Investigating the effective factors on patients' escape from one of the public hospitals in Bushehr city in 2017-2018: A descriptive, cross-sectional study

چکیده زمینه و هدف: خروج از بیمارستان بدون اطلاع پزشک و پرسنل یا به عبارتی فرار از بیمارستان، یکی از چالش های  بزگ نظام سلامت محسوب می شود چرا که می تواند باعث ایجاد هزینه های اقتصادی برای سیستم و زیان جانی برای بیمار گردد . هدف از این مطالعه بررسی عوامل موثر در فرار بیماران و بار مالی ناشی از آن  در یکی از بیمارستان های عمومی شهر بوشهر می‌باشد. مواد و روش‌ها: این پژوهش یک مطالعه توصیفی- مقطعی است که در یکی از بیمارستان‌های شهر بوشهر انجام گرفته است. در این مطالعه، اطلاعات بیماران با روش سرشماری و با استفاده از یک چک لیست  استخراج گردیده است. این چک لیست حاوی سئوالات دموگرافیک، بالینی و اقتصادی می‌باشد. تحلیل داده ها از آمار توصیفی در محیط  نرم افزار spss  نسخه 25  بهره گرفته شد. یافته‌ها: بنابر نتایج حاصل از آنالیزهای آماری نرخ فرار از بیمارستان0018/0 برآورد می‌شود. یعنی به طور میانگین، هر ماه 6 نفر از بیماران فرار کرده‌اند. زیان مالی وارد شده به بیمارستان شهدای خلیج فارس بوشهر بابت فرار بیماران در سالهای 1396 و 1397 بالغ بر ده میلیارد ریال بوده است که سهم بیمارانی که بیمه داشتند در آن بیشتر از افراد فاقد بیمه بوده است. نتیجه گیری: نرخ فرار در بیمارستان مورد پژوهش کم بود. با این حال به دلیل این که فرار علاوه بر زیان مالی قابل توجهی که به بیمارستان ها وارد می‌کند می‌تواند مشکلاتی را برای خود بیماران، خانواده‌‌‌‌هایشان و نیز جامعه ایجاد کند، لازم است تلاش ها در جهت کاهش وقوع این معضل توسط مدیران  به کار گرفته شود.  Background and Aims: Absconding from hospitals presents big challenges to the health care systems, with consequences such as delay and incomplete treatment process. Also it may result in increased personal workload and the cost burden of health system. The aim of this study was to determine absconding rate and its driving factors in a public hospital in Bushehr city in 2017-2018. Materials and Methods: The present descriptive cross-sectional study was conducted in a general hospital in Bushehr. During the study, patients' information was extracted by a checklist from their medical records between 20 March 2017 and 1 March 2018 using census method. Ethical criteria such as confidentiality of patients' names and the hospital under study were observed. Results: Absconding rate was found to be 0.18 percentage. The highest number of escapes was noticed in emergency wards (137 and 92%), meaning that in average 6 persons have escaped each month. Mean age of the patients was 29.02 and they stayed 2.07 days in the hospital. The highest frequency of escape was observed in male patients and in singles which occurred in night shift. About 72%  (117) of patients did not have health insurance, but 88% of  unpaid amount was belonged to insured persons. The total amount of damages was estimated to be 1,411,950,080 Rials. The average cost per patient was also appraised to be 9,540,203 Rials. Conclusion: Despite the low escape rate at the studied hospital, the property damage was significant. Installation of gates and controlling the entry and exit of patients, coupled with increasing the number of physical protection staff and insurance offices, as well as reforming the clearance process and insurance laws are proposed to reduce the occurrence of this problem

Effects of an Orem-based Self-care Program on the Orem's Pattern of Lower-extremity Edema in Patients Undergoing Coronary Artery Bypass Grafting

Background & Objective: Coronary artery disease (CAD) is a cardiovascular disorder associated with long-term constraints in the patients' life. Open heart surgery is an effective treatment for CAD, and the postoperative complications require extensive care, especially by the patient. Self-care education plays a key role in this regard, particularly based on Orem self-care model. The present study aimed to investigating the effects of an Orem-based self-care program on Orem's pattern of lower-extremity edema in patients undergoing coronary artery bypass grafting (CABG). Materials and Methods: This clinical trial was conducted on 74 patients undergoing CABG at Kashani Hospital in Shahrekord, Iran, who were randomly allocated to the intervention and control groups using software. Data were collected using the need assessment form based on the Orem model, and edema was measured using a meter. Data analysis was performed in SPSS version 21. Results: The Orem-based self-care program reduced lower-extremity edema in the intervention group (before: 34.31±31, after: 32.14±2.87), while the changes in the control group were not significant (P>0.05). Conclusion: According to the results, nursing patterns (e.g., Orem's model) could be used to enhance self-care abilities in patients requiring long-term care. Keywords: Self-care, Orem Model, Edema, Coronary Artery Bypass Graftin

The Inhibitory Effect of Connective Tissue Growth Factor Antibody on Postoperative Fibrosis in a Rabbit Model of Trabeculectomy

Purpose: To compare the efficacy of subconjunctival injection of an anti-connective tissue growth factor antibody (anti-CTGF) versus mitomycin-C (MMC) and placebo in reducing scar formation in a rabbit model of trabeculectomy. Methods: A total of 14 rabbits were included. Nine rabbits underwent trabeculectomy with subconjunctival injections of either anti-CTGF antibody, MMC, or balanced salt solution (BSS), each administered in three eyes, before peritomy. The anti-CTGF group received a repeated dose of the antibody five days after surgery. All nine rabbits were euthanized on day 14; the globes were stained with hematoxylin & eosin, Masson’s Trichrome, and immunohistochemistry for detecting alpha-smooth muscle (α-SMA) actin. RNA extraction was performed on five eyes of the remaining rabbits which included one eye without any surgery, one eye 5 hr after trabeculectomy without any injection, one eye five days after trabeculectomy without any injection, and two eyes five days after trabeculectomy with administration of MMC and BSS, respectively. Results: The mean bleb area in the anti-CTGF, MMC, and control groups was 3.8 ± 1.45, 5.9 ± 1.4, and 3.5 ± 1.9 mm2, respectively. Collagenous tissue was found to occupy the bleb area by 13.7%, 13.5%, and 18.5%, respectively. This ratio was significantly higher in the BSS group (P = 0.04). The expression of CTGF mRNA after 5 hr and five days in eyes undergoing trabeculectomy were significantly more pronounced as compared to the unoperated eye. The mean H-SCORE of α-SMA-immune reactive cells calculated as the grade of staining multiplied by the percentage of immune stained cells was 14.6, 10.22, and 140.58 in the anti-CTGF, MMC, and control groups, respectively. While the control eyes had a significantly higher score (Ps < 0.001), the anti-CTGF and MMC groups were comparable (P = 0.87). Conclusion: Based on the results of this animal study, the anti-CTGF antibody injection resulted in a significant reduction in collagenous tissue and myofibroblast cells after trabeculectomy

Cataloging Archival Records of the National Library and Archives of Iran Based on the International Standard Archival Description (ISAD). 3. 2012; 21 (4) :114-134

Purpose: Records catalogues at the National Archives of Iran and the level of their conformity with the International Standard Archival Description (ISAD). The present research is aimed at identifying descriptive elements of the archival. Methodology: Standards, and interviews are employed for gathering research data. e results are presented in tables and -gures through descriptive statistical methods (frequency and percentage). The research community included researchers and experts in arrangement and description of records, manuals, and cataloging worksheets of the archival records existing in National Library and Archives of Iran. This research was based on analytical survey. A checklist, the rules of archival Findings: The research findings also show that information elements including “Author Name” (16.62%) and “Descriptors” (91.26%) are consistent with documentation tools. 8.8% of these information elements are not documented at all. In the eyes of the experts of arrangement and description of documents, cataloging of archival documents based on ISAD has improved the methods of organizing documents. Conclusion: Applying this standardized method of archival description has led to better retrieval of the related documents. This research displays the conformity of descriptive elements in the studied worksheets

Investigating of Underground Economy by Using Currency Ratio and Gap Between Expenditure and Income of the Family

Underground Economy is a series of value added activities which is not defined in the frame of formal economic. Private activities, private organizations and those kinds of market activities which, in some way, are not discovered by officials, totally, are making black or informal economic. Underground economy includes four sections: family, informal, irregular and illegal. The nature of unclearness of black economic, make it hard to estimate and study the economy, because of these, most of current measuring methods are indirect measuring of thise activities which are accompanied by limited assumptions. Through this research, in spite of considering different methods of measuring black economy, we estimate the amount of underground economy, using "currency ratio" and "Gap between expenditure and income of family". The gap between expenditure and income of family method is based on discrepancies between expenditure and income of families which is not reported in the national accounts. In "currency ratio" method we measuring the size of underground economy based on exchange of currency

Normal–Poisson distribution as a lifetime of a series system

In this paper, we introduce a new three parameter skewed distribution. This new class which is obtained by compounding the normal and Poisson distributions, is presented as an alternative to the class of skew-normal and normal distributions, among others. Different properties of this new distribution have been investigated. The density and distribution functions of proposed distribution, are given by a closed expression which allows us to easily compute probabilities, moments and related measurements. Estimation of the parameters of this new model using maximum likelihood method via an EM-algorithm is given. Finally, some applications of this new distribution to real data are given

نظرسنجی کارورزان پزشکی در مورد وضعیت آموزشی بخش اورژانس

Introduction: Emergency is an important department of any hospital, and education of medical students in this ward is of great importance. The students gain necessary skills for facing critical situations in this department. Therefore, educational conditions should be constantly monitored and improved in order to reach an efficient situation. The present study was aimed to survey the interns’ viewpoint on the condition of medical education in the emergency department (ED). Methods: In this cross-sectional study, 100 interns of Shiraz University of Medical Sciences were questioned using a pre-designed checklist during the time between October 2013 and October 2014. The checklist consisted of demographic data and survey questions regarding the current condition, theoretical knowledge, practical skills, educational rank of ED compared to other hospital’s departments, and varying the duration of the educational course in ED. The data were analyzed using SPSS 21. Results: 100 interns were evaluated (55% female), with an average age of 24.7±1.5 years (minimum 23 and maximum 26). Most of the interns believed that training regarding clinical examination, diagnosis expression and treatment orders was enough for learning key points, while bedside education was inadequate. Most of the interns believed that gaining theoretical knowledge on examination and diagnosis, was acceptable except regarding encountering patients with a decreased level of consciousness. Yet, they believed there were some deficiencies regarding theoretical knowledge on treatment, except for treating allergies. Educational rank of ED compared to other departments was believed to be average. 60% of the interns thought that the duration of medical education in ED should be increased, 4% believed it should be decreased, and 36% were satisfied with the current duration. Conclusion: Based on the results of this survey, the interns of two studied Hospitals were averagely satisfied with their educational condition in ED. Most interns believed that there was deficiency in the bedside education and theoretical knowledge, while they were relatively satisfied with the amount and quality of practical skills’ training. مقدمه: بخش اورژانس از بخش‌های حساس و ویژه هر بیمارستان محسوب می‌شود و آموزش بالینی دانشجویان در این بخش از اهمیت ویژه ای برخوردار است. از آنجایی که دانشجویان در این بخش مهارت و آمادگی لازم را در برخورد با شرایط بحرانی کسب می‌کنند، برای رسیدن به آموزش بالینی کارامد همواره باید شرایط موجود پایش گردیده و ضعف و کاستی‌های آن برطرف شود. لذا مطالعه حاضر با هدف نظرسنجی کارورزان از وضعیت آموزش در بخش اورژانس طراحی شده است. روش کار: در اين مطالعه مقطعی 100 کارورز دانشگاه علوم پزشکی شیراز از ابتدای مهرماه سال 1392 لغایت ابتدای مهرماه 1393 با استفاده از چک لیستی طراحی شده، مورد سؤال قرار گرفتند. چک لیست مورد استفاده شامل دو قسمت اطلاعات دموگرافیک و قسمت مربوط به نظرسنجی بود. سوالات مربوط به نظرسنجی به چهار بخش شامل: وضعیت کنونی، میزان فراگیری اصول تئوری، میزان مهارت کسب شده و در نهایت سؤالاتی پیرامون رتبه آموزشی بخش اورژانس در بین سایر بخش ها و تغییر طول دوره آموزشی بخش اورژانس بود. اطلاعات حاصل با استفاده از نرم آماری SPSS 21 مورد تجزیه و تحلیل قرار گرفت. يافته ها: یکصد کارورز مورد ارزیابی قرار گرفتند (55 درصد زن). متوسط سن افراد شرکت کننده ض/5±24/7 سال (حداقل 23 و حداکثر 26) بود. نظر اکثریت کارورزان درباره سطح کنونی نحوه آموزش معاینه، بیان تشخیص و گذاشتن دستورات درمانی در حد یادگیری موارد کلیدی بود در حالی که نحوه آموزش توسط اساتید بر بالین با کاستی مواجه بود. در مورد میزان فراگیری اصول تئوری معاینه و تشخیص موارد مورد مطالعه، نظر اکثریت کارورزان جز در مورد برخورد با بیمار دچار کاهش سطح هوشیاری در حد قابل قبول بود. اما در مورد میزان فراگیری اصول تئوری درمان، نظر اکثریت کارورزان بر وجود نواقص و کاستی‌ بجز در درمان مشکلات آلرژیک و حساسیت بود. رتبه آموزشی بخش اورژانس در بین بخش‌های گذرانده از نظر اکثریت کارورزان در حد متوسط بود. در نهایت 60 درصد کارورزان با افزایش، 4 درصد با کاهش و 36 درصد با ثابت ماندن طول دوره آموزشی بخش اورژانس موافق بودند. نتيجه گيری: بر اساس نتایج حاصل از مطالعه حاضر میزان رضایت‌مندی کارورزان از آموزش در بخش اورژانس بیمارستان‌های نمازی و شهید فقیهی شیراز در حد متوسط بود. نظر اکثریت کارورزان بر وجود نقص در آموزش اساتید بر بالین و کفایت آموزش های تئوری بود. این در حالی است که از میزان و کفایت آموزش مهارت های عملی رضایتمندی قابل قبولی مشاهده گردید

Education in Emergency Department from the Viewpoint of Medical Students

Introduction: Emergency is an important department of any hospital, and education of medical students in this ward is of great importance. The students gain necessary skills for facing critical situations in this department. Therefore, educational conditions should be constantly monitored and improved in order to reach an efficient situation. The present study was aimed to survey the interns’ viewpoint on the condition of medical education in the emergency department (ED). Methods: In this cross-sectional study, 100 interns of Shiraz University of Medical Sciences were questioned using a pre-designed checklist during the time between October 2013 and October 2014. The checklist consisted of demographic data and survey questions regarding the current condition, theoretical knowledge, practical skills, educational rank of ED compared to other hospital’s departments, and varying the duration of the educational course in ED. The data were analyzed using SPSS 21. Results: 100 interns were evaluated (55% female), with an average age of 24.7±1.5 years (minimum 23 and maximum 26). Most of the interns believed that training regarding clinical examination, diagnosis expression and treatment orders was enough for learning key points, while bedside education was inadequate. Most of the interns believed that gaining theoretical knowledge on examination and diagnosis, was acceptable except regarding encountering patients with a decreased level of consciousness. Yet, they believed there were some deficiencies regarding theoretical knowledge on treatment, except for treating allergies. Educational rank of ED compared to other departments was believed to be average. 60% of the interns thought that the duration of medical education in ED should be increased, 4% believed it should be decreased, and 36% were satisfied with the current duration. Conclusion: Based on the results of this survey, the interns of two studied Hospitals were averagely satisfied with their educational condition in ED. Most interns believed that there was deficiency in the bedside education and theoretical knowledge, while they were relatively satisfied with the amount and quality of practical skills’ training