لاله قدیریان

Osteoporosis is the most common metabolic bone disease. It is a chronic disease and a socio-economic threat. The aim of this study was to develop a clinical guideline for osteoporosis to integrate service delivery. This study was designed and conducted in two phases: comprehensive systematic review and expert panel method. First, a comprehensive search of sources was conducted in reliable databases. Then, in the expert panel phase, the clinical questions and recommendations were presented to members of the panel of experts. Finally, among various recommendations for a clinical question, the recommendation, which was approved by more than 70% of the panel of experts, was chosen as the final recommendation. By reviewing the valid guidelines of the world, five guidelines were selected according to the screening criteria of the study and entered into the study. After holding several sessions with the panel of experts and reviewing the recommendations in the initial version, 28 questions and 181 recommendations were extracted. After obtaining the opinions of professors from different disciplines, the final recommendations were reviewed in a meeting with clinical experts, and based on the submitted opinions, the final version of the guideline update, in the form of 34 questions and 111 recommendations in the field of bone health (four questions, 12 recommendations), diagnosis and Evaluation (six questions, 19 recommendations), treatment and rehabilitation (17 questions, 67 recommendations), and Sarcopenia (seven questions, 13 recommendations), were presented. Due to the emphasis on the need for accessing valid protocols to provide optimal and useful services and address the care gap has developed the Osteoporosis Clinical Guide.

Mental health problems have involved many people in the community, which is more pronounced in adolescents. The purpose of this study was to investigate the mental health status of high school students in Tehran.

The present study is a cross-sectional and descriptive-analytical study and the statistical population of this study was all high school students in Tehran. The sample consisted of 2038 students who were selected by multistage cluster sampling. GHQ-28 questionnaire was used as a tool for assessing mental health. The results were analyzed by SPSS 18 software.

In the present study, the possibility of mental disorder was raised in relation to 982 (52.1) participants. The prevalence of anxiety disorders was higher in 919 (45.7) subjects than other GHQ subscales. Mental health status was different in different groups in terms of gender, educational level, academic achievement, physical health, parents' relationship with each other, socio-economic level of the family.

According to the results, almost half of high school students have poor mental health, which indicates the need for special attention to the mental health of this community.

It is difficult to run current organizations without delegating some of the authority to management levels. Despite the importance of delegating authority to managers, this seems to have been neglected in organizations. The aim of this study was to identify effective strategies for delegation of authority in Tehran University of Medical Sciences.

The present study was conducted in 2019 in two stages. In the first stage, existing strategies to increase the willingness of managers to delegate authority were extracted through a review study. In the second stage, by conducting 18 semi-structured face-to-face interviews and holding a focused group meeting, effective and appropriate solutions were identified to increase the desire of managers to delegate authority at the university from the perspective of stakeholders. At this stage, data were analyzed by thematic analysis method by 2 people.

The review of studies showed two groups of strategies at the organizational and individual levels to increase the willingness of managers to delegate authority. The effect of implementing the solutions has not been fully investigated in previous studies. In the analysis of qualitative findings, three themes (including the importance of delegation at the university management levels, barriers to delegation at university and effective strategies for delegation to administrators at the university) and four sub-themes (including clarification of the delegation process, teaching how to delegate, establishing methods Correct monitoring and evaluation and the use of motivational methods appropriate to the performance of managers) were identified.

with regard to the most important barrier to delegation at the managerial level is process-related, it is suggested that the training method and process of performance appraisal and organizational reward be reviewed to increase skills and motivate further delegation. So that, measure the effectiveness and implementation considerations, it is recommended to conduct further studies on the effective implementation of strategies and to monitor and evaluate the effects of the implementation of strategies.

The relationship between medical universities and teaching hospitals is a challenging issue. Lack of appropriate relations can create challenges in hospital management and its various functions, such as providing services, education and research. Therefore, this study was conducted to understand the current challenges of the relationship a university of medical sciences using different stakeholders' perspectives.

For data collection, 33 semi structured in-depth interviews and one focused group discussion were conducted. The participants were selected through targeted and snowball sampling, from educational hospitals and university departments. Qualitative content analysis method using qualitative analysis software, MAXQDA, was used for analyzing data. Coding and classification of codes were done by two researchers independently.

After conceptual categorization, the obtained categories were turned into 14 sub-themes and 4 main themes of “decision and policy making”, “resource provision”,” supervision and evaluation” and “information flow”. All these themes are subsets of the main “unity” theme.

analysis of the condition and related challenges emphasized the need for a revision of the relationships between educational hospitals and university departments. According to scientific evidence, this reform should focus on decentralization in order to increase hospitals decision-making power in different aspects. Obviously, due to social responsibility of university and hospitals and the necessity of their accountability to educational expectations and therapeutic needs of the community, the university governance and supervision role should be well defined and implemented correctly.

Objective (s): Decision making about characteristics of reward system is one of the main challenges in organizations. The current study was carried out in order to design and provide a reward system for staff working in hospital affiliated to Tehran University of Medical Sciences (TUMS) hospitals.
Methods This study was performed in two steps from May 2014 to January 2016 in Tehran. First, the research team identified the main axes of reward system using semi-structured interviews with experts and stakeholders. Then the list of final criteria for rewarding was prepared in addition to weight for each criterion using ‘pairwise comparison analysis’. Secondly, in order to identify the executive requirements, the model was implemented in one hospital as a pilot. The main aspects of reward system were scoring method; type of reward; awareness program; evaluation; executive requirements (including structure and process). After pilot study criteria and scoring method were improved. Although the findings were promising, it seems for model success defining executive requirements (including process and structure) proportionate to available capacities and advocacy from head and senior managers is essential.

The present study was conducted to investigate the relationship between organizational health and empowerment of primary school teachers in Kanarak city in the 2-7 academic year. The method of the present study was descriptive and correlational. The statistical population of this study includes all primary school teachers in the city of Konarak in the number of 400 people and its sample size was determined using the Cochran's formula of 196 people. Data collection tools in this study are two standard questionnaires of organizational health (Hui and Feldman, 1996) and empowerment (Hasanlu and Velayi Maleki, 1396) whose reliability was calculated by Cronbach's alpha method of 0.790 and 0.764, respectively. To analyze the research data in the descriptive statistics section using frequency tables and bar graphs, a description of the demographic characteristics of primary school teachers in Konarak city was presented and in the inferential statistics section to examine the research hypotheses of Pearson torque correlation coefficient. Multiple linear regression tests as well as distribution diagrams were used to show linear relationships between variables. According to the results of this study, there was a significant relationship between organizational health and empowerment of primary school teachers in Kanarak city. It was also observed that there was a significant or non-significant positive and negative relationship between the dimensions of organizational health and empowerment, and a direct and significant relationship between the dimensions of organizational health (institutional unity and consideration) and empowerment (empowerment) with the empowered. There was an inverse and significant relationship; But there was no significant relationship between the dimensions of organizational health (manager influence, resource support, morale and scientific emphasis) with empowerment.

Reward system program is an investment tools in order to improve quality of services. Accordingly, this study was conducted aimed to identify the challenges of the reward system and the solutions for improving that based on the views of stakeholders in Tehran University of Medical Sciences hospitals.
This directional content analysis qualitative study was performed in Tehran University of Medical Sciences during 2014and 2015 using content analysis method. Targeted sampling was done and in-depth semi structured and face to face interviews were performed with a wide variety of experts and professionals including managers, faculties and hospital staffs. After word by word transcripting and extracting codes (meaningful phrases), these codes was reviewed again in order to achieve subcategories. Based on subcategories, information was classified to assossiated categories. For validity and reliability checking, stakeholders and faculties member check and peer debriefing were used.
Eventually, a total of 29 interviews were held. The comments were classified within 6 main categories, 19 subcategories and 1100 codes. The main categories included existing arrangements in hospitals in order to improve staff motivation; reward system challenges; derived opportunities from rewarding experiences; rewarding systematic actions; types of appropriate rewards and making infrastructure for better rewarding system implementation.
Regarding multiple aspects of a reward system which could have an effective role in increasing staff motivation or a contradictory effect when it is inefficient, implementation of an effective reward system in hospitals by designing an appropriate model based on identified key factors in this study, is recommended.

Introduction & Health literacy is the degree to which individuals obtain، interpret and understand basic health information and services to make appropriate health decisions. The aim of this study was to describe health literacy of Bu Ali Sina university staff to help health care policy makers for proper interventions. In this descriptive-analytical study، health literacy of 206 employees was measured using a researcher-made questionnaire. Health literacy about risk factors of cardio-vascular diseases، cancers and diabetes was measured in 7 areas including: “attitude to health”، “understanding the information”، “social support”، “socio-economic conditions”، “ac-cess to health services «،» communication with health professionals«and “application of health information”. Median of overall health literacy level in identification of risk factors for all three dis-eases was 3. 7، and median of health literacy level in “identification of risk factors” for heart diseases، diabetes and cancers were reported 3. 53، 3. 44، and 3. 58، respectively. Except for cancer، health literacy levels about identification of cardiovascular disease and diabetes risk factors were significantly higher in women (P= 0. 02). Educational level increase showed a significant rise in health literacy score (P= 0. 008). As a whole، 75. 2% of cases had inadequate health literacy about risk factors of all three diseases. The lowest level of health literacy was related to the” application of health in-formation”. So، regarding the importance of health literacy and its link to health outcomes، it seems that policy makers need to pay more attention to health literacy improvement، particu-larly in the “application of health information”.

The mortality due to Coronary Artery Bypass Graft (CABG) in patients with chronic renal failure is more common than normal population. This study evalu-ates the impacts of prophylactic dialysis on decreasing mortality and morbidity of non- dialysis-dependent patients with renal failure after CABG surgery. In this study، fifty non-dialysis-dependent patients who were suffering from renal failure and needed to CABG، were selected by convenience sampling method. Se-quentially، they were allocated to prophylactic dialysis (n=20) and no prophylactic dialysis (n=30) groups، using a randomized block design. Exclusion criteria were under 18 year old patients and doing CABG for second time. Mortality rate and some complications such as acute renal failure، brain accident and atrial arrhythmias were compared between two groups after CABG. All cardiac surgeries were performed in a single centre and through a median sternotomy. P value less than 0. 05 was considered as significant. The mean age of patients was (65. 3±9. 9). The patients included %16 (n. 8) of women and %84 (n. 42) of men. There were 20 patients in intervention and 30 patients in control groups. Baseline characteristics were similar in two groups. Comparison be-tween intervention and control groups after surgery did not show any difference in mortality (P=0. 14)، acute renal failure (P=0. 4)، cerebrovascular accidents (P=1) and atrial arrhythmias (P=0. 3)، need to second surgery due to bleeding (P=1)، need to dialysis (P=0. 14)، need to rehospitalization (P=1)، duration of ventilator use (P=0. 4)، duration of need to hospitalization (P=0. 11)، duration of a patients stay in the Intensive Care Unit (P=0. 4) and deep sternal infection (P=0. 7) rates. According the results of this study، prophylactic dialysis، before conduct-ing CABG، does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.

Background and Incidence of neuroendocrine tumors in the world is increasing during these years. These tumors have a high complexity in clinical presentation, tumor stage and grade. In addition, using of markers like Ki67 level could help to estimate tumor grade. Assessing hospital prevalence of neuroendocrine tumors, Their origin and association between pathology and immunohistochemistry with Ki67 level was the purpose of conducting this study. All patients’ records during 2004-2010 were reviewed to select patients with neuroendocrine diagnosis, then their pathology and histochemistry samples were examined again. Patients’ characteristics in addition to type, grade and origin of tumors were entered to check list. Incidence of neuroendocrine tumors was 8 in 1000 patients. Data was gathered from 189 patients with neuroendocrine tumor diagnosis. Mean age was 49/6 years and Prevalence of each sex was 52/9% and 47/1% in men and women respectively. Pathology diagnoses were Carcinoid (27%), Round cell tumor (21.2%) and undifferentiated carcinoma (18.5%). Mean of Ki67 levels were significantly different by tumor grade, location, necrosis, pathology and immunohistochemistry. Based on this study, using Ki67 marker is helpful for diagnosing and determining tumor status, which could be effective on choosing the type of treatment.

Nausea and vomiting after middle ear surgery as one of the most common complications after surgery is considered to become the ground for the incidence of other adverse consequences. The aim of this study was to evaluate the effect of 16 mg prophylactic intravenous dexamethasone on postoperative nausea and vomiting after stapedectomy. In a randomized double-blind controlled trial study, 70 patients candidate for stapedectomy divided into two equal groups, using the same sedation by single surgeon. While the case group received 16 mg Dexamethasone half an hour before surgery, thecontrol group received 4ml intravenous saline as a placebo. Patients controlled 1-24 hours after the surgery in terms of nausea and vomiting and dependent variables such as vertigo and tinnitus. 70 patients (38 females and 32 males) were enrolled in this study. The rate of postoperative Nausea and vomiting in Case group was 31/4% (equal to 11 paticents) and in control group was 60% (equal to 21 patients). The different was statisticall significant(p=%3). The prophylactic use of 16 mg intravenous dexamethasone half an hour before surgery can significantly reduce incidence of nausea and vomiting after stapedectomy.