[ survey on efficiency, benefits and complexities of using hospital information systems from the perspective of physicians in hospitals affiliated to Urmia university of medical sciences]

Introduction: Consequences of implementing hospital information systems have led to a failure in meeting decision makers' expectations on the one hand and a failure in successful execution of the process on the other hand. This study aimed to evaluate physicians' perspective in regards to the efficiency, benefits and complexities of using hospital information systems in public hospitals of Urmia

Methods: This was a descriptive-analytic and cross-sectional study. Stratified random sampling was used for sample selection. Data collection was conducted via a questionnaire. Pearson correlation coefficient and chi-square tests were applied to analyze the assumptions and objectives

Results: The finding of this study showed that there was a significant relationship between the expected performance of HIS and familiarity with information technology [p=0.000] and age [p=0.008]. There was also a significant relationship between the expected performance of HIS and age. The findings showed a significant relationship between the complexities emerging from the use of HIS and familiarity with information technology [p = 0.000] and age [p = 0.049]

Conclusion: Due to physicians' key role in medical procedures and the importance of adopting information systems, familiarity with information technology is crucial. To have optimal use of information technology in hospitals, training courses for physicians are suggested

[Determination of knowledge and health literacy among women with type 2 diabetes in teaching hospitals of TUMS]

Health literacy is the degree to which individuals have the capacity to obtain, process, and understanding basic health information and services needed to make appropriate health decisions. The aim of this study was to assess relationship between health literacy and knowledge of women with type 2 diabetes. In this cross sectional survey, 160 women with type 2 diabetes were selected by convenience sampling method. Data collected by using a STOHFLA standard questionnaire and knowledge was measured by self-administrated questionnaire. Obtained data analyzed by SPSS16 software in two categories of descriptive and inferential statistics [Chi-square and Pearson coefficient]. The mean age of studied population was 52.73 +/- 8.56 years old. The means of health literacy and knowledge was 40.57 +/- 15.87 and 21.52 +/- 2.94, respectively. There was a relation between occupation, education and family history with knowledge and health literacy score, and also between incomes with knowledge. There was reverse significant relation between age and disease duration with knowledge and health literacy. Results indicated that patients did not have the appropriate knowledge in type 2 diabetes, as well as health literacy which was also moderate. These results confirmed the need to develop of education for improving and increasing the appropriate knowledge and health literacy among studied women

[Health seeking behavior study among Zoroastrian residing in Yazd Province, in 2009]

People give you an idea about variety of behaviors when confronting diseases. Different factors such as age, sex, economic and social situations have effect on its. Recognition of these behaviors helps politicians to deliver better services. This study aimed to identify health seeking behaviors of Zoroastrian residing in Yazd province due to advanced number of them in comparison to the other provinces. This study is a cross sectional. The sample size was 196 cases which selected by using simple sampling method. The data was collected via the questionnaire, then data were analyzed by spss.11 software with two test of chi square and exact test of Fisher. The findings showed that 64.3% of the population was female whereas remaining 35.7% were male. 15.58% of participants were single, 76.5% married and the rest of them [7.7%] were widow. Data indicated that 4.1% of individuals were illiterate, 17.3% were high school, 51.3% had diploma, 23.5% had Bachelors degree and 3.6% had Masters Degree or Ph.D. 43.4% of studied population were unemployed and the rest of them [46.7%] were employed. 94.4% of participants had health insurance whereas 5.6% did not had uninsured card. The results showed that the following direct variables had relation with the following mentioned indirect variables; sex with the action during the period of being sick, Place of born with reasons of neglecting sickness, marital status with action during the period of being sick, educational status with action during the period of being sick and referring to practitioner in different stages if sickness and using consultation of different groups, occupational status with the first place to get medical treatment, economical status with reasons of neglecting sickness and completion of treatment period and having health insurance with action during the period of being sick and using consultation of different groups. Considering the fact that educational, occupational and economic status have relation with health seeking behaviors in individuals, developed in education and occupation status could be lead a chance to choose a better health behavior in people

assessment of relations between socioeconomic status and number of complications among type 2 diabetic patients

The prevalence of diabetes mellitus among Iranian aged 25-64 estimated to be about 7.7%. The aim of current study was the assessment of socioeconomic status of diabetic patients and their complications. A cross sectional study was conducted on type 2 diabetic patients with complications in four major teaching hospitals affiliated to Tehran University of Medical Sciences [TUMS] during July 2009 to March 2010. All patients [530] were interviewed through a questionnaire with 85% response rate [450 patients]. Skilled nurses were assigned as responsible for data collection. Collected data analyzed by Exact Fisher and x2 tests using SPSS version 11.5. The majority of patients had experienced one or more complications. Findings revealed that 50%, 33.6% and 16.4% of the patients suffered from one, two, and three complications of type 2 diabetes, respectively. Patients with cardiovascular complications included 22.2%, with both cardiovascular and eye complications [12.7%], and with cardiovascular, eye and foot ulcer together 14% of the respondents. Frequency of complications demonstrated significant relation with sex, age, educational level, type of occupation, duration of diabetes [P 0.001] and social class [P=0.002]. The majority of patients [54.2%] belonged to low income group. It seems patients with low socioeconomic status face more challenges in their social environment together with less psychological support. Health care systems are responsible to empower them to control their illness and feel a better life to live

[Evaluating the hospitalization costs for elderly patients in teaching hospitals of Kashan university of medical sciences during 2009-10]

Considering that hospital costs of the growing elderly population account for a significant share of the health care costs, this study aimed to investigate the elderly hospitalization cost in teaching hospitals of Kashan university of medical sciences. In this cross-sectional study, 2067 patients [age >/= 60] admitted to teaching hospitals of Kashan university of medical sciences during a one-year period [Sep. 2009-Sep. 2010] were randomly selected using stratified random sampling. Data related to hospitalization charges of cases were obtained from medical records and analyzed. The mean hospitalization charge was 5533529 Rials. The highest cost share was for "bed-day" [26.4%]. The highest average hospitalization cost for different diseases were for digestive, neoplastic and respiratory system, respectively. However, diseases of the eye and circulatory system accounted for the largest share of total hospital costs. Regarding the ward, the highest charges were paid for the elderly patients in ICU and CCU, but internal wards had the largest share of total hospital costs. In addition, a significant relation was seen between the cost for each elderly hospitalized and the ward/disease condition [P<0.001], and the comorbidities [P=0.001]. To reduce the hospital costs, careful attention should be paid to disease services with the highest costs. Moreover, the preventive measures as well as alternative low-cost services [e.g. home care] and developing long-term care should be provided

[Medical and non-medical direct costs of cancers in patients hospitalized in Imam Khomeini cancer institution - 2010]

With more than 12 million new cases of cancers and nearly 7.6 million deaths all around the world in 2007, cancer currently is the third leading cause of death in the world. This study was conducted to determine medical and non-medical direct costs of cancer patients' hospitalized in the cancer institute affiliated with Imam Khomeini hospital. This was a cross-sectional study. All patients over 18 years old with kind of head, neck, and stomach cancers that undertaken of oncology treatments in the cancer institute which affiliated " Imam Khomeini Hospital". Initially eligible patients invited to participate in this study. The data was collected through structured interviews with patients and or their carers. The data, then, was analyzed by SPSS software. The average medical and non-medical direct out-of-pocket costs during primary treatment were 2,609,000 and 245,000 Tomans per patient, respectively. Furthermore, the direct average of medical costs for patients who lived in Tehran and other cities were 3,313,000 and 1,870,000 Tomans; while the direct average of non-medical costs for patients who lived in Tehran and other cities were 136,000 and 360,000 Tomans, respectively. The new policies for costs coverage related to cancer patients', particularly the medical insurance organizations, financial supports from finance intuits like as banks or charity organizations, appropriate distribution of cancer's centers or providing accommodation to cancer patients who are referred from the remote sites in other cities, and also achieving the equities in health sectors could be reduced the financial costs of cancer patients and might be helped them to manage of cancers efficiently and effectively

Assessing health system responsiveness: a household survey in 17[th] district of Tehran

Responsiveness is an indicator by WHO to evaluate the performance of health systems on non-medical expectations of consumers. This study measures the health system responsiveness and the factors affecting responsiveness in Iran health system. World Health Survey [WHS] questionnaire was used to collect data on a two-stage cluster sampling in 17[th] District of Tehran in 2003. Of a sample of 773, 677 and 299 individuals who respectively had outpatient or inpatient services utilization responded to the responsiveness module of WHS questionnaire. More than 90% of respondents believed that responsiveness issues were very important. Performance of outpatient services was better than hospital services in terms of responsiveness. [Prompt attention] and [quality of basic amenities] received low score for outpatient services. Service user variables had no significant effect on responsiveness, while type of centers was significantly related to responsiveness. Principal component analysis found three factors for both outpatient and inpatient services that explained 62% and 61% of total variances respectfully. Iran health system should pay more attention to responding non-medical expectations of service users. It sounds that health system interventions are main determinant of responsiveness score compared to demographic or user variables. Training health staff, allocating more resources and reengineering some processes may play a role in improving responsiveness. Responsiveness domains seems to be tailored based on each society's cultural factors

Learning styles of health services management students at Tehran University of medical sciences

Identifying learning styles among students are very important in order to orient in learning and teaching activities. The aim of this study was to determine the learning styles of students in the ground of health services management in Tehran University of medical sciences in 2010. In this descriptive cross-sectional study, total of health services management students' in Tehran University of medical sciences applied in a census study. The tool which used in this research was VARK learning style questionnaire. Data was analyzed by VARK software that later on designed into Excel and SPSS soft wares. In total, 130 out of 150 students completed returned questionnaire [Response Rate=87%]. Only 33.1% of the students preferred a Uni-modal learning style. Among those students; 10.8% preferred kinesthetics style, 10% preferred read and writing style, 9.2% auditory, and 3.1% preferred visual style. In contrast, the most of students [66.9%] preferred multi-modal [Bi-modal [18.5%], Tri-modal [13.1%], Quad-modal [35.4%]] learning styles. There was no significant association between grade point average, sex and education degree with learning styles. Awareness of existing different learning styles among health services management students' will help to trainers and educators to develop the effective learning approaches and also tailored to students in learning styles. Based on results, it is suggested to apply active learning strategies such as discussion groups, role playing, and simulation and so on to students in this field

Barriers and facilitating factors for cervical cancer screening: a qualitative study from Iran

This study aimed to explore the experiences of Iranian women regarding the barriers to and facilitating factors for cervical cancer screening. Eight focus groups [N= 86 participants] were conducted with women referred to a health center in Karaj, Iran from January to March, 2007. Purposeful sampling was used. Married women aged 18 years old and over, not suffering from Obstetrics/ Gynecological disease during last two years and being willing to participate in the study were included. Framework analysis was used to extract the themes from the data. In general, the participants stated that they were not knowledgeable regarding cervical cancer. Moreover, most of the participants had negative beliefs regarding cancer prevention, including lack of free time to do the test, cost of the test, no symptoms cue. The perceived facilitating factors verified by the participants were cues to action, health care motivator, and perceived threat. The findings of this study revealed that there are various psychosocial barriers to cervical cancer screening among Iranian women. High accessibility and availably of the test as well as health care providers' encouragements may improve the rate of cervical cancer screening

[Developing appropriate criteria for benign prostatic hyperplasia surgery using RAND Appropriateness Method [RAM]]

Results of different studies show that a relatively large number of healthcare services offered are inappropriate or unnecessary. Benign prostatic hyperplasia is a benign enlargement of the prostate gland. Clinical features of this disease are one of the most common problems encountered by elderly males. The aim of this study was to assess the appropriateness of benign prostatic hyperplasia surgery. In this qualitative study which was conducted in 2008-9, in Tehran University of Medical Sciences, the RAN/UCLA method was used, which was designed in 1980 by the RAND institute and the University of California in Los Angeles. Regarding the stages of our method, scenarios and indications for benign prostatic hyperplasia surgery were chosen from the latest approved scientific resources and subsequently sent to urology specialists, who were chosen as members of the specialized panel. Panel members gave scores ranging from 1 to 9 to each indication and scenario based on scientific resources, clinical experiences and patient's condition in two separate panel sessions. After compilation, the indications were finally grouped as appropriate, equivocal, and inappropriate so that they could be used to determine appropriateness of benign prostatic hyperplasia surgery in hospitals. In this study, the most suitable and most approved clinical guidelines related to benign prostatic hyperplasia, the Guidelines Evaluation and Research Appraisal [AGREE] were used.The selected guidelines were used as scientific resources for choosing the indications of benign prostatic hyperplasia surgery. SPSS version 16 and kappa weighted value were used in analysis process of the study. Out of 282 scenarios grouped as 9 conditions related to benign prostatic hyperplasia surgery, which were extracted from scientific sources, 73 cases [25.9%] were considered as appropriate, 14 cases [5%] as equivocal and 7 cases [2.5%] were considered as inappropriate. Also 22 cases [7.8%] were considered as appropriate indications for drug therapy and none were found to be suitable for waiting and watching. There were 94 scenarios related to surgery that 75 scenarios [80%] were grouped in appropriate and 8 scenarios [8.5%] identified inappropriate. At the present time, due to the lack of scientific evidence for suitable decision-making in providing health services, methods based upon agreement, including the one used in the present study, and the use of treatment standards derived from similar studies, are amongst the most important measures taken to improve the standard of hearth, provide suitable health services, and to reduce unnecessary costs. In addition, RAM appropriateness method could be an ideal method in determining the appropriateness of health care and in reducing the rate of inappropriate services provided. The similarity of results derived from other studies performed by the RAND method in determining the appropriateness of benign prostatic hyperplasia treatment with the current study shows the validity and reliability of this method

Inappropriate admission and hospitalization in teaching hospitals of Tehran University of Medical Sciences, Iran

To determine the appropriateness of admission and hospitalization of patients in two major teaching hospitals of Tehran University of Medical Sciences [TUMS]. Appropriateness Evaluation Protocol was employed to evaluate 1732 days of hospital stay and 258 patient admissions. Findings indicated that 22.8% of admissions were inappropriate and length of stay for patients who had inappropriate admissions was significantly shorter than those who had appropriate admission. Statistical tests demonstrated a significant difference between hospital wards in terms of inappropriate admission [p < 0.0001]. On average 8.6% of patient days were inappropriate and it is significantly different between two hospitals. It was also found that the more patient length of stay, the more inappropriate patient day. Delay in discharge process was the most frequent reason indicated for inappropriate hospital stay. A substantial proportion of hospital admissions and stays were found to be inappropriate due to management procedures and more likely lack of health care services in lower level of health system

[Postretirement employment and quality of life [QOL] indicators]

The number of elderly persons in our country [more than 7.8% of Iran population] is increasing more and more. Tehran province has the most number of retired with male to female ratio: 2/1. So, in the field of [quality of life] [QOL] increasing needs for giving care [physical and socioeconomic] to these groups have been appeared. In view of the aging process in our population there is a need to identify effective methods to prevent disadvantageous effects of this trend. The main purpose of this research was assessment and comparing of health-related quality of life [HRQOL] between retired staffs and labors. Also the effect of postretirement employment on HRQOL was explored. This study was carried out cross-sectionally and with the participation of 80 retired labor men and 80 retired staff men in Tehran University of medical science. The main purpose of this research was assessment and comparing of QOL items between retired staffs and labors. Also the effect of postretirement employment on QOL items was explored. Other variables such as; age, marriage status, education grade, house ownership were assessed too. In this research, we studied QOL variables in terms of quantitative and used t test. Finding showed that in retired staffs and labors, there was significant difference between quality of life variables. In other word, in staff group in comparison with labors group, there was better state from aspect of physical function, role- physical limitation, general health, social function, mental health, role-emotional limitation, total scores of physical health, mental health and quality of life. These differences were significant. There was a significant relationship between postretirement employment and quality of life [QOL] variables such as: physical function, role- physical limitation, role-emotional limitation, vitality, total scores of physical health, mental health and quality of life. Quality of life in elderly and retirees has relationship with all aspect of health and been influenced by many factors such as economic, mental, physical and social factors. So, based to these conclusions and similar studies, we can go toward quality of life promotion and increasing of community participations. Doing educational, cultural planning and policy making base upon real needs of elderly and retired can be mentioned. The overall improvement of self-reported QOL among elderly people suggests that the onset of disabilities could be postponed, especially if health-related circumstances were more evenly distributed at the start of or even before retirement age. These results suggest we should design appropriate programs to increase elderly people's interaction with others and establish new social networks for them which may enhance a sense of positive self-concept

survey about knowledge and attitudes of people towards violence against women in community/ family settings

In this article a very brief history of violence against women in domestic settings is developed. On the whole, 18 Focus group discussion [FGD] [including 4 pilot FGDs], were conducted in southern part of Teheran Capital of Iran among different groups of people [literate, illiterate, married, unmarried, male, female]. Further, 30 individual interviews conducted with violence and family affaire experts such as police, forensic medicine experts, psychologists, social-workers, authorities, judges, and sociologists. Findings demonstrated a very traditional problem-solving approach to violence and violence-based issues. Moreover, violence is sometimes justified by natural superiority of men to women. It is also considered as a necessity for some purposes and therefore, it is accepted and may continue to exist among families and community for coming years. Public and private spheres are almost genderly divided and formal institutions and organizations are tried to be kept away from family violence related issues. This is mainly because of a belief that domestic violence belongs to private sphere rather than public one

[Survey on quality gap in primary health care in Kashan health centers]

Background: the first basic step in formulating any quality improvement program is recognizing consumers' perceptions and expectations of service quality and determining the quality gap, then adopting guidelines to eliminate the gap

Objective: to assess the service quality gap in Kashan district health centers, based on consumers' perceptions and expectations

Methods: a sample of 300 females' health care consumers completed the research questionnaire. The SERVQUAL instrument administrated to assess the quality of services provided by health centers. To analyze data, descriptive and analytic statistic and correlation coefficient were applied

Findings: results indicated that there was an overall service quality gap between respondents' perceptions and expectations. The smallest gap was in tangibility dimension and the largest in responsiveness. Age and literacy respectively had direct and indirect significant correlation to quality gap

Conclusion: there was a quality gap in services. Thus, improvements are required across all the five dimensions, namely tangibility, reliability, responsiveness, assurance and empathy