Three Dimensional Seepage Analyses in Mollasadra Dam after Its Impoundments

Mollasadra dam is an earth fill dam with a clayey core and a height of 72 m from river bed, constructed on Kor River. pore water pressure in the dam was investigated following its construction and first and second impoundments. The dam was modeled by a finite element mesh. After the first and second dam impoundments, the overall trend in monitored pore water pressure was well modeled by the transient analysis. The result showed the six month time period between impoundments was long enough for the pore water pressure to reach equilibrium everywhere throughout the core, except where considerable initial construction- induced pore water pressure was observed. High values of construction-induced pore water pressure at elevation 2050 m did not dissipate completely during the 6 month period of almost constant reservoir level (el. 2098.3 m) and the pore pressures were still at the transient state throughout the core. Therefore, it was concluded that pore pressures in the core of earth fill dams may not achieve steady state conditions even several months after the dam construction and impoundments

Causes of Surgery Cancellation in Iran: A Systematic Review

Background: Cancellation of surgical procedures is one of the biggest challenges in hospitals throughout the world and it is important as it increases patients' stress, expenses and wastage of time, and prolongs the duration of hospitalization of patients. The aim of this study was to review literature related to reasons of surgery cancellation in Iran. Methods: This systematic review was conducted from March to Sep. 2014. The keywords including cancellation, delay, postpone, cancelled surgery, surgery operation and Iran were searched in international search engines including Pubmed, Scopus, ProQust and Google scholar and Persian indexing websites of SID, Magiran and Iranmedex. All articles related to cancelled operations in Iran, written in English or Persian (from Jan 1, 2004 until Sep 31, 2014) were collected. Then, those articles which contained any of the selected keywords in their titles or abstracts were compiled, and others were excluded. At last, a check list including title of article, time and location of study, sample size and location and cancellation cause was designed for final assessment. Results: A total of 646 records were found in 7 selected databases of which 13 articles met the criteria for inclusion in this study. The main cases of surgery cancellation were related to operating room and hospital, anesthesia, patient's non-clinical problems, the surgeon and clinical problems. Conclusions: Adoption of strategies for on-time initiation of surgical procedures, identification of patients' underlying problems and the appropriate process of hospital admission can be effective in reducing the rate of cancelled operations

Effective Factors in Hospitalization Costs of the Public Hospitals: A Qualitative Study

Introduction:Hospitals are the most expensive health care organizations. In this study, identifying factors influencing hospitalization costs based on the three aspects of the health system including patients, health care providers, and insurance organizations were considered. Methods:This was a qualitative and phenomenological study. In this study, 12 experts in the field of management and controlling hospital’s costs were selected through purposive and snowball sampling method. Data were collected using focused group discussion. Framework analysis was used for data analysis. Results:The factors affecting hospitalization costs were classified into three codes including patients, health care providers, and insurance organizations. Lack of knowledge and awareness and neglecting self-care were the main patient-related factors, and weak management and supervision, lack of medical guidelines, long-term recovery period, lack of implementation of family physician and weak commitments and structural problems of insurance organizations were the main factors related to the health care providers and insurance organizations. Conclusion:The results showed that by increasing and improving self- care programs, providing health-oriented services, implementation of family physician program, specializing the hospital management, improving the quantity and quality of supervisions and reforming expert structure of insurance organizations, the hospitalization costs can be managed. Key¬words:Hospitalization Costs, Patients, Health Care Providers, Insurance Organizations, Public Hospital, Qualitative Study. Citation:Jafari M, Lashkari M,Mahmoudi F, Dehnavi R, NooriHekmat S, Izadi A.Effective Factors in Hospitalization Costs of the Public Hospitals: A Qualitative Study. Journal of Health Based Research 2016; 2(1): 39-54

Evaluation of the Task Compliance of Medical Education Development Centers from the Viewpoint of the Managers of the Centers

Background: Medical education development (MED) centers are established in order to improve the quality of medical education. It seems that after more than two decades since the establishment, the centers still have difficulties to perform some tasks. Objectives: According to the important role of MED centers, the current study aimed at adapting the performances of such centers with their assigned tasks. Methods: The current qualitative applied study was conducted in 2013. The statistical population of the study included managers of MED centers in Iran. Data were collected through a questionnaire containing open questions. During a national meeting the questionnaire distributed among 40 managers of MED centers and then analyzed using content analysis. Results: More than half of the major functions that the managers stated, were referred to the first, second, and fourth tasks of the centers, and only 18% of the major functions were related to other tasks (11 cases). About 28% of the functions performed in such centers had no direct correlation with any of the 14 tasks. Conclusions: Despite the history of MED centers for several decades, they are not justified in respect to their duties. It is recommended that guidelines be developed to address all duties and adequately monitor their implementation. Keywords Medical Education Development Centers Performance Indicator Quality Medical Education Ira

An Investigation of Prescription Indicators and Trends Among General Practitioners and Specialists From 2005 to 2015 in Kerman, Iran

Abstract Background: The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost-effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015. Methods: This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase. Results: Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend. Conclusion: Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients’ misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines

Two-Step Estimation of the Impact of Contextual Variables on Technical Efficiency of Hospitals: The Case Study of Public Hospitals in Iran

Background: Measuring the efficiency and productivity of hospitals is a key tool to cost contamination and management that is very important for any healthcare system for having an efficient system. Objective: The purpose of this study is to examine the effects of contextual factors on hospital efficiency in Iranian public hospitals. Methods: This was a quantitative and descriptive-analytical study conducted in two steps. First, we measured the efficiency score of teaching and non-teaching hospitals by using the Data Envelopment Analysis (DEA) method. Second, the relationship between efficiency score and contextual factors was analyzed. We used median statistics (first and third quarters) to describe the concentration and distribution of each variable in teaching and non-teaching hospitals, then the Wilcoxon test was used to compare them. The Spearman test was used to evaluate the correlation between the efficiency of hospitals and contextual variables (province area, province population, population density, and the number of beds per hospital). Results: On average, the efficiency score in non-teaching hospitals in 31 provinces was 0.67 and for teaching hospitals was 0.54. Results showed that there is no significant relationship between the efficiency score and the number of hospitals in the provinces (p = 0.1 and 0.15, respectively). The relationship between the number of hospitals and the population of the province was significant and positive. Also, there was a positive relationship between the number of beds and the area of the province in both types of teaching and non-teaching hospitals. Conclusion: Multilateral factors influence the efficiency of hospitals and to address hospital inefficiency multi-intervention packages focusing on the hospital and its context should be developed. It is necessary to pay attention to contextual factors and organizational architecture to improve efficiency

Comparison of Serum Cystatin C and Creatinine Levels to Evaluate Early Renal Function after Kidney Transplantation

Background: Accurate and rapid assessment of allograftfunction is essential in renal transplant recipients in order todetect allograft rejection and to monitor drug nephrotoxicity.We aimed to evaluate the usefulness of cystatin C as a markerof kidney allograft function in the early post-transplant periodand to compare this value with that of conventional serumcreatinine concentration.Methods: Twenty four patients scheduled for kidney transplantationat the Kidney Transplant Center of Ghaem Hospital,Mashhad, Iran from September 2006 to November 2007,were sequentially enrolled into the present study. Serumcreatinine and cystatin C concentrations and urine output weremeasured daily after transplantation for 3 weeks or until dischargefrom the hospital.Results: On the 3rd postoperative day, with a cut-off value of75 mL/min for glomerular filtration rate, areas under the receiveroperating characteristic (ROC) curves were 0.926 forcreatinine (P=0.021) and 0.815 for cystatin C (P=0.088). Atthis point creatinine was more sensitive and specific than cystatinC in estimating glomerular filtration rate. On the 7th dayafter transplantation, areas under ROC curves were 0. 893 forcreatinine (P=0.066) and 1.000 for cystatin C (P=0.017).Therefore, cystatin C was more sensitive and specific thancreatinine in estimating glomerular filtration rate. In two patientswith acute rejection and arterial thrombosis, serum cystatinC concentrations increased earlier than serum creatinine.Conclusion: There is a correlation between creatinine and cystatinC early after kidney transplantation. Serum creatinine levelsseem to be more sensitive and specific for detecting transitorychanges in renal function in the 1st week after transplantation.After the 1st week after transplantation, cystatin C wasmore sensitive and specific than serum creatinine concentration

Three Dimensional Seepage Analyses in Mollasadra Dam after Its Impoundments

Mollasadra dam is an earth fill dam with a clayey core and a height of 72 m from river bed, constructed on Kor River. pore water pressure in the dam was investigated following its construction and first and second impoundments. The dam was modeled by a finite element mesh. After the first and second dam impoundments, the overall trend in monitored pore water pressure was well modeled by the transient analysis. The result showed the six month time period between impoundments was long enough for the pore water pressure to reach equilibrium everywhere throughout the core, except where considerable initial construction- induced pore water pressure was observed. High values of construction-induced pore water pressure at elevation 2050 m did not dissipate completely during the 6 month period of almost constant reservoir level (el. 2098.3 m) and the pore pressures were still at the transient state throughout the core. Therefore, it was concluded that pore pressures in the core of earth fill dams may not achieve steady state conditions even several months after the dam construction and impoundments