[Barriers to clinical governance administration from point of view of managers and nurses]

Introduction: clinical governance is a framework in which the organization providing clinical services is accountable for continuing improvement of quality of clinical service excellence

Objective: this study aimed to determine obstacles of clinical governance administration from view point of managers and nurses in hospitals affiliated to Jahrom University of Medical Sciences

Methods: this is a cross-sectional study conducted on 280 nurses and 20 managers selected by census method. Data were gathered by a researcher made questionnaire, consisting of 48 items in 7 domains of clinical governance. Questionnaire validity was done by face and content determination style and its reliability was established through Test-retest method and Spearman test [r=0.73]. Data were analyzed by descriptive statistics

Results: clinical audit and personnel management had the most negative effect in clinical governance administration from participants' viewpoint. From all questions "inattention to personnel job satisfaction" in "personnel management" domain had the most negative effect

Conclusion: according to importance of clinical governance administration, such research results should be considered by health managers

[Efficiency of staff development program and its relationship with nurse's profesional competency]

Introduction: skilled nurses are needed to achieve health promotion strategies, so operation and assessment via staff development program is essential

Objective: the purpose of this study was to evaluate staff development program through west Mazandaran hospital nurses and its relationship with the level of their professional competency

Methods: this study was descriptive - correlations in 205 nurses from general ward who were selected by cluster sampling. Data was collected by two questionnaires for competency level and staff development programs. Face and content validity was approved and reliability of the instrument was assessed by the internal consistency. Analysis of variance and chi-square tests were used to analyze data

Results: the majority of samples reported their competent level as ideal [75/6%], and the effectiveness of the program estimated as average [80/5%]. variance analysis of data showed there are no significant difference in the mean scores of survey instrument staff development, among the nurses with varying levels of competence [p =0/4, df =2]

Conclusion: organizations spend enormous amounts of money to improve development programs. If these programs loss their effectiveness, it is time consuming and will damage the economy. These results could be useful for nursing organization and executives

[ rare case of breast metastasis from a renal cell carcinoma]

Renal cell carcinoma [RCC] is responsible for 90-95% of malignant renal neoplasms. Peak incidence is between the 5[th] and 7[th]decades of life. Metastatic RCC to the breast is extremely rare. A 55-year-old woman presented with a mass in her right breast. Mammography demonstrated a 22x32 mm mass with increased density associated with spiculation and microcalcification areas. Biopsy of the mass reported an invasive ductal carcinoma. During the evaluation of metastasis and staging, another mass [38x33x27 mm] was detected in the inferior pole of the right kidney with heterogeneous appearance. Nephrectomy was performed and the pathological evaluation of the kidney mass reported a clear cell renal carcinoma. Breast mass was vimentin-positive carcinoma that was consistent with metastasis from RCC. Breast metastasis from RCC was diagnosed and the patient treated with immunotherapy [Interferon alfa]. It can be concluded that the breast tissue can be a site for RCC metastasis. Therefore, after detecting a malignant breast mass, a comprehensive evaluation is necessary to differentiate between the primary and metastatic breast cancers

[ relation of binocular symptoms with stereopsis]

To determine stereopsis with local [Titmus] and global [TNO] tests in symptomatic and asymptomatic subjects according to induced disparity [crossed or uncrossed]. In this cross sectional study, 80 students of Zahedan University of Medical Sciences who fulfilled the inclusion criteria were randomly selected. At first, refractive error was determined by retinoscopy and then based on the presence of binocular vision symptoms subjects were divided into symptomatic and asymptomatic. The ocular deviation was determined with use of the alternate prism cover test and stereopsis was determined with TNO and Titmus tests. Data was analyzed in software SPSS.15 using Mann-Withney U, Wilcoxon, Spearman correlation and Fisher's exact tests. Mean stereopsis with the TNO test in symptomatic and asymptomatic subjects with crossed disparity was 133.12 +/- 70.11 and 76.78 +/- 82.57 sec/arc and that with uncrossed disparity was 135.0 +/- 67.5 and 83.2 +/- 49.7 sec/arc, respectively. Using the Titmus test with crossed disparity the value was 44.3 +/- 7.27 and 40.7 +/- 3.4 sec/arc and with uncrossed disparity stereopsis was 50.0 +/- 12.1 and 40.0 +/- 0.0 sec/arc in symptomatic and asymptomatic subjects, respectively. The Mann-Withney U test showed significant difference between stereopsis [with crossed and uncrossed disparity] with symptoms [P<0.05]. Stereopsis is a useful factor in differential diagnosis of individuals with symptomatic and asymptomatic binocular vision that for these purpose the local and global tests can be used, the importance of the global tests is more than local tests. There is no difference between crossed and uncrossed disparity stereopsis in all subjects

Successful conservative endodontic treatment of fused maxillary incisors: a case report

Fusion is a rare developmental dental anomaly and its definitive diagnosis is of great importance for successful endodontic treatment. A twenty-five-year old female attended the Endodontic Department with the chief complaint about dysmorphic right front tooth and a history of vague pain since the previous 11 months, which had ceased during last one month. Oral cavity examination was performed, endodontic oriented sensitivity tests including cold, hot, and electric pulp tests were conducted, and periapical radiography was also ordered. Oral cavity examination revealed an enlarged permanent right maxillary incisor with deep caries on the lingual surface. All vitality tests were negative. Examinations were normal except for one missing tooth in the total count in the upper right quadrant. Periapical radiography clarified a fused maxillary central and adjacent lateral incisor with large coronal radiolucency involving the pulp and a periapical radiolucent area suggestive of a chronic apical periodontitis. The final diagnosis was established as fused maxillary incisors with necrosis and chronic apical periodontitis. A conservative non-surgical root canal therapy was planned and careful negotiation and obturation were performed after obtaining the informed consent, followed by the esthetic reconstruction. A six month follow-up revealed that periapical radiolucency had almost disappeared, the teeth were in function, and the patient reported no complaint

[ case report of angioimmunoblastic T-cell lymphoma in a 16-year-old patient]

Background: Angioimmunoblastic T-cell lymphoma [AITL] which is recognized in the current world health organization classification as a peripheral T-cell lymphoma of the nonhodgkin lymphomas, comprises about 1% of all lymphomas. The average age at the time of diagnosis of AITL is about 65 years and it is rarely seen in patients under 18 years

Case report: A 16-year-old boy suffering from fever, weakness, paleness, and axillary lymphadenopathy was referred to Kashan Shahid Beheshti hospital. Laboratory tests showed pancytopenia and elevated LDH. Splenomegaly and normal liver size were also reported by sonographist. Bone marrow aspiration was normal and reactive follicular hyperplasia was reported on the first biopsy of axillary lymph node, but with continuing fever and pancytopenia biopsy of the axillary lymph node was performed again and this time AITL was also reported using the pathological and immunohistochemical evaluation

Conclusion: AITL, a rare lymphoma under 18 years old, typically manifested by lymphadenopathy, splenomegaly, elevated serum LDH and systemic B-symptoms. One of the most common differential diagnoses of AITL is reactive t-cell infiltrative processes which in some cases pathologists may have difficulty distinguishing between them. The diagnosis was confirmed by immunophenotyping and pathology of the axillary lymph nodes

[Evaluation of dental students' attitude in regard to antibiotic therapy in endodontic treatments in Tehran dental schools]

Inappropriate antibiotic's prescription by dentists has caused several worldwide problems in recent decades. Antibiotics are the most commonly medicine that prescribed by dentists. Inappropriate antibiotic's prescription causes: Development of simultaneous infections, mutations, genetic transmissions and bacterial resistance to antibiotics. The purpose of this study was to evaluate dental student's attitude toward antibiotic therapy in endodontic treatments in Tehran's dental universities in 2009.In this descriptive study, 203 dental students selected by random from Tehran's dental schools. All interviewed students passed theoretical endodontic courses. Validity and reliability of the designed questioner assessed by following tests: Lawshe test [CVR=0/4], Cronbach Alpha Coefficient [0/8] and these tests approved by 3 psychiatrists. The results evaluated by X2 test. The attitude of students regarding antibiotic therapy in endodontic treatments was as follow: completely incorrect [0%], completely correct [15.2%], correct [62.2%] and incorrect [22.6%]. According to the results of the present study, there was no ideal point in dental student's attitude toward antibiotic therapy in endodontic treatments

[Comparison of gradient AC/A ratio with different deviation measurement techniques]

To compare the effect of different deviation measurement techniques and different lens powers on gradient accommodative convergence to accommodation [AC/A] ratio. We randomly selected 78 eligible students of different majors from Zahedan University of Medical Sciences. Following retinoscopy for refractive errors, alternate prism cover test, von Graefe and Maddox rod without additional lenses and with +/- 1, +/- 2 and +/- 3 D lenses were performed for measurement of deviation at near and determination of gradient AC/A Ratio. Data were analyzed using within subject factorial repeated measurement ANOVA and correlation tests. Mean AC/A ratio was 3.6, 3.7 and 4 prism diopter to diopter using alternate cover test, Maddox rod and von Graefe methods, respectively [P=0.2]. The highest and lowest AC/A ratios were related to von Graefe method with +3D and cover test with -1D lens power, respectively. Only differences between AC/A ratios with -1 and +2 lenses as well as with -1 and +3D were significant [P<0.05]. For all different deviation measurement methods, AC/A ratios with plus lenses were higher than minus lenses. The type of deviation measurement method had no effect on AC/A ratio but selected lens power affected the results. We recommend using 2 or 3 diopter instead of 1 diopter lenses to avoid possible effects of depth of focus

[ cross dominancy and structural disorders of head and vertebral column]

Background and aim: The cross dominancy [CD] implicates as a condition that dominant eye and dominant hand are situated in opposite sides of a body. This condition can produce malformation and structural disorders in head posture and vertebral column. The aim of this study was to investigate the relationship between CD and structural disorders in vertebral column and head posture in students of Zahedan University of Medical Sciences

Methods: In this cross-sectional study, 300 students of Zahedan University of Medical Sciences were randomly selected and their dominant eye was determined by Miles test. Then subjects were divided into two groups [with cross dominancy and unilateral dominancy]. The presence of malformations of vertebral column and head posture were determined by checker board and plumb line. The data were analyzed using descriptive and analytical [Chi square] statistical tests

Results: The results of the present study demonstrated that 76 out of 300 students [25.3%] had cross dominancy [CD]. There were a significant difference between CD and scoliosis [P<0.001] or shoulder un-leveling [P=0.03] in two groups, but not between forward head posture [P=0.10] and chin deviation [P=0.22] with CD in two groups

Conclusion: The scoliosis and shoulder un-leveling had higher prevalence in CD subjects that is due to weak muscular support of vertebral column in coronal plane, but because of strong muscular support of vertebral column in sagittal plane, CD had not any considerable effect on chin deviation and forward head posture

[ investigation of relationship between binocular vision status and migraine headaches]

According to controversial results between migraine headaches and binocular vision anomalies, this study was designed to investigate the relationship between some parameters of binocular vision refractive errors and migraine headache. In this case-control study, 30 patients with neurologically diagnosed migraine who had inclusion criteria were selected as case group and 30 persons with no migraine headache were selected as control group. First, patients were screened by standard headache questionnaire and diagnosis refined by neurologist. The Refractive errors were determined by retinoscopy and were corrected. Then near point of convergence, jump convergence, stereopsis, fusional reserves and far and near deviation were determined. Data were analyzed by SPSS.15 software, using Man-Withney U test and multiple logistic regressions. The mean of near phoria, stereopsis, far positive fusional reserve, far negative fusional reserve, near positive fusional reserve, near negative fusional reserve in case and control groups were 6.5 +/- 2.85, 8.3 +/- 6.72 pd, 49.0 +/- 26.11, 154.17 +/- 333.82 sec/arc, 10.7 +/- 2.76, 6.07 +/- 5.07, 18.2 +/- 4.7, 11.0 +/- 7.37, 16.5 +/- 4.49, 13.97 +/- 8.72, 22.7 +/- 5.22 and 14.67 +/- 9.25 pd, respectively. The means of above parameters and jump convergence was significantly different between two groups [P<0.05]. However; no significant difference was observed between two groups for other variables [P>0.05]. In multiple logistic regression only jump convergence, far positive fusional reserve and near positive fusional reserve stayed in model [P<0.05]. This study showed higher rates of binocular vision anomalies [abnormal jump convergence, higher amounts of near deviation, abnormal positive and negative fusional convergence and reduced stereopsis] in migraine group than control. Hence, people who experience migraine headaches should be referred to their optometrist regularly to evaluate their binocular vision statuses

[Comparison of apical leakage using AH26 and Apatite root sealers with immediate and delayed post space preparation]

Successful preparation and treatment of root canal depends on the compatibility between filling material and canal walls. On the hand, proper crown repair most often require post and core preparation. The aim of this study was to compare the effect of immediate versus delayed root canal preparation for post-space on apical seal using 2 types of sealers Apatite root sealer and AH26. This experimental study was conducted on 76 anterior teeth with single root canals. These teeth were sectioned from the cervical area which left at least 12 mm of root portion. All teeth were randomly divided into 4 groups. There were 2 positive and 2 negative control teeth aside from 15 experimental teeth in each group. After cleaning and shaping, root canals were filled with Gutta Percha, using lateral condensation method and AH26 sealer [in groups 1 and 2], and Apatite root sealer [in groups 3 and 4]. Post-spaces were immediately prepared in groups 1 and 3, leaving the last 4 mm of Gutta Percha in root canals. The root canals in groups 2 and 4 were kept in 100% moisture for a week and post-spaces were prepared with the same technique. Finally, all teeth were kept in Indian ink for 72 hours. All teeth were then demineralized in citric acid and demoisturized using ethylic alcohol. Photographs were taken from different angles using stereomicroscope connected to computer with 40x magnification in order to detect dye preparation. Photographs were evaluated by 2 independent individuals separately and dye penetration was measured. Data were analyzed using Two-Way ANOVA and Tukey tests. The immediate AH26 group had the lowest and the delayed Apatite root sealer had the highest rate of apical leakage and dye penetration. A significant difference was detected between immediate and delayed methods of post-space preparation [P<0.01]. There was no significant difference between the 2 types of sealers used [P=0.426]. Immediate post-space preparation before sealer setting had less apical leakage. No significant difference was detected between AH26 and Apatite root sealers

[ effectiveness of pencil pushup training and office-based vision therapy for treatment of convergence insufficiency]

To compare the effectiveness of pencil pushup training [PPT] versus office-based vision therapy in patients with convergence insufficiency. Sixty students of Zahedan Medical University with convergence insufficiency were randomly selected. After determining refractive error [by retinoscopy using cyclopentolate 1%, if needed], near point of convergence [by millimeter ruler], near heterophoria [by alternate prism cover test] and positive relative convergence [by prism bar]; subjects were divided into two groups to receive PPT [3 times daily for 10 min], or office prism training [2 times each week for 30 min]. Subjects were re-examined 4 and 8 weeks after initiation of treatment. Independent samples t-test showed that near point of convergence, phoria and positive relative convergence were not statistically different between the two groups before treatment. After 4 and 8 weeks of treatment only positive relative convergence was different between the two groups. Repeated measurement ANOVA showed considerable difference between the two groups in general but the Bonferroni test showed that the observed difference was related only to positive relative convergence. PPT and office-based vision therapy are comparable for treatment of convergence insufficiency