The economic behavior of general hospitals of Iran

Background and aim: Economic analysis should be applied to hospitals for optimization. Therefore, this study was conducted to evaluate the economic behavior (production-cost) of general hospitals of Iran University of Medical Sciences from 1997 to 2004. Methods: Data was collected using appropriate questionnaire and analyzed by t-test. In this research, Cobb-Douglas function and its T form was used for evaluation of production and cost, respectively. Results: The marginal production of hospital labor for physician was 57, for nurse was 24, and for other personal was 0.04 of the patient admission. The marginal product of capital agent was 18 patient admissions. The personnel and non-personnel costs were 62 and 38 percent of the overall operatic costs respectively. Cost elasticity of overall expense to labor price, capital rate and production was 0.69, 0.48 and 0.32, respectively. Conclusion: The hospitals can be on the decreasing part of LRAC (Long Run Average Cust) care and can decrease the unit cost of production with increasing economic agents

The economic behavior of general hospitals of Iran

چکیده: زمینه و هدف: بیمارستان به عنوان یکی از سازمان‌های اصلی ارائه دهنده خدمات بهداشتی و درمانی، حساسیت و اهمیت ویژه‌ای در اقتصاد و بهداشت دارد و به منظور بهینه‌سازی مفید آن به عنوان یک بنگاه اقتصادی باید از تحلیل‌های اقتصادی استفاده نمود. این مطالعه به منظور بررسی رفتار اقتصادی (تولید- هزینه) بیمارستان‌های علوم پزشکی ایران در طی سال‌های 1376 تا 1383 انجام گرفت. روش بررسی: این پژوهش یک مطالعه توصیفی- تحلیلی است که در سال 1384 انجام شد. جامعه پژوهش شامل 6 بیمارستان عمومی - آموزشی دانشگاه علوم پزشکی ایران بود. برای جمع‌آوری داده‌های مورد نیاز از پرسشنامه تولید- هزینه استفاده گردید در این پژوهش اطلاعات از طریق فرم‌های اطلاعاتی جمع‌آوری گردید و با استفاده از نرم‌افزار SPSS و با بهره‌گیری از آزمون t تجزیه و تحلیل شد. شکل تابع برای تولید از نوع کاب داگلاس و برای هزینه از نوع فرم‌ تبعی کاب داگلاس بود. یافته ها: تولید نهایی عوامل تولید نیروی کار برای: پزشک 53، پرستار 24 و سایر پرسنل 4/0- پذیرش بستری بود و تولید نهایی عامل سرمایه (تخت فعال) 18 پذیرش بستری بود. هزینه‌های پرسنلی 62 درصد و هزینه‌های غیر پرسنلی 38 درصد کل هزینه‌های عملیاتی را تشکیل می‌دادند. حساسیت هزینه کل به نرخ نیروی کار، نرخ سرمایه و تولید به ترتیب 69/0، 48/0 و 32/0 بود. نتیجه گیری: از لحاظ رفتار تولیدی و هزینه‌ای، بیمارستان‌های مورد مطالعه در منطقه کارآمد اقتصادی قرار داشتند و می‌توانند در بلند مدت با افزایش عوامل اقتصادی (نیروی کار و سرمایه) هزینه واحد تولید را کاهش دهند و در قسمت نزولی منحنی هزینه بلند مدت واقع شوند

Massive malignant pleural effusion due to lung adenocarcinoma in 13-year-old boy

A 13-year-old boy with no risk factors for lung cancer presented with a massive left-sided pleural effusion and a mediastinal shift on chest radiography and computed tomography. A chest tube drained bloody pleural fluid with an exudative pattern. A pleural biopsy and wedge biopsy of the left lower lobe revealed mucinous adenocarcinoma in the left lower lobe wedge biopsy and metastatic adenocarcinoma in the pleural biopsy. The patient is currently undergoing chemotherapy. Radiotherapy is planned after shrinkage of the tumor. Adenocarcinoma of the lung is very rarely seen in teenagers or children, especially in the absence of risk factors. © SAGE Publications

The menopausal age and associated factors in Gorgan, Iran

Background: Considering the physical, emotional and psychological complications of early or delayed menopause on women's life, it is necessary to determine associated factors of menopause age. This study designed to determine menopausal age and associated factors in women of Gorgan, i.e. the capital of Golestan province in the north-east of Iran. Methods: In this cross-sectional study, 804 menopausal women in Gorgan were selected via two-stage sampling method in 2009. The study included only women who had undergone natural menopause and had their last menstrual bleeding at least one year before. Data were gathered through structured questionnaire that included individual characteristics, socioeconomic characteristics, menstrual and fertility characteristics and climacteric complaints. Socioeconomic status was defined using principal component analysis. Data were analyzed with Tstudent's and ANOVA tests using SPSS version 16 (SPSS Inc, Chicago, IL, USA) for Windows. Results: The mean menopause age was 47.6±4.45 years with the median age of 48 years. The mean menopause age in women with first pregnancy before 30 years (47.58±4.47years), without pregnancy (46.26±4.90years) and without delivery (46.30±4.47years) was significantly lower than others (p 0.05). Socioeconomic status was not associated significantly with menopause age (p>0.05). Conclusion: This study illustrated that menstrual and fertility factors have influence on menopausal age while socioeconomic factors were not effective

The most important Iranian medicinal plants with immunomodulatory property according to traditional medicine and modern research findings

nnate immunity is the body's first line of defense against different pathogenic agents. Macrophages and neutrophils are two main cells that contribute significantly to innate and acquired immune responses, and important effector cells to destroy harmful agents. Function of these cells can be modulated by natural and synthetic compounds. Nowadays, the immunomodulatory effects of herbal plants is a hot research issue worldwide as a good candidate to strengthen immune system. The aim of this review article is to report the most important medicinal plants of Iran with immunomodulatory effect. The search terms including immunomodulatory, medicinal plants, and Iran were used to search for relevant articles in some national databases such as Scientific Information Databases, and Google Scholar search engine. Thyme, Pennyroyal, Garlic, Echinaceae and Olive were found to be traditionally used to strengthen the immune system of the body. Aloe (Aloe barbadensis), Palm (Phoenix ductylifera), Fennel (Foeniculum Vulgare) and Cumin seed (Cuminum cyminum) have been reported to have immunomodulatory effects according to scientific research

اجرای پانل صدای بیماران در اولین همایش کشوری دانشجویی بیماری‌های نادر و ژنتیکی ایران: تجربه‌ای از آموزش پاسخ‌گویی اجتماعی Social Accountability Education To The Students Through The Panel “Voice Of Patients” At The First National Student Conference On Rare And Genetic Diseases In Iran.

از زمانی که آموزش پزشکی به سمت جامعه محوری و جامعه‌نگری سوق پیدا کرده است، به مفهوم پاسخ‌گویی اجتماعی آموزش پزشکی توجه شایانی معطوف گردیده است(1). دانشکده‌های پزشکی باید از نظر اجتماعی پاسخ‌گو باشند و باید درجات خاصی از پاسخ‌گویی در قبال سلامت جامعه را بپذیرند(2). دانشکده‌های پزشکی برای این که به اجتماع پاسخ‌گو باشند می‌بایست 10 استراتژی را به کار گیرند، اولین استراتژی "پاسخ به نیازهای سلامتی جاری و آتی و چالش‌های موجود در جامعه" تعریف شده است(3). از طرفی شواهد حاکی از آن است که برنامه‌های درسی آموزش پزشکی از نظر بینش‌های انسان‌گرایانه دچار فقر است. دانشکده‌های پزشکی از فراگیران انتظار حرفه‌گرای و سلوک حرفه‌ای را دارند در حالی در برنامه‌های درسی رویکرد انسان‌گرایانه آموزش داده نمی شود. مفاهیمی همانند پزشک به عنوان وکیل مدافع جامعه و همچنین آموزش علوم اجتماعی که از الزامات پاسخ‌گویی‌اند در برنامه‌های درسی مغفول مانده‌اند(1). اولین همایش کشوری دانشجویی بیماری‌های نادر و ژنتیکی ایرانی با محوری بیماری نوروفیبروماتوز در 25 آبان ماه 1394 در دانشگاه علوم پزشکی گلستان، گرگان برگزار شد(4). این همایش بهانه‌ای بود برای قدرت بخشیدن به صدای بیماران نادر و ژنتیکی، ایجاد همدلی در پژوهشگران جوان علوم پزشکی. نویسنده از سال 1386 به واسطه همکاری با دفتر پژوهش‌های دانشجویی با بیماری ژنتیکی نوروفیبروماتوز آشنا شد. این بیماری در مراحل پیشرفته خود بدشکلی‌های متعددی در ظاهر فرد ایجاد می‌کند و سبب مشکلات متعددی از نظر روحی و روانی، اجتماعی، اقتصادی و جسمی شدید برای مبتلایان می‌شود. در این همایش بر آن بودیم تا پژوهشگران جوان علوم پزشکی با دنیای بیماران نادر ژنتیکی به ویژه نوروفیبروماتوز آشنا شوند. بر این اعتقادیم که این همایش به دلیل برخورداری از چندین ویژگی، یک امر نوآورانه آموزشی در راستای آموزش پاسخ‌گویی اجتماعی بوده است: شکل‌گیری ایده برگزاری همایش توسط بیماران- عضو هیأت‌علمی/دانشجو، همکاری بیماران با دانشجویان در تهیه مقالات علمی، فیلم، عکس و سایر آثار همایش، حضور 15 بیمار مدعو از نقاط مختلف کشور، برگزاری همایش توسط دانشجویان، مشارکت هلال احمر، حمایت خیرین شهری و سخنرانی بیماران در پانل "صدای بیمار". سه بیمار (آقایی با دیستروفی عضلانی دوشن وابسته به صندلی چرخدار، دختر جوانی با بیماری نوروفیبروماتوز نوع یک، مادر کودکی با آتروفی نخاعی عضلانی) در این پانل سخنرانی کردند. فرایند شناسایی بیماران نیز توسط دانشجویان صورت گرفت، آنان شرایط حضورشان را فراهم نمودند و تجربیات زندگی با بیماری را در قالب پژوهش کیفی گردآوری و به صورت فیلم مستند و داستان آموزشی نیز تهیه نمودند. از طرفی این برنامه همانند کوریکولوم پنهانی بود که درس‌های متعددی در آن (از کار تیمی تا آشنایی با سازمان‌های نهاد مردمی، برقراری ارتباط با مسؤولین استانی) برای دانشجویان به ویژه دانشجویان پزشکی (مقاطع پیش کارآموزی و ورود به بالین) وجود داشت. می‌توان آن را یک کلاس درس بزرگ نامید که برای دانشجویان تیم علمی و اجرایی یادگیری‌های متعددی در یک دوره 9 ماهه (از ابتدای تا انتهای کار) داشته است؛ به طوری که فراگیران قادر شدند از طرق مختلف؛ سخنرانی، پوستر، پمفلت، عکس، نقشه مفهومی، مستند، با چالش‌های زندگی با بیماری ژنتیکی آشنا شوند. دبیر علمی و دبیر اجرایی این همایش هر دو نیز دانشجوی پزشکی بودند که در المپیاد علمی دانشجویی در حیطه فلسفه در پزشکی، رتبه سوم گروهی کشوری را کسب نمودند. از این رو نویسندگان حاضر برگزاری همایش‌هایی با ساختار پیشگفت را به عنوان یک مدل کاربردی آموزش پزشکی جامعه‌نگر و پاسخ‌گویی اجتماعی پیشنهاد می‌دهند

Cost-effectiveness of single-photon emission computed tomography for diagnosis of coronary artery disease: A systematic review of the key drivers and quality of published literature

Background: Single-photon-emission computed tomography (SPECT) being one of the most commonly used methods that significantly improved the detection of coronary artery disease. The objective of this study was to perform a systematic review of the cost-effectiveness of SPECT in diagnosis of coronary artery disease. Methods: Electronic databases including PubMed, Scopus and Web of Science were searched from 1997 through 2017. The full economic evaluations of SPECT as the first and only test in diagnosis of coronary artery disease were included in this study. Non-English studies, conference abstracts and letters/editorials were excluded. The Consolidated Health Economic Evaluation Reporting Standards checklist was used to review the methodological quality of included studies. Results: Eight studies met the systematic review inclusion criteria. In general, the quality of the included studies was high. The abstract of studies had the least degree of compliance with the Consolidated Health Economic Evaluation Reporting Standards checklist. The majority of the papers used decision tree model and estimated cost from a payer's perspective. This study revealed wide heterogeneity in the methodology particularly in setting, comparators, time horizon, and perspective. Conclusion: By conducting this systematic review on 8 valid studies, it was found that the cost-effectiveness of an imaging test strongly depends on the pretest likelihood of disease. The included studies on cost-effectiveness provide conflicting evidence in support of the use of SPECT in diagnosis of coronary artery disease. This study showed that the cost-effectiveness of an imaging test varied between subgroups of patients. © 201

Bi-fuel SI Engine Model for Analysis and Optimization

YesThe natural gas as an alternative fuel has economical and environmental benefits. Bi-fuel engines powered by gasoline and compressed natural gas (CNG) are an intermediate and alternative step to dedicated CNG engines. The conversion to bi-fuel CNG engine could be a short-term solution to air pollution problem in many developing countries. In this paper a mathematical model of a bi-fuel four-stroke spark ignition (SI) engine is presented for comparative studies and analysis. It is based on the two-zone combustion model, and it has the ability to simulate turbulent combustion. The model is capable of predicting the cylinder temperature and pressure, heat transfer, brake work , brake thermal and volumetric efficiency, brake torque, brake specific fuel consumption (BSFC), brake mean effective pressure (BMEP), concentration of CO2, brake specific CO (BSCO) and brake specific NOx (BSNOx). The effect of engine speed, equivalence ratio and performance parameters using gasoline and CNG fuels are analysed. The model has been validated by experimental data using the results obtained from a bi-fuel engine. The results show the capability of the model in terms of engine performance optimization and minimization of the emissions. The engine used in this study is a typical example of a modified bi-fuel engine conversion, which could benefit the researchers in the field

Normalization and reliability evaluation of persian version of two-pair dichotic digits in 8 to 12-year-old children

Objectives: All subjects suspected of Central Auditory Processing Disorder (CAPD) were previously tested by free recall dichotic digits test (DDT). The study objective was normalization and reliability evaluation of two-pair DDT in 750 native Persian subjects aged 8 to 12 years. Materials: A total of 750 subjects were divided into five age groups varying between 8 years and 12 years and 11 months old. Each age group had 150 subjects. DDT was tested in free recall condition. For evaluating DDT test-retest reliability, 300 participants (60 subjects in each age group) were tested again after one month. Results: Right and left ear mean score increased from 71.68(±2.19) and 58.51(±1.71) in the 8-year-old group to 90.26(±1.96) and 88.38(±1.36) in 12-year-old group, respectively. The mean Right Ear Advantage (REA) decreased from 13.16(±2.58) in the 8-year-old group to 1.88(±2.49) in the 12-year-old group. A high stability was observed between test-retest results (P < 0.0001). Discussion: Persian version of two-pair dichotic digits exhibited proper reliability for evaluating 8 to 12-year-old subjects, and the study results can be used for evaluating the dichotic hearing function in subjects of the same age group

Patient safety culture in hospitals of Iran: A systematic review and meta-analysis

Background: Nowadays, for quality improvement, measuring patient safety culture (PSC) in healthcare organizations is being increasingly used. The aim of this study was to clarify PSC status in Iranian hospitals using a meta-analysis method. Methods: Six databases were searched: PubMed, Scopus, Google Scholar, Cochrane Library, Magiran, SID and IranMedex using the search terms including patient safety, patient safety culture, patient safety climate and combined with hospital (such as "hospital survey on patient safety culture"), measurement, assessment, survey and Iran. A total of 11 articles which conducted using Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire initially were reviewed. To estimate overall PSC status and perform the meta-analyses, Comprehensive Meta-Analysis (CMA) software v. 2 was employed. Results: The overall PSC score based on the random model was 50.1. "Teamwork within hospital units" dimension received the highest score of PSC (67.4) and "Non-punitive response to error" the lowest score (32.4). About 41 of participants in reviewed articles evaluate their hospitals' performance in PSC as 'excellent/very good'. Approximately 52.7 of participants did not report any adverse event in the past 12 months. Conclusion: The results of this study show that Iranian hospitals' performances in PSC were poor. Among the 12 dimensions of HSOPSC questionnaire, the "Non-punitive response to error" achieved the lowest score and could be a priority for future interventions. In this regard, hospitals staff should be encouraged to report adverse event without fear of punitive action