mohammad keshvari

Tympanostomy surgery and ventilation tube (VT) placement are reliable methods to reduce the complications of eustachian tube dysfunction and inadequate middle ear ventilation. However, tympanostomy is associated with some complications. This study aimed to investigate the frequency distribution of tympanostomy surgery, success rate, its complications and the demographic characteristics of patients during 2011-2017 in Sari, Iran.

This retrospective descriptive study was performed using data from the records of 512 patients who underwent VT surgery in Sari during 2011-2017. A checklist was used to collect the data and SPSS V24 was used for data analysis.

The most common complaint at the time of referral was hearing loss (38.3%). In 79%, bilateral VT was performed and 6.5% had complications after the operation. The most common complication was purulent otorrhea (4.1%). Postoperative success rate of VT was found to be 93%.

Given the high success rate of VT surgery, this procedure could be a good method in treatment of hearing loss, acute recurrent middle ear infections, and the adverse effects of tonsillitis and allergy on middle ear.

Hospitals are the most important element of the health system. Hospitals play a key role in providing health services and have a major impact on the health system's performance. The success of organizations depends on their managers’ performance. Organizations with qualified and experienced managers will be more successful in achieving their goals and can reach optimal efficiency. This is a phenomenological qualitative study in which content analysis was used to achieve study objectives. The study population included the hospitals managers and senior experts of the vice chancellor for treatment of a provincial department of the Ministry of Health and Medical Education in Iran. Participants were selected by purposive and heterogeneous methods and data collection continued until data saturation was achieved. Data were collected by semi-structured face-to-face interviews. From our data, seven main themes were drawn, consisting of monitoring and control, planning, organizing, leadership and motivational factors, management of resources and information, communication and interdepartmental coordination and patient orientation Hospital managers play a key role in improving hospital function. Assessing hospital managers' performance, determining their strengths and weaknesses and taking corrective actions are beneficial to the improvement of hospitals’ performance.

  Optimal management of human resources is considered as a basic and most fundamental principle of management of the health services because manpower is the most important organizational resources. The aim of this study was to identify the challenges in the optimal management of human resources in hospitals. This qualitative study was conducted in hospitals affiliated to Tehran University of Medical Sciences and all experts who had sufficient knowledge of the human resources management programs were included. Nineteen participants were selected using non-probability purposive sampling. Data were collected through semi-structured interviews. Qualitative content analysis was used to analyze the data.   Three major themes emerged: organizational, motivational, and knowledge-related factors. Organizational factors included lack of up-to-date job descriptions, staff recruitment through university and hospital constraints in the selection of employees, lack of the culture of team working and process attitudes, incomplete establishment of occupational health and safety, and deficiencies in the evaluation system. Motivational factors included absence of a performance-based pay system, lack of communication between evaluation and incentive systems, and lack of motivation and confidence of the staff in solving problems. Knowledge-related factors included old human resources and resistance to change, lack of knowledge, and non-learner hospital environment.   Clear job description, implementation of dynamic organizational culture, safe environmental conditions, performance-based pay system, and directing hospitals towards becoming learning organizations play an important role in reducing the challenges of human resources management.

Information technology is one of the most important issues in health systems. It has been developed in health sectors and is widely used by hospital managers. Identifying barriers in the use of hospital information systems can be the first step for better information management and better implementation of quality improvement and clinical governance plans.
The aim of this study is to investigate the barriers for the using of information systems in hospitals.
This is a qualitative study, which used content analysis for analyzing to achieve study objectives. Sampling was done using purposive and heterogeneous methods and data collection continued until data saturation. The researcher was referred to hospital managers to identify individuals who had the most information regarding health information systems to identify barriers of using information system.
Results of this study showed that challenges and barriers of information management and use of information systems are related to each other. Based on the results of this study the most important challenges of using information systems are knowledge factors.
Designing a comprehensive plan can eliminate barriers of using information systems because barriers and challenges are integrated and related to each other.

Clinical Governance is a Framework in which health care provider will be responsible for continuous quality improvement. This study aimed to identify implementation challenges of Clinical Governance in the area of risk management.
This is a descriptive-qualitative study. We used Content Analysis method for data analysis. Study environment contained 7 teaching hospitals, and the study population included the hospitals staff engaged in Clinical Governance implementation. Using purposive non-randomised sampling, 18 participants were selected. A semi-structured face-to-face interview was used for data collection. Content Analysis method was used to conceptualize, interpret and analyze the texts and maxQDA software for data analysis.
Our research findings presented two main themes as cultural factors and lack of resources.
Promoting management as well as empowering health care providers could act as a key factor in addressing problems related to the implementation of risk management in health care environments.

Obesity is a major public health problem worldwide. This review was carried out to assess obesity among Iranian primary school students.
All cross-sectional studies that conducted on prevalence of obesity in adolescents in Iran without any restrictions was examined. The search engines included national and international databases including: Magiran, SID, Iranmedex, Scopus and PubMed in August 2015. Stata software version 12 was used for analysis of data and to obtain a summary measure.
In all 25 papers had the inclusion criteria for the study. Studies showed that the prevalence of obesity in Iranian primary school students was 7.18 percent (95% CI: 5.63-8.73). The prevalence of obesity was higher in boys than girls (8.02% vs. 6.07 %).
This information might help to implement interventions to prevent obesity among Iranian primary school students. It seems that implementing interventions that aim to improve lifestyle and dietary patterns of this age group range are essential.

Due to little attention to the combined effect of diabetes and pregnancy on mother an infant’s microelements in literatures. This study aimed to compare newborns growth parameters, Apgar score, the cord blood zinc, magnesium, calcium and phosphor between pregnant women with and without gestational diabetes mellitus.
This prospective cohort study was conducted in Hamadan city, Iran, during 2013-14. Gestational diabetes considered as exposure and 20 women with gestational diabetes were individually matched with the 20 non-diabetic pregnant women in terms of the variables age, number of pregnancies, and type of delivery were included in this study. The cord blood and mother vein blood samples were taken immediately after delivery.
The mean of newborn's head circumference was 34.85±0.9 cm and 33.90±0.97 cm in mothers with gestational diabetes and non- diabetic mothers respectively (P This prospective cohort study showed the imbalance of some micronutrient in cord blood of mothers with gestational diabetes in comparison to non-diabetic mothers. Therefore in pregnant women with gestational diabetes should be more attention to be paid the concentrations of microelements.

Clinical governance is a framework in which service provider organizations are accountable for continuous improvement of responsive quality and protect high service standards by creating an environment where clinical service excellence is flourished. The purpose of this study was to explore challenges of establishing clinical governance in the field of patient education.
This qualitative study was conducted in four teaching hospitals of Tehran University of Medical Sciences and the population consisted of experts involved in the clinical governance program. Sixteen participants were selected using non probability purposive sampling and known cases. Data were collected through semi-structured interviews which were recorded, transcribed and analyzed after informed consent was obtained. Qualitative content analysis was used to analyze the data.
Two major themes were emerged: “organization-related and patient-related factors”. Cultural factors included “poor teamwork culture, nurses’ lack of motivation to train patients, unvalued education, lack of time and high workload, shortage of personnel, lack of clear guidelines for education, overtime processes, managers’ neglect of education”. Patient-related factors, included “patients’ unawareness of their legal rights, public predicament and lack of cooperation from patients, patients’ illiteracy and low literacy, low motivation, cultural diversity of patients and difficulty to communicate with them”.
Informing patients of their rights to receive comprehensive education and informing caregivers of such rights are the manifestation of patient-orientation concept and could pave the way to remove the challenges of clinical governance program.

This study aimed to identify the challenges of risk management in the context of clinical governance in selected hospitals of Tehran University of Medical Sciences. This study was implemented in two phases: qualitative step and quantitative step (survey). The first step was conducted using in-depth interviews and the second was carried out through a survey by questionnaire. Data were collected in hospitals through in-depth interviews with hospitals managers and the experts involved in clinical governance who had been introduced by the hospital manager. All professionals affiliated with clinical governance in Baharloo, Firoozgar, Farabi, Shahid Rajai, Ziaeian, Motahari and Sina hospitals were selected. 35 experts involved in clinical governance were interviewed. According to these experts, the main obstacles in hospital risk management were: Lack of an error reporting culture, exaggerated fear of the consequences, and physicians'' lack of interest in this domain. High workloads in this area have led to a reduction in employees'' contributions. Establishing clinical governance in health care organizations has had many benefits, such as improving patient care, increased level of patients'' satisfaction, establishment of a risk management system, improvement in staff and health-care personnel cooperation, and achieving a more successful organizational management. Appropriate changes in the organizational culture are necessities for the successful establishment of risk management. Human and cultural obstacles that hinder the implementation of risk management in hospitals are evident; thus, major actions are necessary to implement risk management properly in a disciplined manner.