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Volume 60, Issue 4 (7-2002)
Introduction: The bone mass density (BMD) may vary in different countries due to different genetic and environmental factors. This study was performed to determine the BMD of the normal population in Iran.
Methods and Materials: Subjects were selected randomly from different works and social classes in Tehran (from the lowest to the highest). For each decade and sexes, 20 normal subjects were selected (140 men and 140 women). BMD was measured with a Hologic 1000 plus machine by dual energy x-ray absorptiometry (DEXA) method for the lumber spine (L1, L2, L3, L4, L1-L4) and the femoral neck (neck, trochanter, intertrochanter, ward, total). Data were treated by polynomial approximation (3 rd degree). The obtained curves were compared with the standard Hologic curves for Caucasians.
Results: In female the peak bone mass (PBM) was 1.019 g/cm² for the lumbar spine and 0.832 for the femoral neck. In male the peak bone mass (PBM) was 0.987 g/cm² for the lumbar spine and 0.907 for the femoral neck. The BMD of both lumbar spine and femoral neck were lower than the Hologic standards. For the lumbar spine the mean difference was 6.5 percent (2 to 21 percent, CI=1) for women and 13.8 percent (2 to 36 percent, CI=1.45) for men. In femoral neck the mean difference was 5.4 percent (2 to 16 percent, CI=0.96) for women and 4.6 percent (1 to 14 percent, CI=0.96) for men.
Conclusion: The BMD of the lumbar spine and the femoral neck was lower in Iranian compared to the Hologic standards for Caucasians. This was seen in all age groups and in both sexes. It was less pronounced for the PBM in spine was lower in men than woman. The lower BMD of the spine in men was also seen in a cohort of patients with different diseases (inflammatory and non-inflammatory).
Volume 61, Issue 2 (5-2003)
Opioids are increasingly being recognized as the primary treatment for cancer pain management. Optimal treatment of cancer pain involves assessing its characteristics, considering different management strategies, evaluating side effects and adverse drug reactions and establishing the most appropriate therapeutic regimen. This study was designed to review the current status of pain management for advanced cancer cases using opioid analgesics.
Materials and Methods: A questionnaire was used to collect data on demographics, disease characteristics, and opioids use indicators in 700 cases of advanced cancer patients.
Results: A total of 700 cancer cases, 42 percent females and 58 percent males, between 17-80 years age range (Mean age of 57.25) were studied retrospectively. Cancers of breast (21 percent), colorectal (12 percent), lung (7 percent), stomach (7 percent) and bone either primary or metastatic (6 percent ) in women and stomach (17 percent), lung (12 percent), colorectal (11 percent), prostate (9 percent ), and bone (8 percent ) in men were the most common causes of opioids prescription in study group respectively. Advanced primary cancer (in 52 percent), bone metastasis (in 32 percent), and treatment complications (in 7 percent ) were considered as physical basis for pain in patients. Morphine (by injection), Opium (by oral intake) and methadone (injection and/or oral) were the most common opioids prescribed. Using equianalgesic conversion chart, the daily dosages and therapeutics schedules of morphine administration were as follows:
43 percent received 21-30 mg. in 2-4 divided doses
27 percent received >30 mg. in 3-5 divided doses
21 percent received 11-20 mg. in 2-3 divided doses
9 percent received 5-10 mg. in 1-2 divided doses
Conclusion: Pain management of cancer patients is not adequate and opioid use is not rational. New educational and managerial strategies are needed to optimize cancer pain treatment in routine medical practice. To overcome current barriers, WHO stepwise model for cancer pain control and palliative care is recommended. Publishing Standard Treatment Guidelines for different levels of health care system is another recommended approach to optimize cancer pain.
Volume 67, Issue 7 (10-2009)
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Background: Standard thoracotomy necessitates division of
thoracic large muscles leading to pain and impaired respiratory movements
muscle sparing postero-lateral thoracotomy has been suggested as an alternative
to reduce the aforementioned effect. The aim of this study was to compare
muscle saving posterolateral thoracotomy with standard thoracotomy.
Methods: This study was a clinical
trial. All patients who were candidates for elective thoracotomy were included
and divided into two groups of muscle saving thoracotomy and standard
thoracotomy randomly. Required time for opening and closing the chest, amount
of prescribed narcotics, shoulder movements (flexion, extension, abduction and
internal rotation), pulmonary function (FVC, FEV1, VC), development of seroma, and
duration of hospitalization were assessed. Shoulder movements and pulmonary
function were measured immediately before operation and 7 days later while pain
measured in 1st and 7th post-operative days.
Results: 60 patients (42 males) entered the study and
there were no significant differences regarding age and sex distribution
between two groups (p>0.05). Mean
duration of opening the chest in muscle saving thoracotomy was significantly
longer than standard procedure while the duration of closing the chest wall was
significantly shorter in muscle saving thoracotomy (p<0.05). FVC and range of motion of the
shoulder were higher and post-operative pain was lesser in muscle saving
thoraocotomy than standard thoracotomy (p<0.05). There were no significant differences regarding
prescribed narcotics and duration of hospital stay (p>0.05). Seroma developed in 13% (n=4) of muscle saving group.
Conclusion: Muscle saving thoracotomy can be used as an
appropriate alternative for standard postero-lateral thoracotomy in elective
thoracic operations.
Volume 70, Issue 7 (10-2012)
Background: The aim of this study was to provide a valid Persian version of the Ages and Stages Questionnaires, in order to compensate the lack of developmental screening tools in Iran.
Methods: Forward and backward translation, face and content validity determination, and cultural and linguistic adaptation of the questionnaires were performed, consecutively. Next, a pilot study was carried out on 100 Iranian parents of 4- to 60-month-old children, recruited by consecutive sampling in Tehran, Iran during the year 2006 to determine the degree of clarity for each item and explore cultural adaptations. In order to determine inter-rater reliability, we had parents of 38 children complete the questionnaires. For determining the psychometric properties of the tests, we later recruited a representative sample of 555, 4- to 6-year-old children by consecutive sampling from health care centers in five main geographical areas in Tehran.
Results: Performing cultural and lingual adaptations, our expert team made some inevitable changes to the questionnaires. Almost in all age groups older than 10 months, cultural or linguistic changes were made in items in the “communication” domain. Overall, the questionnaires’ Cronbach alpha was 0.79. The constructive validity of the tests was also satisfactory. Another important finding was determination of the children’s developmental mean scores.
Conclusion: The culturally adapted Persian copies of the Ages and Stages Questionnai-res have proper validity and reliability for being used as developmental screening tools for children in Tehran.
Volume 74, Issue 10 (1-2017)
Background: There is no need to explain the importance of collection, recording and analyzing the information of disease in any health organization. In this regard, systematic design of standard data sets can be helpful to record uniform and consistent information. It can create interoperability between health care systems. The main purpose of this study was design the core dataset to record colorectal cancer information in Iran.
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Methods: For the design of the colorectal cancer core data set, a combination of literature review and expert consensus were used. In the first phase, the draft of the data set was designed based on colorectal cancer literature review and comparative studies. Then, in the second phase, this data set was evaluated by experts from different discipline such as medical informatics, oncology and surgery. Their comments and opinion were taken. In the third phase refined data set, was evaluated again by experts and eventually data set was proposed. Results: In first phase, based on the literature review, a draft set of 85 data elements was designed. In the second phase this data set was evaluated by experts and supplementary information was offered by professionals in subgroups especially in treatment part. In this phase the number of elements totally were arrived to 93 numbers. In the third phase, evaluation was conducted by experts and finally this dataset was designed in five main parts including: demographic information, diagnostic information, treatment information, clinical status assessment information, and clinical trial information. Conclusion: In this study the comprehensive core data set of colorectal cancer was designed. This dataset in the field of collecting colorectal cancer information can be useful through facilitating exchange of health information. Designing such data set for similar disease can help providers to collect standard data from patients and can accelerate retrieval from storage systems. |
Volume 75, Issue 4 (7-2017)
Methods: This descriptive, applied and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire. The study population consisted of 914 hospital managers. Overall 547 hospital managers were surveyed through stratified random sampling. SPSS software was used for data analysis.
| Results: Almost 71.7 percent of hospitals achieved grade one and above in the first round of national accreditation survey. The mean score of managers’ satisfaction of hospital accreditation method was 3.21±0.63 out of 5 (Average). About 38 percent of hospital managers were satisfied with the hospital accreditation method. Most complaints were related to lack of reliability among surveyors and their low knowledge, skills and experience. Hospital managers were satisfied with surveyors’ attitude and adequacy of the number of survey days. Hospital managers mostly believed that accreditation is better to be done by Ministry of Health, compulsory, and every two years. About 95 percent of hospital managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey. Conclusion: Hospital managers were moderately satisfied with the national accreditation system. Developing job description and person specification for accreditation surveyors and recruiting them accordingly, and providing professional education and training for them help improve the effectiveness of Iranian hospital accreditation method. The method of hospital accreditation in Iran has to be changed. Self-assessment, unannounced surveys, review of hospital key performance indicators and patient satisfaction surveys should be added to the current scheduled on-site surveys to enhance the credibility of the accreditation result. |
Volume 75, Issue 6 (9-2017)
Methods: This is a retrospective study which is about all of the deceased individuals in Tajrish and Modares Tehran hospitals from april 2013 until the march 2014 who had death certificates. In this study the data related to 777 individual’s death certificates and medical files was analyzed. The sampling method was census and all the cases in the study’s time period who had death certificates were studied. The cases that had a gap in their required information were ruled out of the study. The data that included age, sex, place of death, issuing doctor’s expertise, general information and the cause of death was extracted from the archived files.
| Results: The cases studied, 421 people died in Tajrish Hospital and 356 in Modarres Hospital. The highest number of deaths in both hospitals were in the internal wards (336 cases) and surgery (168 people). 45.6% of death certificates have been issued by a forensic expert. 64.8% cases correctly inserted ICD-10 code. Conclusion: Training of physicians for the importance of death certificate and how it should be completed is very important. This research showed that in the cases which the death certificates were completed by the hospital forensic medicine specialists were more useful and accurate. |
Volume 76, Issue 11 (2-2019)
Volume 76, Issue 12 (3-2019)
Methods: This descriptive and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire designed to examine accreditation effects on hospital performance, hospital employees, patients, and the society. The study population consisted of 914 hospital managers in Iran. Overall, 547 hospital managers were surveyed through stratified random sampling.
Results: About 71% of hospitals achieved grade one and above accreditation status. The mean score of accreditation positive effects in hospitals was 3.16±0.66 out of 5 (Average). Almost 38% of managers were satisfied with the accreditation results in their hospitals. Hospital accreditation program was successful in improving patient and staff safety, reducing medical errors and enhancing staff competencies. Its success in improving communication, promoting organizational culture, continuous quality improvement, resource utilization, and reducing nosocomial infections and hospital mortality rates was moderate. Accreditation was less successful in improving staff satisfaction, getting physicians involved in process improvement, practicing evidence based medicine, attracting patients and increasing hospital income. A statistically significant correlation was found between hospital size and accreditation results (P=0.038, r=-0.090). There was no correlation between using quality management models and getting better accreditation results (P=0.085). However, there was correlation between using accreditation consultants and positive accreditation results (P=0.045, r=-0.087). Utilizing hospital resources, organizational learning, continuous quality improvement and effective communication had the most effect on accreditation success.
Conclusion: The accreditation program had a moderate effect on hospital performance. It is costly to implement accreditation standards in hospitals. Hence, changes should be made to the accreditation system including accreditation standards and methods in order to have more positive effects on the staff and hospitals’ performance.
Volume 77, Issue 1 (4-2019)
Methods: A mixed method approach was used for such a descriptive and cross-sectional study. First, using a comparative study, accreditation standards and measurement criteria of children friendly hospitals were extracted from 10 well-known hospital evaluation and accreditation models and initiatives. Second, complementary interviews with 57 hospitals senior, middle and front line managers and pediatrics doctors and nurses were conducted to identify more children friendly hospital accreditation standards and measurement criteria. Third, children friendly hospital accreditation standards and criteria were modified considering the Iranian context. Finally, five pediatrics doctors reviewed, modified, finalized and confirmed accreditation standards and criteria.
Results: The Iranian framework for accreditation of children-friendly hospitals was consisted of ten standards covering management and leadership, planning and policy making, education, patient management, employee management, resource management, process management, patients’, employees’ and organization results and 132 measuring criteria. Such a systemic framework covers pediatrics hospitals’ structures, processes, outputs and outcomes. A children friendly hospital achieves better results for employees and patients through strong management and leadership, proper planning and policy making, continuous education and training staff and patients and effective management of employees, patients, resources and processes.
Conclusion: The proposed children-friendly hospitals accreditation model can be used for evaluation and accreditation of children hospitals and provide a clear picture of the performance of these hospitals.
Volume 79, Issue 7 (10-2021)
Methods: This comparative study was conducted between April and September 2016. Hospital disaster risk management accreditation standards were extracted from the hospital accreditation standards of 11 countries including the United States, Canada, Australia, Malaysia, India, Thailand, Egypt, Turkey, Saudi Arabia, Denmark and Iran. Overall, 27 hospital disaster risk management accreditation standards were introduced. The opinions of 22 disaster risk management experts were used to assess the content validity of the proposed disaster risk management accreditation standards.
Results: Differences were observed in the quality and quantity of those countries’ disaster risk management standards. The national accreditation standards of the United States, Australia, and Canada had comprehensive standards and covered all aspects of the disaster risk management cycle. Finally, 27 standards were proposed for developing Iranian hospitals’ disaster risk management accreditation standards. The CVI & CVR validity of the proposed standards were acceptable.
There were significant differences in the quantity and quality of hospital disaster risk management accreditation standards in selected countries. The most comprehensive standards belonged to the US National Standards (12 standards and 113 sub-standards), followed by the Australian and Canadian accreditation standards. The accreditation standards of the developing countries and Iran were not comprehensive and did not meet the international goals of disaster risk management. The proposed hospital disaster risk management accreditation standards had high content validity.
Conclusion: Disaster risk management accreditation standards in Iran and developing countries need to be revised and upgraded. Comprehensive standards based on international experiences and expert opinions were introduced in this study that can be used to develop hospital accreditation standards in Iran and other countries.
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