[Influential of Relationships between ISO 9001-2008 Quality management system and altering indictors of effectiveness in Rasht hospitals]

Introduction: increasing pressure to follow a vision on complete health care organizations, better quality and excellence selection systems has become one of the main concerns for organizations and their managers

Objective: the aim of this study is to determine the relationship between the level of ISO 9001- 2008 quality management system and altering indictors of quality effectiveness in Rasht Hospitals

Methods: this is a descriptive and correlational study which was performed in three ISO-certified hospitals. The degree of ISO implementation measured using the requirements of ISO 9001 standards through questionnaires. Data of quality effectiveness indictors were compared using dependent T-test before and after the implementation when determining the mean and coefficient of variation

Results: there was a significant relationship between some indicators of quality effectiveness such as patient satisfaction, number of inspected complaints and improved procedure within implementations of ISO quality system [p<0.05]. On the other hand there was no significant difference between the mean alteration of the average length of patient's hospitalization before and after the placement

Conclusion: create a systemic visualization of the powerful tool such as ISO quality management system and imperative practical performance system in one organization discriminant addition to correcting systems and improving staff performance, will improve some indicators of hospital

[Assessment of anesthesia-surgery risk management at hospitals of Isfahan university of medical sciences, using ECRI institute standards in 2011]

Introduction: Up to the present, the most complaints are about medical malpractice in anesthesia - surgery wards. To identify defects and promot patient safety, an efficient and effective system of risk management is necessary. The aim of this study is to determine anesthesia- surgery risk management and root cause analysis of events in Isfahan University of Medical Sciences hospitals

Methods: A standard structured checklist that has been developed by ECRI institute was applied. The checklists were filled onsite through direct observation and interviews with anesthesia and surgical personnel in 46 operating rooms at 4 hospitals. Data were analyzed by SPSS, Excel and Minitab software. Root causes of events were plotted using Fish Bone diagram

Results: Total means score of anesthesia- surgery risk management status was 2.13 on the scale of 3 which is at the intermediate level. There was a significant difference between the four hospitals. These hospitals only met 45% of the predetermined standards. The highest compliance with standards [69%] was for "Anesthesia and surgical equipment" while the lowest with 11% was for "Training in risk management"

Conclusion: The results of this study developed a list of factors leading to risks and errors in anesthesia - surgical wards. The results can be used in benchmarking hospitals and performing educational and managerial interventions. Also, these results can lead to the development of a clinical guideline that could be mandated by policymakers to reach the final goal of health care systems, i.e. promotion of patient safety and provision of consumer satisfaction

[Comparative study on health human resources composition in the Eastern Mediterranean Countries [2007-2008]]

The health human resource is the heart of health system and the majority of problems within the health care system are caused by shortage, surplus, or imbalance in health manpower. This study was aimed to compare the health human resources in Eastern Mediterranean countries based on income and geographical groups. This was a comparative study based on library resources performed in 2007. Twenty three countries in the Eastern Mediterranean region were classified based on the World Bank income groups [4 income groups] and geographical region [African countries, non-oil and oil-rich countries]. Later, the data concerning the health human resources in 2007 were extracted from the international websites including the WHO and EMRO. Data were statistically analyzed using the bivariate Pearson's correlation coefficient. Significant disparities were found in health workforce density within the Eastern Mediterranean countries in particular among the low and high income countries. Health workforce density showed negative correlation with country population [P<0/01] whereas a positive correlation was observed with per capita income [P<0/05]. Also, the income level, to some certain extent, affected the health workforce density. Population, immigration rate of health workforce, and general government expenditure on health are the factors influencing the health workforce density

[Assessing clinic's panel of general practitioners in Qazvin]

This descriptive study was aimed to assess clinic's panels of the general practitioners and the compliance with the general standards and criteria on the clinic panels of 60 general practitioners in Qazvin city in 2009. Of the total, 30% of the physicians had written the title of "general practitioners" on their panels and 66/61% of them had written 3 special practicing fields such as internal diseases, pediatrics, dermatology, etc and 66/21% of them had written 4 special practicing fields on their panels. All of the panels had not Iranian medical council sign. Also all of the panels within the normal size 50x70 cm as standards and 66/86% of the panels had a white background. Owing to the misplacement of the general practitioners in medical service versus specialists in the health system dos not work, ignoring the effectiveness of their roles in the health care and the lack of awareness of the citizens can be the reasons for not writing the title of "general practitioners" on their panels and the use of special practicing field names

[Effect of Diclofenac suppository on postoperative shivering in cesarean section]

Background: Postoperative shivering is a complication of general anesthesia. Shivering increases cardiac output, oxygen demand, and postoperative surgical incision's pain

Objective: The aim of this study was to evaluate the effect of Diclofenac Na suppository on postoperative shivering

Methods: This was a case-control study performed on 140 women who were divided into two equal groups of 70 members each and marked as case and control groups. The case group received diclofenac Na supp 100mg, ten minute before the induction of anesthesia whereas the control group was given no such medication. Axillary temperature was measured before the induction and 1 hr after the extubation. Data were analyzed by SPSS and chi-square test

Findings: The incidence of shivering in case and control groups were [27.1%] and [48.1%], respectively. There was a significant difference between two groups [P=0.014]. The mean temperature changes in case and control groups were [-0.18[degree]C +/- 0.02[degree]C] and [-0.29[degree]C +/- 0.029[degree]C], respectively. The difference between two groups was found to be significant, statistically [P=0.004]

Conclusion: Our findings showed that diclofenac Na supp has the potential to effectively decrease the postoperative shivering while maintaining the body temperature more stable

[Economic evaluation of students' screening program in the city of Komijan [Iran-2009]]

Background: Economic evaluation is one of the measures of decision making for providing efficient services

Objective: To calculate the cost outcome of students' screening program in the city of Komijan

Methods: This was a descriptive analytical study carried out on all first grade students of different educational courses including primary schools, guiding schools, and high schools. The cost-unit method was used to calculate the cost followed by analysis of data using the Excel software

Findings: Screening program showed that 0.1% of total students had diabetes, 0.2% cardio-vascular disorders, 0.26% asthma, 3.07% anemia, 32% pediculosis, 0.1% tinea, 18.33% dental caries, 0.54% hearing problems, 6.42% optic problems, 0.8% behavioral [otism] disorder. The total cost of students' screening program was 164495020 Rials and the average cost equal to 88773 Rials. The minimum cost of detection a single disorder among the students of primary, guiding, and high schools was associated with dental disorders which was equal to 4736, 7037, and 12268 Rials, respectively. The maximum detecting costs for a single disorder were for speech disorders among the students of primary schools [3500301 Rials] and hearing disorders in students of guiding schools [2075018 Rials] and high schools [3900784 Rials]

Conclusion: The students' health screening program within the rural and urban regions of the city of Komijan is cost-effective and thus could be continued

[Factors influencing the selection of study field in students of Qazvin university of medical sciences]

One of the important choices of the young people after high school period is to make decision about their future field of study. The aim of this study was to assess the factors affecting the selection of educational field among the students of Qazvin University of Medical Sciences. In this a cross-sectional study, 400 students [24.4% male and 75.6% female] were interviewed in 2009-2010. Data were analyzed using SPSS software and Fisher exact test. Of total students, 71.6% mentioned the reason to choose their field of study was the need of the society, 70.8% interested in the future income of the field, and 34.2% for personal interests. Students should be properly oriented toward their fields of study during pre-university period

Risk management status of waste anesthetic gases Using ECRI institute standards

The aim of this study was assessment the risk management status of waste anesthetic gases in academicals hospitals in Iran to prevent from harmful effects of these gases on employees' health. A descriptive-analytic study was designed in 2011. Standard structured checklist developed by ECRI institute [Emergency Care Research Institute] was applied. Checklists were filled onsite through direct observation and interviews with anesthesia personnel in 46 operating rooms at 4 hospitals from all of the hospitals under affiliation of Isfahan University of Medical Sciences. These hospitals were selected based on the number of surgical beds. Total means score of WAGs risk management status was 1.72 from the scale of 3. In the studied operating rooms, only 28% complied with predetermined standards, 16% needed improvement and 56% had no compliance. Total mean scores of compliance in planning, training and evaluation and monitoring of waste anesthetic gases were weak and equipment and work activity was at medium level. The risk management status of waste anesthetic gases in the hospitals to be weak, therefore operating room personnel are exposed to medium to high level of these gases. The hospital mangers should prepare and apply scavenging equipment, development of control program, quality improvement, risk management and maintenance of anesthesia equipment. Finally, ongoing monitoring and evaluation, education to personnel and modification of policy and procedures and improvement of work activities should be considered

[Comparing the protein of 2-hour and 24-hour urine samples in patients with suspected preeclampsia]

Determining the protein content of a 24-hour urine sample is the gold standard for diagnosis of hypertensive disorders in pregnancy. To determine whether the 2-hour urine protein value can be used as a substitute for the 24-hour urine protein value in patients with preeclampsia. This was a cross sectional study performed on 60 inpatient women with suspected preeclampsia due to positive urinary test strip with minimum protein content of 1[+] and BP >/= 140/90 at Kosar Teaching Hospital in Qazvin [Iran] during autumn and winter 2008. Urine samples were collected within 24 hours in successive periods: The first 2-hour and the next 22-hours urine, in separate containers. The protein contents of 2-hour and 24-hour urine samples were calculated and the correlation between both groups was determined using Pearson's correlation. The cut off point for 2-hour urine protein was obtained with ROC curve. Of 60 patients studied, 42 had proteinuria less then 0.3gr/24h and 18 with proteinuria higher than 0.3gr/24h. No patient with severe proteinuria [2gr>24h] was detected. There was a significant correlation between the 2-hour and 24-hour urine protein content in patients' samples. Pearson's correlation coefficient [r] was 0.788 [p=0.000]. The cut off point for mild proteinuria was determined at 0.035gr/2h with sensitivity, specificity, positive predictive value, and negative predictive value of 63.3%, 89.5%, 77.8% and 80.95%, respectively. Total protein values of 2-hour samples positively correlated with values of 24-hour samples of preeclampsia women and therefore can be substituted for assessing the protein content of 24-hour urine samples as a more convenient, faster, and cheaper method for diagnosis of preeclampsia

[Assessing the information management from the health houses to the health centers of Qazvin Province [2008]]

Efficient health information management can lead to timely and useful decision in the system. To assess health information management in health system of Qazvin Province. This cross-sectional study was conducted in 2008. The 3 levels of Health Care System of Qazvin were assessed. By targeted sampling; 10 Health Houses, 5 Rural Health Centers and Shahid Bolandian Health Center of Qazvin city were selected to study. Questionnaires and Checklists were used for data collection. The data were analyzed with spss 13 software. From 9262602 units of information were produced in health system, about 683563 units [7.3% of total information] were sent to higher levels. The frequency distribution views of experts which were gathered about situation of health system about data collection and information transfer were as: moderate [23.2%], fair [76.8%] and data processing and analyzing: weak [0%], moderate [15.9%] and fair [84.1%]. concerning the interpretation of information: weak [1.4%], moderate [23.2%] and fair [75.4%], and method of data control: moderate [21.7%] and fair [78.3%]. With respect to findings for effective decision making, it is necessary to pay attention to screening subject in low levels and educating of information interpretation methods to statisticians in these levels

Effect of low dose ephedrine and lidocaine on pain and hemodynamic changes due to propofol injection

The aim of this study was to compare the intensity of pain and hemodynamic changes during propofol injection when pretreatment is performed with ephedrine and lidocaine. In a randomized double blind clinical trial [IRCT: 2766] in Shahid Rajaee Hospital during the year 2009, 99 patients with ASA physical status I and II, aged 20 to 50 years were recruited. The patients were planned to undergo elective surgeries under general anesthesia and had no history of cardiocascular, neurologic, or allergic diseases. The subjects were randomly assigned into three groups to receive 40mg intravenous lidocaine [group L], 30|jg/kg ephedrine [group E] or 2ml normal saline [group P]. After one minute, 2mg/kg propofol was injected into a dorsal hand vein. Pain was assessed using face pain scale [FPS]. Arterial blood pressure and heart rate were also recorded before induction, just before intubation, and one minute after intubation. Hemodynamic changes and also the incidence and intensity of pain in group L were less than the other groups. The patients in group L had significantly lower FPS compared with group P [P=0.004] and patients in group E had lower FPS compared with group P; however, the difference was not statistically significant [P=0.247]. Pretreatment with a small dose of ephedrine [30 micro g/kg] reduces the incidence and intensity of propofol induced pain. Although lidocaine is more effective, ephedrine results in a more stable hemodynamic status

Study economic efficiency of teaching hospitals of Qazvin university of medical sciences [1999-2007]

Hospitals as important sectors of health care system has special location in Health economic science. Increasing of the operational costs in hospital and limitation in financing cause that hospital as an economic firm use economic analysis and prepare effective using of resource and boost productivity. To analyze economic efficiency and resource allocation situation of teaching hospitals of Qazvin university of medical sciences [1999-2007]. This study was conducted in 2008. Need data [human and capital resource information] was collected from data center of research deputy of university and teacmg hospitals and registered at information sheets and then was analyzed by DEAP2 software and data evolvement analyze method. Average technical, pure and scale efficiency of centers during the period of study was appointedrespectively 0.90, 0.96 and 0.93 50 percent of centers were efficient for using of resource [Total Technical Efficiency [TTE]= 1]. Another 50 percent of centers had no efficient situation [TTE = 1]. Efficiency rate of studied centers was variable during the time of study and had not uniform trend. Human and capital resources were made 67 and 33 percent of total operational cast of centers respectively. The average of annual cost estimated per labor 30.1 xl0[6] and for capital resource 19.9 x 10[6] Rails. Labor and capital resources have more costs for hospital industry, therefore policy and decision makers must determine need for resource by using economic analysis and correct planning methods and then employ them, appoint optimal capacity for centers to service delivery, enhance positive efficiency indexes and distinguish the ways that is more effective in boosting of resource performance

[Cost analysis of information generation in Alborz healthcare]

Information economics analysis is important issue for creation of appropriate intelligence about information mobility, evidence based ondecision making and boosting of policy making process in system. To calculate the costs of information generation in Health Houses, Rural Health Centers and County Health Center of Alborz county health care system. This descriptive analytical study was conducted in 2008. The study population included Alborz county health center, 3 Rural Health Centers and 8 Health Houses. Data were collected through observation activities, checklists, costing forms and interviews. Activity Based Costing [ABC] method was used to analyze the costs. The costs of human resources, special and general materials, energy and general costs, capitals deprecation and repairmen in proportion to total costs were 70%, 3% and 2%, 8% and 17%respectively.The proportion of information cost to total operational costs in Health Houses, Rural Health Centers and County Health Center were 45.8%, 24.7% and 4.1% respectively. Average unit-cost of generated information in HHs, RHCs and CHCs were $0.76, $2.74 and $3.73 respectively. The total amount of generated information were 545180 units with total cost of $82000 Information generation cost was 15.6% of total operational costs in the system. Regarding the cost of information generation in this healthcare system, the need for using and screening information for evidence-based on decision making is obvious. Hence, more efforts have to done by managers and policymakers in healthcare system for implementation of a standard HMIS and to train personnel in order to generate optimum information by minimum costs

[Assessing the progress of strategic plan in Qazvin University of Medical Sciences, 2008-2009]

Considering the concept of strategic planning, the survival and success of an organization is in close connection with application of a strategic plan as it is primarily not only a future-oriented plan predicting the future changes with the capacity to regulate proper actions but it is also considered as an environment-oriented scheme and while tightly associated with the surroundings it has the potential of having immediate communication with the environment and rapid response to changes if required. To compare the progress of the strategic plan of Qazvin University of Medical Science in 2008 with that of the year 2007. This was a descriptive-analytical study performed within the different divisions affiliated to Qazvin University of Medical Sciences. The evaluation method and the progress reporting forms were formulated through team discussions and participation of the stakeholders. It took several sessions for the strategic committee to analyze the information on forms completed by the divisions. At the end of the year 2008, only 53% of the University's goals were completely achieved, while 32% were met by 50-90% and 11% by less than 50%. Totally, 4% of the goals were shown to have been unattained during the same time course. By the end of 2007, from the total defined goals of the University, only 49% were achieved by 100%. Budget deficiency was proved to be the most important obstacle in achieving the full defined goals in 2007 and 2008. Considering an achievement level of higher than 50% of the goals in 2008, it could be concluded that the development process of the University's strategic plan was promoted, however, the problems and obstacles such as shortages in human resources and budget and credit deficiencies prevailing the year 2007, were demonstrated to have played a hindering role against achieving the goals of 2008

[Community intervention to modify beliefs, traditions and practices of oral health in Yahya-Abad village]

Following a qualitative study on beliefs, traditions, and practices on children's oral health in one of the countryside of Qazvin, it was shown that the commitment to wrong beliefs and traditions could lead to various problems associated with practice of health recommendations by villagers. To design a set of guidelines to modify the beliefs, traditions and practices of oral health in Yahya-Abad village. In this community intervention qualitative research, 50-70 persons in two main groups including mothers and teachers of primary schools participated in educational workshops. Tooth brushes, tooth pastes and dental flosses were distributed among the children and their families. During an eight-month period of continuous oral health education, the effect of this practice was evaluated through focus group discussions. The educational program used in our study resulted in an increase in level of knowledge and skill about oral health among the study populations. Although the education program was shown to have little effect on beliefs and practices of the study group yet the majority of individuals gave up some unhealthy traditional self-treatments. The distribution of tooth brushes among children made motivation for dental care only for a short time and the teachers failed to properly perform their roles in improving the healthy behaviors of the students. Although increasing the knowledge of parents and teachers in promoting the degree of oral health is necessary however this alone seems to be inadequate to achieve desirable healthy behaviors

Assessing the dental office sign of general dentists in Qazvin

This descriptive study was aimed at assessing the dental office sign of general dentists and compliance with the general standards and criteria. A total of 73 signs from clinics of general dentists in the city of Qazvin [Iran] were examined in 2009. Of 73 signs, 5.47% showed the title of [general dentist], 43.83% displaying the practice of a dental specialty such as surgery, dental prosthesis, pediatric dentistry, and 20.54% demonstrating the practice of four different dental specialties. There was no sign showing the logo of the Iranian Medical Council. However, 97% of the signs were within the standard size of 50x70 cm and 89% with a white background. It seems that the lack of public awareness over the availability of different dental specialties and the distinction between the dental specialists and general dentists, to be among the reasons encouraging the dental practitioners to avoid including the title of [general dentist] on their dental clinics' signs

[How does the elderly spend their leisure time in Qazvin?]

Of the total population of 1,143,000 in Qazvin province, 7.3% are over 60 and there is no plan to help them spending their spare times. To identify how the elderly should spend their spare times to get benefit the community from their abilities and skills. Both quantitative and qualitative approaches were applied. A total number of 104 aged people as well as the representatives of 18 GOs and NGOs were included in the investigation. The data were collected through structured questionnaire, focussed group discussions, and interviews. Later, the data were classified and analyzed, statistically. also, A pilot interventional study was carried out using the assistance of 5 aged volunteers, 3 men and 2 women, while the whole process was videotaped during 2007- 8. The study revealed that most elderly have no plan on how to spend their times and feeling dissatisfied with their situations. The aged population was willing to be useful to the community with demand for access to particular places for gathering and transfer of their skills to younger people. Only 500 persons of the elderly people were the members of NGOs and 4500 as state pensioners. Nearly 68% of the elderly were interested of having their abilities applied to the community. To pilot the intervention, 3 men and 2 women were volunteered and presented their skills in teaching 150 younger people in cooking, archeology, painting, literature and yoga. Municipalities, GOs, NGOs, and mass media should have strategic plans to take advantage from the aged people's abilities as a social capital while improving their quality of life

Comparing the importance and planning of information technology in education and general hospitals of Iran University of Medical Sciences [2006]

Today, the information technology extension is among the inseparable parts of any economical, social, and cultural policies. Thus, every organization including the hospitals is forced to employ the most appropriate strategy and planning associated with application of information technology. The aim of the present work was to determine the rate of importance of IT in hospitals, planning for application of IT and also the most important cases of IT application in hospitals and the effect of hospital demographic specifications on IT importance. This was a descriptive study carried out in all educational and general hospitals of Iran University of Medical Sciences. A research questionnaire, assessed for validity and permanency, was the study tool completed by directors of medical documents or statistics and information office. The data were further analyzed by descriptive statistics and SPSS software. Our data indicated that the majority of people in charge of libraries or IT centers believe the importance of IT in managing hospital affairs [on the average 4.41 in educational hospitals and 4.52 in general hospitals]. However, the managers were shown to have less support for allocating enough budgets to implement IT [on the average 3.30 in educational hospitals and 2.81 in general hospitals]. In addition, it was shown that 44.44% of educational hospitals and 40% of general hospitals have no planning for application and extension of IT and it was the managerial affairs as an issue with higher priority to be dealt with. Considering the benefits associated with application of IT, it is necessary for hospitals to prepare a comprehensive program for exploitation and extension of IT through allocation of appropriate budget. Also, holding educational courses, proper control and supervision by the ministry of health and medical education is recommended

[Evaluation of medical residency theses in Qazvin]

Introduction: Theses are the most important sources of academic research and correct writing of them has important role in progressive of Educational and research Aims

Objective: Evaluate medical residency theses in Qazvin medical faculty with respect to writing and content

Materials and Methods: A total of 59 theses were submitted to study. A checklist consisting of 3 different parts structural, content and general characterized was completed for each case. Parameters related to structure and content were analyzed separately

Results: The field of the study most of theses [35.6%] was anesthesiology. Most of theses [55.9%] were designed and experimental studies. The overall writing of theses consisted of: 1.7% as weak, 74.5% as average and 23.5% as good. The weakest parts in theses were introduction, findings, conclusion and recommendations. Only 28.8% of the theses were published in journals

Conclusion: The overall most of medical residency theses, were on average level about writing and had very problems in various sections. Then, it is necessary to use some ways such as research workshops and Designing correct writing frame for promotion of quality of writing

[Effect of different dosage of intramuscular vitamin D3 on serum 25[OH]D]

Pareneteral vitamin D3 administration, a common practice in Iran, is usually used based mainly on clinical symptoms or serum mineral disturbances. Since studies about the effects and side effects of parenteral vit D3 preparations are limited, this study was designed to evaluate the effect of different intramuscular vitamin D3 dosage on serum 25[OH]D levels. In this study, 54 health volunteers were selected, and randomly assigned to 4 groups, based on their serum vitamin D3. Mean body mass index, age and sex frequency were not significantly different between groups. Mean serum 25[OH]D levels before injections were 27.24 +/- 21.30, 25.21 +/- 17.09, 24.70 +/- 16.8 and 25.10 +/- 14.48 ng/mL in groups I to IV respectively. Vitamin D3 was injected in dosages of 300/000, 600/000, 900/000 units and placebo in groups I-IV respectively. 25[OH]D levels were determined before, and at 2 weeks, 2 months and 4 months after injection. Serum 25[OH]D levels before injection were significantly higher compared to levels assessed 2 and 4 months after injection. At the end of study, in groups I to III, mean serum 25[OH]D levels in group I to IV were 48.20 +/- 28.32 ng/mL, 65.46 +/- 33.52 ng/mL, 72.90 +/- 37.68 ng/mL, and 14.38 +/- 11.14 ng/mL respectively. Frequency of vitamin D hypervitaminosis in groups I, II and III was 9%, 38% and 40% respectively. Usage of parenteral vit D3, especially dosages higher than 300/000 III, is associated with a high risk of vitamin D hypervitaminosis