فهرست مطالب

سازمان نظام پزشکی جمهوری اسلامی ایران - سال سی و سوم شماره 2 (پیاپی 130، تابستان 1394)
  • سال سی و سوم شماره 2 (پیاپی 130، تابستان 1394)
  • بهای روی جلد: 30,000ريال
  • تاریخ انتشار: 1394/06/28
  • تعداد عناوین: 11
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  • Sharifiyazdi Mohammadkazem, Heidarzadeh Siamak, Vahedi Saeid, Rahimi Forushani Abbas, Jabbari Hossain, Soltandallal Mohammadmehdi* Page 91
    Introduction
    Acute otitis media (AOM) remains a frequent global infection of childhood. This study was conducted to determine the frequency of Staphylococcus aureus and Pseudomonas aeruginosa and determine the antibiotic susceptibility patterns in patients with acute middle ear infections referred to Amir Alam hospital.
    Methods
    In total 102 middle ear discharge specimens were collected during 6 months period from patients with acute otitis media. Specimens were assessed for isolation and identification by microscopic examination and culture. The antibiotic susceptibility test was done by disk diffusion method of Kirby-Bauer and sensitivity frequency of tested antibiotics was assessed by appraisal diameter of the growth inhibitory zone.
    Results
    Of 102 tested specimens, 90 (88.2%) were recognized as Staphylococcus 27(26.5%), Streptococcus 7(6.9%), Moraxella catarrhalis 2(2%), Proteus 11(10.8%), Streptococcus pneumonia 15(14.7%), Pseudomonas15 (14.7%), Corynebacterium 6(5.9%), Haemophilus influenza 7(6.9%) and 12(11.8%) specimens were non cultureable. Almost all the isolated bacteria to antibiotics that are commonly prescribed to patients by Physician routinely including penicillin, ampicillin, and amoxicillin showed resistance.
    Conclusion
    According to the emergence of resistant strains to conventional antibiotic therapy, especially beta-lactam antibiotics and erythromycin, it is recommended to perform further studies to determine full picture of antibiotic susceptibility in circulating in patients with AOM to revise existing guidelines of empirical therapy of AOM in Iran.
    Keywords: Acute Otitis media, Antibiogram, Staphylococcus aureus, Pseudomonas aeruginosa
  • Nekoei Moghadam Mahmoud, Ghorbaninia Rahil*, Kamyabi Abbas, Behzadi Franak, Mehrabian Mitra Page 101
    Introduction
    Quality of working life is a variable that has recently attracted attention of many managers who are seeking to improve quality of human resources. Improving Quality of working life enhances employee satisfaction, and help strengthening workplace learning and coping with changing w environment. The aim of this study is to assess the family physicians’ quality of work life, in the Kerman province in 1389.
    Methods
    The sample was composed of 114 family physicians. Van Lar quality of work life questionnaire was used to collect information. data were analysis with SPSS 19 using descriptive statistics (mean and SD) and statistical T-test and Anova.
    Results
    The average overall family doctors’ quality of work life in Kerman province was 28.98%. Quality of life was higher in male physicians (mean=73.9, SD=2.05) than females (mean=66.36, SD=1.44). According to cooperation motivation, all fields (career and job satisfaction, work conditions, General well being, work- life balance, and stress at work) were significantly related except quality control of work.
    Conclusion
    The family physicians’ quality of work life is not in a satisfactory level, we need to consider programs and strategies to improve that.
    Keywords: Quality of working life, career, job satisfaction, working conditions, General well being, work, life balance, stress at work, work control, family physicians, praimery
  • Mosadeghrad Alimohammad, Khalaj Fatemeh* Page 110
    Introduction
    Surgical Site Infection is a common side effect of surgeries that causes an increase in morbidity, mortality, patient length of stay in the hospital and hospital expenses. Quality management as an organizational strategy helps improve working processes and enhance hospital productivity.
    Methods
    This study aimed to examine the impact of applying a quality management technique on reducing Surgical Site Infection in a cardiology hospital in Tehran, Iran. A participatory action research was used for the intervention. Using a checklist, the reasons for Surgical Site Infections were identified, investigated and an action plan was developed and implemented for its reduction.
    Results
    Using the quality management strategy, Surgical Site Infection was reduced by 28 percent. Standardization of processes, proper planning and using anesthetics clinic helped reduce the Surgical Site Infection.
    Conclusion
    Implementing an appropriate quality management model appropriately helps reduce Surgical Site Infection in hospital operation theatres.
    Keywords: Surgical Site Infection, Quality management, Continuous quality improvement, Hospital
  • Moradi Alireza, Erfani Hossein, Zanganeh Moharram, Neshani Ali, Alipour Alimohammadreza, Mostafavi Ehsan* Page 119
    Introduction
    disease control in Iran is mainly based on routine reporting of notifiable diseases in the national health system. On time reporting of diseases and appropriate action for reported cases are essential in this system. The aim of this study was to determine the status of routine reporting system of notifiable diseases in private sector physicians of Hamadan province.
    Methods
    This cross-sectional study was performed with participation of private sector employed physicians of Hamadan province using a standard questionnaire. The data were analyzed using chi-square test. p-value less than 0.05 was considered statistically significant.
    Results
    A total of 354 physicians including 178 (5%0.3) general practitioners, 138 (39%) expert physicians, 15 (%4.2) specialist and 23 (6.5%) laboratory associates were interviewed. 5%1.1 of the participants expressed that they report notifiable diseases. Cooperation of the laboratory associates (69.5%) and general practitioners (6%1.2) in reporting the notifiable diseases were significantly higher than the expert physicians (%39.8) and specialists (6%.3) (P = 0.001). There was no significant difference between job experience, work experience in the public health system and employment in the public sector of the health care system and the cooperation in reporting notifiable diseases.
    Conclusion
    Cooperation of private sector physicians in reporting the notifiable diseases was in an intermediate level. So, it seems necessary to hold the periodic retraining courses for physicians. Existing methods should be revised for promotion of this level of reporting.
    Keywords: Surveillance System, Notifiable Diseases, Questionnaire
  • Suri Mohsen, Mirhashemi Seyyed Hadi*, Moeenara Raheleh, Peyvandi Hassan, Naderi Kaveh, Hajinasrollah Esmaeil Page 125
    Introduction
    laparoscopy is a novel surgical method and has became the gold standard of treatment in some diseases. Development of hernia in laparoscopic port sites is a major complication. repairing port sites has always been of concern because of their small sizes which may lead to intestinal, omentum and intra-abdominal organs damage. This study aims to investigate the effects of fascial closure on development of incisional hernia in 10 mm trochars sites.
    Methods
    170 candidates of laparoscopy surgery that were referred to Loghman Hakim hospital were randomly allocated in two groups: 1) fascial closure performed in 10 mm trochars sites 2) fascial closure not performed in 10 mm trocar sites. Patients followed at 3, 6 and 12 months after surgery. signs and symptoms of incisional hernia Were closely controlled and sonographic evaluation performed in suspected cases. Data were analyzed using SPSS version 16; t-test and chi2 for quantitative and qualitative variables, respectively.
    Results
    10 patients where lost to follow-up. patients were matched for age,sex,BMI, existence of Diabetes mellitus and anemia. incidence of incisional hernia in group one and two were 2.5% VS 1.25%. this difference was not statistically significant.
    Conclusion
    it is highly probable that closure and non-closure of facia does not affect the incidence of incisional hernia in 10mm trocar sites.
    Keywords: lomm trocar, trocar site hernia, fascia repair, umblicus
  • Yavari Masoud, Ardehali Seyyed Hossein, Moeini Mahshid* Page 131
    Introduction
    putting high standard of care in ICU units will decrease overall cost by reducing preventable deaths etiologies. The ultimate goal of the ICUs can be achieved by proper financial resource allocation, monitoring standards, fixing old or non standard physical structure of units, providing high quality equipments, and recruiting skilled nursing and medical staff. To study standard of care observance in Intensive Care Units of Shahid Beheshti Medical University hospitals.
    Methods
    The data were collected by questionnaire in 6 criteria including management, human resources management, physical environment, improving quality and patient safety and patient care processes in ICUs. These Questionnaires were validated by health experts. Data were analyzed by spss software version 18.
    Results
    The total score was 1052 in all ICUs. The total score of the best ICU among all hospitals was 618 and the total score of the weakest ICU among all hospitals was 470. Among the 6 evaluating aspects, highest score was belonged to the management aspect and lowest one was related to patient care process.
    Conclusion
    Total scores of intensive care units were lower than overall score; meanwhile, all hospitals were assessed as grade 1 in national accreditation system. It represents the gap between national and international standards in all aspects that should be fixed.
    Keywords: Standard, Management, medical equipment, designing, safety, quality improvement, clinical processes, Hospital, intensive care unit (ICU)
  • Abbasi Mahmoud, Dehghani Ghazaleh*, Rezaee Raheleh Page 138
    Introduction
    Public health is the Science and art of preventing disease And providing, maintaining and promoting health and human capabilities. This concept is expanded in human life area. Therefore, from the international point of view, prophetic missions, policies, duties and public health activities are globalized and expanded from nation to the worldwide society.
    Method
    This article tries to carry out a study to review the documents and resources and find the legal obligations of the international documents in the field of public health policy as well as the challenges facing it. in fact respecting international obligations in hygiene and health by governments can guarantee the health of humans in international society. Access to health services with the purpose of promoting, protecting and providing every single person in society is a basic necessaries in development of any society and it is the right of all human beings to have it. States obligation is seen in the UN constitution, the world health organization constitution, the universal declaration of human rights and other international and regional documents in order to respond to this public health needs. Therefore, paying attention to the importance of international documents and treaties that Encourage governments to put policies in order to maintaining and providing public health seems necessary.
    Keywords: Public health, Public hygiene, Human rights, Millennium Declaration of development
  • Torabi Ardakani Atefeh*, Hosseini Saeed, Oroomiei Nadia, Mirzaee Saeed Page 147
    Introduction
    Health and security are two basic components of human rights in society. From the perspective of the World Health Organization, Family Medicine is the heart of global efforts to improve service quality, reduce costs, enhance effectiveness and equality of health care system. But without the participation of stakeholders and cultural changes in society it is not possible. The aim of this study was to investigate perceptions, knowledge and expectations of physicians and Shiraz people in Fars province aboutthis project.
    Methods
    This study is a cross-sectional study in 2013. sample and data collection Was through semi-structured interviews that were conducted with 30 patients and their analysis was done using analysis framework.
    Results
    From participants’ physician point of view five original codes with titles: The lack of adequate infrastructure, payment system problems, weak cooperation, misunderstood viewpoint on family physicians and 17 sub-codes and From people’s point of view two original codes with titles: Understanding and Awareness, and Expectations and 6 sub-codes were extracted.
    Conclusion
    The results showed that many people do not have the appropriate knowledge about the family physician program, so Training tailored to the local culture is needed, and also motivation system is needed to improve referral system. In order to keep family physicians in this system, solving economic problems and increasing motivation of family Physicians is necessary.
    Keywords: Understanding, attitude, Expectations, Family physician