The impact of quality management on reducing canceled elective operations: a participatory action research

Background and Aims: Surgery operations cancellation causes problems in operation theatre planning and results in hospital inefficiency as well as resource wastage. In addition, it causes stress for both patients and their relatives.This study aimed to examine the impact of quality management on surgery operations cancellation in Vali-e-asr hospital’s operating theatre department (Tehran) in 2014-2015.Materials and Methods: In this participatory action research, the reasons for surgery operations cancellation were identified using a checklist. These reasons were assessed and an action plan was developed for cancellation reduction. The plan was implemented using the action research cycle. SPSS software (version 22) was used for data analysis. Ethical issues such as respect for patients and staff and the confidentiality of information were all considered.Results: Patients failing to turn up, lack of ICU beds availability, and prolonged previous surgeries were the most common causes of surgery operations cancellation. Surgery operations were increased by 15 percent and surgery operations cancellation was reduced by 14.6 percent through the implementation of quality management strategy. Standardization of processes, proper planning, using HIS based operation list, recruiting more staff and giving more information to patients helped reducing the surgery operations cancellation.Conclusion: Formation of quality improvement team, using an appropriate quality management model and its appropriate implementation can help enhance hospital departments’ productivity and reduce surgery operations cancellation.Keywords: Quality management, surgery operations cancellation, hospital, action researc

Simplified Time-Dependent Column Shortening Analysis in Special Reinforced Concrete Moment Frames

Necessity for adaption of high-rise reinforced concrete structures’ design and practical steps of implementation through nonlinear staged analysis by consideration of long-term behavior of concrete have always been strongly recommended by researchers in recent years. Cumulative column shortening in conventional analyses is the most important consequence of neglecting the above issues. In this article, numerous modeling and extensive nonlinear staged analyses are carried out on structures with different geometrical characteristics and extremely simple empirical equations to estimate column shortening caused by creep, shrinkage and time changes of modulus of elasticity are provided in such a way that these relations can be independent of conventional parameters of ACI209R-92 regulations used in prediction of mentioned axial strains. Results obtained from validation of the proposed equations show high compliance of all proposed equations for up to 30 floors and also show accuracy of proposed shrinkage equation for the moment frame structures higher than the studied range

تأثیر مدیریت کیفیت بر کاهش موارد لغو اعمال جراحی: یک مطالعه اقدام پژوهی مشارکتی

Background and Aims: Surgery operations cancellation causes problems in operation theatre planning and results in hospital inefficiency as well as resource wastage. In addition, it causes stress for both patients and their relatives.This study aimed to examine the impact of quality management on surgery operations cancellation in Vali-e-asr hospital’s operating theatre department (Tehran) in 2014-2015.Materials and Methods: In this participatory action research, the reasons for surgery operations cancellation were identified using a checklist. These reasons were assessed and an action plan was developed for cancellation reduction. The plan was implemented using the action research cycle. SPSS software (version 22) was used for data analysis. Ethical issues such as respect for patients and staff and the confidentiality of information were all considered.Results: Patients failing to turn up, lack of ICU beds availability, and prolonged previous surgeries were the most common causes of surgery operations cancellation. Surgery operations were increased by 15 percent and surgery operations cancellation was reduced by 14.6 percent through the implementation of quality management strategy. Standardization of processes, proper planning, using HIS based operation list, recruiting more staff and giving more information to patients helped reducing the surgery operations cancellation.Conclusion: Formation of quality improvement team, using an appropriate quality management model and its appropriate implementation can help enhance hospital departments’ productivity and reduce surgery operations cancellation.چکیدهزمینه و هدف: لغو اعمال جراحی یی از دلال عدم کارای بخش اعمال جراحی بیمارستانها است که علاوه بر اجاد اختلال در برنامهرزی،ک ییییمنجر به اضطراب بیمار و همراهان وی میشود. ان پژوهش با هدف بررسی تأثیر مد رت کیفیت بر کاهش موارد لغو اعمال جراحی در یین.بیمارستان ولیعصر  تهران در شش ماهه اول سال 1393 انجام شد مواد و روشها: ان پژوهش از نظر هدف کاربردی و از نوع اقدامپژوهی مشارکتی است. با استفاده از ک مدل مد یرت کیفیت، فراندهای یییییو راش 22 استفاده شد. SPSS کاری بخش به منظور کاهش لغو اعمال جراحی استاندارد و ارتقا افتند. برای تحلیل داده ها از نرم افزاریییدر کلیه مراحل پژوهش موازن اخلاقی از جمله احترام به کارکنان و بیماران و محرمانه تلقی کردن اطلاعات شخصی افراد شرکت کننده دری.پژوهش رعات شدی یافتهها: عدم مراجعه بیمار، نبودن تخت ICU، تشخیص در هنگام مشاوره و ... از دلال عمده لغو اعمال جراحی در ان بیمارستان بود. اجرای ییی مدل مد رت کیفیت منجر به افزاش 15 درصدی تعداد اعمال جراحی و کاهش 14/6 درصدی لغو اعمال جراحی شد. از اقدامات انجام شده ییی برای رفع ا کاهش لغو اعمال جراحی میتوان به تهیه پروتل آماده سازی بیماران برای جراحی در اتاق عمل، پیگیری به موقع انجام و زت ک یییپزش ان و تهیه پروت ل درخواست مشاورههای درمانی برای بیماران وآموزش بیمار و کارکنان بود.کک نتیجهگیری: تشیل تیم بهبود کیفیت، ب ارگیری ک مدل مناسب مد رت کیفیت و اجرای درست آن میتواند در کاهش موارد لغواعمال جراحی بیماران موثر باشد. &nbsp

A hybrid analytical network process and fuzzy goal programming for supplier selection: A case study of auto part maker

The aim of this research is to present a hybrid model to select auto part suppliers. The proposed method of this paper uses factor analysis to find the most influencing factors on part maker selection and the results are validated using different statistical tests such as Cronbach's Alpha and Kaiser-Meyer.The hybrid model uses analytical network process to rank different part maker suppliers and fuzzy goal programming to choose the appropriate alternative among various choices. The implementation of the proposed model of this paper is used for a case study of real-world problem and the results are discussed

Comparison of Lasix and Methyldopa in Controlling Hypertension in preeclampsia patients: A Double-Blind Randomized Clinical Trial

Introduction: Preeclampsia is a specific gestational syndrome that reduces organ perfusion due to vascular spasm and endothelial activation. Despite the use of magnesium sulfate, the patient's blood pressure sometimes remains uncontrolled, and therefore, it is necessary to use other medications, especially diuretics and Methyldopa. Hence, the aim of this study was to compare Lasix and Methyldopa in controlling postpartum hypertension in preeclampsia patients after magnesium sulfate treatment. Material and Methods: This double-blind randomized clinical trial was carried out on 100 women with preeclampsia referred to Akbar Abadi Hospital-Iran. In the first 24 hours after the termination of pregnancy, the participants’ blood pressure was measured and those with a blood pressure of 140/90 to 160/100 were divided into two groups. In the first and second 24 hours, and then one week after the intervention, systolic and diastolic blood pressure as well as diuresis and drug complications in the two groups were assessed and compared.  The present study was registered in the Iranian Registry of Clinical Trials (IRCT) under the ID of IRCT20180114038349N1. Results: The mean age of individuals was 29.93 ± 6.65 in the Methyldopa group, and 32.35 ± 4.85 in the Lasix group (P = 0.479). Systolic and diastolic blood pressure had a substantial reduction in both groups, but there was no significant difference between the two groups (P> 0.05). Systolic blood pressure was reduced by 31 mmHg (reduction from 146 to 115) in the methyldopa group and 30 mmHg (reduction from 145 to 114) in the Lasix group. Furthermore, the reduction in diastolic blood pressure was 25 mmHg (from 95 to 70) in the methyldopa group, and 21 mmHg in the Lasix one (from 91 to 70). Conclusion: The present study showed that using Lasix and methyldopa was effective enough in changing blood pressure in patients with preeclampsia, and the effects observed in the two groups were the same. Therefore, it could have a great impact on the wellbeing of couples

Evaluation of Fertility Rate in the Couples after Uterine Septum Resection

Introduction: Uterine septum is one of the most common congenital abnormalities in women that leads to numerous gynecological problems and adverse obstetrics outcomes. This study aimed to evaluate the effects of Hysteroscopic Resection on pregnancy outcomes in women undergone the surgery.Methods: In this quasi-experimental study, 90 women were included from April 2016 to June 2018 from patients attending to Rasoul Akram hospital of Tehran. The inclusion criteria included: the age lower than 35 years old, primary infertility, idiopathic recurrent spontaneous abortion, BMI between 19 and 30, and having informed consen. Septum was resected by scissor upward and lateral. After 10 months of follow-up in average, we assessed rate of live births, abortions, birth weight and presentation.Results: 82 individuals were assessed for occurrence of conception (response rate=91%).  The mean age of patients was 30.01 ± 6.76 years and the mean BMI was 26.25 ± 4.88. Out of 82 patients, 36 patients were pregnant, of whom 16 (44.4%) had abortions. 5 (14.9%) of the pregnancies ended with preterm birth, and 6 (17%) ended with stillbirth.Conclusion: The present study showed that the infertile patients with uterine septum and with no other causes of infertility were more likely to be pregnant compared to other patients with idiopathic infertility. Our study showed that post-operation fertility following Hysteroscopic Resection was lower than that in previous reports. According to the findings of this study, scissors may be safe, effective and cost-effective method for removing uterine septa.

Clinical and Epidemiological Aspects of Multiple Sclerosis in Children

How to Cite This Article: Nasehi MM, Sahraian MA, Naser Moghaddasi A, Ghofrani M, Ashtari F, Taghdiri MM, Tonekaboni SH, Karimzadeh P, Afshari M, Moosazadeh M. Clinical and Epidemiological Aspects of Multiple Sclerosis in Children. Iran J Child Neurol. Spring 2017; 11(2):37-43.AbstractObjectiveOverall, 2%-5% of patients with multiple sclerosis (MS) experienced the first episode of disease before the age 18 years old. Since the age of onset among children is not similar to that in general population, clinicians often fail to early diagnose the disease. This study aimed to determine the epidemiological and clinical patterns of MS among Iranian children.Materials & Methods In this cross-sectional study carried out in Iran in 2014-2015, information was collected using a checklist with approved reliability and validity. Method sampling was consensus. Data were analyzed using frequency, mean and standard deviation indices by means of SPSS ver. 20 software.Results Totally, 177 MS children were investigated. 75.7% of them were female. Mean (SD), minimum and maximum age of subjects were 15.9 (2), 7 and 18 yr, respectively. The most reported symptoms were sensory (28.2%), motor (29.4%), diplopia (20.3%) and visual (32.8%). Primary MRI results showed 91.5% and 53.1% periventricular and spinal cord lesions, respectively.Conclusion MS is significantly more common among women. The most common age of onset is during the second decades. Sensory and motor problems are the most symptoms, while, periventricular and spinal cord lesions are the most MRI results. References 1. Ascherio A, Munger K. Epidemiology of multiple sclerosis: from risk factors to prevention. Semin Neurol 2008; 28(1): 17-28.2. Abedidni M, Habibi Saravi R, Zarvani A, Farahmand M. Epidemiologic study of multiple sclerosis in Mazandaran,Iran, 2007. J Mazandaran Univ Med Sci 2008; 18(66): 82-6.3. Taghdiri MM, Gofrani M, Barzegar M, Moayyedi A, Tonekaboni H. The survey of 20 cases of multiple sclerosis in children in mofid hospital of Tehran. J Rehabil, 2001; 4(6-7):61-67.4. Benito-Leon J, Martinez P. Health-related quality of life in multiple sclerosis. Neurologia 2003; 18: 207-10.5. Nedjat S, Montazeri A, Mohammad K, Majdzadeh R, Nabavi N, Nedjat F, et al . Quality of Life in Multiple Sclerosis Compared to the Healthy Population in Tehran. Iran J Epidemiol 2006; 2 (3 and 4) :19-24.6. Marrie RA. Environmental risk factors in multiple sclerosis aetiology. Lancet Neurol 2004; 3(12):709-18.7. Milo R, Kahana E. Multiple sclerosis:geoepidemiology, genetics and the environment. Autoimmun Rev 2010; 9(5): A387-A394.8. Banwell B, Ghezzi A, Bar-Or A, Mikaeloff Y. Multiple sclerosis in children: clinical diagnosis, therapeutic strategies, and future directions. The Lancet Neurol, 2007;6(10):887-902.9. Ebers GC. Environmental factors and multiple sclerosis. The Lancet Neurol, 2008;7(3):268-277.10. Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple Sclerosis. N Engl J Med 2000; 343(13):938-52.11. Rudick RA, Cohen JA, Weinstock-Guttman B, Kinkel RP, Ransohoff RM. Management of multiple sclerosis. N Engl J Med 1997: 337(22): 1604-11.12. Greer JM, McCombe PA. Role of gender in multiple sclerosis: clinical effects and potential molecular mechanisms. J Neuroimmunol 2011;234(1-2): 7-18.13. Boiko A, Vorobeychik G, Paty D, Devonshire V, Sadovnick D. Early onset multiple sclerosis A longitudinal study. Neurology 2002; 59(7):1006-1010.14. . Ashtari F, Shaygannejad V, Heidari F, Akbari M. Prevalence of Familial Multiple Sclerosis in Isfahan, Iran. Journal of Isfahan Medical School, 2011;29(138.2):555- 561.15. Mazaheri S, Fazlian M, Hossein Zadeh A. Clinical and Epidemiological Features of Early and Adult Onset Multiple Sclerosis in Hamedan, Iran, 2004–2005. Yafteh 2008; 9 (4) :39-44.16. Saman-Nezhad B, Rezaee T, Bostani A, Najafi F, Aghaei A. Epidemiological Characteristics of Patients with Multiple Sclerosis in Kermanshah, Iran in 2012. J Mazand Univ Med Sci 2013; 23(104): 97-101 (In Persian).17. Renoux C, Vukusic S, Mikaeloff Y, Edan G. Natural history of multiple sclerosis with childhood onset. N Engl J Med 2007. 356(25): p. 2603-2613.18. Ness JM, Chabas D, Sadovnick AD, Pohl D, Banwell B, Weinstock-Guttman B. Clinical features of children and adolescents with multiple sclerosis. Neurology 2007; 68(16 suppl 2):S37-S45.19. Etemadifar M, Janghorbani M,Shaygannejad V, Ashtari F . Prevalence of multiple sclerosis in Isfahan. Iran. Neuroepidemiology 2006; 27(1):39-44 (In Persian).20. Saadatnia M, Etemadifar M, Maghzi AH. Multiple sclerosis in Isfahan, Iran. Int Rev Neurobiol 2007; 79: 357-75.21. Nabavi SM, Poorfarzam S, Ghassemi H. Clinical Course and prognosis of 203 patients with MS in shahid Mostafa Khomeini Hospital, Tehran 2002, Tehran University Medical Journal, 200l 64( 7)6: 90-97

Evaluation of Microbial Quality of Traditional Sweets, Zoolbia and Bamieh, During Ramadan in Mashhad, Iran

Background: The aim of this study was to evaluate the microbial quality of traditional sweets, Zoolbia and Bamieh made in the confectioneries of the Mashhad during the holy month of Ramadan. Materials and Methods:  This study was a cross-sectional study. Seventy five samples  of traditional sweets, Zoolbia and Bamieh were collected randomly from confectionaries  of Mashhad during Ramadan month in 2018. Microbial quality tests including mold and yeast, E. coli, Enterobacteriaceae and S. aureus enumeration and Salmonella isolation were performed. Results: Of the total samples tested 22.6% ‏of the samples were within the specified limit of the standard. The contamination rate of mold and yeast was 13.3%, Salmonella 6.6%, Enterobacteriaceae 13.3%, E.coli  16% and S. aureus  28%. The highest level of contamination was related to S.aureus and the lowest level related to Salmonella. Conclusion: The results showed that the contamination rate of Zoolbia and Bamieh is high and significant, therefore, given the high percentage of contamination of samples, production and distribution practices as well as the workers hygiene must be under more control and attention. The existence of vulnerable groups among consumers adds to the importance of this issue

Kliničko značenje povišene razine olova u krvi u ovisnika o opijumu s jakom boli u području abdomena

There are inconsistencies regarding the association of blood lead level (BLL) in opium addicts with severe abdominal pain. In present study, we aimed to assess BLL in opium addicts presented with severe abdominal pain. This cross-sectional study was conducted on 60 opium-addicted individuals admitted to our rehabilitation center in Zabol city during February-October 2016. BLL was measured using potentiometric-stripping analysis (PSA) method. Statistical analysis was conducted in SPSS 20 software. From 60 addicts re-cruited, 47 (78.3%) were males. The mean age was 40.3±18.1 years old. The mean BLL was 43.1±117.4 µg/ dl. Considering a threshold of 18 µg/dl, 22 (37.6%) of the addicts had elevated BLL. The mean BLL in addicts with oral, inhalation and mixed method of consumptions were 54.9±1.5 µg/dl, 47.4±9.2 µg/dl, and 10.1±95 µg/dl respectively (P=0.5). No differences were found regarding the mean BLL among different age groups or between different genders. Furthermore, there were no significant difference in neither hematological pa-rameters or liver enzyme in addicts with normal and elevated BLL. The BLL was not of significant difference in addicts with different methods of opium usage and severe abdominal pain. It is recommended to investigate the effects of factors such as the duration of opium usage and the concentration of lead in opium to influ-ence BLL.Postoje nedosljednosti u vezi povezanosti razine olova u krvi (OUK) u ovisnika o opijumu s jakim bolovima na području abdomena. U ovome radu nam je bio cilj odrediti OUK u ovisnika o opijumu s jakim bolovima u trbuhu. Provedeno je presječno instraživanje na 60 ovisnika o opijumu primljenih u naš rehabilit-acijski centar u gradu Zabol od veljače do listopada 2016. OUK je mjereno metodom potenciometrijske strip-ing analize. Statističke analize su učinjene programom SPSS 20. Od ispitanih 60 ovisnika, 47 (78,3 %) su bili muškarci. Srednja dob je bila 40.3 ± 18.1 godina. Srednja vrijednost OUK je bila 43.1 ± 117.4 μg/DL. S obzirom na prag od 18 μg/DL, 22 (37,6 %) ovisnika imalo je povišeno OUK. Srednje vrijednosti OUK u ovisnika koji su sredstvo konzumirali peroralno, inhalacijski i mješano su iznosile 54.9 ± 1,5 μg/DL, 47.4 ± 9,2 μg/DL i 10.1 ± 95 μg/DL (P = 0,5). Nisu pronađene značajne razlike srednje vrijednosti OUK među različitim dobnim skupinama ili između spolova. Nadalje, nije bilo značajne razlike ni u hematološkim parametrima ili jetrenim enzimima u ovisnika s normalnim i povišenim OUK. OUK se nije značajno razlikovalo u ovisnika s različitim načinima konzu-miranja droge i jakim bolovima u trbuhu. Preporuča se istražiti kako čimbenici kao što su trajanje konzumacije opijuma i koncentracija olova u opijum utječu na razinu OUK

Estimating the Annual Risk of Tuberculosis Infection and Disease in Southeast of Iran Using the Bayesian Mixture Method

Background: Tuberculosis is still a public health concern in Iran. The main challenge in monitoring epidemiological status of tuberculosis is to estimate its incidence accurately. Objectives: We used a newly developed approach to estimate the incidence of tuberculosis in Sistan, an endemic area in southeast of Iran in 2012-13. Patients and Methods: This cross-sectional study was conducted on school children aged 6-9 years. We estimated a required sample size of 6350. Study participants were selected using stratified two-stage cluster sampling method and recruited in a tuberculin skin test survey. Indurations were assessed after 72 hours of the injection and their distributions were plotted. Prevalence and annual risk of tuberculosis infection (ARTI) were estimated using the Bayesian mixture model and some traditional methods. The incidence of active disease was calculated using the Markov Chain Monte Carlo technique. Results: We assumed weibull, normal and normal as the best distributions for indurations due to atypical reactions, BCG (Bacillus Calmette–Guérin) reactions and Mycobacterium tuberculosis infection, respectively. The estimated infection prevalence and ARTI were 3.6% (95%CI: 3.1, 4.1) and 0.48%, respectively. These estimates were lower than those obtained from the traditional methods. The incidence of active tuberculosis was estimated as 107 (87-149) per 100000 population with a CDR of 54% (40%-68%). Conclusions: Although the mixture model showed slightly lower estimates than the traditional methods, it seems that this method might generate more accurate results for deep exploration of tuberculosis endemicity. Besides, we found that Sistan is a high endemic area for tuberculosis in Iran with a low case detection rate