[Effects of mouthwashes on color stubitity of hleached teeth]

Background and Aim: Bleached teeth are susceptible to discoloration. The aim of this study was to evaluate discoloration of bleached teeth following short-term use of several mouthwashes.

Materials and Methods: In this In-vitro experimental study, 48 extracted maxillary central incisorswere selected and divided into four groups of 12. All the teeth were subjected to external bleaching with 38% hydrogen peroxide [H2o2]. After bleaching, the teeth were immersed in in distilled water [control group or group 1], chlorhexidine [CIx; group 2], Irsha [group 3] or Persica [group 4] for three, seven and 14 days. The color change was assessed by a spectrophotometer at each time point and reported as INCREMENT El, INCREMENT E2 and INCREMENT E3. The results were analyzed by paired t-test, repeated measures ANOVA, one-way ANOVA and LSD test.

Results: Different mouthwashes [p:0.0a3] and immersion times [p:0.03g] caused significantly variable color change in bleached teeth. After 14 days of immersion, the color change of samples in Persica group had significant differences with that of other goups [p<0.000]. The results of repeated measures ANOVA was only significant for the persica group indicating significant color change over time. Thus, paired t-test was applied for pairwise comparison of the time points, which revealed significant differences between INCREMENT EI and INCREMENT E3 and also INCREMENT E2 and INCREMENT E3 [p<0.0S].

Conclasion: Persica mouthwash would cause significant discoloration in recently bleached teeth.

[Effect of translucency and opacity of fiber reinforced posts on fracture resistance of compromised teeth]

Severely damaged teeth with no support at the coronal portion of root canal are very difficult to restore. The aim of this invitro study was to evaluate intraradicular reinforcement by dual cure composite resin and two different types of fiber reinforced composite [FRC] posts [translucent and opaque] in structurally compromised roots. Root canal therapy was performed for 48 maxillary central incisors. The teeth were divided into four groups, and specimens from three groups were prepared to simulate the teeth with flared canals. In the 1[st] group, no weakening was done. In the 2[nd] group, the compromised area of the root canal was filled with gutta percha. In the 3[rd] and 4[th] groups, universal DT light and DT white posts were used respectively in the root canal to 8 mm below the margin of the palatal wall. The posts were cemented with dual-cure composite. In all groups, the access cavity was restored with light-cure compo-site resin. After being mounted, all specimens were pressed at an angle of 45? relative to the long axis of the teeth. The amount of force at fracture was recorded. Results of fracture load were evaluated by one-way ANOVA and LSD post hoc test and the results of mode of fracture were evaluated by chisquare test. The mean fracture load for the four groups was 170.12, 71.40, 125.8 and 148.59 kgf, respectively. There was a significant difference between the mean fracture load of 1[st] and 2[nd] groups and that of other groups [P=0.001]. The mean fracture load of the 4[th] group was significantly [P=0.002] higher than that of the 3[rd] group. The frequency of restorable fractures was significantly different between these two groups [P<0.001]. Using dual cure composite resin and FRC posts in roots with thin walls will reinforce the compromised teeth but the type of post will affect the outcome

[Financial statements analysis medical universities in Iran]

Evaluation of financial performance of organizations is regarded as an important financial function of managers since this allows them to make the right decisions and maintain the organizational productivity and control. The aim of this study was to assess the financial performance of medical universities in Iran employing financial ratio analysis. This was a cross-sectional descriptive study. Qualitative and quantitative data analysis techniques were used. Content analysis and Delphi panel qualitative data collection techniques were applied to enrich our understanding of the financial statements and ratios in medical universities in Iran. Additionally, a questionnaire was used to collect quantitative data on the financial statements and ratios of all 38 medical universities. The sampling method used was purposive, and for data analysis standard deviation variation, mean central tendency and frequency were used. Financial ratios [12], grouped in two categories of liquidity ratios, activity ratios and productivity of resources, were identified. The most important financial ratios were: quick ratio [mean=2.53], current ratio [mean=3.58], collection period ratio [mean=114], operating income, divided by total hind [mean=0.44], budget productivity [mean=0.79] and the assets return rate [mean=0.84]. The results indicate that the mean of liquidity ratios in medical universities in Iran was higher than the other sectors. This was due to the inappropriate year-end allocation of annual funds by the government. The other findings on activity ratio and operating cash flow ratio indicate lack of financial resources management regarding the assets conversion and resources and capitals combination within the universities studied. This shows that medical universities in Iran have not used the authoritative power of the board of trustees. We recommend further research on the development and standardization of financial reports in accordance with the type of services, disposable incomes, trade, and financial regulations in medical universities

Driving to contract management in health care institutes of developing countries

Public hospitals can privatize management activities by contracting with a private organization or person to perform the work. Management contract is a method which uses private sector for major government projects like hospitals. This study evaluates contract management in health care institutes of developing countries. Information has been collected by reviewing the management contract condition of selected countries. Different forms of public private partnership for private participation in hospitals were surveyed. The effects of management contract is expanding market opportunities to include public sector clients, capturing a market to be protected from competitors and providing a reliable and timely source of revenue. Contracting with non-governmental entities will provide better results than government provision of the same services. Contracting initiatives must be regulated and monitored at the highest level of government by experienced and astute policy makers, economists and operational personnel

[Relationship between structural empowering and nurses' readiness for change]

People are the focus of all changes in organizations. Therefore, their readiness for change is among most important factors in current organizations. Empowerment enables employees to deal with the problems and threats with endurance and flexibility. The purpose of this study was to investigate the relationship between structural empowerment with nurses' readiness for change. It was a descriptive correlational study. One hundred and thirty nurses working in Hasheminejad hospital in Tehran were recruited by simple random sampling. Data related to people's readiness for change, and structural empowering was collected by means of Pankern Han et al. [1998] tool and Conditions of Work Effectiveness Questionnaire- 11 [CWEQ-11] respectively. Data was analyzed using Spearman correlation test and multivariate linear regression analysis by means of SPSS-PC [v. 16]. There was a significant positive relationship between structural empowerment and nurses' readiness for change [P

[Changes in bleached enamel microhardness after application of fluoride and CPP-ACP]

Tooth bleaching decreases enamel microhardness. The aim of this study was to evaluate the changes in microhardness of bleached enamel after applying fluoride and CPP-ACP [casein phosphopeptide amorphous calcium phosphate]. In this experimental study, sixty extracted human molars were divided into six groups [ten each]. The flatted occlusal surface was covered with nail varnish. In the second, third and fourth groups, tooth bleaching was performed. The first and second groups were positive and negative control groups. In the third and fifth groups, the specimens were covered with sodium fluoride varnish and the fourth and sixth groups underwent CPP-ACP therapy. Subsurface enamel microhardness was determined on the occlusal surface with 300 micron distance from the buccal or lingual surface. One way ANOVA and Tukey post hoc were used for statistical analysis. Microhardness of bleached enamel was significantly lower than the other groups. The teeth treated by fluoride agent or CPP-ACP after bleaching had a significant increase in their microhardness in contrast with the bleached enamel. CPP-ACP and fluoride treatment had no significant effect on sound enamel microhardness. Although using CPP-ACP and fluoride increases the enamel microhardness, there was no significant differences between them. Fluoride and CPP-ACP components increase bleached enamel microhardness

[Benchmarking records of administrators and officers at health deputy headquarters of Iranian universities of medical sciences: 2008 - 2010]

Benchmarking is used to identify the successful experiences and achievements of a business to develop and improve organizational performance. This study aimed to determine, firstly, the frequency of benchmarking made by administrators and officers at Health Deputy headquarters of Iranian universities of medical sciences and, secondly, the relationship of this frequency to individual and organizational factors. This cross-sectional study was conducted in spring 2010. The research population constituted administrators and officers at Health Deputy Headquarters of Iranian universities of medical sciences from which thirteen universities were randomized and stratified. All available administrators and officers in the selected universities were interviewed and, then, were asked to complete a reliable and valid questionnaire consisting of individual and organizational variables. From the 293 administrators and officers under study, 75 [26.5%] could exploit 167 cases of successful experiences and achievements of other organizations to improve and develop their organizational performance. While 46.7% of benchmarking was conducted through site visits, 86.2 % of all the process was performed by the health sector, and 91% of the activity was done within the country. Among individual and organizational factors, only the educational degrees of the participants showed a significant relationship with benchmarking rates [p=0.045]. To promote the low amount of benchmarking capita among the administrators and officers, it seems necessary to design and implement intervention programs

Development of a clinical pathway for normal vaginal delivery in Emam Reza hospital in Urmia

Since normal vaginal delivery is concerned in the mother's health and their child, different levels of the healthcare system are engaged in this process, and due to the high rates of studies related to normal vaginal delivery is one of the priority areas in medical research worldwide. Function of normal vaginal delivery process- like many other clinical processes- is far from optimal in Emma Reza hospital, and needs improvement. This study was carried out with the aim of development of a clinical pathway for normal vaginal delivery to improve this process. In this paper we report the process of clinical pathway development. We will report the results of its implementation later. This is a quality improvement study which is one of the effectiveness or on-line studies. In this study we used Dr. Lameei's model for clinical pathway development. The following activities were done for the pathway development: 1] the quality improvement steering committee of the hospital took the responsibility of the overseeing the clinical pathway development process and policy issues in the hospital. 2] The steering committee created the criteria for selection of the first clinical process for pathway development. 3] Based on the criteria, the normal vaginal delivery process was selected for clinical pathway development. 4] Flow chart of the process was depicted and a multidisciplinary team was formed. 5] The multidisciplinary team assessed the current function of the process. 6] Using methods of evidence-based medicine, the team found out the best practice regarding normal vaginal delivery. 7] The team determined the format and content of the pathway. 8] It created a list of possible variances from the pathway. 9] Finally, the team developed the standing orders and necessary evidence based protocols. The outputs of the pathway development stage of this study were: 1] normal vaginal delivery clinical pathway. 2] Inclusion criteria into the pathway. 3] List of the variances. 4] Evidence based actions regarding each variance, standing orders, and necessary protocols. Clinical pathway was an effective tool for designing and standardization of clinical processes based on evidence based medicine. Nine steps model [FOCUS-PDCA] which used in this study was performable. The pathway development took more about one and half years, which was longer than the time western countries have used to develop clinical pathways. Two outstanding constraints in affecting the time devoted for clinical pathway development were: 1] Non familiarity of the multidisciplinary team with the concepts and principals of the clinical processes quality improvement in general, and the clinical pathway development in particular. 2] It took a very long time for the team to go through the team development stages and becoming a mature performing team

Educational performance assessment of Hashemi Nejad educational hospital based on model of Malcolm Baldrige, Teharn, Iran, 2007

However, medical education, played a great role in human health in the twentieth century but this system has changed over time requires, so this study is conducted with aim of Educational performance assessment of Hashemi Nejad Training hospital in Tehran based on Educational Model of Malcolm Baldrige Excellence Model. descriptive study, conducted by cross-sectional method. The environment of this research was Hashemi Nejad educational Hospital in Tehran. Data gathering tools was international and standard checklist of Malcolm Baldrige's Model. Data gathering approach was interviewing chief managers of hospital, studying the records and documents in each criterion and separately supplementing the checklist. The data are analyzed qualitatively. This hospital has obtained 222 of total 1000 points exist in Malcolm Baldrige's score in educational field [22.2% of the total score of 100 percent in model]. Finding also shows those main criteria of strategic planning and the focus on students, interest groups and marker obtain the maximum score. Since, each of them has obtained 33 percent of total score of the model and the minimum score, 18 percent, belongs to results of organizational performance criterion. the hospital's performance in educational fields was weak. Since the first mission of hospital activities to better education and training student, so more attention to organizational performance is necessary

[ impact of medical emergency base on the quality of services to passengers in Tehran metro station]

Providing medical services to injured passengers and personnel in a short time is the major goal of Tehran metro superior services regarding the progressive increase in population in metropolises; the importance of public transportation network development; and also the role of metro in transporting a large number of passengers. This research aims to study the effect of medical emergency bases on the quality of the passenger services in Tehran metro stations. In this cross-sectional research which is case study, about 402 persons including emergency personnel [37]; customers of main stations [185] and customers of secondary stations [180] were surveyed by using three separate kinds of questionnaires, which their validity was confirmed by Cronbach's Alfa test [0.82 for emergency personnel and 0.90 for customers of the main and secondary stations]. The scoring system was determined based on Likert and the related experts' viewpoints. The findings show the major factors of satisfaction are as follows: the quality indicator of "providing services" in viewpoint of personnel [p value = 0.004]; the indicator of "transportation" in the viewpoint of the main stations customers [p value = 0.000] and also passengers were more satisfied with medical emergency bases than the referred personnel [p value = 0.096]. According to the results, establishment of medical emergency base is the major factor of customers' satisfaction from main stations and it has a great effect on the quality of passenger services despite less satisfaction of personnel

[Relationship between leadership style of managers and job satisfaction of medical emergency technicians]

Job satisfaction in medical emergency technicians is vitally important regarding their working conditions and the necessity of accuracy and speed in saving lives. Managers' leadership styles are the most important factors which may be correlated with job satisfaction. This research aims to study the relationship between managers' leadership style [Transformational, Transactional and Laissez Fair Leadership] and job satisfaction of medical emergency technicians. In this research, all persons in emergency medical center of Isfahan city such as technicians, managers of different levels including bases supervisors, deputies, and also head of the center were studied. It was used Multifactor Leadership Questionnaire [MLQ] and Job Descriptive Index questionnaire [JDI] in order to assess leadership style and job satisfaction respectively. The relationship between leadership style and job satisfaction was surveyed by using Pearson correlation analysis. Based on the findings, there was a meaningful relationship between both transactional and transformational leadership styles with job satisfaction [P<0.01]. There was no relation between laissez fair leadership style with job satisfaction. Research has shown that there is a significant relationship between leadership styles of managers and personnel job satisfaction increase. Based on the results, the transformational leadership style improves job satisfaction

[Effect of used diamond burs on dentin bond strength]

Many researchers have reported that, constant use of diamond burs can reduce their cutting efficacy during cavity preparation. The aim of this study was to evaluate the effect of changes in diamond bur sharpness on dentin bond strength when using self-etch bonding system. A total of seventy-two caries-free human 3[rd] molars were included in this in-vitro investigation. The teeth were sectioned in occlusal surface in order to expose dentin, and then were randomly divided into four groups. For dentin preparation, a fine diamond bur was used in group 1, a new coarse diamond bur was used in group 2, a used coarse diamond bur was used in group 3 after applying on porcelain for two minutes, and a used coarse diamond bur was used in group 4 after it was applied on porcelain for ten minutes. Unique composite capsules were bonded to all dentin surfaces using Clearfil SE Bond and then cured. After storage for 24 hours in 37°C distilled water, the bonded teeth were subjected to shear testing by using Instron testing machine. The bond strengths were calculated and recorded as failure. Bond strength data were analyzed by One-Way ANOVA and Tukey tests. The mean [Standard Deviation] of shear bond strength in each group can be reported as follows: 22.2Mpa[3.38] for group one, 18.05Mpa[4.54] for group two, 24.5Mpa[5.69] for group three and the figure was 22.4Mpa[4.52] for group four. The statistical analysis demonstrated that Shear bond strength of new coarse diamond bur preparations were significantly [P<0.001] less than fine or used diamond burs. Used diamond burs of different durations can affect dentin bond strength of SE Bond self etch bonding system. Accurate type of bur and adhesive selection are essential in optimizing dentin adhesion to self-etching adhesives

[Effect of cavity liners on micro leakage of Cl V amalgam restorations]

There is no bonding between amalgams and restored cavity walls. Therefore, these restorations are prone to leakage despite the deposition of corrosion products. The aim of this in vitro study was to evaluate the effectiveness of three cavity liners in reducing micro leakage of class V amalgam restorations. Sixty-eight extracted intact human molar teeth were selected. Class V cavity preparations were performed in all teeth and they were randomly divided into four groups. Group one was used as a control group [no liner], and the rest were Varnish, Resin Cement [Panavia F], and Light-cured dentin bonding agent [Single Bond] groups. Or alloy amalgam was condensed into the prepared Cl V cavities. All teeth were immersed in distilled water at 37°C, for 24 hours. All restorations were subjected to 1000 thermal cycles at 5-55 degrees centigrade. For micro leakage test, all teeth were immersed in 0.5% Basic Fuchsine and sectioned. Dye penetrations were evaluated by stereomicroscope. The collected data were analyzed statistically by Kruskal-Wallis and Bonferroni test. The results showed significant differences between four groups [P< 0.05]. Control group showed the maximum and Panavia group revealed the minimum micro leakage. There was no significant difference between Panavia and Single Bond groups. On the other hand, no significant difference [P>0.008] was observed between occlusal and gingival margins in the control, Single Bond and Panavia groups. Although, the difference was statistically significant in varnish group [P=0.002]. When compared with control group, the dentin bonding agent, varnish and cement resin groups demonstrated significantly decreased micro leakage at the enamel margin [P=0.0001]. However, when compared with varnish and control group, the dentin bonding agent and cement resin groups demonstrated significantly decreased micro leakage at the cementum margin [P<0.008]. Findings of this investigation clearly demonstrate the advantage of using lining materials in amalgam restorations. Therefore, we can conclude that such materials may significantly increase the sealing ability and decrease the micro leakage in Class V amalgam restorations

Designing a model of drug quality assurance for Iran

To take up the project for designing a Drug Quality Assurance Model [GMP] for Iran. It is a descriptive and comparative study. GMP models from USA, EU, Australia and Iran, and WHO, ICH and PIC/S were selected for the comparative study. Internet sites and scientific journals were used for data collection. The comparative study determined the primary proposed model. Then, based on Delphi technique, the primary model was evaluated by experts and eventually the final model was designed, for application in Iran. The comparative study and feedbacks of experts determined the final proposed model for pharmaceutical quality assurance [GMP] for Iran, which consisted of two parts. The first part included thirteen chapters consisting sixty-two major titles. The second part consisted of sixteen annexes. Establishment of standards of the final model of GMP in the drug industry could lead to the improvement of quality of national manufactured drugs, hence, promoting the population health levels

[Designing a model of drug quality assurance for Iran]

Manufacturing substandard and low quality pharmaceutical products will lead to waste of resources with added health risks to public health. The research was a descriptive and comparative study. USA, EU, Australia and Iran, and WHO, ICH and PIC/S were selected for the comparative study. Internet sites and scientific journals were used for data collection. The comparative study determined the primary proposed model. Then, based on Delphi technique, the primary model was evaluated by experts and eventually the final model was designed. Pharmaceutical quality assurance model of USA had two parts without annexes. The first part described the general concepts. The second part was much larger and had eleven subparts. Each subpart included some GMP requirements. The model of EU was based on two parts. The first part, with nine chapters, presented the basic GMP requirements, and the second part, consisted of nineteen annexes, and illustrated the method of GMP implementation on specific areas of production. The model of Australia was very similar to EU model, structurally and contextually. The model of WHO had written the GMP principles in seventeen chapters without annexes. The model of ICH consisted of nineteen chapters and had no annexes. The model of PIC/S was designed as EU model completely. Iran had no pharmaceutical quality assurance model. The comparative study and feedbacks of experts determined the final proposed model for pharmaceutical quality assurance [GMP] of Iran, which consisted of two parts. The first part, chapters, included thirteen chapters and each chapter described isolated parts of GMP principles. Each chapter was divided to some major titles. Overall, the first part [chapters] consisted of sixty-two major titles. The second part of model consisted of sixteen annexes, which illustrated the method of GMP implementation on specific areas of production. Establishment of standards of the final model of GMP in the drug industry could lead to the improvement of quality of national manufactured drugs, hence, promoting the population health levels

[ comparative study on results of hospitals in Tehran based on the organizational excellence model]

During recent years, due to the importance of health services quality, the health service managers have been paying enormous attention to improvement of health care quality and therefore, the Organizational Excellence Model is increasingly in use as a competition framework for recognition of achievement towards the organizational quality, performance excellence, and also the growth of organizational knowledge regarding the quality and performance excellence. To assess the results of two hospitals affiliated to Social Security Organization in Tehran based on the Organizational Excellence Model. The present work was a cross-sectional study carried out at two hospitals named as Alborz and Panzdah-e-Khordad in 2005. Both hospitals were granted an ISO 9001 certification. The data gathering tool consisted of an EFQM questionnaire filled in during group working sessions, interview with hospital managers, and also the available documents kept at different wards. Data were collected according to the "four criteria of results" in the hospitals. The highest scores were gained in Panzdah-e-Khordad hospital in key performance results [56.5%] followed by customer results [46.1%], society results [40.6%], and people results [39%]. Totally, our findings showed that Panzdah-e-Khordad hospital achieved a higher score [236.1out of a total of 500 points] compared to Alborz hospital with 212.2 points. It is believed that the health care area is one of the best fields for application of the model towards the performance excellence and gaining better organizational results and hence, it seem that the model has a high potential in responding to problems commonly seen in health sector

influence of Iranian temporary components on shear bond strength of composite resin to deep dentin in a single bottle bonding system

There are controversies about the effect of eugenol containing cements on composite-dentin bond strength. This study was designed to evaluate the effect of eugenol containing temporary cements on shear bond strength of composite bonds to deep dentin when using Single Bond. In this in-vitro study, ninety extracted human third molars were sectioned horizontally at deep dentin and randomly divided in six groups after embedded into self cure acrylic material. Samples in five groups were covered with: Cavisol, Temband, and Zoliran with three different powder/liquid ratios of 10/2 gr., 10/3 gr., and 10/2 gr. respectively. The samples in group six were used as control and therefore they received no treatment. After elapse of one week, the temporary cements were removed mechanically from all samples in the first five groups. Only the samples in group five were cleaned by ethanol. All groups were pretreated with single bond and then composite cylinders were added. Debonding and shear bond strength was tested by using DARTEC universal testing machine. These data were analyzed using One-Way ANOVA and Duncan tests. The median shear bond strength were calculated for all six groups as follows: The values were 17.96 [ +/- 0.73], 15.06 [ +/- 0.78], 16.14 [ +/- 0.75], 13.76 [ +/- 0.66], 16.79 [ +/- 0.34], 18.12 [ +/- 36] Mega Paschal respectively. Significant group differences were found for all groups [P<0.001] except for first and sixth [P >0.05] as well as third and fifth groups. Temporary cements containing eugenol significantly reduced the shear bond strength of composite to deep dentin when using Single Bond

Shear bond strength between aged hybrid and new flowable composite resins using different bonding agents

Flowable composite is an appropriate choice for repairing old composite restorations because of its conservative nature, easy application and various colors available on the market, The aim of this study was to evaluate the shear bond strength between old hybrid and new flowable composite resins using Adhes, Single bond, Prompt L Pop and no dentin bonding agents. Eighty acrylic cylinders were fabricated with a standard cavity in the center. Tetric Ceram hybrid composite was placed in the cavities and cured. The cylinders were divided into two groups; one group was kept in water for one month and was then randomly divided into four subgroups. Dentin bonding agents were not used in the first subgroup but the selected bonding agents were applied to the cylinders in the other subgroups. Tetric Flow composite was placed on the primary composite. The same procedure was used for the second group except that the samples were not stored in water for one month. The shear bond strength was measured using a universal testing machine. The data were subjected to LSD variance and independent t-analysis. Shear bond strength values ranged from 33.27 to 16.62 MPa in the first group [in decreasing order: Adhes, Single-bond, control and Prompt L pop subgroups] and from 32.73 to 18.15 MPa in the second group [in decreasing order: Adhes, Single-bond, Prompt L pop and control subgroups]. In the first group, a significant difference was observed between the control versus Adhes and control versus Single bond subgroups and also between the Adhes and Prompt L pop and finally between the single bond and Prompt L pop subgroups. There was no significant difference between the control versus Prompt L pop and Adhes versus Single-bond subgroups. The results obtained in the 2nd group were similar to the first group. The shear bond strength between aged hybrid and new flowable composite resin may increase after application of dentin bonding agents