The correlation between ultrasonographic findings and clinical symptoms of pelvic endometriosis.

OBJECTIVE: Considering the importance of endometriosis and its relatively high prevalence among women, this study sought to investigate clinical and Transrectal and transvaginal ultrasounds (TVS) findings of disease. METHODS: This descriptive-analytical study was performed based on medical records of 155 women with endometriosis admitted to Rasool-e Akram Hospital in Tehran for a TVS. All the sonography data and patients' information were collected into checklists and analyzed in SPSS-25 software (IBM). RESULTS: The mean age of participants was 32.4 ± 6.1 years, ranging from 18 to 50 years. Endometrioma was prevalent in 129 patients (84.8%). Size of endometrioma (diameter) was more than 3 cm in 79.9% of patients, and 3 cm or fewer in 20.1% of cases. Bladder, intestinal, vaginal, and rectosigmoid involvements with endometriosis implants were observed in 4 (2.6%), 54 (35.5), 3 (0.2%), and 51 (33.5) of patients, respectively. A total of 64.5% of patients were diagnosed with incomplete stenosis of the Douglas pouch and 35.5% had complete stenosis. Deep infiltrating endometriosis (DIE) was less than 1 cm in 20.7%, 1 to 3 cm in 42.3%, and over 3 cm in 37% of patients. The most common manifestations of endometriosis Obliteration of the Douglas pouch, endometrioma, and DIE. In addition, imaging modalities have shown promising results, indicating the necessity to use transvaginal ultrasound as the first line of diagnosis in patients with clinically suspected endometriosis.

Relationship between the severity of endometriosis symptoms (dyspareunia, dysmenorrhea and chronic pelvic pain) and the spread of the disease on ultrasound.

OBJECTIVES: About 10-15% of women of childbearing age have endometriosis. The present study aimed to investigate the relationship between the severity of symptoms of endometriosis and the spread as well as the stage of the disease on ultrasonography. The present cross-sectional study evaluates the relationship between the severity of endometriosis symptoms and the spread of disease on ultrasonography in patients with endometriosis. RESULTS: Considering different analyses, the cumulative size of posterior deep infiltrative endometriosis (DIE) (less than 1 cm) is significantly correlated with minimal severity of dyspareunia and chronic pelvic pain. The incidence of dyspareunia was more prevalent in patients with complete stenosis of Douglas pouch than those with incomplete stenosis. Furthermore, the incidence of severe and very severe pain in patients with Douglas pouch stenosis is relatively higher than that in patients without stenosis. Only dyspareunia is related to the stage of endometriosis, and patients with dyspareunia are five times more at risk of a higher stage of the disease. The severity of dyspareunia is related to the stage of endometriosis and the severity of Douglas pouch stenosis. The results showed a correlation between chronic pelvic pain and r-ASRM score (revised American Society for Reproductive Medicine score).

Acceptability of the Urban Family Medicine Project among Physicians: A Cross-Sectional Study of Medical Offices, Iran.

INTRODUCTION: It is essential to organize private physicians in urban areas by developing urban family medicine in Iran. Acceptance of this project is currently low among physicians. The present research determined the factors affecting acceptability of the Urban Family Medicine Project among physicians working in the private sector of Mazandaran and Fars provinces in Iran. METHODS: This descriptive-analytical and cross-sectional study was conducted in Mazandaran and Fars provinces. The target population was all physicians working in private offices in these regions. The sample size was calculated to be 860. The instrument contained 70 items that were modified in accordance with feedback from eight healthcare managers and a pilot sample of 50 physicians. Data was analyzed using the LISREL 8.80. RESULTS: The response rate was 82.21% and acceptability was almost 50% for all domains. The fit indices of the structural model were the chi-square to degree-of-freedom (2.79), normalized fit index (0.98), non-normalized fit index (0.99), comparative fit index (0.99), and root mean square error of approximation (0.05). Training facilities had no significant direct effect on acceptability; however, workload had a direct negative effect on acceptability. Other factors had direct positive effects on acceptability. CONCLUSION: Specification of the factors relating to acceptance of the project among private physicians is required to develop the project in urban areas. It is essential to upgrade the payment system, remedy cultural barriers, decrease the workload, improve the scope of practice and working conditions, and improve collaboration between healthcare professionals.

The Effect of Time-to-Provider, Left-without-Treatment and Length-of-Stay on Patient Satisfaction in Training Hospitals' Emergency Department, Iran.

BACKGROUND: It is necessary to consider into hospital emergency services' quantity and quality in different aspects such as time-to-provider, left-without-treatment and length-of-stay. The aimof this research was to identify the effect of these factors on patient satisfaction in training hospitals. METHODS: In this descriptive-analytical and cross-sectional study, the sample size was calculated 768. The instrument included 54 questions and 8 sections. Three questions were in the field of following factors: 1) Time to provider was defined as the time from initial triage to initial provider evaluation. 2) Left-without-Treatment patients were defined as those who were initially triaged but were unable to be evaluated by a provider because they had left the ED. 3) Length-of-Stay was defined as time from initial triage to the time of final ED disposition, either discharge or admission. It was analyzed by descriptive statistics, simple logistic regression, multiple logistic regressions, simple linear regression and multiple linear regression. RESULTS: The time-to-provider lower than 15 minutes, LWOT and LOS lower than 6 hours were 92.8%, 3.9% and 90.3%, respectively. The mean of time-to-provider and the mean of LOS were 18.1 minutes and 202 minutes. Time-to-Provider affected satisfaction of admission, guardians, nursing care and managing proceedings (P<0.001). LOS affected satisfaction of admission, guardians and diagnosis proceedings (P<0.01). LWOT did not affect satisfaction and its domains (P>0.05). CONCLUSION: Decreasing time-to-provider and LOS has the effect on patient satisfaction in some domains. Furthermore, left-without-treatment rate is not a good proxy of patient satisfaction.

Patient safety in tehran university of medical sciences' general hospitals, iran.

BACKGROUND: It is important to focus on creating opportunities for patients' participation at all levels of health systems in order to promote their ability to improve patient safety and quality of services. The general aim of this study was to determine patient safety level in Tehran University of Medical Sciences' (TUMS) general hospitals, Tehran, Iran from patients' perspective and to determine the contributory factors on their perspective. METHODS: This was a cross-sectional study. In the spring 2011, the list of clinical departments of the six general hospitals affiliated to TUMS was obtained through the Website of TUMS. By using stratified random sampling, the sample size was calculated 300 patients. Data were collected by using a structured questionnaire and its validity and reliability were acceptable. Descriptive statistics, linear regression and logistic regression were used for analyzing the data. RESULTS: Totally, 60% of patients were female. Patient safety was evaluated high by 60% of respondents. The unmarried or educated or employed individuals tend to score lower than others. CONCLUSION: TUMS's general hospitals are enough safe from patients' perspective, patient safety should be improved. In clinical governance, contributing patients' perspective to the improvement of patient safety reforms is critical in generating new models of good practice.

The Relation between Nursing Administration's Self-Confidence and the Staff's Vocational Satisfaction.

BACKGROUND: Self-confidence is a glorious feature of an effective administrator. Their main goal is the organizational success. Therefore, we approached this idea by evaluating the self-confidence of nursing Administration in Tehran University of Medical Sciences (TUMS) Teaching Hospitals and its relation to vocational satisfaction of the staff. METHODS: In a cross-sectional study, we interviewed 200 nursing administrators and 200 staff in different departments of the TUMS Teaching Hospitals using a standardized questionnaire to assess the self-confidence among nursing administrators and staff satisfaction. Data were entered in SPSS (17.0) and analyzed using this software and STATA (11.0) using non-parametric tests and Spearman's correlation of coefficient. The significant level was set as P<0.05. RESULTS: Of 200 nursing administrators 58 (29%) were male and 142 (71%) were female. Mean ± SD of the self-confidence score for the nursing administrators was 134.9 ± 19.8. Among the staff 68 (34%) were male and 132 (66%) were female. The mean ± SD of the vocational satisfaction for staff was 89.12 ± 18.3. After considering the effect of departments in a regression model, the correlation between nursing administration's self-confidence and the staff's vocational satisfaction was found not significant (P=0.055). CONCLUSION: Gender and years of employment were the only factors affecting self-confidence and vocational satisfaction between the nursing administration and staff respectively, which not significantly correlated after adjustment.

[ relationship between nursing managers' self-reliance and patients' satisfaction in hospitals affiliated to Tehran university of medical sciences[TUMS]]

Self-reliance is a psychological belief that is formed in an individual during growth and is not changed easily and quickly. The present study aims to evaluate the relationship between nursing managers' self-reliance and patients' satisfaction in hospitals affiliated to Tehran University of Medical Sciences [TUMS]. In this cross-sectional study, 400 individuals [200 nursing managers and 200 patients] were interviewed in various clinical wards of TUMS hospitals. Nursing managers' self-reliance and patients' satisfaction were evaluated using a structured questionnaire. The data were entered into Stata 11 software and analyzed with non-parametric ANOVA and Spearman's correlation coefficient tests. The significance level was determined to be p<0.05. Of the nursing managers, 58 [29%] were male and 142 [71%] were female. The mean and SD of their self-reliance were 134.9 and 19.8, respectively. The patients, however, comprised 81 [40.5%] males and 118 [59.5%] females. The mean and the standard deviation of patients' satisfaction were 57 and 18.2, respectively; the only individual factors affecting their level of satisfaction were educational level [p<0.005] and insurance status [p<0.0001]. Besides, a multivariate analysis showed that there was a significant negative association between managers' self-esteem and patients' satisfaction [P=0.04]. The findings revealed that female managers had less self-esteem than male managers. Moreover, it showed that managers' higher self-esteem would cause patients' lower satisfaction. Furthermore, patients with higher education and/or with health insurance were more satisfied than others