Changes in clinical signs after treatment in calves with experimental colisepticemia with Escherichia coli

Background: Colisepticemia is an acute fatal disease in farm animal neonates. Clinical finding of septicemia is non-specific and cannot be differentiated from signs of non-infectious disease or disease with local infection such as diarrhea

Objectives: Evaluation of clinical signs variations in calves with experimental septicemia with Escherichia coli 01 11 :H8

Methods: Colisepticemia was experimentally induced in ten Holstein bull calves after an adaptation period. Vital signs and 7 clinical criteria were recorded from 24 h before septicemia until 48 h after that. Blood culture was performed and treatment was done based on antibiogram from 24 h after challenge

Results: Changes of suckling reflex and shock were not significant. Changes of appetite, dehydration, behavior, standing ability, total score from 24 h before the challenge to 24 h after treatment were significant [p=0.00l]. Fecal consistency altered with treatment [p<0.04]. Heart rate [p=0.04 and p=0.033, respectively], respiratory rate [p=0.009 and p=0.001, respectively] and body temperature [p0.00l and p=0.004, respectively] have significant changes till 24 h after challenge and till 24 h after starting treatment. Blood cultures were positive except for 0 h and 48 h after challenge

Conclusions: The present study indicated clinical signs changed unfavorably following septicemia that were dissolved approximately during 24 h, depending on treatment in appropriate time and drug choice. Thus, a targeted scoring system will be useful in clinical evaluation of septicemia, quantifying the changes procedure and treatment efficacy

Quality dimensions of educational morning report sessions

Morning report sessions had long-standing history in medical education. Morning report management is an important aspect of professional medical education. To evaluate the contents of the morning report sessions, including management, staff training, deep learning, attention to learners at different level of education, record keeping, feedback, and final summarizing, direct observation of 73 sessions was conducted in five teaching hospitals in a medical university in Tehran. The following scores were obtained: morning report management [91%], training faculty members [9%], residents' training [4%], direct learning by patient management instead of memorizing study material [88%], paying attention to the different educational levels of learners [28%], record keeping [36%], systematic feedback [48%], and a final summarizing session [26%]. Out of eight, five dimensions related to teaching in the morning report sessions need improvisation, specifically on the training of faculty members and residents, paying attention to different educational levels of learners, brief summary of all sessions, and record keeping

[Determining the efficiency of social security hospitals of Tehran based on Pabon Lasso Model]

Introduction: hospitals are the centers consuming most of the resources in the health sector. Determining the efficiency of hospitals is very beneficial when resources are limited. To determine efficiency of an organization, several indicators are used for comparison. Pabon Lasso Graph is one of the techniques that simultaneously compares these indicators. The main purpose of this study was to determine the efficiency of social security hospitals of Tehran based on Pabon Lasso Model in 2011

Methods: this descriptive cross-sectional study was carried out in seven hospitals under the direct supervision of social security in Tehran in 2011

Results: in this study, the average bed occupancy rate, average length of stay and bed turnover rate in hospitals were 77/75%, 4/03 days, and 82/29 per year, respectively. The results showed two hospitals were in zone I, a hospital in zone II, a hospital in zone III and three hospitals were located in zone IV. And only one hospital was efficient

Conclusion: the findings showed that only one hospital [14/2%] from seven hospitals appeared to be efficient. Hospital manager should take into consideration the hospitals that were inefficient

[ role of health technology assessment in evidence- based decision making and health policy: a review study]

Introduction: The purpose of this study was to show the major challenges and opportunities related to Health Technology Assessment [HTA] that most countries have faced with when launching and developing an HTA system for making appropriate decisions in policy making

Review of studies: This was a review study in the field of HTA and health policy. All literature potentially relevant to this issue had been studied via library and the Internet search of data bases related to HTA to select and present materials extracted. The search was focused on English papers published in 1980-2014.The impact of HTA depends in large part on the quality and transparency of the assessment and decision-making processes, as well as institutional, organizational, political and cultural dynamics broader than the scopes of national health care systems. As many countries increasingly gear their health systems towards policies emphasizing measurement, accountability, transparency and evidence-based practices, the challenges of HTA should be addressed in order to achieve concurrent health care system goals, and support those services offering large value of money and impact on health care outcomes

Conclusion: The role of HTA offering extensive opportunities to support governments and other stakeholders in decision-making has grown substantially. Countries should, therefore, seek to capitalize on the strengths of established HTA systems, while pioneering solutions to address major challenges and strengthening the HTA enterprise

[Quality of working life and its relation with productivity of nurses' performance in Shahid Beheshti University of Medical Sciences hospitals]

The quality of working life is a very important variable in connection with human resources. Therefore, it should be taken into consideration by managers if they aim to improve the capabilities and efficiency of their staff, which will, in turn, lead to improved productivity and economic growth. Productivity is an important factor in the success of hospital nurses too. The objective of this study was to determine the association between the quality of working life and productivity of nurses. Knowledge of this relationship can help plan to improve the nurses' quality of working life and, subsequently, improve their productivity and, ultimately, productivity of a hospital. This was a cross-sectional correlation study conducted in 2011. The study population was nurses of the Shahid-Beheshti University of Medical Sciences hospitals in Tehran, Iran. Using the randomized stratified multistage sampling method, 380 nurses were selected as the study sample. Data on the nurses' quality of working life and productivity were collected using two questionnaires and analyzed using SPSS-17, the statistical tests being Chi-2, ANOVA, T-test, and the Pearson correlation test. The findings showed that nurses' quality of work life and productivity were at the middle level, with a mean of 2.47 and 3.07, respectively. A very small number [1.55%] of the nurses reported that their quality of work life was at a high level, while the majority [82.4%] believed their quality of work life to be at a moderate level. The Pearson correlation test showed a significant positive relationship between the quality of work life and productivity of the nurses [r = 0.66, p-value = 0.001]. Only a low proportion of the nurses report their quality of working life and productivity to be at a high level. Therefore, bearing in mind that a statistically significant relationship exists between the quality of working life and productivity, authorities should a tempt to promote the nurses' quality of work life in order to increase their productivity

[Effect of two educational models based on compliance and empowerment on the quality of life of patients with asthma]

Quality of life of patients with asthma is affected by many factors including the lack of knowledge about the disease. Different training methods with different outcomes have been applied to improve the quality of life of these patients. The aim of this study was to design to investigate and compare the effect of two educational models based on compliance and empowerment on the quality of life of patients with asthma. In this s quasi-experimental study, the effect of two educational models on quality of life of 70 patients with asthma was assessed. The samples were randomly assigned into two groups. The training was based on the compliance model [CM] and patient empowerment model [PEM] in each group. Both groups completed the asthma quality of life questionnaire before the intervention and eight weeks after it. Data were analyzed using descriptive and inferential statistics. The mean age of the patients was 47.6 years in the CM group and 44.5 years in PEM group. The mean scores for overall and dimensions of quality of life and self management knowledge were not significantly different between the groups before and after the intervention [P>0.05]. Significant increase in the mean scores of overall and dimensions of quality of life and self management knowledge after the intervention in comparison with the scores before the intervention in both groups was reported [P<0.05]. Both training methods improved quality of life patients with asthma. The role of education in order to improve the quality of life for patients with asthma should be considered by health care team members especially nurses

Ovarian cancer incidence in Iran and the world

Introduction: Ovarian cancer ranks the 8th cancer causing death in the world. This study aims to compare incidence rate of ovarian cancer in Iran with other countries

Patients and methods: Data from International Agency for Research on Cancer's GLOBOCAN 2008 database is used to compare ovarian cancer age standard incidence rate from different parts of the globe considering the developing and developed regions

Results: Iran is among countries with low incidence of ovarian cancer and an age standard incidence rate of 3.07 in 2005 and 3.1 in 2008

Conclusion: Ovarian cancer is the most common gynecologic cancer in Iran. Various risk and protective factors of ovarian cancer might be clarified in Iran in order to prevent increasing incidence of this cancer in the future. At the present this disease is significant considering its disease burden

[Determination of radiology services cost in selected hospitals affiliated with Tehran university of medical sciences in 2010-2011, using the activity based costing method]

Regarding to the escalating costs of health care and limited resources in this field, the appropriate identification and control of costs is inevitable. This Study aimed to determine the unit cost of radiology services, in selected hospitals of TUMS. This was a descriptive retrospective study. At first, we selected two hospitals [Shariati and Sina] out of general - teaching hospitals of TUMS randomly. After gathering data, using activity based costing method, the unit costs of radiography services in these centers in 1389 fiscal year [2010-2011] were calculated. The unit costs of radiography services in Shariati and Sina hospitals were 251255,5 and 334996,2 respectively. Building rent and human resources costs included the most share of total costs. The unit cost of radiography services in this study is very different comparing with other studies. Calculated building rent costs in this study could be one of the possible reasons of this difference [other studies did not consider this costs]. The other point is that, regarding the high share of human resources and building costs from total costs, special attention to these sources of costs and appropriate and adequate use of them, can be an important step toward improving the efficiency and cost savings in our national health system

[Survey of psychosocial problems in thalassemic children and their siblings]

Introduction: Beta-thalessemia is a chronic disease that can cause psychosocial problems in patients and their sibling. The purpose of this study was to determine psychosocial problems of thalassemic children and their sibling and compare them with control group

Methods: This is a discriptive commparative study that conducted by structrual interview and PSC check list. The sample size was 572 children that 167 of them were thalassemic children between 4 to 16 years Old, and 166 of their sibling without chronic diseases in same age group and 239 of healthy children in similar age as compare group. The collected data were analysized with descreptive and analytic Ststistics by X[2], ANOVA and t-test

Results: Among all children, 20.4% of thalassemic, 12% of their healthy sibling and 7.9% of healthy children had psychosocial problems and these difference were significant

Conclusion: Whether thalassemic children have psychosocial problems their sibling who live with them have more psychosocial problems than healthy children So due to this finding it is better in care plans to pay special attention to the sibling of thalesmic patients

psychometric properties of the Farsi version of "hospital survey on patient safety culture" In Iran's hospitals

If you want to start a long journey towards patient safety, you should create a good culture of patient safety among employees alongside structural interventions. The first step in doing so is the assessment of current culture in the organization using different tools. One of the most commonly used instruments of measuring patient safety culture is Hospital Survey of Patient Safety culture [HSOPS]. The aim of this study was to assess the validity and reliability of Farsi version of this questionnaire for the first time in Iran's hospitals. We purposefully selected four hospitals out of seven general Tehran University of Medical Sciences affiliated hospitals. Then a 420 sample of staff of these hospitals were taken randomly. Staff was asked to complete the questionnaire. Confirmative factor analysis, correlation coefficient, Cronbach's alpha were employed in statistical analyses. Factor loadings for almost all questions were acceptable. Factors jointly explained 77.8% of the variance in the responses. The Cronbach's alpha coefficient was between 0.57 and 0.8. The study revealed that over 70% of employees were working at their hospitals more than 40 hours a week and also more than half of the employees were not reporting errors. Farsi version of HSOPS with 12 dimensions and 42 questions is a valid and reliable questionnaire to measure patient safety culture for the first time in Iran hospitals. This tool will be helpful in tracking improvements and in heightening awareness on patient safety culture in Iran

[Job burnout and some of its risk factors on the health workers (Behvarz) in Koohrang County, I.R.Iran, in 2010]

Emotional exhaustion, depersonalization and lack of personal accomplishment are three dimensions of job burnout. Symptoms occur when employees' abilities and skills are not match with job demands. In a health care organization, staffs are exposed to physical, mental and emotional stresses and predisposed to job burnout. In this survey we studied Job burnout and some of its risk factors among Koohrang county Rural Health Workers [RHW or Behvarz] in 2010. This descriptive-analytical study designed to assess job burnout dimensions in RHW of Koohrang county in 2010. Total koohrang county RHW [n=81] entered to the study. Two types of questionnaires were used for data collection: 1] Demographic data questionnaire include of age, sex, marriage status, level of education, type of employment and working years. 2] Maslach Burnout Inventory [MBI] as a common valid questionnaire for assessment of job burnout. The reliability and internal validity of MBI questionnaire had been proved in previous studies. Data were analyzed by SPSS using ANOVA, spearman correlation and simple t tests. In different dimensions of job burnout, frequency of high lack of accomplishment, high emotional exhaustion and high depersonalization were 24.5%, 4.6% and 2.7% respectively but severity of emotional exhaustion and depersonalization were 6.7% and 1.3%. None of them reported severe lack of personal accomplishment. The relation between demographic factors and job burnout was not statistically significant [P>0.05]. There were significant correlation between emotional exhaustion and depersonalization and between personal accomplishment and emotional exhaustion [P<0.001]. The study shows that frequency and severity of job burnout in different dimensions are low. It could be explained by their appropriate socioeconomic status, short distance to workplace as one of its advantages, job security, low level of life expectations accompanying with nice climate

[Comparison of chest pain and clinical presentation of acute coronary syndrome in men and women admission on coronary care unit]

Acute coronary syndrome is a collection of symptoms that could be different in female and male due to their differences in the physical or psychological and cultural differences subjects. This study was aimed to compare the clinical symptoms of chest pain and acute coronary syndrome in women and men hospitalized in the intensive coronary care units. In this cross sectional study the pain characteristics and clinical symptoms of acute coronary syndrome of admitted patients to the coronary intensive care units were compared. We helped as the questionnaire and McGill Pain Scale as studied research instrument. Data was analyzed by SPSS software with Chi-square test, t test and calculation the odds ratios and confidence intervals. The pain by women has more chance to occur in the other places other than chest. Being a woman enhances the chance of experiencing the heart palpitations, anorexia, nausea, indigestion, shortness of breath and sweating would whereas men were more likely to feel vomiting. Bloating, hiccup, fainting, dizziness and anxiety were similar in both sexes. Women have showed the different symptoms than men, so more attention to women's health is important dealing with these symptoms

effect of service quality on patient loyalty: a study of private hospitals in Tehran, Iran

Service quality is perceived as an important factor for developing patient's loyalty. The aim of this study was to determine the hospital service quality from the patients' viewpoints and the relative importance of quality dimensions in predicting the patient's loyalty. A cross-sectional study was conducted in 2010.The study sample was composed of 943 patients selected from eight private general hospitals in Tehran. The survey instrument was a questionnaire included 24 items about the service quality and 3 items about the patient's loyalty. Exploratory factor analysis was employed to extracting the dimensions of service quality. Also, regression analysis was performed to determining the relative importance of the service quality dimensions in predicting the patient's loyalty. The mean score of service quality and patient's loyalty was 3.99 and 4.16 out of 5, respectively. About 29% of the loyalty variance was explained by the service quality dimensions. Four quality dimensions [Costing, Process Quality, Interaction Quality and Environment Quality] were found to be key determinants of the patient's loyalty in the private hospitals of Tehran. The patients' experience in relation to the private hospitals' services has strong impact on the outcome variables like willingness to return to the same hospital and reuse its services or recommend them to others. The relationship between the service quality and patient's loyalty proves the strategic importance of improving the service quality for dragging and retaining patients and expanding the market share

Quality of working life on residents working in hospitals

Residents play an important role in the delivery of hospital care. They regularly work overnight, in emergency situations and with workload and stress which can affect their performance and quality of working life [QWL]. This study explores the QWL and its contributory factors in residents working at hospitals affiliated with Tehran University of Medical Sciences [TUMS], Tehran, Iran. Medline was searched to identify questionnaires for measuring QWL in healthcare professionals and these questionnaires were used to design a comprehensive questionnaire for measuring residents QWL. Face and content validity of the questionnaire were examined by 7 experts. The questionnaire then was completed twice with one-week interval by 14 residents to assess the intera-rater reliability. Then 310 questionnaires were distributed among residents working at different specialties in 7 hospitals affiliated to TUMS including a large general hospital, two medium general hospitals and four small single specialty hospitals. Statistical analyses were performed by SPSS. Totally, 263 residents [84%] completed the questionnaire. The quality of working life was very well in 18%, well in 32%, moderate in 31%, low in 14% and very low in 5% of residents. Pediatric residents had the highest and urology and internal medicine residents had the lowest quality of working life. The QWL is high in the majority of residents, but the QWL is still not desirable in a significant proportion of them. The questionnaire used in this study is reliable and valid. The residents' QWL still need improvement

[Inpatient perceptions of participating in cure decision making and safety among public hospitals of Tehran medical sciences university]

Focusing on making opportunities to participate of patients in all levels of health care system is important in order to develop of system capability that could make improving of patients' safety and quality of care services. The aim of this study was to determine inpatient perceptions in general hospitals of Tehran medical university regarding patient participate in treatment decisions and safety. This was a cross-sectional study in 1390. First, the list of eight general hospitals affiliated to Tehran University of medical sciences and all clinical wards were obtained through the university website. Then, stratified random sampling method applied to collect 300 patients as a sample size. Data were collected by using a structured questionnaire that validity and reliability were accepted. Descriptive statistical methods, linear regression and multivariate logistic regression were applied to analyze. From total of 300 patients, 60% of them were female. The level of participating by patients in cure decision making were at high level [59.7%] and 27% in low level. The range of patients' safety was at high [60%] and low [26%]. The level of participate in decision making of cure process had high rate among young people and employed participants. The patients who were unmarried, educated, and employed had lower score in patients' safety. The participants' perception had no effect on the patients' safety perceptions. The symptoms that might be interpreted as an abnormal could be interpreted in different ways by the others. These unusual could come from dissimilarities in demographic features

[Validation of Farsi version of hospital survey on patient safety culture questionnaire, using confirmatory factor analysis method]

Patient safety is one of the most important components of health care quality. Given that assessing the current culture of patient safety is the first step in improving patient safety, we decided to translate and validate one of the most used patient safety culture assessment tool [HSOPS questionnaire] for the first time in Iran, and in this way take a step toward improving patient safety in our hospitals. This cross sectional study was done among four general hospitals of Tehran University of Medical Sciences [TUMS], which were selected purposefully. Questionnaires randomly distributed among 420 members of the study population, and were collected after completion. were analyzed using Confirmatory Factor Analysis [CFA], internal Consistency and correlation. The value of Fitness function [FF] was 14.25 and according to that, the value of Goodness of Fit Index [GFI] was 0.96. Almost in all of the dimensions, the internal consistency of items in the translated Persian questionnaire was lower than the original one and ranged between 0.57 to 0.8. Regarding to the findings of this study the Persian translation of the HSOPS questionnaire is a valid tool for the assessment of patient safety culture in Iran's hospitals

Assessing health system responsiveness: a household survey in 17[th] district of Tehran

Responsiveness is an indicator by WHO to evaluate the performance of health systems on non-medical expectations of consumers. This study measures the health system responsiveness and the factors affecting responsiveness in Iran health system. World Health Survey [WHS] questionnaire was used to collect data on a two-stage cluster sampling in 17[th] District of Tehran in 2003. Of a sample of 773, 677 and 299 individuals who respectively had outpatient or inpatient services utilization responded to the responsiveness module of WHS questionnaire. More than 90% of respondents believed that responsiveness issues were very important. Performance of outpatient services was better than hospital services in terms of responsiveness. [Prompt attention] and [quality of basic amenities] received low score for outpatient services. Service user variables had no significant effect on responsiveness, while type of centers was significantly related to responsiveness. Principal component analysis found three factors for both outpatient and inpatient services that explained 62% and 61% of total variances respectfully. Iran health system should pay more attention to responding non-medical expectations of service users. It sounds that health system interventions are main determinant of responsiveness score compared to demographic or user variables. Training health staff, allocating more resources and reengineering some processes may play a role in improving responsiveness. Responsiveness domains seems to be tailored based on each society's cultural factors

Patients length of stay in women hospital and its associated clinical and non-clinical factors, Tehran, Iran

Length of Stay [LOS] is an appropriate hospital indicator to evaluate hospital resource utilization rate, efficiency, and quality of services delivered. In this survey, we aimed to study hospital LOS and determine its association with clinical and non-clinical factors in Women Hospital in Tehran. In this cross-sectional study, we reviewed all 3421 charts of patients admitted in Oncology, Surgery and Obstetrics units in 2008. We used a data collection sheet and conducted interviews to collect the following data: distance from living area, medical insurance coverage types, admission and discharge months, days and times, inpatient units, final diagnoses and the number of diagnostic tests. The overall median of the LOS in the studied hospital was 50.8 hours. The medians were 48.5, 54.4, and 94.2 hours in the Obstetrics, Surgical and Oncology units, respectively. Results showed that the associated factors with the LOS were patient admissions on Thursdays, admitting by residents, the number of performed diagnostic tests [p<0.001], suffering from neoplastic diseases [p=0.005] and spouse jobs. Among the associated factors, policy makers and managers can only change the admission days and the number of diagnostic tests to decrease the LOS. Further researches are needed to find other factors associated with LOS

[Comparison of the therapeutic effects of fluoxetine, citalopram, estrogen and progesterone and placebo in the treatment of hot flushes in perimenopausal women]

Frequency and morbidity of hot flushes has led to development of multiple hormonal and non hormonal treatments in the recent years. Fluoxetine and citalopram with limited side effects and high tolerability by most women with hot flushes have attracted the researchers' attention but there are plenty of rooms for disagreement on their effectiveness. In this study the effects of fluoxetine, citalopram, hormone therapy and placebo on perimenopausal flushes, were compared with one another. This study was a randomized clinical trial [RCT]. The study population included 46 to 55 year old women with hot flush who had lack of menstruation and reached menopause for at least 1 year. Sampling method was blocked randomization and the patients were divided into four groups including fluoxetine, citalopram, hormone therapy and placebo groups. The collected data were introduced into the SPSS software and analyzed by chi-square, ANOVA and Kruskal-Wallis tests. There were no significant differences between the groups in the mean duration of menopause, history of any chronic disease, drug use and frequency of hypertension before intervention [p<0.05]. But there was significant differences between the values of the mean age of the groups before intervention [P=0.03]. The mean frequency of hot flushes decreased by 57%, 74.7%, 81.8% and 80% after intervention in estrogen+progesterone, fluoxetine, citalopram and placebo groups respectively [P<0.001]. Considering the high rate of success of the treatment of the hot flushes with citalopram and fluoxetine and few side effects of these drugs, they can be regarded as good alternatives to hormone therapy and for thoese who are not willing to take estrogen