HAKIM RESEARCH JOURNAL
Year:2008 | Volume:11 | Issue:2|Papers Count:11

Introduction: During the past decade, neonatal mortality rate in Iran has not decreased satisfactorily. Regionalization of perinatal care services is a potential solution to improve the access of those in need to the best quality care within economic and administrative constraints. This study aims to develop a framework for optimized and efficient distribution of perinatal care services at different levels of care provision.Methods: We utilized small area analysis in an iterative process to divide the country into service areas of Perinatal Care Regions (PCRs), to distribute three levels of perinatal services and hospital beds in PCRs, to minimize patients’ traveling distances, and to fit the facilities to the needs while incurring minimum changes to the current administrative borders and available infra-structure.Results: We divided the country into 33 PCRs. A total of 1256 level-III (Neonatal Intensive Care Unit) beds and 3768 level-II neonatal beds were required in the country and distributed to the districts. One level-III district was designated as the center for each PCR. Sixty one districts were identified as level-III and 104 as level-II. Level-I and Ib districts were allocated to the nearest next level districts. Our proposed model decreased the average distance of districts from the center from 125 to 109 km. The average distance and the distance weighted by population of the districts from the PCR center also reduced to 79 and 42 km, respectively.Conclusion: Our model reduced the distance between levels of care provision and balanced the care facilities with population needs at the district level. Implementing this model requires resources. It may encounter some resistance in practice. Such resistance should be tackled with setting regulations, monitoring, training, advocacy, and appropriate incentives. A sustainable national regionalization model should be developed centrally, and customized to the specific needs and circumstances of each region.

Introduction: Thoracocotomy is one of the surgical operations associated with sever pain, and in alleviation of post- thoracotomy pain, which is associated with important physiologic, psychologic, ad pathologic consequences. Each method has its own advantages and disadvantages. The post- operative analgesic method used most frequently in each treatment center is considered as method of choice in that center. In this meta- analysis, frequently used post- thoracotomy analgesic methods were compared. to find the best reliable method for pain control with the least side effects and/ or side effects.Methods: We compared the post- thoracotomy pain in first 24 hours as measured by visual analog scale for patient groups undergoing epidural analgesia plus systemic opioids, epidural analgesia plus intercostals nerve block (INB), epidural plus paravertebral block (PVB), and epidural plus interplural information was assessed from 28 randomized clinical trials that compared these methods two among 1697 post- thoracotomy patients. Random effects model, effect size index, and standardized mean differences were used. Statistical values were assessed using standard errors and results were using 5% lower and upper confidece limits.Results: Epidural analgesia has had better effects with less side effects in comparisson with systemic administeration method during first 24 hours. ( 95% CI= 0.9812 to 0.3844) Epidural method has had no significant difference with intercostal nerve block during average first 24 houes ( 95% CI= O 2171 to + 5906 ) Epidural analgesia has had better effects in comparisson with interpleural method in first. 24 hours ( 95% CI= - 101166 to – 0.0106). Epidural analgesic is more effective than paravertebral method in the first 24 hour (95% CI= + 01744 to – 0.4572).Conclusion: In conclusion to our study it seems that. Epidural analgesia is suitable and preferable method for post- op. analgesia at most circumstances.More studies with much more articles will evaluate this results in the future.

Introduction: Perspective to retrieval of equity, access to services, effectiveness, efficiency, social acceptability, and strive for continuous improvement of services, Total Quality Management (TQM) has broadened new horizons in health sector. Hence it can result in efficiency and renovation of health services delivery system. Therefore we aimed to determine the influencing factors on implementation of TQM at teaching hospitals affiliated with Iran University of Medical Sciences in Tehran, Iran.Methods: We assessed the views of all the 90 managers and supervisors of the hospitals under investigation about the eight factors influencing on implementation of TQM. In a descriptive cross-sectional study, we used an eight-part questionnaire with 75 Likert-type questions for data collection. Validity of the questionnaire was verified with Delphi method. Chi square and t tests and analysis of variance were used for statistical analysis.Results: We assumed an average of 50% for responses indicative of desirability as the minimum acceptable level in each of the eight factors. Of the eight factors studied customer orientation (59.7%), organizational communication (55%), and appropriate organizational structure (50%) proved to be acceptable. The other five factors ranked average (40-50%). There was significant difference among the total means of influencing factors in the studies hospitals (p = 0.001).Conclusion: After five years have passed since the implementation of TQM in the studied hospitals, attention of managers to organizational culture, staff participation, human resources development, teamwork, and leadership commitment can result in improvement of the services, effectiveness of the activities, and social acceptability of hospitals.

Introduction: Central nervous system develops during the first years of life. Millions of synapses form among nervous cells before two years of age. The present research was performed to assess the effects of mothers’ training about complementary feeding and developmental skills on growth and development of 5-7 month infants referring to health centers in city of Shiraz in Southwest of Iran.Methods: Mothers of 5-7 month old infants were the units of this study. Two hundred and forty infants were selected randomly from those referring to two urban clinics and were assigned randomly to two groups of intervention and comparison. Mothers in the intervention group participated in monthly sessions for six months where pamphlets and movies were used for training. Infants’ height, weight, head circumference, arm circumference, and gross motor developmental functions (using Denver Developmental Test) were monthly assessed in both groups.Results: Statistical analysis was performed on 207 subjects remaining after attrition. Mean weight gain (and its standard deviation) was 8.05 (and 7.52) Kg in intervention group and 0.64 (and 0.60) Kg in comparison group. Weight, height, head circumference, and arm circumference charts were drawn for the two groups and were compared with each other, with pertinent charts form National Center for Health Statistics (NCHS), and with charts published by Ayatollahi et al. Developmental functions in the two groups were compared with each other and with Denver’s study results.Conclusion: The results of this research show that the training of mothers on complementary feeding can contribute to infants’ weight gain (p=0.003), but does not have an effect on their height (p=0.1), head circumference (p=0.173), and arm circumference (p=0.882). Mothers’ training on developmental skills did not have any effect on developmental functions’ progression.

Introduction: Childbirth is a painful experience for most of women. Acupressure is a noninvasive method that has been suggested for labor pain relief. The aim of present study was to determine the effect of acupressure on labor pain relief among parturient women in Kamali hospital in city of Karadj, near Tehran in year 2006.Methods: This double-blind randomized clinical trial was performed on 128 women in labor admitted with cervical dilatation of 3 cm. They were randomly assigned to intervention group with 30 minutes of acupressure on SP-6 point or comparison group with SP-6 point touch for 30 minutes. Visual analogue scale assessments were used to measure labor pain in both groups and to compare the results in several stages: before intervention, immediately after intervention, 30 minutes after intervention, and then every hour until the end of the first stage of labor. Differences of pain intensity as measured in different stages within each group were also compared with each other.Results: None of the above-mentioned comparisons showed a significant difference, except for significant difference in pain intensity as measured at different stages within each group, which indicated increasing pain intensity from immediately after intervention through the end of f the first stage of labor in both groups ( p<0.0001).Conclusion: These finding showed that SP-6 point acupressure alone cannot effectively relieve labor pain and needs to be accompanied with other noninvasive analgesic methods.

Introduction: The present study is part of a comprehensive nutritional status assessment of “Iran University of Medical Science” (IUMS) students in Tehran. The objective of this part of study was to determine the status and composition of fat intake of these students.Methods: A cross-sectional descriptive study was performed on 1000 students recruited in a multi-stage stratified sampling from six faculties of IUMS (faculties of medicine, paramedical sciences, nursing and midwifery, public health, rehabilitation, and management and medical informatics). Data was collected using a standard 24-hours dietary recall method and analyzed with nutrition-specific software DFP (FP2, NIII) for assessing intake of nutrients and macronutrients including fats’ composition and their comparison with Recommended Daily Allowance (RDA) and Dietary Reference Intakes (DRI) values. Statistical analysis was performed with t-test and chi-square using SPSS software.Results: Mean daily energy intake was 1810±645 Kcal and mean total fat intake was 76±28 gr. Mean contribution of total fat to energy intake was 38%±7%. Fat intake was higher than the recommended amounts and there was a significant difference between male and female students’ mean fat intake (p<0.0001). There was no significant difference between students resident in dormitory and other students in terms of mean fat intake. Assessment of intake fat composition revealed that the mean daily intake was 215±199 gr for cholesterol, 25±11 gr for saturated fats (with a contribution of 12% to total energy intake), 17± 11 gr for poly-unsaturated fats, and 28± 10 gr for mono-unsaturated fats. Significant differences in mean cholesterol intake and mean saturated fat intake were seen between males and females, but these values were not significantly different for students resident in dormitory as compared with other students.Conclusion: The results showed the proportion of daily calorie derived from fats and the cholesterol and saturated fat intakes were higher than the recommended amounts. These would be risk factors for cardiovascular disease during the middle age. It is necessary to decrease the nutritional risk factors for cardiovascular diseases by modification of nutritional behavior and diet composition pattern in the young age group. The nutritional composition should also be improved through lowering of dietary fat intake and harmonizing the share of fats in energy production.

Introduction: Conflict management is regarded as a basic organizational leadership skill in the 21st century. Hospitals as the important centers of the health system need effective methods and appropriate strategies for organizational conflict resolution in order to reach their cardinal objective of communities’ health. The present research aims to determine the conflict management strategies used by managers of hospitals affiliated with Lorestan University of Medical Sciences (LUMS).Methods: This study is descriptive-analytic. The study population consists of 177 managers from 13 hospitals affiliated with LUMS. Data was collected through interviews using questionnaire containing demographic questions and Stephen Robin’s conflict management questionnaire and was analyzed with SPSS software.Results: Average age of managers was 36.47 ± 6.9 years, their mean years of service were 12.5 ± 8.2, and their mean years of managerial experience were 5.8 ± 5.6. Females constituted 53.1% and males constituted 46.9% of the subjects. Identified strategies of conflict management were non-intervention (49.7%), control (44.6%), and solution orientation (5.7%). Conflict management strategy and sex of managers had significant association (p = 0.36). Correlation coefficient showed significant association between conflict management strategy and age of managers (p = 0.01).Conclusion: According to our research results, styles of conflict management are different among managers and many factors influence organizational conflict management. Therefore, determination of conflict management styles is very important in every organization, especially in complex environment of hospitals.

Introduction: The aim of this study was to determine the key organizational dimensions that influence the autonomy of university hospitals and the level of granted autonomy in each dimension. Methods: Six hospitals were randomly selected from those affiliated with three medical universities of Tehran, Iran and Shahid Beheshti. In this qualitative study, we interviewed 27 hospital managers (response rate of 82%). The semi-structured interview guide was developed based on the results of four initial indepth interviews and the organizational reform model of the World Bank. We used the framework method for the analysis of qualitative data.Results: Nine themes were identified as the key factors influencing hospital autonomy: decision right in strategic management, decision right in human resources management, decision right in financial management, decision right in physical resources management, product market exposure, procurement market exposure, financial residual claim, governance arrangements and accountability mechanisms, and social functions of the hospitals. Limited decision rights in strategic, human resources, and physical resources management were granted to hospitals. Hospitals were not the financial residual claimant, but were exposed to competitive product market. Autonomy was limited regarding the procurement market. Governance systems were hierarchical and accountability mechanisms were supervisor-supervisee oriented. Some of the social functions of the hospitals were defined, but the expenses of these functions were not totally reimbursed by the government and the insurance industry.Conclusion: The autonomy granted to the hospitals is unbalanced and paradoxical. More decision rights should be granted for management of strategic, human resources and physical resources as well as hospitals entry to the procurement market. Hospitals need to be the financial residual claimant. The hierarchical administrative systems should be transformed to cooperative ones. Instead of supervisorsupervisee oriented control measures, Ministry of Health and Medical Education needs more regulatory mechanisms for controlling hospitals’ performance and social functions.