A Study of the Performance of Referral System in Urban Family Physician Program in Fars Province, Iran

Introduction: The family physician referral system has been determined as a major goal to economic, social, and cultural development in the field of health in Iran. The necessity of implementing this system has been explicitly stated in high-level documents. Hence, the aim of this study was to evaluate the overall performance of the referral system in Fars Province in 2015. Methods: In this cross-sectional study, 20% of family physicians (75 doctors) were randomly selected; then, all patients of these physicians (1289 patients) in one work shift were studied. The data were collected in three parts containing the questions related to the physician and patients using data collection forms. Finally, data analysis was performed through SPSS, version16, using descriptive statistics and Chi-square test. Results: The results showed that 70.3% of the patients (906 patients) had used the referral system to visit specialists. Most of the referral forms had been completed correctly (63.6%). Most of the referrals (820 cases) were recognized as necessary (59.4%) and from the first level of referral, i.e. by the family physician (96.3%: 1241 cases). The patients aged 70 and over had the minimum self-referrals, whereas young people aged lower than 20 had the maximum selfreferrals (P=0.03). Also, more self-referrals were observed among highly educated patients (P=0.001). Conclusion: Based on the findings, the most important problems of the referral system included self-referrals, incomplete referral forms, and unnecessary referrals. Self-referral could be solved through education, establishment of an electronic referral system, and legal measures. Also, educating doctors, making an electronic referral system, and using auxiliary staff and incentive measures can reduce the incompleteness of the referral forms. To reduce the patients’ unnecessary referrals, development of referral guidelines might be very effective

Skills, Capabilities, and Requirements of Hospital Managers: A Qualitative Study

Introduction: The hospital, as the most important organization in the delivery of health care services, requires effective and efficient management more than other organizations. Therefore, the skills and capabilities of hospital managers are important issues. The aim of this study was to determine the skills, capabilities, and requirements of hospital managers. Method: This qualitative study was conducted in Shiraz University of Medical Sciences, Shiraz, Iran, in 2015. The study population was composed of teaching hospital managers, senior managers, faculty members, and postgraduate students of Shiraz University of Medical Sciences. Sampling was conducted through purposive sampling method and continued until data saturation. In this study, interview and focus group discussion were used for data collection, and data analysis was performed using content analysis method. Results: The skills and capabilities of hospital manager were classified into 7 themes (communication, work experience, managerial knowledge, knowledge of the hospital, motivation and interest, systemic thinking and problem solving, individual characteristics and integrity) and 24 sub-themes. For the enhancement of these skills and capabilities, 2 themes (empowerment before and after obtaining the managerial post) and 8 sub-themes were identified. Conclusion: Hospital management requires specific skills and capabilities. Decision makers and policy makers in the health sector should select hospital manager based on these skills. Keywords: Capabilities, Manager, Hospital, Qualitative stud

The Relationship between Energy Consumption and Hospital Functional Indicators in Teaching Hospitals of Shiraz University of Medical Sciences: 2009-2011

Background: Hospitals as major energy consumers can manage their energy consumption by intelligent interventions. Therefore, this study aimed to determine the amount of energy consumption of Water, Electricity, and Gas, and their association with functional indicators in teaching hospitals of Shiraz University of Medical Sciences from 2009 to 2011. Methods: The present study was descriptive and cross-sectional in design which analyzed energy consumption and functional indicators from the beginning of 2009 to the end of 2011. The sample consisted of 7 teaching hospitals affiliated to Shiraz University of Medical Sciences. Data were collected from the departments of consumption pattern reform and statistics and recorded in the data collection form  developed by the researcher. Data were entered in SPSS16 and analyzed using descriptive and analytical tests such as Pearson correlation test. Results: The average consumption of water, electricity, and gas per occupied bed days were 0.09 m3, 2.78 kWh, and 1.56 m3, respectively. Also, statistically significant and positive relationships were found between the amount of water consumption and the number of active beds (P = 0.009) and occupied bed days (P = 0.007). Conclusion: Energy consumption in teaching hospitals of Shiraz is lower than similar domestic studies and in some cases more than foreign studies. More active beds with lower productivity increase energy consumption. Hospitals can reduce energy consumption and their costs with more efficient use of resources

Prediction of Seven Candidate Transcription Factors in B-Cell Acute Lymphoblastic Leukemia Using System Biology Approaches

Background and Objectives: Acute lymphoblastic leukemia is caused by damage to self DNA leading to uncontrolled cellular growth. The aim of this study was to find out a new appropriate diagnostic and therapeutic methods using differential gene expression and protein analyzes in different methods of the biology system.   Methods: Microarray library GSE20011 was downloaded from GEO database and analyzed using GEO2R software. In this study, two groups of control (with benign Hodgkin lymphoma) and treatment (with acute lymphoblastic leukemia of B cells), were compared with each other. In BALL cancer, 338 genes were up-regulated and 252 genes were down-regulated, that analyzes of protein kinases, transcription factors, gene function, protein-protein interaction, and finally, drawing differential genes protein network, were performed by KEA, ChEA, DAVID, Gene2Network, and yEd databases, respectively.   Results: In this study, for the first time, seven transcription factors LYL1, SPI1, TET1, POU3F2, LMO2, CUX1, and ELF1, were reported as the candidate for diagnosis and treatment for BALL. Also, the importance of the role of membrane in BALL cells with the function of 97 up-regulated genes increased from the total 338 genes in cell membranes, showed the importance of membrane protection; and 97 genes were identified in cell resistance function for BALL cells, which can be interpreted as high resistance of BALL cells to molecular-based therapeutic approaches.   Conclusion: The results of this study can help to better understand the cellular resistance mechanism of BALL to treatment and provided seven candidate proteins for diagnosis and possibly treatment. &nbsp

The Relationship between Gender Inequality Index and Indicators Related to Children in Countries with Different Income Levels: An Ecologic Study

Background: Gender inequality index shows reduction in human development due to inequality between men and women, which results in vulnerability to diseases. Therefore, this study aimed to investigate gender inequality in all countries with different levels of income and analyze the relationship between gender inequality index and indicators related to children. Methods: The present ecological study assessed all countries of the world in terms of gender inequality index and indicators related to children. All countries were analyzed by census method. The collected data were related to year 2013 and were extracted from the reports of World Bank and United Nations. Spearman correlation coefficient and one way ANOVA tests were used to check the relationship between variables. Data were analyzed using SPSS 20 software. Results: There was a significant difference in terms of gender inequality in countries with different levels of income (p < 0.05). The results further showed a significant positive relationship between gender inequality index and infants' (children younger than five years) mortality rate in countries with different income levels. No statistically significant relationship was found between gender inequality index and the percentage of children vaccinated against measles in OECD countries and non OECD countries (p = 0.932, p = 0.389). Conclusion: Increase in gender inequality can enhance the mortality of infants and children less than five years; it also can decrease the percentage of vaccination coverage in children. However, gender inequality happens more in countries with less income. Therefore, to reduce child mortality, not only health interventions, but also socio-cultural and economic activities are required. Hence, Cross-sectoral policies should be developed and implemented

Shift Work and Related Health Problems among Medical and Diagnostic Staff of the General Teaching Hospitals Affiliated to Shiraz University of Medical Sciences, 2012

Introduction:Today, shift work is considered as a necessity in many jobs and for some 24-hour services the use of shift-work is growing. However, shift work can lead to physiological and psycho-social problems for shift workers. This study aimed to determine the effects of shift work on the associated health problems, together with the demographic and job characteristics underlying the problems, among the medical and diagnostic staff of the general teaching hospitals affiliated to Shiraz University of Medical Sciences in 2012. Method:This study was an applied, cross-sectional and descriptive-analytical one. The study employed a sample of 205 employees from the medical and diagnostic staff using stratified sampling proportional to the size and simple random sampling methods. Data were collected using the Survey of Shift workers (SOS) questionnaire, validity and reliability of which have already been confirmed. Finally, the collected data were analyzed using SPSS 16.0 software through ANOVA, Chi-square, Independent-Samples T-Test, as well as Pearson Correlation Coefficient. A P<0.05 was considered statistically significant. Results: The results showed that among the demographic and job characteristics studied, the individual, family and social problems had significant associations with work schedules, shift work and job satisfaction. In addition, there were significant associations between musculoskeletal disorders and the satisfaction of shift work; cardiovascular disorders and marital status and occupation; digestive disorders and the work schedules; sleep disorders and the satisfaction of shift work; musculoskeletal disorders, cardiovascular disorders and sleep disorders and age, job experience and shift work experience. And finally, there were significant associations among sleep disorders and age, job experience and the shift work experience. Conclusion: Based on the findings of this study, demographic characteristics such as age, marital status, as well as job characteristics can increase the individual, family and social problems, and cardiovascular, musculoskeletal, digestive and sleep disorders. Therefore, in order to reduce these problems and disorders, the following suggestions are made: allowing voluntary shifts for the staff, shortening the hours of night work, limiting the employment of older people in the shift work systems, etc