SAREM JOURNAL OF MEDICAL RESEARCH (SAREM JOURNAL OF REPRODUCTIVE MEDICINE)
Year:2018 | Volume:3 | Issue:3|Papers Count:9

Systems assessment and evaluation are variable and critical processes, especially when they were compared with standards. Lack of this processes would cause serious menaces for organizations and recipients of services. This process is vital, especially for hospitals and health delivery systems because of the importance of the community health. In fact, all over the world, accreditation and related programs are systematic and structured evaluation process to investigate meeting compliance of desirable standards. These processes are performed by authentic and non-beneficiary centers that accredit various organizations based on their types, characterizations and goals. Under these circumstances, the given validity is genuine and coherence in all aspects including structure, process and the consequence which can be felt. Recipients of services can vividly distinguish accredited centers from others, based on their quality of the services. In the field of health care, one of the most important administrative functions and policies is hospital accreditation. Hospitals provide comprehensive health care services including diagnosis, treatment and rehabilitation, therefore they are considered as the key role in the health care system of a country. Accreditation of hospitals takes place in various countries, including Iran. From prominent characteristics of successful hospital accreditation we can mention the established standards which must be comprehensive, genuine, coherent, aligned and clear. These standards should associate with appropriate methods for targeted assessment and also they need coherence with general policies, appropriate channels for implementation and proper opportunity for assessment by impartial experts. The central issue in this topic is the concept of the quality, which is not static, but it is a dynamic concept and makes clear that continuous improvement of quality is considered. Through accreditation of hospitals, the dynamic concept of quality assurance and continuous improvement of quality are associated with all the process which is related to the maintenance and improvement of standards caring for patients. These are the most obvious examples as follow; generation and adequate use of information and data, teamworks and cooperations, reducing unwarranted variations in healthcare, application of evidence-based practice, safety and effectiveness of health services, satisfaction of patients, staff and principals, Increasing productivity and efficiency in hospitals and etc. If in a program a desirable sense of the quality, continuous improvement and satisfaction is not tangibly distinguished by the individuals both by (the provider and the recipient of the services), then we should seek the reason in structure, framework and components of the process. One of the points to consider is the "established standards" itself. Experiences of successful quality improvement and implementation of standards in the world reflect that the correct formulation of standards is very important. The standard book contains a set of requirements, and makes the evaluated individual to implement and execute standards, but does not provide an explanation for accomplishment (This section is assigned to secondary systems and complimentary structures), and its features include; comprehensiveness, obviousness in conceptual conception, lack of overlapping in content and lack of contradictions in the definitions. These features act in exactly the same direction for a particular purpose and often emphasize on key results of hospital performance and outcomes, not just on the structural and process factors. The lack of integrity through evaluation of an organization as an interconnected system is similar to the separated evaluation of a living organism with huge foot, small heart and no brain that while expected to solve the problem. The standards and the manner of evaluation form the standpoint and performance of organizations as well as the manner of the educational assessment that determines the study style of the students. Comprehensive organizational vision eliminates unhealthy competition between hospital departments and replaces it with interaction and consultation that facilitates the system management and induces a sense of confidence to anxious managesr. Functional and outcome-oriented attitude makes the result of the evaluation closer to the reality. Conceptual harmonization of the standard and its implementation and evaluation path, compliance with other standards and other monitoring programs, accommodation with international standards and standards related to the subordinate units of the hospital (like laboratories) is also very effective in achieving the desired outcome of the validation program. The other group is the structure and method of accreditation. For example, accreditation should be optional. However, accommodation with minimum standards for obtaining permission to work in the health system of the country is necessary, but validation, which is based on maximum standards, should be voluntary. It means that hospitals that claim high quality should perform voluntary and if they get successful in receiving the credit they should also receive major and great encouragements, and thus the market for healthy competition in the country will be flourished. The final important point is about the accreditation system's assessors and surveyors. The (ethical and professional) competence of assessors and their impartiality are the critical issues involved in the implementation and achievement of the desired outcome in the credibility of a program. The assessor, while possessing ethical features and knowledge in the area of assessment, must have sufficient knowledge of the evaluation, a deep understanding of the standards, and good practical experience (sufficient apprenticeship) of the assessment. Impartiality not only for the assessor but also for the organization responsible for the evaluation process is crucial, so that there should be no conflict or common benefit between the evaluated systems. The sum total of the factors mentioned above will provide face viability, executive credibility, and comparative validity of the accreditation process.

Aims Because of the importance of age-linked physiological changes and the effects of physical activity on hematological parameters, this study was conducted to investigate the effects of age and hard endurance workouts on blood cell count and erythrocyte indices. Materials & Methods In this interventional study 87 male volunteers were studied in 3 groups including young (n=30), middle (n=30) and old (n=27) age groups in Sarem hospital (Tehran, Iran). Immediately before and after their endurance activity and during recovery period, hemodynamic factors were measured and 3 blood samples were collected for blood cell count and erythrocyte indices. The data were analyzed by one-way analysis of variance (ANOVA) for independent groups and repeated measures ANOVA for related groups using SPSS 16 software. Findings The plasma volume (%) was decreased significantly after hard endurance workouts and increased significantly during recovery period. Endurance activity caused significant increases in all measured factors other than mean cell volume (MCV). However, there were significant decreases in all studied factors after recovery, except MCV, mean cell hemoglobin (MCH) and mean cell hemoglobin concentration (MCHC). There was no significant difference in responses of hematological factors to the endurance activity and recovery period between different age groups. Conclusion Age does not affect the responses of hematological factors to the hard endurance workouts and subsequent recovery period. bone marrow is fractal.

Aims Laparoscopy is accepted as a golden standard method in treatment of endometriosis. The main objective of this study was to evaluate the effects of endometriosis management protocol using a combined drug-surgery treatment in various stages. Materials & Methods This non-experimental and interventional study was conducted on 47 patients with confirmed endometriosis in Sarem women’ s hospital (Tehran, Iran) in 2011-2012. The patients were divided into 4 groups according to the endometriosis stages of I to IV. Laparoscopy surgery (electro-coagulation and the adhesions removing) was performed for all patients, and then they treated for monthly injection of GnRH analogues. The second and third laparoscopy procedures were performed after 3 and 6 months for relevant groups, respectively. Findings In the stage-I endometriosis group 9 (90%) patients showed complete recovery after 3 months of treatment and 1 remained case showed complete recovery after 6 months. For stage-II and stage-III groups 16 (72. 7%) and 5 (50%) cases showed complete recovery after 6 months of the treatment, respectively. The remained patients of stages II and III treated with GnRH for an additional 3 months and showed complete recovery (excluding one case) after 9 months. In Stage-IV, 2 (40%) cases showed complete recovery and 3 out of 5 patients were candidate to laparotomy. Conclusion The patients with high stages of endometriosis require more invasive and longer treatments. The success of combined drug-surgery treatment for patients in stage-I endometriosis is possible in the course of 3 months. It requires 6 months for patients in stage-II and between 6 to 9 months for patients in stage-III for complete recovery.

Aims Ovulation induction is one of the main steps in assisted reproductive technology (ART). Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ART. The patients with polycystic ovary (PCO) are at higher risk for OHSS when they are subjected to such techniques. The objective of this study was to investigate the pregnancy outcomes of mild and moderate OHSS in PCO and non-PCO patients. Materials & Methods This retrospective cross-sectional study was carried out on 321 OHSS patients candidate for IVF/ICSI based on their medical records in Sarem Women’ s Hospital (Tehran, Iran) in a period of two years. The general characteristics of the patients and the parameters related to pregnancy were compared between the group of PCO and non-PCO patients. Data were analyzed by Fisher exact test and T-test using SPSS 13 software. Findings A significant difference was found in hospitalization periods between PCO and non-PCO groups (p=0. 002). The PCO group showed higher level of OHSS severity compared to the non-PCO group (p=0. 0001). The number of transferred embryo had significant difference between PCO and non-PCO groups (p=0. 015). There was no significant difference in clinical pregnancy success rate between PCO (11. 8%) and non-PCO (14. 2%) patients (p=0. 602). Conclusion In OHSS patients, the overall pregnancy success rate is lower than normal. The PCO background is not a determining factor for the pregnancy success rate in the patients with OHSS. A similar pregnancy success rate can be achieved by longer duration of treatment for OHSS and more number of transmitted embryos in individuals with PCO.

Aims Recurrent spontaneous abortion (RSA) is one of the most common problems experienced during pregnancy. Immunologic factors, particularly autoimmunity, are contributing to the outcomes of pregnancy in the patients with RSA. Autoimmune antibodies can have a detrimental effect on the placenta and on the fetus and lead to abortion. Therefore, the objective of this study was to compare the serum levels of anti-peroxiredoxin 3 (Anti-Prx3) and anti-peroxiredoxin 4 (anti-Prx4) antibodies in the patients with a history of RSA and healthy women. Materials & Methods This case-control study was conducted on 100 females with a history of at least three RSA as the case group and 32 healthy women with at least two successful pregnancies without any abortion as the control group in Sarem women hospital (Tehran, Iran). The serum levels of anti-Prx3 and anti-Prx4 were measured in the groups using ELISA method. The data were analyzed by Mann-Whitney U test using SPSS software. Findings The level of anti-Prx4 in patients with RSA was significantly higher than control group (p=0. 004). However, there was no statistically difference in the level of anti-Prx3 between patients with RSA and healthy women (p=0. 51). Conclusion The serum level of anti-Prx3 autoantibody in the patients with RSA and healthy women is not different, while the serum level of anti-Prx4 autoantibody in the patients with a history of RSA is higher than that of healthy women.

Aims Group B Streptococcus (GBS) is one of the most important causes of neonatal infections. This bacterial pathogen is associated with preterm birth and neonatal mortality. This study was aimed to evaluate the presence of GBS in the placenta of infected pregnant women. Materials & Methods This analytical case-control study was conducted on pregnant patients referred to Sarem women’ s hospital (Tehran, Iran) for delivery during 2013-2014. A total of 80 formalin-fixed and paraffin-embedded placenta tissues were studied, including 55 samples from GBS positive patients (30 samples with chorioamnionitis and 25 without chorioamnionitis) and 25 samples from GBS negative subjects with chorioamnionitis as the controls. The presence of GBS for each sample was tested by polymerase chain reaction (PCR) and 1. 5% agarose gel electrophoresis. Findings GBS genomic DNA was not detected in any sample from the placenta tissue. Conclusion Group B Streptococcus is not present in the placenta of the women infected with GBS (with or without amniotic membrane inflammation).

Introduction Until 1928, the midwifery school was not stable in case of organizational structure. Sometimes, it was under the authority of municipality, interior ministry, and ministry of education and fine arts, and in a period of time, it was under the supervision of ministry of education in terms of science and education and under the supervision of interior ministry in terms of structure and budget allocation. The aim of this study was to develop a cohesive history on the evolution of midwifery school and to present a more accurate history of the midwifery education until the establishment of the higher school of obstetrics, using archival documents. Conclusion Until 1928, the midwifery school had no regulations and statutes, and on February 7, 1930, its regulations were approved by the Supreme Council of Education, and the school became one of the branches of the School of Medicine under the supervision of ministry of health. On April 4, 1936, the Iranian Academy of the Arts began its activities in order to edit Persian words to avoid non-Persian language, and on May 16, 1937, based on the suggestion of municipality, the term “ midwife” (Ghabele) was changed to “ obstetrician” (Mama). Subsequently, the name of midwifery school was changed to the higher school of obstetrics and it was developed with the new name and management in terms of organization and education. At the beginning of its establishment, the midwifery school had some shortcomings in passing from the traditional to the classical educational practices and it was gradually becoming an official educational institution with statute, regulations, and curriculum that set the foundation for the establishment of higher school of obstetrics and, then, nursing and midwifery faculties.

Introduction Male infertility is a complex medical condition, within which epigenetic factors play an important role. The present review study was conducted to collect epigenetic changes in infertile men. Therefore, more than 50 articles published in the PubMed database were reviewed. All articles published until April 2016 containing the keywords epigenetics, epimutation, and epidrug with the word infertility were reviewed. Conclusion The recent studies have revealed the effects of several epigenetic factors on infertility in men, including histone modification, defects in chromatin-modifying complexes, and methylation modification in promoters of various genes. At present, the available treatments do not account for all infertile men, and this is especially important for idiopathic infertility. Regarding the epigenetic role in male infertility, recognizing epigenetic mechanisms enables us to develop new epidrugs that can be used in the treatment of infertility in near future.

Patient Information Hydrothorax is a rare disorder in fetal period with the prevalence of 1 in 15, 000 pregnancies referring to level 3 clinics, often caused by the accumulation of lymphatic fluid in pleura. Moderate to severe cases are associated with the high incidence of mortality and morbidity in fetal and neonatal period; in this cases, fluid depletion via thoracentesis can reduce the complications of the disease. After doing ultrasonography and screening, a 29-year-old pregnant woman at 31 weeks pregnant was referred to Sarem Hospital due to fetal hydrothorax. In ultrasonography result, the severe right-sided pleural effusion and mediastinal and heart shift to the left were reported. For the fetus, thoracentesis was performed by mother’ s skin ultrasound. The fluid was reaccumulated after several days. Then, amniotic sac was ruptured and with premature labor pain, caesarian section was done; a neonate was borne with hydrops. At birth, thoracentesis was performed in the neonate and the chest tube was inserted. After 10 days, the neonate was discharged with good condition. The fluid obtained from pleural aspiration was Chylous. Conclusion Hydrothorax is a life-threatening disease in fetal period, whose subsequent complications can be prevented by the timely treatment. Thoracentesis is a standard treatment that can be associated with complications, such as preterm labor and hydrothorax relapse.