مجله پیاورد سلامت
سال هفتم شماره 3 (امرداد و شهریور 1392)

FLT3 gene is a member of class III receptor Tyrosine Kinase، which is expressed in most patients with acute myeloid leukemia (AML). Mutations of FLT3 such as Internal Tandem Duplication (ITD) and point mutation of the D835 are the most common genetic defects in myeloid leukemia. These two mutations in patients with MLA and their effect on survival rate were studied for the first time in Iran. DNA was extracted from the blood or bone marrow samples of 100 patients with AML from October 2008 to September 2009. For further analysis، PCR was performed to determine the prevalence of these mutations and their association with prognosis. Moreover، t and x2 statistical tests were applied for data analysis. According to the results، 15% of patients revealed FLT3-ITD mutations and 8% showed mutation of D835 in FLT3 gene. In terms of achieving complete remission (CR)، patients with mutation of ITD had more chance than those without such mutation (83. 5% versus 53. 3%). The white blood cell count was significantly higher in the ITD+ (mean = 73،646/ml) than ITD- patients (mean = 26،580/ml). The results indicate that FLT3-ITD mutations may reduce the chances of Complete Remission (CR) in patients; however، FLT3-ITD mutation is an important factor in selecting appropriate treatment.

Strategic thinking plays a very important role in guarding organizational survival and increasing development in today''s dynamic and changing environment. One of the elements of strategic thinking is systemic thinking، which forms the conceptual framework to solve issues in an organization. This study aims to determine the ability of Tehran University of Medical Sciences (TUMS) senior managers to stick to systemic thinking based on Friedrik Goldman’s model. This is a cross-sectional، descriptive- analytic study conducted on a sample of 100 TUMS senior managers in 2010. The data collection instrument was a standard questionnaire on systemic thinking، the response rate of which turned out to be 97%. The reliability and validity of the questionnaire were confirmed prior to its distribution. SPSS software was used for data analysis. To this end، single sample t-test and Friedman statistical methods were also applied. The findings revealed that the ability of systemic thinking was optimal among most TUMS senior managers. Enhancing and strengthening systemic thinking among TUMS senior managers are suggested، especially regarding omniscient and multi-end approach.

A goal of modern cancer research is to reach targeted therapies with drugs having fewer side effects. AZD1152 is a highly specific inhibitor of Aurora Kinase B، which leads to the programmed cell death by different mechanisms. The aim of this study was to evaluate the effects of AZD1152 on viability and metabolic activity of NB4 cells (APL derived cell line). The cells were treated with various concentrations of AZD1152. After 24، 48 and 72h treatments، the metabolic activity and viability of inhibitor-treated NB4 cells were assessed using MTT and trypan blue dye exclusion assays، respectively. Data were analyzed by applying student’s t-test (Microsoft Excel). A t 25، 50 and 100 nM، AZD1152 reduced the metabolic activity by 9. 2، 15. 5 and 56. 2% (after 24h)، 10. 3، 19. 5 and 59. 9% (after 48h)، and 17. 1، 28. 4 and 64. 8% (after 72h)، respectively. Meanwhile، the percentage of viability was decreased to about 51، 45 and 40% (after 24h)، 39، 36 and 30% (after 48h)، and 34، 32 and 28% (after 72h)، respectively. According to the results، AZD1152 has substantial efficacy on APL cell line and may be applied in some cases، e. g.، for patients who have relapse or who become refractory to the conventional chemotherapy. Further studies are needed to show the molecular mechanisms regulating effects of this anti-cancer agent.

Cutaneous leishmaniasis (CL) is prevalent in most tropical and subtropical countries of the world and leads to adverse economic consequences. This study was performed to estimate the cost of healthcare services delivered to CL patients in Qom Province. Based on the data from 638 CL patients، this cross-sectional study was performed in Qom during 2009-2011. First، using researcher-made forms and based on the accounting documents، the direct and overhead costs of health services in the studied areas were calculated. Then، the out-of-pocket costs per patient were obtained. Finally، the gathered data were calculated using the excel software. In total، more than 1،600 million rials was spent on providing health services to 638 patients with cutaneous leishmaniasis in endemic foci of Qom. The direct healthcare cost was estimated to be about a thousand million and the overhead cost about 600 million rials. Besides، the state cost per patient was estimated to be over 2،520 thousand and the out-of-pocket cost per patient about 240 thousand rials. Moreover، the average total cost per patient was calculated to be 2،760،772 in the studied period. Based on results، considerable costs are spent for CL diagnosis and treatment in Qom. Therefore، health planners should give priority to the prevention of this disease in their programs.

To optimize emergency services depend s on appropriate management structures and efficient and effective information system design. This study aim ed to investigate emergency department staff''s information needs of emergency information system and to design a conceptual model of these needs. This descriptive study was performed among nurses and emergency medicine professionals working in emergency units of 9 hospitals affiliated to Tehran and Shahid Beheshti U niversities of M edical S ciences. Data w ere collected by interviewing 25 staff members in the emergency department، model d esign by RUP method and UML language and questionnaire d istribution among 315 staff members in the emergency department. Data collected were analyzed by descriptive statistics and SPSS. Most nurses and emergency medicine physicians believed that multiple data elements such as time of patient’s first visit and procedure، t he latest status of patient، medical procedure taken، and paraclinical procedure taken must exist in the emergency information system. Also 68. 3% (108) of them agreed with the relationship between data elements required in the clinical practice process. It is concluded that the presence of identity، clinical، and paraclinical data in emergency information systems can produce an electronic medical record. According to these data، elements can improve the coordination between the hospital emergency and pre- hospital rescue teams، controlling of victim status، access to patient reports and quality of service to patients.

Transforming government hospitals into autonomous units improved hospitals. This study was performed to evaluate the responsiveness of board of trustees hospital according to the world bank’s organizational reform model (Preker Model) in isfahan city. The study was a qualitative research method. In this research، depth and semi-structured interviews were carried out and purposive sampling was used. The study population were top managers of Amin and Alzahra hospitals. Sampling was started with the first participant until saturated level of information، participants completed the 8 cases. According to interviews، the current role and contribution of non-university institutions (e. g. municipalities representatives) in hospital board of trustees is neither bold nor transparent. These hospitals can address minimum changes in their mechanisms of accountability after developing board of trustees. It is rational for hospitals as they undergo organizational reform and developing board of trustees، to have more rights for decision making. Further more، their accountability mechanism should change accordingly.

Peripheral and intermediate laboratories have an important role in diagnosis، treatment and prevention of tuberculosis. Today، without these laboratories، maintaining health and preventing the spread of tuberculosis is not possible. The aim of this study was Evaluation of manpower، equipment and quality control standards in peripheral and intermediate laboratories assessment checklist within seven selected provinces in year 2011. This study was a cross-sectional survey. In this study eighty tow peripheral and intermediate laboratories from seven selected provinces were studied in year 2011. A standardized checklist was used to assess peripheral and intermediate laboratories. The result showed that Esfahan with 20 labs and 8870000 population had the highest number of labs and coverage people between other provinces. Khorasan Razavi with an average of 263 per month has the highest number of admission number and Golestan، with an average of 139 positive cases per month، had the highest number of positive cases between other provinces. In 82 labs 117 laboratory technicians were engaged providing services to patients. The results of this study showed that conditions of most peripheral and intermediate laboratories are optimum and nearly standard. Control and evaluation of peripheral and intermediate laboratories، expert personnel، facilities and equipment are necessary to improve the TB control program in the country. Keywords:

Having a preparedness program for earthquake in hospital، with regard to its function for victims of accidents، is very important. The main objective of this study was evaluation of effective factors on the rate of preparedness of Tehran University of Medical Sciences’ teaching hospitals، to deal with earthquake danger of earthquake. This cross-sectional analytical survey was performed in the follow ing hospitals: Sina، Farabi، Roozbeh، and Razi. Data was collected by checklists and questionnaire. Data analysis was performed using statistical software (SPSS19) and Pearson correlation، ANOVA، t-test statistical tests. The most and the least preparedness against earthquake was in disaster management and construction mitigation plan fields respectively. Relationship between the field of hospital curriculums with construction mitigation plan (p= 0/045 and r=0/644) and hospital environmental health action plan (p=0/048 and r=0/636)، was significant. Average of Hospitals preparation against earthquake was evaluated in an intermediate level (51. 81percent). Due to the significant relationship between education and other fields that are listed above; it is suggested that in addition to short-term training programs، non-structural retrofitting of hospitals should be considered as a priority.