Effect of Nd:YAG laser irradiation on the number of open dentinal tubules and their diameter with and without smear of graphite: an in vitro study

Dentin hypersensitivity [DH] is characterized by tooth pain arising from exposure of dental roots. In this study the efficiency of neodymium yttrium-aluminum-garnet [Nd:YAG] laser in association with graphite on dentinal surface changes as the alternative to the treatment of DH was evaluated. Sixteen noncarious human third molars were collected and sectioned into 5 parts from cementoenamel junction [CEJ] to the furcation area. The prepared samples were randomly assigned into five groups [Gs] of each 16: Control [G1], treated by Nd:YAG laser at 0.5 W [G2], irradiation of Nd:YAG with a 0.25 W output power[G3], smeared with graphite and then using Nd:YAG laser at output powers of 0.5 W [G4] and 0.25 W [G5]. For all groups the parameters were 15 Hz, 60 s, at two stages and with a right angle irradiation. The number and diameter of dentinal tubules [DT] were compared and analyzed by SPSS software, One way ANOVA and Post hoc LSD tests. The number of open dentinal tubules varied significantly between all groups except among G1 with G3 and G2 with G5. Multiple comparison tests also exhibited significant differences regarding the diameter of tubules between the groups two by two except among G2 with G5. Nd:YAG laser used at 0.25 W and 0.5 W with application of graphite smear was able to reduce the number and diameter of dentinal tubules

Serum levels of interleukin-6 and interleukin-8 as diagnostic markers of acute pyelonephritis in children / 소아과

PURPOSE: Early diagnosis and treatment of acute pyelonephritis in children is of special importance in order to prevent serious complications. This study was conducted to determine the diagnostic value of serum interleukin (IL)-6 and IL-8 in children with acute pyelonephritis. METHODS: Eighty-seven patients between 1 month to 12 years old with urinary tract infection (UTI) were divided into 2 groups based on the result of 99m-technetium dimercapto-succinic acid renal scan: acute pyelonephritis (n=37) and lower UTI (n=50) groups. White blood cell (WBC) count, neutrophil (Neutl) count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, platelet count, and serum IL-6 and IL-8 concentrations of both groups were measured and compared. RESULTS: There was a significant difference between two groups regarding WBC count, Neutl count, ESR, and CRP concentration (P<0.05). In addition, the difference between the two groups regarding serum IL-6 and IL-8 concentrations was not significant (IL-6, 60 and 35.4 pg/mL and IL-8, 404 and 617 pg/mL, respectively). The sensitivity and specificity of serum IL-6 and IL-8 for diagnosis of acute pyelonephritis were 73%, 42% and 78%, 32%, respectively. Sensitivity, specificity, negative and positive predictive values of serum IL-6 and IL-8 were less than those of acute phase serum reactants such as CRP. CONCLUSION: This study showed that there was no significant difference between acute pyelonephritis and lower UTI groups regarding serum IL-6 and IL-8 levels. Therefore, despite confirming results of previous studies, it seems that IL-6 and IL-8 are not suitable markers for differentiating between acute pyelonephritis and lower UTI.

Designing a model for trauma system management using public health approach: the case of Iran

Trauma is a leading cause of death and disability around the world. Injuries are responsible for about six million deaths annually, of which ninety percent occur in developing countries. In Iran, injuries are the most common cause of death among age groups below fifty. Trauma system development is a systematic and comprehensive approach to injury prevention and treatment whose effectiveness has been proved. The present study aims at designing a trauma system management model as the first step toward trauma system establishment in Iran. In this qualitative research, a conceptual framework was developed based on the public health approach and three well-known trauma system models. We used Benchmarks, Indicators and Scoring [BIS] to analyze the current situation of Iran trauma care system. Then the trauma system management was designed using the policy development phase of public health approach The trauma system management model, validated by a panel of experts, describes lead agency, trauma system plan, policy-making councils, and data-based control according to the four main functions of management: leading, planning, organizing and controlling. This model may be implemented in two phases: the exclusive phase, focusing on resource integration and the inclusive phase, which concentrates on system development. The model could facilitate the development of trauma system in Iran through pilot studies as the assurance phase of public health approach. Furthermore, the model can provide a practical framework for trauma system management at the international level

[Perceptions of patient safety culture among staff of selected hospitals affiliated to Tehran university of medical sciences]

Patient safety is a critical component of health care quality .Safety culture plays an important role in the approach toward greater patient safety in health care settings. The purpose of this study is to measure patient safety culture in three teaching hospitals affiliated to Iran University of Medical Sciences [IUMS]. This research is a cross sectional study. The Hospital Survey on Patient Safety Culture -HSOPSC -was distributed hospital-wide in these hospitals. It evaluates ten patient safety culture dimensions and four outcomes. In total, 311 individual responded [overall response rate = 90 per cent], including 198 nurses, 57 physicians, 32 pharmacy, laboratory and radiology assistants and 24 of other staff. Research findings indicate that the patient safety culture scores of selected hospitals were considerably low. The lowest scores were "non-punitive responses to error" [17/8 per cent], "teamwork across hospital units [18/2 per cent], "feedback and communication about error" [19/8 per cent] and "communication openness" [19/9 per cent] .The dimension "teamwork within hospital units" generated the highest score [47/2 per cent]. In addition, the staff of hospitals "A and B" graded the safety performance of their hospitals as acceptable and hospital "C" performance was graded as poor. According to respondents, in the hospital "A" only 1-2 events were reported during past 12 month and in hospitals "B" and "C" no events were reported. Findings of this research indicate that the important aspects of the patient safety culture in these hospitals need improvement. This is an important challenge for all managers desiring improvement in patient safety

[ survey on present status of health services priority setting in Iran]

To analyze the process of priority setting at different levels of Iran's health system. In this qualitative study, 19 Experts of different levels of health system were interviewed. The semi-structured interview guide was designed based on literature review and four initial in depth interviews. Framework analysis method was used for the analysis of qualitative data. Eight themes and 22 sub-themes regarding health priority setting were identified: Health priority at macro-level; Priority setting between and within medical universities; Priority setting criteria; Measuring costs and outcomes; Resource shift; Public participation; and Resource allocation decision rule. Health sector share of public budget was unrealistic and was based on historical patterns. Political factors and lobbying influenced resource allocation between and within medical universities. Resource allocation was mainly structure based and health factors were least influential. Although resource shifting was possible within programs but it was impossible within them, Public participation in priority setting was not sufficient and systematic, decision making on resource allocation was mainly based on needs and judgment. Some priority setting activities are in progress, but they do not tend to be either comprehensive or systematic. In order to improve priority setting, developing an approach which enables stakeholders' involvement is suggested

[Challenges of determining basic health insurance package in Iran]

To assess challenges of determining basic health insurance package in Iran. We interviewed a purposeful sample of 20 participants from 7 main stakeholders in Iranian health insurance system in 2009. We asked about main challenges of determining basic health insurance package in Iran and used the framework method for the analysis. Agreement on General Principle, determining Criteria to define Basic Health Insurance Package, Organization, Financing, Payment System, Regulations, Benefits range, Composition and manner of population coverage, Coordination, Behavior, Policy Making, Surveillance and Control had been introduced as main Challenges of Determining Basic Health Insurance Package in Iran. Determining an appropriate health insurance package in Iran needs a systematic view and a long term plan. The plan should aim to respond to the above concerns

[Empowerment position in Tehran social security hospitals based on the organizational excellence model [The EFQM]]

The purpose of this research, according to legal requirements for applying the model as national productivity model, has been assessment of empowerment in Tehran Social Security Organization Hospitals Based on The Organizational Excellence Model [EFQM]. The method of this research is descriptive and cross-sectional. This research had been done in Alborz and panzdah khordad varamin hospitals. Data gathering tool was the EFQM questionnaire that had been completed during group working sessions, interview with leaders of the hospitals and referring to necessitous units. Research data had been gathered according to five empowerment criteria in the hospitals. Alborz hospital has had the higher score in leadership criterion [46.1%], policy and strategy [50.6%] processes [61%]. Panzdah khordad hospital has had the higher score in people [47.39%], partnership and resources [49.5%]. Totally, the finding shows that Panzdah khordad hospital had been higher score 254.35 and then Alborz hospital with 235.46 scores. Assessment of hospital performance based on empowerments, according to European Organizational Excellence Model, is the first empirical experience in hospitals of our country. The findings have showed that European Organizational Excellence Model and empowerment segment of the model is very applicable in health care. Benchmark and supervision to hospital performance will be possible by using the model especially in management attention and follow up to hospital and people empowering that facilitate to reach the organizational goals and results

[Sustainable universal health insurance coverage barriers in Iran: 2007]

Contribute to a better understanding of the Iranian health financing system and draw some useful clues for policy makers are the aim of the study. We interviewed a purposeful sample of 25 participants from 7 main actors in Iranian health Insurance system in late 2007. We asked about three main tasks of health financing system: revenue collection, Risk Pooling and Purchasing and used a model suggested by Guy Carrin to design the study and the framework method for the analysis. Unknown insured rate, Regressive financing and, non transparent financial flow, Fragmented system and non compulsory insurance, Nonscientific designed BP, non health oriented and expensive payment system, uncontrolled demands and defect in administrative efficiency are seven themes which explain the defects of current universal coverage in Iran. A long term systematic approach plan is required in any reform in Iran's health financing system. The plan should aim to respond the above problems systematically

Performance assessment of Hasheminejad hospital in 2007 according to the The Baldrige Criteria for Performance Excellence

The Baldrige Criteria for Performance Excellence provide a systems perspective for understanding performance management. They reflect management practices against which an organization can measure itself. The Criteria have been accepted internationally as the model for performance excellence. This descriptive cross-sectional study was performed at Hasheminejad hospital, a training hospital of Iran University of Medical Science And Health Services, in Tehran. Members of the study team interviewed the Hospital administrator and senior managers according to the standard global Malcolm Baldrige questionnaire and documented the data. 7 criteria were used for performance assessment. This hospital got 426 points from a maximum of 1000 [42.6%]. Of 426 point, 46 [37% of maximum point] was for leadership criteria, 38 [44%] for strategic planning, 41 [50%] for focus on patients and other costumers, 40 [44%] for criteria of data assessment, analysis and management, 43 [51%] for focus on personnel, 33 [39%] for process management and 185 [41%] for function of organization. Baldrige model can be used as comprehensive model for assessing the performance of training hospitals. By using this model, managers can find strengths and weaknesses of organizations and then use this model for performance improvement