rahmat allah jadidi

Tuberculosis is an important health challenge with a worldwide increasing trend, especially in developing countries. Early diagnosis and advances in the effective treatment are two of the key elements in tuberculosis control program. The current study was designed to determine the delay in diagnosis and treatment of pulmonary tuberculosis patients regarding to clinical signs and risk factors.
This is a historical cohort study that conducted with inclusion of 113 tuberculosis patients from Markazi Province of Iran (Saveh and Zarandieh) between 2008 to 2014. Data was provided by a self-structured questionnaire and patient’s medical records. Data was analyzed by t-test and analysis of variances.
The mean age of patients was 57.7±92.1 years, with 52.2% being females. The mean of total delay was 129.9±171 days; including patient 52.7±92.1, health system 47±91.9 and treatment 2.1days. The mean in diagnosis and treatment delay did not show significant differences with gender, marital and nationality of patients. But patients with coughing more than two weeks had shown lower patient’s delay. In addition, patients who had previous contact with tuberculosis patients showed shorter diagnosis’ delay (p Long delay in early diagnosis and treatment is the result of defect finding the cases of tuberculosis within the health system, especially in urban communities. Therefore, increasing the level of health awareness about signs of disease and clinical symptoms would be effective in accelerating the references of suspected people to the health systems

According to the toxoplasmic retinochoroiditis leading to loss of central vision، corneal opacity، tearing، photophobia، and is، therefore early treatment is very important. This study aimed to evaluate the efficacy of intravitreal injection of toxoplasmic retinochoroditis clindamycin in comparison with conventional therapy (oral drug) was performed. In this clinical trial، target population was all patients with the toxoplasmic retinochoroiditis referred to clinics in ophthalmology Arak city، that stratified randomly into two groups، interventional group “A” was received treatment with intravitreal injection clindamaycin «and control group “B” was received standard oral treatment (Pyrimethamine and sulfadiazine and clindamaycin). Tool for data gathering was questionnaires and medical records of patients in which visual acuity based on the Senllene Chart and retinal thickness with use tomography layers of the retina (OCT). Results of measurement were recorded by specialist retina before and after intervention (weekly and monthly until complete resolution of lesions in retina) during one year. The data entered into the SPSS 16 software and after matching age &sex of patients، was final analysis the using descriptive and inferential tests such as t-test was performed. Of the 26 patients with toxoplasmic retinochoroditis، 16 (61/5%)، urban and number 10 (38/5%) were rural. The average improvement in visual acuity between the two groups in mean time to lesion healing (A) and (B) was different. The visual acuity in before and after treatment (separation of treatment) was significant difference in both groups (P<0/05). Also central macular thickness (in patients with toxoplasmic retinochoroditis) between before and after treatment in each group was different (P= 0/001)، but the changes mean central macular thickness (in cases of toxoplasmic retinochoroditis) There was no significant difference between treatments (P= 0/452). Although any two methods of treatment are effective، but intravitreal injection clindamaycin method due to shorter lesion healing time and increase higher visual acuity، is better than the alternative similar way.

According to the organizational intelligence to increase access of the knowledge in organizations and can to create competitive advantage in order to improve efficiency & effectiveness in organization، but that are affected by the structural dimensions of centralization، formalization، complexity (which reflects the characteristics of the internal organizations). This study aimed to investigate the relationship between organizational structure & organizational intelligence in Arak Medical University affiliated teaching hospital was performed. In this study، the research community was comprised official staff that have high school diploma، working in hospitals that were selected for this study by sample stratified random studied. Tool for data collection، was questionnaire Robbins organizational structure and standardized questionnaire Alberkht about organizational intelligence. After confirming the validity and reliability of questionnaires، these were distributed between colleagues in teaching hospitals and then were collected. Using data collected from 16 SPSS software testing was analyzed by Spearman correlation coefficient. From 87 respondents، most of them have had a bachelor''s degree and about 52 people who (74%) had experience about five years. The results were shown of the significant correlation between the organizational structure &intelligence in teaching hospital (r =-0 /612 and p=0/001). The relationship between the complexity of organizational with organizational intelligence was not significant (r = 0/157 & p= 0/53)، but by two other organizational dimension of structures (i. e.، degree of formalization، centralization) with organizational intelligence was obtained significant respectively (r =- 0/693and p=0/001) and (r =- 0/711and p=0/001). Based on findings from this research، teaching hospitals must be review current situation about organizational structural dimensions particular through decreasing centralization، formalization، to provide necessary field for developing and implementation of organizational intelligence

Scientific research in the medical sciences is known as a basic necessity for professional development which leads to clinical improvement. This study aims to compare the barriers to research activities among students of Arak University of Medical Sciences and provide proper strategies for student research management. This analytical comparative study was carried out in year 2012 on 325 students of Arak University of Medical Sciences. Non-researcer students were selected through stratified sampling while researcher students were selected by census. Data was collected using two researcher-made questionnaires classified using Likert scale that compared barriers existing in institutional and individual area. The scores given to these barriers were compared to those found by similar studies in 25 published articles. Strategies for improving student research management were validated using the Delphi technique. Validity and reliability of the questionnaires were confirmed and data was analyzed using ANOVA and t-test. According to the viewpoints of researcher students، mean score for barriers in instutional area was (3. 32±2. 14) and according to non-researcher students، mean score for existence of barriers in individual area was (3. 68±1. 98) which is considered high. The highest barrier scores belonged to the lack of of trained research assistants (4. 35±1. 3)، no application of research outcomes in the community (4. 25±. 9)، and students’ unfamiliarity with digital library (4. 31±1. 5). The mean score of institutional barriers given by non-researcher students was significantly different among different schools (p=0. 001). No significant correlation was observed between gender or students’ grand point averages with scores of research barriers (p>0/05). Finally improvement strategies for students’ reasearch management in three fields of structure، process، and function were represented. This research emphasises on the required infrastructures for student researches، taking benefit of well-trained research assistants and encorporating research methodology course in curricula of all medical sciences disciplines as the main basis for student research activity improvement.

Endophthalmitis is the most important complication after cataract surgery which its incidence can lead to severe loss of vision or even loss of vision; therefore, methods of prevention are very important. This study investigated the influence of vancomycin consumption during cataract surgery on prevention of endophthalmitis.

In this experimental study, the study population included patients of cataract surgery that were admitted to Amir Kabir Hospital. The patients were randomly assigned to two groups: with and without receiveing vancomycin in serum. Demographic characteristics of the patients before surgery and incidence of endophthalmitis with the examination until two weeks after surgery were recorded. To compare the frequency (incidence) of infection, endophthalmitis in two groups, Fisher's exact test and X2 test were used.

Of the 1281 patients, 539 were administered vancomycin in serum. The examination after two weeks indicated that 3 (0.23%) patients developed endophthalmitis. Of these, 2 (0.16%) patients belonged to the group without vancomycin and 1(0.07%) patient belonged to the group receiving vancomycin. Fisher's exact test did not show any significant differences between the groups receiving vancomycin and the control group in the prevalence of endophthalmitis.

Although the relative frequency of endophthalmitis in patients without receiving vancomycin was further than control group, the difference was not statistically significant. Thus, adding a drop of vancomycine was not effective in prevention of endophthalmitis and the causes should be sought in other cases.

Two of the most common complaints of patients who refer red to ophthalmology clinic are headache and asthenopia which are induced or intensified by exodeviation. This study was conducted to determine the relationship between exodeviation and headache or asthenopia. In this cross-sectional study, the sampling method, was screening of patients who referred to ophthalmology clinic with headache and asthenopia in 2006. Inclusion criteria were age above three, rejection of other causes of headache and asthenopia. Also, patients with organic headaches such as tumor were eliminated from the study. A questionnaire was provided for the patients and Cover-uncover test was also conducted for determining the existence of exotropia. Of 206 patients, participating in this study, 90.77% had exotropia and the majority of them were female. The most common symptom in these patients was headache. A direct relationship was observed between both headache and asthenopia with exodeviation. Exodeviation also had a direct relationship with gender. Noticing the direct relationship between headache and asthenopia with exodeviation in patients referring with such complaints, exodeviation examinations must be done in order to prescribe surgical or non surgical treatments asneeded.

Myopia is the most common refractive defect and degenerative myopia is one of the five causes of blindness in the world. The aim of this study is to examine degenerative myopia and its related risk factors. In this cross-sectional study, the data was collected through a questionnaire along with the auto-refraction apparatus, which was utilized for determining the myopic degree. The inclusion criteria for this study were the age above the 10, myopia or astigmatic myopia, apparent media (in fonduscopic examination), and the absence of age related retinal defect. A total 65 patients participated in this study 51% of whom had degenerative myopia. Choroid neovascularization was observed in 17.65% of the subjects. There was a significant difference in the relationship between hypertension(r=28%), diabetes mellitus (r =22%) and glaucoma, and degenerative myopia; however, this difference was not observed between cataract and myopia. The correlation coefficients between hypertension and diabetes mellitus, and degenerative myopia were 28% and 22%, respectively. This correlation was very low in the case of glaucoma. The greatest correlation existed between the myopic crescent and hypertension (r=0.295%). In all of the cases, the correlation coefficient between diabetes mellitus and all the myopic complications was positive but below 40%. The majority of the patients had degenerative myopia. Hypertension and diabetes mellitus were the most common co-existing diseases. Noticing the correlation coefficient existing between hypertension and myopia, the need for controlling hypertension and diabetes mellitus for preventing retinal complications is emphasized. Also, for preventing the adverse effects of degenerative myopia in retinal defects, controlling glaucoma is suggested.

Necessary to making constant revisions in the continuous education programs and updating the physicians’ knowledge in accord to the needs of society seems to be essential. The present study was conducted to conformity of continuous educational programs’ content of radiology department with needs of Continuous medical education learners, Markazi province, 2008. In this cross- sectional study, in 2008, the opinions of 40 physicians falling under continuous medical education (CME) were collected through a questionnaire on a Likert scale in more than 30 instructional topics. Before educational program performance, priorities in education were assessed and after performance, rate of coverage and requirements conformity with content was determined. The most educational need was indication of chest x-Ray with mean of 4.21 and the less need was wrist MRI with mean of 2.42. After program performance, the greatest conformity of needs with educational content was indication of mammography (mean= 83.1) and wrist and shoulder MRI (mean=53.2) which was the least required. Though, there was a general correlation between need and content coverage in both areas of graph indication order and interpretation, but was not base on priority needs. There was significant relationship between physicians needs with educational needs (p<0.001). But about gender and work experience was not significant relationship. Lake of complete coverage of needs base on educational priority of CMS learners will seek greater attention and emphasis or scientific secretary and lecturer on needs in special educational objectives frame for accelerating of continuous education effectiveness.

Recognition of mortality-related factors in Intensive Care Units (ICUs) could increase efficiency and effectiveness of these units. This research determined the relationship between the physical structure، human resources and their relevance to mortality rate in Intensive Care Units. Methods and Materials: In this cross-sectional study، all ICUs of hospitals in Markazi province were considered. Data gathering tools were resource (human، physical and training) questionnaires and checklists which their reliability and validity were accepted by Monitoring and Validation Center of Ministry of Health. Mortality rate after 24 hours of admition was also determined in relation to hospital resources and activities. Data were analyzed with descriptive statistics، Spearman and Kruskal-Wallis tests.

Total score of human، physical and training resources in hospitals of Markazi Province is 55 percent of the country standard score. Mortality ratio after 24 hours of admission، to all patients (released and deceased patients) was highest in Vali-e-Asr hospital (25%) and lowest in Saveh Shahid Chamran Hospital (5%). There wasn’t significant difference in this ratio among hospitals. There were no significant difference between obtained scores of each resource (human، physical and training) among University، Social Insurance and Qods (private) hospitals with respect to mortality rate 24 hours of admission.

Human، physical and training resources have not direct effect on decreasing mortality rate after 24 hours of admission but can create necessary conditions for providing higher quality services.

Optimum management of medical equipment in hospital settings has tremendous effects on decreasing costs and providing desired health and treatment services. This research has been undertaken to design a medical equipment management model for public hospitals of Iran. In this adaptive research, medical equipment management among United States of America, United Kingdom, Germany, Canada, Australia, Sweden and Italy, which have successful experiences and determined patterns for medical equipment management, are assessed with respect to 6 dimensions as structure, purchase, control, maintenance, training and distribution; and according to the shared strategies in the mentioned countries, a model was designed for Iran's public hospitals. This model was validated using expert's survey in DELFI method. In all of the studied countries, the medical equipment engineering unit is established for effective management of medical equipments and in direction with the main purpose of ensuring safety and improving patient care, clinical engineers are being trained. Trainings are designed according to international federation course plan for clinical engineers “which are combination of necessary engineering and managing courses for activities of hospital medical equipment management”. Under study issues include: precise need assessment for medical devices, balancing, use of life span expenditure, stock management, location finding, and needed physical space prediction, selection and purchase committee establishment, entering controls plus reception test, performance and safety control, activities documentation, using computerized systems for preventive maintenance and semi-centered distribution, are among necessary processes in the medical equipment management cycle of under studied countrie's hospitals. Management and medical equipment engineering unit establishment in hospitals, selection and purchase committee formation, continuous equipment performance control during calibration process, equipment preventive maintenance according to workforce training schedule, training needed experts, and with respect to the topics of international federation courses for clinical engineering training in universities, will improve medical equipment efficiency in hospitals.