Epidemiology of Animal Bites and Factors Associated With Delays in Initiating Post-exposure Prophylaxis for Rabies Prevention Among Animal Bite Cases: A Population-based Study / 예방의학회지

OBJECTIVES: One way to prevent deaths due to rabies is the timely utilization of post-exposure prophylaxis (PEP). Therefore, in addition to an understanding of the epidemiological distribution of animal bites, it is necessary to explore the factors leading to delays in PEP initiation. METHODS: This cross-sectional study was conducted in Iran in 2011, and included 7097 cases of animal bites recorded at the Rabies Treatment Center of the Shiraz University of Medical Sciences using the census method. Logistic regression was used to identify factors associated with delays in PEP. RESULTS: Among the patients studied, 5387 (75.9%) were males. The prevalence of animal bites in Fars province was 154.4 per 100 000 people. Dogs were the most frequent source of exposure (67.1%), and the most common bitten part of the body was the hands (45.5%). A delay in the initiation of PEP was found among 6.8% of the studied subjects. This delay was more likely in housewives (odds ratio [OR], 4.66; 95% confidence interval [CI], 2.12 to 10.23) and less likely in people with deep wounds (OR, 0.65; 95% CI, 0.43 to 0.97). CONCLUSIONS: Although all animal bite victims received complete PEP, in some cases, there were delays. Further, the type of animal involved, the depth of the bite, and the patient’s occupation were the major factors associated with a delay in the initiation of PEP for rabies prevention.

Using queuing theory and simulation modelling to reduce waiting times in An Iranian emergency department

Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department [ED] is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time

Methods: This is a cross-sectional study in which simulation software [Arena, version 14] was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them

Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run [actually these patients received services out of their defined capacity]. The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the "bed area" server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients

Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution

Technical efficiency of Shiraz school of medicine in research and education domains: a data envelopment analysis

Introduction: Efficiency evaluation of universities and faculties is one of the tools that help managers to identify the departments' strengths and weakness. The main objective of the present research was to measure and compare the technical efficiency of Shiraz school of medicine departments using Data Envelopment Analysis [DEA] technique

Methods: This cross-sectional and retrospective study was performed on clinical and non-clinical departments in research and education domains over the period of 2006 to 2011. Different inputs and outputs were considered for research and educational domain separately. Efficiency was measured based on the observed optimal performance

Results: Findings showed that pathology and anatomy departments achieved the score of 100 in technical efficiency in education during 2006 to 2011. During this period, parasitology, psychiatric and pediatrics department's achieved the score of 100 for technical efficiency in research domain. The lowest mean of relative educational efficiency belonged to orthopedic department; as to relative research efficiency, the lowest mean was shown in orthopedics and genetics departments. The mean technical efficiency of non-medical departments in education and research domain was 91.93 and 76.08, respectively, while the mean technical efficiency of the clinical department in educational and research fields was 91.02 and 82.23, respectively

Conclusion: Using multiple input and output in DEA technique provided a comprehensive evaluation of efficiency in Shiraz school of medicine departments. The DEA could successfully estimate the technical efficiency of the departments in research and educational fields. Moreover, the deficiency in each department was found; this could help them to plan for improvement

Relationship between family-work and work-family conflict with organizational commitment and desertion intention among nurses and paramedical staff at hospitals

Background: High turnover intention rate is one of the most common problems in healthcare organizations throughout the world. There are several factors that can potentially affect the individuals' turnover intention; they include factors such as work-family conflict, family-work conflict, and organizational commitment. The aim of this research was to determine the relationship between family-work and work-family conflicts and organizational commitment and turnover intention among nurses and paramedical staff at hospitals affiliated to Shiraz University of Medical Sciences [SUMS] and present a model using SEM

Methods: This is a questionnaire based cross-sectional study among 400 nurses and paramedical staff of hospitals affiliated to SUMS using a random-proportional [quota] sampling method. Data collection was performed using four standard questionnaires. SPSS software was used for data analysis and SmartPLS software for modeling variables

Results: Mean scores of work-family conflict and desertion intention were 2.6 and 2.77, respectively. There was a significant relationship between gender and family-work conflict [P=0.02]. Family-work conflict was significantly higher in married participants [P=0.001]. Based on the findings of this study, there was a significant positive relationship between work-family and family-work conflict [P=0.001]. Also, work-family conflict had a significant inverse relationship with organizational commitment [P=0.001]. An inverse relationship was seen between organizational commitment and turnover intentions [P=0.001]

Conclusion: Thus, regarding the prominent and preventative role of organizational commitment in employees' desertion intentions, in order to prevent negative effects of staff desertion in health sector, attempts to make policies to increase people's organizational commitment must be considered by health system managers more than ever

Cost-utility analysis of IEV drug regimen versus ESHAP drug regimen for the patients with relapsed and refractory Hodgkin and non-Hodgkin's lymphoma in Iran

Background: Chemotherapy for lymph nodes cancer is often composed of several drugs that are used in a treatment program

Objectives: The aim of this study was to perform a cost-utility analysis of IEV regimen [ifosfamide, epirubicin and etoposide] versus ESHAP regimen [etoposide, methylprednisolone, high-dose cytarabine, and cisplatin] in patients with lymphoma in the south of Iran

Patients and Methods: This was a cost-utility analysis done as a cross-sectional study in the south of Iran. Using decision tree, expected costs, quality -adjusted life years [QALYs] and the incremental cost-effectiveness ratio [ICER] were estimated. In addition, the robustness of results was examined by sensitivity analysis

Results: The results of this study indicated that the total lymphoma patients were about 65 people that 27 patients received IEV regimen and 38 patients ESHAP [43 patients with Hodgkin's and 22 with non-Hodgkin lymphoma]. The results of decision tree showed that in the IEV arm, the expected cost was dollar 20952.93 and the expected QALYs was 3.89 and in the ESHAP arm, the expected cost was dollar 31691.74 and the expected QALYs was 3.86. Based on the results of the study, IEV regimen was cost-effective alternative to the ESHAP regimen

Conclusions: According to the results of this study, it is recommended that oncologists use IEV instead of ESHAP in the treatment of patients with lymphoma and because of high costs of IEV drug costs, it is suggested that IEV drugs should be covered by insurance

financial cost of preventive and curative programs for breast cancer: a case study of women in Shiraz-Iran

This cross-sectional study was conducted to compare the average costs of breast cancer screening and treatment among women with the age of 25 and over in Shiraz-Iran. Three majors hospitals affiliated with Shiraz University of Medical Sciences [SUMS] were selected for data collection. Financial documents and interviews with the hospitals' financial officers were used for data collection. Finding shows that the total cost of screening would be 5,847,544.96 US dollars for age groups of 25-34 and 35 and above, demonstrating the huge expense of screening programs. On the other hand, the average cost of breast cancer treatment for each patient would be 3608.47, 996.89, and 311.47 US dollars for mastectomy, radiotherapy, and chemotherapy, respectively. In addition, the total average cost for treatment of 2217 patients would be 1,466,988.9 US dollars, which is much less than screening programs expenses. It is concluded that although screening can be effective for improving quality of life and treatment effectiveness, considering the high costs of screening, it is not economical in Iran. Screening methods within suitable intervals, and also considering patients' medical history have been recommended by the present study

Cost-effectiveness of rabies post exposure prophylaxis in Iran

The rabies is one of the most important officially-known viral zoonotic diseases for its global distribution, outbreak, high human and veterinary costs, and high death rate and causes high economic costs in different countries of the world every year. The rabies is the deadliest disease and if the symptoms break out in a person, one will certainly die. However, the deaths resulting from rabies can be prevented by post-exposure prophylaxis. To do so, in Iran and most of the countries in the world, all the people who are exposed to animal bite receive Post-Exposure Prophylaxis [PEP] treatment. The present survey aimed to investigate the cost-effectiveness of PEP in southern Iran. The present study estimated the PEP costs from the government's Perspective with step-down method for the people exposed to animal bite, estimated the number of DALYs prevented by PEP in the individuals using decision Tree model, and computed the Incremental cost-effectiveness Ratio. The information collected of all reported animal bite cases [n=7111] in Fars Province, who referred rabies registries in urban and rural health centers to receive active care. Performing the PEP program cost estimated 1,052,756.1 USD for one year and the estimated cost for the treatment of each animal bite case and each prevented death was 148.04 and 5945.42 USD, respectively. Likewise 4,509.82 DALYs were prevented in southern Iran in 2011 by PEP program. The incremental cost-effectiveness ratio for each DALY was estimated to be 233.43 USD. In addition to its full effectiveness in prophylaxis from rabies, PEP program saves the financial resources of the society, as well. This study showed performing PEP to be more cost-effective

relationship between quality of work life and human resource productivity in knowledge worker

Introduction: Health care systems depend critically on the size, skill, and commitment of the health workforce. Therefore, researchers have a close observation on the subjects which leads to an increase in the productivity of human resources. This study aims at determining the relationship between the quality of work life and the productivity of knowledge workers of the central field of Shiraz University of Medical Sciences, in order to determine the factors effective in the quality of their working life

Method: This cross-sectional study was conducted on 300 individuals selected by stratified random sampling method. On 761 knowledge workers of the central field of Shiraz University of Medical Sciences by using Timossi questionnaire of Quality of Work Life and Knowledge Worker Productivity Assessment questionnaire of Antikainen, during May and June 2011 The collected data were recorded by SPSS version 15 software and then it underwent statistical analysis using Pearson correlation. The P value level for statistical significance was set at 0.05

Results: In general, 50% of the knowledge workers were dissatisfied about their quality of work life, and the other 50% had little satisfaction. 18% of the staff were in an unfavorable condition and 82% had a poor productivity. Also, the quality of work life had a positively significant relationship with the productivity of human resources [r=0.568; P>0.001]

Conclusion: Most of the knowledge workers in the central field of Shiraz University of Medical Sciences had low productivity and quality of work life. Considering the relationship between the two variables, taking measures to improve the quality of work life can lead to more creative and profound planning in presenting services and, as a result, improving the productivity of the knowledge workers

Executive and financial manager's awareness of economic issues in private and public hospitals in Shiraz

Introduction: Managers, as the members of decision making team in hospitals, are required to understand economic issues In order to increase their knowledge, make better decisions making, and bring about economic growth in hospitals. Thus by measuring the managers' level of economic knowledge and understanding their weaknesses at this field, we can take an important step in line with this transcendental target

Method: This was an analytical– descriptive study conducted in 2013. In this study, the views of 30 hospital executives and financial managers about various aspects of hospital economy including payment methods, techniques of economic evaluation, hospital income, and cost and subtractions were studied using questionnaires and interviews. SPSS 18 was used to analyze the collected data. P<0.05 was considered statistically significant

Results: None of the studied managers had a good level of knowledge and most managers [80.7%] had an undesirable level of knowledge, and few of them had a moderate level of knowledge. The administrators' average knowledge of the ways to reduce the cost and increase the income of private hospitals was more than that of hospital administrators; as to the economic evaluation techniques and methods of payment, hospital administrators had more knowledge than managers of private hospitals

Conclusion: The managers' low level of economic knowledge can be enhanced by more selective appointment of individuals for these sensitive positions and also increased by their participation in workshops and training courses

Cost-utility analysis of neonatal screening program, shiraz university of medical sciences, shiraz, Iran, 2010

The most important cause of infant mortality during the first month of life is related to congenital abnormalities. Nevertheless, timely diagnosis of these diseases can reduce the severity of their effects. The present study aimed to investigate the cost-effectiveness of the neonatal screening program in Pars Province, Iran. In this study, costs of executing the screening programs, treatment of the diagnosed cases, treatment of affected, non-screened individuals, quality of life, and incremental cost-effectiveness ratios were measured in two study groups. Performing the screening programs for phenylketonuria, congenital hypothyroidism, galactosemia, and favism resulted in respectively $3386, $13078, $19641, and $1088 saving per patient. Overall, the study results revealed the cost-effectiveness of execution of the neonatal screening program. Neonatal screening program is one of the health interventions which lead to long-term beneficial outcome for the patients, financial saving for the society, and improvement of the patients' quantity as well as quality of life

Cost efficiency of the family physician plan in Fars province, Southern Iran

In recent years use of family physicians has been determined as a start point of health system reform to achieve more productive health services. In this study we aimed to assess the cost-efficiency of the implementation of this plan in Fars province, southern Iran. This cross-sectional descriptive study was done in 2007 in 18 provincial health centers as well as 224 rural health centers in Fars province. Data were collected using forms, statistics, and available evidence and analyzed by expert opinion and ratio techniques, control of process statistics, and multi indicator decision model. Although in the family physician plan more attention is paid to patients and the level of health training, availability, and equity has improved and the best services are presented, it has not only decreased the costs, but also increased the referrals to pharmacies, laboratories, and radiology clinics and the costs of healthcare. Although the family physician plan has led to more regular service delivery, it has increased the patients' referral to pharmacies, laboratories, and radiology centers and more referrals to family physicians. It seems that the possibility of setting regularity in health system can be gained in the following years of the family physician program mainly via planning, appropriate management and organizing correct health plans according to need assessments, and continual supervision on activities, which would happen according to current experiences in this plan

Necessity of admissions in selected teaching university affiliated and private hospitals during 2007 in Shiraz, Iran

The use of acute hospital beds is an issue of concern both to policy-makers and practitioners. In most countries attempts are underway to improve efficiency in this sector. One of the most widely used instruments for assessing inappropriate hospital use is the Appropriateness Evaluation Protocol, which consists of a set of standards based on objective criteria relating the condition of the patient to the clinical services received. The aim of this study was to measure inappropriateness of admission and inpatient stays at four major hospitals in Shiraz, Iran. The results showed that 22% of the total admissions in four hospitals were rated as inappropriate. The most as well as the least inappropriate admissions were found in both teaching university affiliated hospitals. Our data has shown that a total of 29.6% [average 6.40%] of the hospital stays in the study population were judged to be inappropriate. The result of the Least Significant Difference Test indicated a significant association between the mean days of inappropriate stay and turn of admission in all hospitals. In the four hospitals, a significant association was observed between the inappropriateness of hospital stay, costs, and length of stay. Considering the findings of this study, in addition to other studies in Iran and other countries, we can conclude that the factors involving inappropriate admission of patients to hospitals are mostly similar. In order to solve this problem we can use strategies such as: improving the performance of the referral system, using standard criteria for an appropriate evaluation protocol by the medical staff, and extending outpatient diagnostic services to reduce inappropriate hospitalization