طراحی چارچوب مدیریت دانش هم‌افزا در بیمارستان‌ها و مراکز درمانی

Improving quality and reducing the expenses in Department of Health has always been one of the main priorities of different stakeholders and value seekers in this very prominent section of communities and governments. Knowledge asset management in this field has had an undeniable effect on the aspects of quality improvement and cost reduction strategies as well as playing an effective role in medical decision making and clinical processes. The purpose behind the present study was achieving a true understanding of the actual position knowledge management processes in health centers and hospitals. Moreover, it was aimed at proposing technology-driven solutions, based on knowledge management, to manage such valuable medical assets. The current study was qualitative from the viewpoint of administrative process, and falls into applied research from the perspective of results. In addition, in order to describe and discover the phenomena relating to knowledge management in hospitals, field studies have been drawn upon. To represent the findings, different approaches and methods regarding knowledge management in hospitals were expressed. In knowledge acquisition level, controlled and uncontrolled activities to elicit knowledge have been considered. Knowledge storage process, knowledge encoding, and benefits of reusing knowledge repertoires in hospitals have been regarded as well. Also, in publishing and distributing sector of knowledge, access was personalized and maintaining security has been expressed. Meanwhile, in the implementation and operation phase, the manner of using proved explicit knowledge has been mentioned. The results show that tools and indices of knowledge management are capable of helping the hospitals in acquisition, storage, retrieval, and learning assets relating to knowledge, both tangibly and non-tangibly. Applying knowledge process in order to utilize tacit and explicit knowledge in hospital environment is recommended. Knowledge management will be able to establish consistency in the knowledge structure resources in hospitals, assuring that by experts and elites leaving the field, their knowledge will remain stable and intact

سامانه مدیریت دانش، گزیری هوشمند برای بهبود در مدیریت خطاهای درمان

Errors in treatment process are of the main issues regarding patient safety in health centers and hospitals that have had a growing rate, causing concern in health industry. Using the knowledge associated with such incidents in hospitals has facilitated management as well as reporting process. It is also effective in managerial decisions. The purpose of this study is exploiting the main processes of knowledge management for improving the management and reporting medical errors for medical centers and hospitals, paving the way for achieving and recording the knowledge related to such incidents by presenting proper strategies. Afterwards, by disseminating and proper transferring of knowledge to right people, implementation and efficient utilization of this knowledge will be made possible. The present study is qualitative from the viewpoint of the implementation process and is applied from the perspective of studying the results. Next, to understand the role of knowledge management processes in hospitals, filed studies have been employed. In presenting the findings, we managed to achieve various methods and approaches of the four processes of knowledge management in management of documents related to errors in hospitals. The manner of doing different stages was considered from individual, group and inter organizational viewpoints. Then, the manner of gaining knowledge related to treatment errors was explained. At the stage of storing knowledge, the manner of coding knowledge and the benefits of reusing knowledge repositories in hospitals has been mentioned. At the stage of publishing and distributing knowledge, the importance of maintaining the security and privacy of individuals as well as respecting their privacy have been regarded. In the process of adoption and utilization, the method of using knowledge in making decisions and planning is expressed. The results reveal that knowledge management systems are capable of creating cohesion and sustainability. In explicit knowledge associated with treatment errors, they can also help preserve the knowledge and experience of experts and the elite in this field. In case they leave, this knowledge and experience will not vanish

Opium use and risk of bladder cancer: a multi-centre case-referent study in Iran

Background Bladder cancer (BC) is the 10th most common type of cancer worldwide and the fourth most common type of cancer in Iran. Opium use is considered as one of the risk factors for BC. We aim to assess the association between various parameters of opium use, which in Iran is mainly ingested or smoked in various forms, and the risk of BC. Method In this multi-centre case-referent study in Iran, 717 BC cases and 3477 referents were recruited to the study from May 2017 until July 2020. Detailed histories of opium use (duration, amount, frequency) and potential confounders were collected by trained interviewers. Multivariable unconditional logistic regression models were used to measure adjusted odds ratio (OR) and 95% confidence intervals (CI). The ORs were adjusted for age, gender, place of residence and pack-years of cigarette smoking. Results Regular opium consumption was associated with an increased risk of BC (OR 3.5, 95% CI: 2.8, 4.3) compared with subjects who never used opium. Compared with continuous users, the risk decreased to one-third for those who stopped opium more than 10 years ago. The adjusted OR for those who used both crude opium (teriak) and opium juice was 7.4 (95% CI: 4.1, 13.3). There was a joint effect of opium and tobacco (OR for users of both opium and tobacco 7.7, 95% CI: 6.0, 9.7). Conclusions Regular opium use is associated with an approximately 4-fold risk for BC. The OR decreases along with the increasing time since stopping opium use

Opium use and risk of lung cancer : A multicenter case-control study in Iran

Opium use was recently classified as a human carcinogen for lung cancer by the International Agency for Research on Cancer. We conducted a large, multicenter case-control study evaluating the association between opium use and the risk of lung cancer. We recruited 627 cases and 3477 controls from May 2017 to July 2020. We used unconditional logistic regression analyses to estimate the odds ratios (OR) and 95% confidence intervals (CI) and measured the association between opium use and the risk of lung cancer. The ORs were adjusted for the residential place, age, gender, socioeconomic status, cigarettes, and water pipe smoking. We found a 3.6-fold risk of lung cancer for regular opium users compared to never users (95% CI: 2.9, 4.6). There was a strong dose-response association between a cumulative count of opium use and lung cancer risk. The OR for regular opium use was higher for small cell carcinoma than in other histology (8.3, 95% CI: 4.8, 14.4). The OR of developing lung cancer among opium users was higher in females (7.4, 95% CI: 3.8, 14.5) than in males (3.3, 95% CI: 2.6, 4.2). The OR for users of both opium and tobacco was 13.4 (95% CI: 10.2, 17.7) compared to nonusers of anything. The risk of developing lung cancer is higher in regular opium users, and these results strengthen the conclusions on the carcinogenicity of opium. The association is stronger for small cell carcinoma cases than in other histology.Peer reviewe

Opium use and risk of bladder cancer : A multi-centre case-referent study in Iran

Background: Bladder cancer (BC) is the 10th most common type of cancer worldwide and the fourth most common type of cancer in Iran. Opium use is considered as one of the risk factors for BC. We aim to assess the association between various parameters of opium use, which in Iran is mainly ingested or smoked in various forms, and the risk of BC. Method: In this multi-centre case-referent study in Iran, 717 BC cases and 3477 referents were recruited to the study from May 2017 until July 2020. Detailed histories of opium use (duration, amount, frequency) and potential confounders were collected by trained interviewers. Multivariable unconditional logistic regression models were used to measure adjusted odds ratio (OR) and 95% confidence intervals (CI). The ORs were adjusted for age, gender, place of residence and pack-years of cigarette smoking. Results: Regular opium consumption was associated with an increased risk of BC (OR 3.5, 95% CI: 2.8, 4.3) compared with subjects who never used opium. Compared with continuous users, the risk decreased to one-Third for those who stopped opium more than 10 years ago. The adjusted OR for those who used both crude opium (teriak) and opium juice was 7.4 (95% CI: 4.1, 13.3). There was a joint effect of opium and tobacco (OR for users of both opium and tobacco 7.7, 95% CI: 6.0, 9.7). Conclusions: Regular opium use is associated with an approximately 4-fold risk for BC. The OR decreases along with the increasing time since stopping opium use.publishedVersionPeer reviewe

Parent Training Based on the Choice Theory: Analysis of its Impact on Mothers’ Sense of Self-efficacy and their Conflicts with their Daughters

Background This research aimed to study the effectiveness of “parent training based on the Choice Theory” on the mother-daughter conflicts and increasing mothers’ sense of self-efficacy. Methods The quasi-experimental method was used to examine the research variables. The research population included a group of mothers of the students who were in sixth to ninth grade at Nure Narges school in region 5 of Tehran. The parent- adolescent conflict questionnaire (teen’s papers) was used to assess the frequency and intensity of the conflict. A group of 24 volunteer mothers whose daughters had reported the most conflicts with their mothers was randomly assigned to the experimental and control groups. Both groups filled the parent- adolescent conflict questionnaire. The experimental group were trained parenting skills based on the Choice Theory for 8 sessions, while the control group were not trained. Finally, both groups answered the questionnaire again. They also answered the questionnaires three months later, as a follow-up. Multivariate analysis of covariance was used for data analysis. Results The results showed a significant difference between the scores of the experimental and control groups. Conclusions Parent trainings based on the choice theory can improve the mother-daughter relationship, increase the mother’s sense of self-efficacy and reduce the mother-daughter conflicts significantly

A comparative study of Fistulotomy and Sclerosing Agents in the management of perianal fistula: A randomized controlled clinical

Background and Aims: The perianal fistula is a pathological tract between two epithelial surfaces of the anorectal canal and perianal skin. The most common treatment method is fistulotomy which leads to complications, such as incontinency. The present is study aimeds to compare the results of fistulotomy surgery and sclerotherapy in the management of managing the perianal fistula. Materials and Methods: This Randomized controlled clinical study was performed on 24 patients with anorectal fistula. The procedure performed for group 1 was surgical fistulotomy, and group 2 underwent sclerosant agent injection. Recovery time, recurrence rate, post-operative pain, and degree of incontinency were evaluated. The statistical analysis was performed in SPSS software (Version 18), and a p-value less than 0.05 was considered statistically significant. Results: There were 5 (41.7%) men and 7 (58.3%) women in the sclerosing group, as well as 7 (58.3%) men and 5 (41.7%) women in the fistulotomy group. There was no significant relationship between the two groups (P=0.68). The recurrence rate was 3 cases (42.9%) in sclerosing group and 4 cases (57.1%) in the fistulotomy group, which was not statistically significant (P=0.65). The fecal continency score after sclerotherapy was greater than that in the fistulotomy group (P<0.05), and the length of hospitalization, post-surgery discomfort, and the time it took for the fistula to heal were all considerably shorter in the sclerosing group. Conclusion: We concluded that injectable sclerotherapy is effective, safe, simple, acceptable and affordable in the treatment of perianal fistula

Comparison of Depression Signs Before, During and After the Kidney Transplantation in Babol Shahid Beheshti Hospital

Background: Depression is the most common psychological problem in patients with chronic renal failure, which has a negative effect on the outcome of treatment and life quality. The aim of this study was to compare the symptoms of depression in patients referring to the Kidney Transplant Unit of Babol Shahid Beheshti Hospital before transplantation, at discharge and three months after transplantation.       Methods: This descriptive analytical study was conducted on 51 patients receiving renal transplant from November 2014 to February 2015 in Babol Shahid Beheshti Hospital. The non-random sampling method was used. Data were collected using demographic questionnaire and Beck Depression Inventory distributed in three stages. Descriptive and inferential statistics and SPSS18 were used to analyze the data. P=0.05 was considered significant level. Results: Before, at and three months after renal transplantation, 70.6%, 56.9% and 52.9% of the patients had mild to very severe depression, respectively. Mean scores of depression were 19.25 ± 11.99, 14.78 ± 11.45 and 12.82 ± 9.96 before transplantation, at discharge and three months after transplantation, respectively. Paired t-test showed a significant difference between the mean scores of depression before transplantation and at discharge after transplantation (P=0.006), before and three months after kidney transplantation (P = 0.000). There was no significant difference between the time of discharge and three months after transplantation (P=0.135). In addition, no significant difference was found between the scores of depression with gender, marital status, education, occupation and income (p = 0.391). Conclusion: The results indicated a lower incidence of depression in kidney transplanted patients. It is recommended that the patients awaiting transplantation and subsequently their depression status should be intermittently examined and drug or non-drug treatment should be designated for these patients based on the results

The Iranian Study of Opium and Cancer (IROPICAN) : Rationale, design, and initial findings

Background: The International Agency for Research on Cancer (IARC) recently classified opium use as a Group 1 carcinogen. However, much remains to be studied on the relation between opium and cancer. We designed the Iranian Opium and Cancer (IROPICAN) study to further investigate the association of opium use and cancers of the head and neck, bladder, lung, and colon and rectum. In this paper, we describe the rationale, design, and some initial results of the IROPICAN Study. Methods: The IROPICAN is a multi-center case-control study conducted in 10 provinces of Iran. The cases were all histologically confirmed and the controls were selected from hospital visitors who were free of cancer, were not family members or friends of the cancer patients, and were visiting the hospital for reasons other than their own ailment. The questionnaires included detailed questions on opium use (including age at initiation, duration, frequency, typical amount, and route), and potential confounders, such as tobacco use (e.g., cigarettes, nass and water-pipe), and dietary factors. Biological samples, including blood and saliva, were also collected. Results: The validation and pilot phases showed reasonably good validity, with sensitivities of 70% and 69% for the cases and controls, respectively, in reporting opium use. The results also showed excellent reliability, with intra-class correlation coefficients of 0.96 for ever opium use and 0.88 (95% CI: 0.80, 0.92) for regular opium use. In the main phase, we recruited 3299 cancer cases (99% response rate) and 3477 hospital visitor controls (89% response rate). The proportion of ever-use of opium was 40% among cases and 18% among controls. Conclusion: The IROPICAN study will serve as a major resource in studies addressing the effect of opium on risk of cancers of the head and neck, bladder, lung, and colon and rectum.publishedVersionPeer reviewe