BioMed2008-38092 SMART ENDOSCOPIC TOOL FOR THE MEASUREMENT OF FORCE AND SOFTNESS OF GRASPED OBJECT IN MINIMALLY INVASIVE SURGERY

ABSTRACT One of the shortcomings of the current endoscopic graspers is the lack of tactile sensing. We are reporting the results of the first stage of a research project to rectify the tactile sensing in endoscopic tools. This paper introduces a smart endoscopic grasper equipped with sensors for measuring the applied force and the angle of the grasper tip. It is shown that using this method, the softness of the grasped object can be estimated. The next phase of this research would be devising an appropriate method to feedback the measured date

Family physician and referral system adherence in iranian primary healthcare system

Background. One of the main strategies to improve access to and the quality and efficiency of healthcare systems is a fam ily physician program (FPP) as the primary care provider within an appropriate referral system. Objectives. The aim of this study was to investigate the level of adherence of rural insured patients to family physicians (FP) and the referral system, as well as factors that affect self-referral. Material and methods. This multicenter, cross-sectional study was conducted between April 2018 and February 2019 in East Azerbaijan Province, Iran. A questionnaire-based survey was used to collect data on patient characteristics, adherence to the FPP and referral system, and the reasons for self-referral from 1,553 participants recruited using multistage cluster sampling. Results. Overall, 58.9 of participants adhered to the FPP and referral system. The total self-referral rate was 41.1, including 24.3 patients who had attended an FP appointment only to obtain a referral code, and 16.8 had self-referred directly. Data on age, sex, family monthly expenditure, and place of residence were associated with self-referral. Structural pitfalls, societal knowledge and attitudes, and cultural challenges were identified as the patients� reasons for self-referring. Within these categories, the most frequent reasons included uncertainty about the knowledge and skills of FPs (74.2), easy and inexpensive access to specialized services (66.7), better quality of specialized services (59), and a lack of awareness of the FPP and the services provided at level 1. Conclusions. A significant percentage of enrollees did not adhere to the FPP and referral system. Considering the unwelcome consequences of self-referral, designing and implementing practical interventions seems essential in order to encourage patients to be more compliant. © by Wydawnictwo Continuo

The role of the urban family physician plan in utilization of outpatient services in Iran

Background. The family physician (FP) is vital for the continuity of care (CoC) and is also a reliable guide in choosing the preferred treatment pathways, which lead to a reduction in the utilization of unnecessary services. Objectives. To investigate the utilization of outpatient services in the Fars province as a pilot center for the urban family physician program (UFPP) and East Azerbaijan. East Azerbaijan is a province which has been selected for comparison (control) through clustering. Material and methods. This population-based, comparative and cross-sectional study was conducted in Iran. Retrospective data on specialists/subspecialists visits (SSV), prescribed medicine (PM), laboratory services (LS) and medical imaging services (MIS) was obtained from administrative claims data of the Iranian Health Insurance Organization (IHIO) for a random sample of 4,800 people between September 2017 and September 2018. Results. Overall, 50.2 of the participants were female. In the Fars province, the mean SSV, PM, LS and MIS utilization during the study period was 1.21, 3.05, 0.49, and 0.29, respectively. These amounts were 1.14, 1.71, 0.36 and 0.21, respectively, in East Azerbaijan. Multivariate analysis showed significant differences in the utilization of SSV, PM, LS and MIS between provinces (p < 0.05). The largest difference was observed in the utilization of PM by a mean difference of 1.33 (1.17�1.50, p < 0.001). Females were associated with more PM utilization (p = 0.003), and older people utilized more outpatient services (p < 0.05). Conclusions. Unexpectedly, after five years of the implementation of UFPP, utilization of services was higher in Fras than East Azerbai-jan. Improved access by removing barriers, especially for women and the poor, as well as program execution problems could be the reason for these results. Further research is urgently needed to solve this mystery. © by Wydawnictwo Continuo

Occupational stress and associated risk factors among nurses: a cross-sectional study

Background: Nursing can be demanding and stressful with occupational stress posing a serious threat to nurses and patient outcomes.Aims/Objectives: To determine the prevalence of nurses' occupational stress and its associated risk factors. Design: Cross-sectional survey design.Methods: Nurses in 115 tertiary-level hospitals in 13 provinces in Iran were surveyed from August 2016-December 2017. Demographic information and occupational stress were assessed. 5422 distributed questionnaires were distributed with 2895 of returned surveys analyzed. One-way ANOVA and multiple linear regression analyses identified risk factors for occupational stress. Results: Mean score for overall occupational stress was 3.48 indicating a stress level between moderate and high, with 78.4% of respondents reporting that their job was stressful. Nurses reported issues with shiftwork, staffing, pay, workplace discrimination, management, policy and excessive workloads as sources of occupational stress. Risk factors in the multivariate analysis for higher occupational stress were female gender (p = .002), being married (p = .008), having lower educational levels (p p p = .025), general wards (p = .012) and teaching hospitals (p  Conclusions: The high prevalence of occupational stress amongst nurses in Iran demonstrates the extent of the issue, with recent reforms not effectively addressing occupational stress. The risk factors identified allow for more targeted interventions