مجله پیاورد سلامت
سال پنجم شماره 2 (تابستان 1390)

The operating room is one of the main units in a hospital, where the most important phase of treatment is performed. Due to the physical properties, use of gases, and different electric devices in the operating room, the safety of both the patients and the staff should be considered carefully. This study aims to estimate the safety standards of the operating rooms in ‎Tehran University Hospitals and to provide solutions to the existing problems.

This is a descriptive, cross-sectional study conducted in the operating rooms of TUMS hospitals. The research instrument was a checklist used by interviewers while observing the place. The safety standards were studied in terms of physical environment, protection against fire‎, personnel safety, patient's safety, and infection control. The data were analyzed by SPSS software.

The overall safety of the operating rooms of TUMS hospitals was found to be 84.9 percent. The figures for infection control and personnel safety, however, were lower.

The operating rooms of Tehran University of Medical Sciences hospitals were studied in terms of five safety standards. Considering the physical environment, fire protection, and patient safety, they were quite safe but as to infection control they were relatively safe. However, they were found to be unsafe regarding the safety of their staff. Tehran Heart Center with an overall safety of 97.5% for its operating rooms can be considered as a model for the other TUMS treatment centers.

Myocardial infarction (MI) is a major cause of morbidity and mortality worldwide. Epidemiological studies indicate that MI results from complex interactions between long-term environmental influences, concomitant disorders, and genetic susceptibility factors. Identification of genetic risk factors, particularly in premature MI, is very important. Since thrombosis plays a critical role in the pathophysiology of MI, recent studies focus on coagulation genetic polymorphisms. The critical role of platelets and their surface glycoproteins in the formation of occlusive thrombus leading to acute myocardial infarction is now well accepted. Platelets have two major receptors for collagen, glycoprotein I/IIa (integrin α2β1) and glycoprotein VI. In the present study, platelet GP VI T13254C polymorphism was chosen due to its potential association with altered platelet reactivity. The aim of the present study was to determine whether or not GP VI T13254C polymorphism was associated with premature acute myocardial infarction. One hundred patients with premature acute myocardial infarction and 100 age-matched controls with normal coronary angiograms were studied. Genotyping was done using PCR followed by RFLP. Statistical analyses included chi-square, t-test and logistic regression model. The findings of the present study showed that the prevalence of T13254C polymorphism did not differ much between patient (38%) and control (33%) groups and that polymorphism was not associated with premature acute MI (P=0.46). Logistic regression analysis also indicated no association between this polymorphism and premature acute MI (P=0.20). This study showed that there was no significant association between GP VI T13254C polymorphism and premature acute MI.

Vaccination is one of the most important primary prevention and preventing the spread of infectious diseases. DTP3 is commonly used as a criteria for the availability of health services. The purpose of this study was determining vaccination coverage of DTP3 and factors influencing it. One thounsed and four hundred fiftey eight children (12-24 month old) from 17th district of Tehran were enrolled in this cross sectional study. In this study, vaccination status of the DTP3 vaccination schedule according to the demographic variables was determined. Information was collected by a questionnaire referring to children's vaccination card. Sampling method was cluster sampling and included 146 clusters with 10 children in every cluster. Data collected were analyzed using spssv13 software and chi-square and t tests. In this study, 744 girls and 714 boys participated. 1241 patients, (85.1%) cases received their vaccines at the right time. 190 patients (13%) cases had not received the vaccine at the proper time, and 27 patients (1.9 %) were not vaccinated. Between vaccine status and mother's education (p=0.003), father's education (p=0.012), family income (p=0.003), number of children in the family (p=0.006), birth order (p=0.007), and status of family's medical record in the health center (active - inactive)(p=0.002), significant difference was observed. Although vaccination coverage rate of DTP3 was 98%, more than 13% of cases, did not receive the vaccine at the right time and this constitutes to childhood illness. More research is needed to identify factors influencing no vaccination at the right time.

Salmonellosis is a gastroenteritis caused by different serotypes of Salmonella and is the most common type of food poisoning in the world. The purpose of this research study is to optimize the conventional method for the isolation of Salmonella SPP from the diarrheic specimens of children. Stool specimens were obtained from one hundred patients admitted to Children's Medical Center for diarrhea. The enrichment media were prepared by 3 Rappaport Vassiliadis broth (RV), Tetrathionate broth (TT), and Selenite Cystine broth (SC). Then, for the isolation of Salmonella SPP, the enrichment methods RV and TT were used and incubated at 42° C, and SC at 37° C. After 24 hours of incubation, the enrichment samples were inoculated into the following 6 different media: Hektone Enteric agar (HE), Rambach agar (RA), CHROMagar Salmnella (CHROMagar Salmonella), Brilliant Green agar (BG), Salmonella-Shigella agar (SS), and Xylose-Lysine-Deoxycholate agar (XLD). In total, 13 out of one hundred samples were identified as Salmonella SPP. All of these 13 Salmonella SPP samples (i. e., 100%) were positive on RV broth; the figures were 8 (61.5%) and 3 (23%) on SC and TT broths, respectively. The highest amount of isolation was found by the combination of RV broth and RA agar (100%). The lowest rate, however, was obtained by the combination of TT agar and BG broth (15.4%). The comparison results of 3 enrichment media and 6 selective media showed that the mixture of RV broth and RA agar would be very fine for the isolation of Salmonella SPP.

The hierarchical and bureaucratic form of governmental administration is changing into a new type of flexible and market-based public management called Enterpreneurial Management Revolution. According to Stevenson, entrepreneurial management comprises a number of opportunity-based management activities for the maintenance of organizations in order to have their contribution in social value creation. This research study aims to study the organizational performance of medical sciences universities of Tehran based on Stevenson Model. This research is a field study in which a structured questionnaire containing 22 main questions on the Likert Scale was distributed among the staff members of medical sciences universities in Tehran. The validity of the questionnaire was confirmed by experts and its reliability was estimated using Test- Retest Method. The Cronbach alpha coefficient was found to be 0.95. The data collection device was given to 379 staff members, of whom 325 filled it out. The data were completely recorded and then analyzed by SPSS software version 18. The results of the study show that regarding entrepreneurial management approach, medical universities are at an average level. According to the present research and all related studies, this is the case in all other governmental organizations. The results of the study indicate that organizational restructuring, decentralization, and continuous improvement in processes are the milestones of entrepreneurial revolution strategies in medical universities and all other public organizations.

Group B streptococcus(GBS)(Streptococcus agalactiae) is the leading cause of morbidity and mortality of the newborn infant and accounted as a factor leading septicemia after birth in mothers. Infections in infants are usually acquired by contact with the genital tract of the mother during labor and delivery. So a rapid screening test for group B streptococcus that could accurately identify pregnant women who are carrying the bacteria at the time of delivery would obviate the need for prenatal screening.The goal of this study was molecular epidemiology of group B beta Hemolytic Streptococcal(GBS) colonization in the vaginal flora of pregnant women. Samples were taken from mucus of anal and vaginal of 250 pregnant women during 35-37 week's ingestion by swap. Samples were tested by standard culture using Todd Hewitt Broth and Blood Agar and also by PCR using cfb gene. Culture identified 21(8.4%) women as carriage of GBS from 250 women but PCR assay could identify 24(9/6%) women. In comparison to culture results, sensitivity, NPV Specificity PPV of PCR Were(100%, 100% and 97%, 82%) respectively. The times that used for PCR assay and culture were 2h and 36h respectively. In conclusion, we found that group B streptococci can be detected rapidly and reliably by a PCR assay of combined vaginal and anal secretions from pregnant women at the time of delivery. Also this study shows that incidence of GBS is at high rate in Iranian pregnant woman, so we recommend screening of pregnant woman for detecting of GBS emphatically.

Annually, large amounts of fees that paid by hospitals will not be reimbursed as deductions by health insurances and takes irreparable financial losses to hospitals. The purpose of this study was to determine the amount of deductions imposed on hospital bills of Tehran University of Medical Sciences and their causes related to documentation. The present research was a cross-sectional and descriptive study performed in year 2009 on educational hospitals of Tehran University of Medical Sciences. All deductions reports related to Medical Services and Social Insurance related to year 2008 was collected from Income Unit of hospitals. The amount of deduction of each hospital was extracted and organized in the form of comparative tables. Data was analysed by descriptive statistics and Excel application. Then, the amount, type and causes of annually deduction of each hospital was determined. Most deductions imposed on inpatient bills have been related to the tests, appliances, medicine, residency, surgeon commission, and anesthesia and for outpatient bills have been related to visit, tests and medicine which most of them have been created due to documentation deficiencies. Most of deductions are due to unfamiliarity of care staff with documentation requirements of insurance organizations. Therefore it is necessary to use a multi-aspect mechanism including education of documentation principles to staff, supervision on record control in the Medical Record Unit and establishment of a committee by university for related activities.

The disabled people are a part of our society (1%) and a disabled will face incorrect behaviors from childhood that is caused by an incomplete understanding of the society, but family can play a constructive role to increase the disabled abilities.This study was conducted to determine the views of deaf, blind and physical motor handicaps and their families regarding disability in the family in the Qazvin and Karaj.

One hundered and fifty handicaps and their families from handicaps center, welfare office, the disabled school students, the Mostazafan and Janbazan foundation were enrolled in this study. Information was collected by using 2 questionnaires. T test and Analyses Of Variance have been applied for data analysis, using SPSS software.

The results show that among different disabilities, the deaf ones and their families had more positive view than other disabled ones about their disabilities.Also, increasing the number of family members can cause more negative view about disability (p<0.05). This study shows that there isnt a significant relationship between the disabled view and his / her gender, cause of disability and parents high education

With regard to the similarity of the disables and their families views about disability and also their need to obtain more awareness about disability, the disable's needs and complications, it is necessary to stress on correct training of disabled person, his/ her family and the society.