ABSTRACT
Since equal distribution of health services is impossible in different levels of health network, small centers should refer patients to upper level for special services and if it doesn't be according to referral system, causes crowding and insufficiency of health services in upper levels and leads to uselessness of medical services in small centers. This study was done to assess the function of referral system in Babol health care delivery network. This cross-sectional study was performed in Paeengatab health center during autumn 2003. All referred patients to upper levels were included in this study. Data was collected by interviewing with patients and referral forms and then were analyzed. From 445 forms, 200 had complete data. Most referred patients were female [73%] and were at the age of 20-29 [42%]. Most people [58.2%] were referred for paraclinical services [Sonography and laboratory] and the most referred cases were the patients with gynecological and obstetric disorders [18.6%]. Shahid Beheshti, Yahyanejad and Amirkola hospitals accepted the most referred patients, respectively. The feedback rate from hospital to health centers was zero. Referral system is only being performed as one way from health centers to hospitals and there is no feedback, since, gynecological and obstetric disorders make the largest number of referred patients, it is necessary to increase health and treatment services in rural health centers in order to decrease the number of patients who referred to hospitals
ABSTRACT
Atherosclerosis and its complications are a major cause of ischemic heart diseases. Platelets play an important role in initiation of atherosclerosis and coronary thrombus formation. Large platelets are shown to be hemostatically more active. Evaluation of platelet volume parameters could be useful and significant in prediction and differentiation of coronary events. In this study, 100 patients with chest pain were divided into 3 groups according to clinical manifestation and standard diagnostic criteria. 25 patients were with unstable angina, 25 patients with chronic stable angina and 50 patients with non-cardiac chest pain as normal population. Platelet indices and count were assayed within 1 to 3 hours, after sampling from venous blood and collection in K3 EDTA, by a Sysmex KX21 analyzer. Data were provided for each group and surveyed by ANOVA and Tukey tests with Pearson correlation and P-value less than 0.05. Patients with unstable angina had a significant higher MPV [Mean platelet volume] [10.7 +/- 0.23 fl], PDW [Platelet distribution width] and PLCR [Platelet-lerge cell ratio] than those in chronic stable angina and normal group [P<0.05]. MPV in chronic stable angina patients [10.1 +/- 0.2 fl] was higher than normal population [9.5 +/- 0.1 fl] but platelet count and other indices were not statistically significant difference. There were no sex or age differences in MPV amounts in population group. Platelet volume indices are increased in unstable angina probably because of platelet activation and a compensatory volume enhancement. Platelets count reduction in this condition results from platelet consumption. These changes in platelet count and volume could differentiate unstable angina patients from chronic stable patients and normal individuals