=0.31).
Conclusion: There was no statistically significant difference in comparing positive se-rology of toxoplasmosis, between the two groups. However, to obtain a perfect result, a larger sample size are required.
Soror Roozafzay , Khadijeh Hekmat , Kobra Shojaei , Pourandokht Afshari , Mohammad Bahadoram ,
Volume 72, Issue 5 (August 2014)
Abstract
Background: Bacterial vaginosis (BV) is the most prevalent causes of abnormal secre-tion in women at fertility age. Also, Bacterial vaginosis is one of the most common dis-eases in women who refer to gynecology clinic. The main cause of the pathogenesis is increasing pH of vagina due to reduced number of lactobacillus and growth of anaero-bic bacteria. Prevalence of BV varies between 10 to 30 percent in different societies. Amsel criteria is used as diagnostic test in BV. This interventional study was designed to assess the impact of vaginal lactobacillus suppository and metronidazole compared to metronidazole alone on the recovery and recurrence of bacterial vaginosis.
Methods: This study was a prospective, randomized, double-blind clinical trial which was conducted on 130 women with bacterial vaginosis to compare the effects of vagi-nal lactobacillus suppository and metronidazole. Bacterial vaginosis was diagnosed us-ing Amsel criteria that based on some clinical symptoms. Patients were divided into two groups, first group were treated with oral metronidazole plus lactobacillus and second group were treated with metronidazole alone. Patients were followed-up one week and four weeks after initiation of the treatment.
Results: One hundred and thirty women completed the study. Patients were followed at one and four weeks after initiation of intervention. Amsel criteria and recovery rate in both groups compared before treatment one and four weeks after treatment. The crite-ria and treatment were significantly improved, but this improvement was higher and statistically significant in the metronidazole plus Lactobacillus group compared to sec-ond group (P< 0.0001).
Conclusion: The protective effects of lactobacillus in dealing with anaerobic patho-gens as well as the negative impact of metronidazole on lactobacillus of vaginal flora, use of lactobacillus along with metronidazole especially in patients with recurrent infec-tions is recommended. In other words, using lactobacillus with metronidazole for treatment of bacterial vaginosis is more effective than metronidazole alone.
Ladan Afshar Khas , Azardokht Tabatabaei , Samileh Noorbakhsh , Atefeh Kargozar ,
Volume 73, Issue 7 (October 2015)
Abstract
Background: Convulsion is one of the common cause of hospital admission in children. Idiopathic seizure is when no anatomic, electrolytic, metabolic or hemorrhagic causes are found. Recently, lead poisoning, which is considered when serum lead levels are higher than the normal levels (previously 10 &mug/dl changed to 5 &mug/dl). Even lower levels of lead inflict harmful consequences in central nervous system (CNS) development in pediatric group. Due to air pollution and high lead level in air of Tehran, investigation the probable role of lead in producing or predisposing convulsion in children is very important. To determine the cerebrospinal fluid (CSF) lead level in children with idiopathic convulsion in compare with nonconvulsive ones (control). Methods: A case-control study upon 60 children (30 convulsive and 30 nonconvulsive control) admitted in Rasoul Akram and Ali Asghar University Hospitals, Tehran, from 2012 to 2013 had done. One ml of CSF obtained and lead level determined by atomic absorption test. Results: The mean age between cases and controls was not different (mean= 30.18+27.36 vs 25.46±20.56 months, P= 0.1). The CSF lead level (&mug/dl) had not meaningful difference between 2 groups (3.43+3.07 vs 2.78+2.77, P= 0.3), and no related to type of convulsion in cases (P= 0.7), the area under the curve (AUC) was 0.588 1-0.433, P= 0.2). The CSF lead cutoff was 1.65 &mug/dl sensitivity of 70%, specificity of 46%, PPV and NPV was 56% and 60% respectively. Conclusion: The toxic blood level for lead is 3.5 &mug/dl. The CSF lead level even in little amount (1.65 &mug/dl) is an acceptable sensitivity but lower specificity for differentiation the convulsive from nonconvulsive children. Although the role of genetic and other causes should be considered in idiopathic convulsion, probably, the high level of lead in CSF could predispose those children to convulsion. It can effect CNS development in children even in small amounts. Indeed, long-term effects of lead which continue to adulthood should be considered as well. Hence, it is paramount to rectify the ambient air lead pollution in Tehran.
Behshsd Pazooki , Orkideh Olang, Ali Afshari , Nasim Khajavirad , Batool Ghorbani Yekta,
Volume 74, Issue 8 (November 2016)
Abstract
Background: To assess patient' reaction towards bedside teaching in the nephrology ward of Imam Khomeini Hospital Complex (Tehran) and to identify the factors that may influence it.
Methods: A cross-sectional study was conducted in the nephrology ward of Imam Khomeini Hospital Complex from march to September, 2014. All inpatients present on the day of the study were interviewed using a structured questionnaire.
|
Results: 146 patients were examined in this study that 62 patients (42.5%) were women and 84 cases (57.5%) were men. 112 (76.7%) of patients had a good feeling about the training to physicians. The behavior of students was evaluated respectful by 132 individuals (90.4% of patients). Total number of 106 individuals (72.6% of patients) had trusted to the health care team and 120 people (82.2% of patients) knew that the physicians’ behaviors are associated with the respect to their religious beliefs. Not being same sex of the examiners was important for 47 individuals (32.2% of patients). The number of 123 cases (84.2% of patients) evaluated the physicians' behavior with respect to their privacy. The number of 119 individuals (81.5% of patients) received their responses from the examiners. Statistical tests indicate a significant relationship between the respectful behavior of students with patient and good feeling about training to physicians, so that the 95.5% of people who have seen the respectful behavior of students to oneself had a good feeling about training to physicians (P˂0.001). The relationship between the presence of teacher with students and good feeling on training to physicians was significant (P=0.013). Positive feeling about practicing physicians was associated with patient age. So the age average of people who feel good about practicing physicians was significantly lower than the other people (47.2±17 versus 55.6±18 and P=0.028).
Conclusion: The relationship between respectful behavior and presence of teacher with students and age and good feeling on training to physicians was significant.
|
Zahra Kamali Sarwestani , Alireza Dasdar , Setareh Agha Kuchak Afshari , Mohsen Gerami Shoar , Seyyed Jamal Hashemi , Reza Pakzad , Pegah Ardi , Alireza Abdollahi , Mohammad-Taghi Haghi-Ashtiani, Shahram Mahmoudi ,
Volume 75, Issue 4 (July 2017)
Abstract
Background: Fungi have a worldwide distribution which can cause a broad spectrum of disease ranging from allergic to systemic infections, particularly in immuno-compromised individuals. Fungal spores are an important group of bioaerosols in hospital environment which are an emerging cause of hospital-acquired infection. Nosocomial infections cause significant morbidity and mortality as well as large financial burden on the healthcare system. This study aimed to evaluate the frequency and species distribution of airborne fungi in selected wards of two tertiary hospitals in Tehran, Iran.
Methods: In this cross-sectional study, samples were collected during six months from July 2016 to December 2016 by using of settle plate method. Samples were collected from selected wards of Imam Khomeini Hospital and Children's Medical Center and then incubated at 28 °C for 8-10 days. Fungal isolates were identified using the macroscopic features of colony and microscopic characteristics in slide cultures. Yeast isolates were identified by CHROMagar candida medium. PCR-sequencing of ITS1-5.8 S-ITS2 region of ribosomal DNA was used for identification of unknown isolates.
Results: A total of 202 colonies including 133 colonies from the Imam Khomeini Hospital and 69 colonies from the Children's Medical Center were isolated. Cladosporium spp. were the most common obtained fungi accounted for 30.1% and 47.8% of all isolates in the Imam Khomeini Hospital and the Children's Medical Center, respectively. Penicillium spp. and Aspergillus spp. were other frequent species in two hospitals. Infectious diseases ward in Imam Khomeini hospital and emergency and urology wards in Children's Medical Center had the highest rate of contamination.
Conclusion: According to the results of this study, the frequency and diversity of fungal spores in hospital wards were different. In addition, since the fungal contamination in the hospital environment are affected by various environmental factors and the efficiency of ventilation systems, some of these wards require better ventilation system as well as regular monitoring to remove these fungal bioaerosols in order to maintain the health of patients and health care workers.
Ali Mohammad Mosadeghrad , Mahnaz Afshari ,
Volume 75, Issue 10 (January 2018)
Abstract
Background: Hospitals are dealing with unlimited demands and limited resources. Hospital managers should use appropriate strategies to improve quality of services, enhance patients’ satisfaction and increase financial resources. This study aimed to examine the impact of quality management.
Methods: A participatory action research was used for the intervention on income of operating theatre in Vali-e-Asr Hospital in Tehran University of Medical Sciences, between March and September 2014. A quality improvement team was established and improved operational processes of the operating theatre department of the hospital using Mosadeghrad’s ten-step quality management model. The quality improvement team standardized processes, identified goals for the processes and improved them until achieved the goals. Accordingly, an action plan was developed and implemented for increasing the income of the operating theatre department. Income data of the operating theatre department were obtained for a 6-month period in 2014, and were compared with a control 6-month period in 2013.
Results: Implementing quality management increased the number of surgeries by 14.96 percent, decreased cancelled surgeries by 14.6 percent and reduced bill deductions imposed by health insurance companies by 44.9 percent. As a result, the operation theatre department income has increased by 68.8 percent (P=0.028). Some of solutions used for increasing the income were as standardizing and improving working processes, removing unnecessary activities, empowering staff; increasing department’s working hours, on time visit of patients by doctors and surgeons, reducing surgery cancellations, increasing number of patients, reducing deductions applied by the health insurance companies and training staff and patients.
Conclusion: Implementing an appropriate quality management model appropriately helps improve quality of services and enhance hospital departments’ income.
Ali Mohammad Mosadeghrad , Negar Mirzaee , Mahnaz Afshari , Alireza Darrudi ,
Volume 76, Issue 4 (July 2018)
Abstract
Background: Tariff setting in healthcare is an important control knob affecting the quality, access and cost of services. As part of Iran Health Transformation Plan (HTP) in 2014, the relative value of health care and services was increased to motivate healthcare providers to deliver high quality services. This study aimed to examine the impact of HTP on health services tariffs.
Methods: This descriptive and cross-sectional study used the data from California Tariff Book (2013 edition) and the new relative value book (2016 edition). The weighted average of the relative value of the anesthetic and surgical services in both books was calculated and compared.
Results: The California book and the new relative value book had 5281 and 3448 service codes respectively in 13 major medical specialties (34.7 percent reduction of service codes in the new tariff book). Overall, 64985.9 K and 125133.6 K were considered in the California book and the new relative value book (92.6% growth). The California book and the new relative value book considered 25,976 K and 22,307 K for anesthesia services, respectively in those 13 medical specialties (14.1% reduction). The HTP has increased the relative value of healthcare services tariff by 1.9 times in average.
Conclusion: The HTP has doubled the tariff of healthcare services. A rise in the relative value of healthcare services has incurred financial burden on Iranian public health insurance companies and made it difficult to finance health system of the country. A sustainable health financing system should be developed as well a change should be applied in provider payment system to control the cost and increase the health system efficiency.
Gholamreza Amin, Aram Mousavi Pharm , Shohreh Vosough , Zahra Jafary Azar , Mamak Shariat , Fedyeh Haghollahi , Shima Afshar ,
Volume 76, Issue 6 (September 2018)
Abstract
Background: Menopause is a critical and sensitive period and has a common symptom of vasomotor signs, psychologic changes and sleep disorders. With regarding the citalopram complications and effects of Iranian herbs, the aim of this study was to compared the therapeutic effect of the combination of area part of Melissa officinalis and fennel fruits extract with Nigella sativa powder with citalopram on menopausal symptoms of post-menopausal women.
Methods: This randomized clinical trial was conducted in Islamic Azad University of Pharmaceutical Sciences, Tehran, Iran, from April 2015 to October 2017. 56 postmenopausal women referred to the clinics of Gorgan health centers with the age between 45 and 65 years, natural menopause confirmed by amenorrhea for at least 12 months, discomfort a hot flash were randomized to two treatment groups. Group 1 (28 patients) received 1000 mg (Melissa officinalis extract, Nigella saliva powder, and fennel fruits) and Group 2 (19 subjects) received 20 mg citalopram in an eight-week course of treatment (1 per day for each group). The frequency of the variables in the Menopause-Specific Quality of Life Questionnaire (MENQOL) was compared in the two groups before and post intervention. The questionnaire included of twenty-nine questions in four domains of vasomotor, psycho-social, physical and sexual symptoms.
Results: The mean age in the herbal treatment group was 47.78±5.5 years and in the citalopram group was 46.4±4.9 years, and t-test did not show this difference in two groups (P=0.362). There was no significant difference in the improvement of menopausal symptoms compared to the citalopram group in the combined product group, but the feeling of anger and fatigue in the citalopram group was greater after treatment (P=0.03).
Conclusion: The present study showed that the combination of Nigella Sativa, Melissa officinalis extract, and fennel fruits generally do not reduce menopausal symptoms in postmenopausal women, and it's just the feeling of anger and fatigue has been better than the citalopram group.
Babak Mansour Afshar , Mohammad Reza Gheini, Tayeb Ramim ,
Volume 76, Issue 12 (March 2019)
Abstract
Background: Asymptomatic hemorrhagic transformation infarct (AHTI) is known as a complication of ischemic attack and maybe occurs in the entire stroke. However, the role of AHTI in the result of the treatment is still not clear, because it is based on the definition of an asymptomatic and not identifiable. The aim of this study was assessment and evaluation frequency of AHTI in acute ischemic stroke patients.
Methods: This prospective cross-sectional study was done in Neurologic Department, Tehran University of Medical Sciences, Tehran, Iran, from April 2015 to April 2016. Second evaluation was done about new neurologic signs and symptoms ten days after stroke. In addition, brain CT scan was used to diagnose of hemorrhagic event in infarct area. If the hemorrhagic event was occur in different area, the patient was consider as a non-hemorrhagic transformation and excluded from the study. Other exclusion criteria include intracranial hemorrhage (ICH), trauma to the head during admission, cerebral vein thrombosis, coagulation disorder, anti-coagulant (heparin, warfarin) administration, induced transformation within 10 days of onset of ischemia, lacunar ischemic and unobservable in thirty T-brain scan, patient's lack of referral for examination and CT scan 10 days after the onset of symptoms, died before CT was considered.
Results: Three hundred and eighty seven patients had inclusion criteria. 249 cases were excluded due to lost following, vein thrombosis of the brain, lacunar ischemia, anti-coagulants recipient (heparin, warfarin), asymptomatic hemorrhagic transformation and death. Finally, 138 cases (86 men, 52 women) with 66.61±9.37 years (50-101 years) were participated in data analysis. Frequency of positive CT scan was evaluated for ischemic stroke evidence in two stages. Of the 138 patients who participated in the study, 75 (54.3%) were positive in the first and 63 (45.7%) cases in the second time. 27 cases (19.6%) had AHTI.
Conclusion: Coronary artery bypass graft (CABG) had significant correlation with ATHI in acute ischemic attack. However, stroke history correlated with decreasing of ATHI. Concerning smoking and consuming the results showed that smoking did not affect the asymptomatic hemorrhagic transformation. Also, the results showed that the use of aspirin and Plavix also had no significant effect on increasing the incidence of ATHI.
