[Nurses' perceptions of the justice in performance appraisal: a qualitative study]

Introduction: Performance appraisal is an important responsibility of health care system and increases employee's morale and productivity. The aim of this study is to explore nurses' perceptions of justice in Performance appraisal

Method: This qualitative study was conducted in Tehran in year 2012. Nurses were selected purposively from an educational hospital of Shahid Beheshti University of Medical Sciences. For data gathering, 5 focus group sessions, involving 10 to 7 nurses at each session, were held by using semi-structured interview and continued until the data reaches saturation. Data were analyzed using framework analysis

Results: Four major themes and 14 subthemes were emerged from the analysis of textual data. These themes were organizational context [discrepancies nursing standards and nursing duties, lack of appropriate incentives for nurses, the lack of an appropriate institutional framework, lack of a clear nursing job description, and the gap between educational theory and practice], performance appraisal structure [inefficient systems of laws and regulations introduction, subjective appraisal, overall appraisal form, discontinuation in appraisal], performance appraisal process [lack of strict supervision of the authorities, unfair appraisal, and lack of respect for the persons dignity] and performance appraisal results [lack of proper feedback and little attention to meritocratic]

Conclusion: Participants believed nurse performance appraisal system facing with multiple problems that are affected justice in performance appraisal. It seems to achieve the ultimate goal of performance appraisal, improved quality of patient care, change and revision is necessary

[Study of bone turnover markers and inflammatory disease activity in rheumatoid arthritis patients visiting rheumatology clinic of Loghman hospital during 2008-09]

Rheumatoid arthritis [RA] is the most common inflammatory arthritis affecting 0.5 to 1% of the general population worldwide. The cause of RA remains unknown. In active RA, bone turnover markers change in serum and urine before the appearance of erosions in radiography. In this study, we compared RA activity index with bone turnover marker levels in serum of RA patients. In this cross-sectional study, RA patients referring to the Rheumatology Clinic of Loghman Hospital were studied. One hundred fourteen established RA patients were included. Bone turnover markers were measured in 75 patients. DAS28 and cumulative dose of steroid were calculated in all patients. RF, Anti-CCP, ESR, CRP, bone turnover markers consisting of osteocalcin, P1NP, betaCTX and ALP were measured for all the patients. Cases were divided based on whether steroid and DMARD were used or not. Comparison of DAS28 and bone turnover markers was done with Chi square Pearson test. Also, the relation between bone turnover markers and consumption of DMARDs, steroid and bisphosphonate was evaluated. SPSS V. 16 was also used for data analysis. There was significant correlation between DAS28 and serum osteocalcin [p<0.05], but no correlation was found with other markers. There was significant correlation between bisphosphonate consumption and decreased serum osteocalcin [p=0.05] and borderline correlation with decreased P1NP [p=0.06]. Significant correlations was found between "erosion and decreased level of osteocalcin" and "erosion and DAS28".In active RA patients, decreased bone formation markers especially osteocalcin are suggestive of severe and erosive disease for which early aggressive treatment is recommended. These markers can be applied for differentiating osteoporosis from RA in these patients. Thus increased level of bone formation markers is seen in idiopathic osteoporosis and decreased level in active RA

[Components of clinical preventive services system in a specialized educational hospital: a qualitative approach]

Introduction: At first conference of health promotion in Ottawa in 1986, rearrangement of health providing services, especially hospitals, was introduced as a main strategy in health promotion. Health promoting hospitals project had been also proposed by the World Health Organization a decade before. According to the project, hospitals should have health promoting and disease preventing activities. In Iran, preventive services have not been defined as hospitals tasks and most efforts in hospitals are for medical treatment and rehabilitation. The purpose of this study was to recognize various components of clinical preventive services in Taleghani hospital in Tehran

Methods: In this qualitative study, 20 professionals and experts were interviewed using purposive sampling. Data were analyzed using content analysis

Results: Main themes extracted from the interviews consisted of: 1] challenges and barriers of clinical preventive services; 2] role of clinic of prevention in hospitals; 3] human recourses; 4] information recourses; 5] insurance system; 6] receiving and perusing patients; and 7] educating personnel

Conclusion: Providing preventive services is a perspective of future hospitals. Important necessities for implementation of these services in our country are description of the service packages, designing necessary structures, and training human recourses in this field

[Intraocular pressure assessment before and after photorefractive keratectomy using static, dynamic and noncontact pneumotonometry [air puff]]

To compare the preoperative and postoperative measurement of intraocular pressure [IOP] using goldman applanation tonometry [GAT], the air puff and pascal dynamic contour tonometers [PDCT] in eyes undergoing myopic and myopic astigmatic photorefractive keratectomy [PRK]. In a descriptional -analytic and prospective study, a complete examination was performed at the slit lamp, followed by pachymetry and pentacam imaging in patients scheduled for PRK.IOP was measured in myopic and myopic astigmatic eyes before and 2 months after PRK by GAT, PDCT and the air puff tonometer in a randomized sequence at similar times. 1] Before PRK the difference among the 3 tonometers in IOP measurement was compared 2] After PRK the difference among the 3 tonometers was compared in the same manner 3] The difference between pre-operative and post-operative measurements for each instrument was measured 4] Finally dissimilarity of changes from preoperative to postoperative among the 3 instruments was compared. The study included 402 eyes [201 patients, 162 females, 39 males] with mean age of 28.7 +/- 7.03 [18-48]. Mean tonometry before PRK with GAT, PDCT and air puff was: [15.44 +/- 2.79], and [16.81 +/- 3.39], [16.31 +/- 3.36] respectively. Mean IOP after PRK with GAT, PDCT and Air puff was: [12.04 +/- 2.63], [13.57 +/- 2.91] and [11.01 +/- 3.29] respectively. The difference between 3 tonometer in IOP measurement was statistically significant [P<0.001]. In the same manner the difference between 3 tonometer was statistically significant post operatively [P<0.001]. There was statistically significant difference between mean pre-operative and post operative measurement taken by the three instruments [P<0.001]. There was no statistically significant difference between mean changes preoperative with postoperative measurement taken by PDCT and GAT [P= 0.778]. Briefly PDCT and GAT underestimate IOP approximately equally. There was a significant difference between mean changes preoperative with postoperative measurement taken by Air puff compared with GAT, and air puff compared with PDCT [P<0.001]. Measurements of IOP may be underestimated after PRK, by GAT, PDCT and Air puff. This underestimation probably relate to biomechanical changes of the cornea after surface ablation

[L-Asparginase effect with 6000U/m2 on lipid profile in children with acute lymphoblastic leukemia]

One of the major etiologies of lipid disorders in malignancies is the use of chemotherapy drugs, the most important of which is L-Asparginase. Studies in different centers with high dosages of L-Asparginase demonstrated different results. The aim of this study is to evaluate the effect of L-Asparginase at a dose of 6000 U/m2 on lipid profile in Iranian children with newly diagnosed acute lymphoblastic leukemia in Mofid Children Hospital of Tehran. We performed a nonrandomized trial in which all children with newly diagnosed acute lymphoblastic leukemia [ALL] aged <15 years participated. Every case serves as his/her own control. The cholesterol, triglyceride [TG], HDL, LDL, VLDL, APOA, APOB and LPa were evaluated in three stages: before, during and 2 months after treatment with L-Asparginase after which the results were compared. In our study, 82 newly ALL diagnosed patients with the mean age of 6 years [within the age range of 0.12-14 and SD of 3.5] were evaluated. Mean seum level of TG in pretreatment stage was 163.9 mg% and during treatment with L-Asparginase 123 mg% demonstrating significant decline in TG serum level after administration of L-Asparginase [p=0.002]. Mean serum level of cholesterol before administration of L-Asparginase was 151mg% and during treatment 140 showing no statistically significant difference [p= 0.061]. LPa level in pretreatment phase was 24mg% and during treatment 14 showing a statistically significant difference [p= 0.0001]. L-Aspar resulted in decline in TG serum level and increase in HDL though with no significant difference in cholesterol level. Overall, L-Asparginase even at a dose of 6000U/M2 does not raise blood level of triglyceride and cholesterol

[Effects of bupivacain infiltration on insulin, glucose, prolactin and cortisol responses to operative stress after unilateral inguinal hernoiraphy among 3-7 year-old children]

Operative stress and post-operative pain are important issues in medicine. After any types of surgery, the stress hormones release responding to pain. In this study we applied Bupivacain infiltration in surgical wounds of inguinal hernia amongst children aged 3-7 years and evaluated its effects on some stress hormones and plasma levels of glucose. In this prospective study, 116 children aged 3-7 years [24 females, 92 males] undergone unilateral repair of inguinal hernia under general anesthesia at Mofid children hospital during 2005-2007, were devided into 2 groups. Perincisional wound infiltration of 1-2 mg/kg of Bupivacain was performed in experimental group. In both groups, 10-15 mg/kg of Acetaminophen suppository were recommended at the recovery room. 4 ml of blood samples were obtained at three distinct stages [preincisional stage, at the end of operation and 4 hours after operation] to measure the insulin, prolactin cortisol and glucose plasma levels of subjects. Post operative pain was measured objectively by Hannalla scale. In both groups plasma prolactin levels increased at the end of operation along with insulin, cortisol and glucose. However, these differences became statistically significant just for insulin. There were no significant differences between other variables. In addition, although the plasma concentration of above mentioned variables became lesser in the 4[th] hour of postoperative period in experimental group, there were no statistically significant difference compared to those of control group. Wound infiltration of Bupivacain decreases the stress hormones and pain during the post-operative period. We recommend this type of infiltration applying long-acting anesthetic agents with fewer numbers of side-effects

Osteoporosis and its association with estrogen receptor- alpha gene polymorphism in a population of Iranian women referring to Loghman hospital

Osteoporosis is a common disease in which the bones become prone to fracture as a result of loss of bone mineral density [BMD]. The estrogen receptor [ER] gene is a candidate gene for osteoporosis. This study assesses the relation between estrogen receptor- alpha gene polymorphism and osteoporosis in a population of Iranian women. In the present study, we investigated 200 pre- and/or post-menopausal Iranian women, aged 35-80 years, stratified for BMD into normal and patient groups. The genomic DNA of both groups was amplified by PCR using specific primers and products were digested by restriction enzymes PvuII or XbaI to identify the related genotypes. The genotypes of intron 1 PvuII or XbaI poly-morphisms of the ER- alpha gene were detected and introduced so that the upper case and lower case letters of Pp [PvuII] and Xx [XbaI] signified the absence or presence of restriction sites in RFLP experiments. Based on our results, no significant relationship was observed between BMD and intron 1 RFLPs of the estrogen receptor alpha gene. Three genotypes, Pp XX, pp XX and PP xx, were detected, all at a very low frequency in this population of Iranian women. To conclude no significant relationship was found between BMD and intron 1 RFLPs of the estrogen receptor alpha gene. Larger numbers of patients need to be investigated to ascertain and confirm whether ER- alpha genotypes are associated to the disease etiology and if any other factors are involved

[Effects of leukocyte-depletion filters on alluimunization derived reactions of platelet transfusion in acute leukemic patients]

Leukemia is the most common malignancy among adults and children which may develop several side affects such as anemia, infection and thrombocytopenia-related hemorrage. Many modalities have been suggested for prevention of Alluimunization and one of them is using of leukocytes free products. In fact, platelets could not solely stimulate immune reaction. This study is conducted at two hospials of "Shohada" and " Taleghani" to demonstrate the usefulness of such products. This research is a single- blinded clinical trial. All the patients had acute leukemia. In control group [24 subjects] we used a routin infusion set for transfusion and in experimental group [20 subjects] a biofilter was applied during the transfusion, platelet were counted one hour and 24 hr after transfusion. CCI formulate was used to represent a signs for Alluimunization. If CCI was less than 10x10 L/M[2] after transfusion or it became below 5-7x10 L/M[2] after 18-24 hr, the subject was considered alluimmune. After one hour, 21 cases out of 24 were alluimmuned in control group whereas in experimental group 13 cases from 20 patients became alluimmune. After 24 hours, 5 cases in control group and 5 ones in experiments were found to be Alluimmune. We did not prove any preventive properties from leukocyte-depletion filters in reducing the risk factors of Alluimunization amongs patients with acute leukemia

Persistent unstable chromosomal aberrations in lymphocytes of radiotherapy workers after 1[st] mitotic divison in Tehran, Iran

Studies indicate that ionizing radiation can induce persistent genetic instability in a high proportion of exposed cells. It has also been reported that exposure of radiotherapy workers to ionizing radiation causes chromosomal damages. Some of the damaged cells show a large number of aberrations such as dicentrics, polycentrics, rings, and numerous acentric fragments.To determine, whether chromosomal damages can be used as a biomarker of possible radiation in occupational exposure in a hospital setting. In this study, chromosome abnormalities were evaluated in peripheral blood lymphocytes from fifty medical radiotherapy workers who handled ionizing radiation for an average of twelve years, and forty three control individuals who did not knowingly come in contact with any radiation source. Chromosome aberrations were evaluated by the conventional solid stain technique. Dicentrics, fragments, followed by ring chromosomes, as well as total chromosome aberrations were elevated in the experimental group. We did not observe any aneuploidy chromosome in the present study. Although the level of exposure was below the annual permissible limit of twenty mSv/y recommended by the International Commission for Radiation Protection for whole body exposure, the mean frequencies of different chromosomal aberrations were higher in radiotherapy workers compared with controls [P=0.041]. Although the mean frequencies of chromosomal aberrations in the female workers [3.5 +/- 1.42] was slightly higher than in males [3.28 +/- 0.95], there was no significant differences [P=0.74] in the frequency of chromosome aberration between males and females of ionizing radiotherapy workers. The results of this study underscore the need of adopting measures to avoid or minimize overexposure to radiation in hospital settings

[Prevalence of congenital abnormalities in familial and non-familial marriage]

Several studies have indicated that compared to non-familial marriage, familial marriage would increase the incidence of congenital abnormalities. Since the rate of consanguinity marriage is high in our country, this study was performed to determine the prevalence of congenital anomalies between familial and non-familial marriage. For this analytic descriptive study, 928 couples were participated as the population of this investigation. Of them, 358 were familial-marriage couples and 570 were non-familial-marriage couples. We evaluted the variables such as parents age, familial and non-familial marriage rate and rates of congenital abnormalities between both groups. Both the questionnaire and face to face interview technique were applied in this study. Congenital anomalies were identified in 26 [7.26%] children of familial marriage group and 11[1.92%] ones in non-familial marriage group. The average rate of consanguineous marriage in this study was found to be 38.57%. Considering that the rate of congenital anomalies in familial marriage was more than that of non-familial marriage, it seems that it is essential to consult and teach families and young couples about the risks of familial marriage

Diagnostic value of human telomerase for detection of squamous cell carcinoma in oral smears

Human telomerase has been associated with most malignant tumors such as squamous cell carcinoma [SCC] of the oral cavity. One simple non-aggressive method for early diagnosis of oral SCC is taking smears. The aim of this study was to assess the frequency of telomerase expression in smears of oral SCC, compared with normal mucosa. Smears were obtained from 18 subjects with SCC of different sites in the oral cavity, presenting with various degrees of malignancy. Control samples were taken from the contra-lateral normal epithelium of the same subjects. The expression of hTERT, the most reliable marker of telomerase activity, was registered by extracting RNA, performing RT-PCR and then nested PCR by specific primers. Fisher's exact test was used to analyze the data. Positive expression of telomerase was detected in 8 of the 18 cases, while the normal epithelial samples demonstrated no such expression of telomerase. A significant difference in the expression of telomerase was reported between the two groups by Fisher's Exact test [P<0.003]. There is a potential for telomerase enzyme activity to act as a simple non - aggressive diagnostic tool in detection of oral SCC using smears of the lesion

[Isolation of anaerobic, aerobic bacteria and mycobacterium from foot skin infections of diabetic patients]

Diabetic foot infections are a potentially severe complication of diabetes. Diabetic foot infections can sometimes lead to long-term debilitation and, in the most severe cases, amputation. They are the most common infections in patients with diabetes, whose weakened immune systems put them at an increased risk of acquiring antibiotic resistant infections. For this descriptive study, 120 diabetic patients [30 women and 90 men age ranged between 45-65 years and disease duration of 0.5 to 37 years] were investigated. Immediately after the hospitalization, specimens from infected foot lesions were taken using Thio and BHI as transport medium. Aerobic cultures were carried out in all cases according to conventional methods while anaerobic cultures were performed when appropriate. Finally, susceptibility tests were performed on isolated microorganism. Totally, 75% of cases were polymicrobial infections. We isolated gram positive cocci 95%, gram positive bacilli 35%, gram negative 55% and mycobacterium 10%. Meanwhile, we found that 12.5% of our bacteria were anaerobic and 87.5% were facultative aerobic bacteria. In antimicrobial susceptibility testing, Rifampin was the most effective antibiotic against S.aureus and peptostreptococcus. Surprisingly, E.coli was resistant to all tested antibiotics. Diabetic foot infections have a polymicrobial nature. Antibiotic treatment of infections should be prescribed on the results of microbiological investigation