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

Shiraz medical students' perceptions of their colleagues' professional behavior

Introduction: Today, development of professionalism is a critical aim of medical schools. Studies have demonstrated that medical students' perceived level of professionalism is inadequate worldwide. This study aimed to investigate the medical students' perceptions of their colleagues' professional behavior

Methods: This study is a cross-sectional study with 280 medical students at Shiraz University of Medical Sciences in their fifth to seventh year of study as the sample. The study was performed during one month in 2013, using stratified random sampling method. The instrument of the study was the Persian version of the questionnaire of the American Board of Internal Medicine [ABIM].The questionnaire includes demographic information, questions about the meaning of the professionalism, history of medical ethics education programs and 12 behavioral questions. The data were analyzed using student t-test and Pearson correlation test. The significance level was set as 0.05

Results: Forty percent of respondents did not know the meaning of professionalism. The mean +/- SD score of behavioral questions was 5.9 1 +/- 1.2 on a scale from 0 to 10. The mean +/- SD score of excellence questions was 4.94 +/- 1.7. It was 7.05 +/- 1.9 for 'honor/integrity', and 6.07 +/- 2.1 for 'altruism/respect' questions. There was a significant association between gender and excellence score [p=0.007]

Conclusion: Medical students assessed their colleagues' professional behavior as poor. They did not have proper information about professionalism. Medical students are future general practitioners and respecting medical ethics by them is very important in a perfect health system. Universities should emphasize the importance of teaching professionalism to medical students and faculty members, using innovative education methods

qualitative study of the causes of improper segregation of infectious waste at Nemazee hospital, Shiraz, Iran

Medical waste management is a major concern for healthcare facilities. One important element is the segregation of infectious waste from domestic, non-infectious waste. The aim of this qualitative study was to identify factors that negatively affect proper segregation at Nemazee Hospital, which is affiliated with Shiraz University of Medical Sciences. Study data came from focus groups involving hospital workers. Participants expressed their opinions regarding barriers to proper segregation of medical wastes. The participants gave their permission to have their comments recorded. Data analyses were based on a grounded theory approach. The results indicated that managerial weakness was an important factor in suboptimal disposal of medical waste. It appears that hospital authorities should pay better attention to educational planning, organizational resources and supervision. Together, these considerations should help reduce waste-management errors. The results also suggest that healthcare worker training needs improvement. In general, patients and their companions, as well as the local population, did not appear to have sufficient knowledge concerning disposal of infectious medical waste. Hospital authorities should conduct a broad review of medical waste management, including improved employee training. This step should have a positive effect on local health, as well as the environment. Improvement is also needed in the infection prevention performance of hospital healthcare workers. This approach should reduce additional production of infectious waste and costs associated with healthcare

Medical students' knowledge of indications for imaging modalities and cost analysis of incorrect requests, Shiraz, Iran 2011-2012

Medical imaging has a remarkable role in the practice of clinical medicine. This study intends to evaluate the knowledge of indications of five common medical imaging modalities and estimation of the imposed cost of their non-indicated requests among medical students who attend Shiraz University of Medical Sciences, Shiraz, Iran. We conducted across-sectional survey using a self-administered questionnaire to assess the knowledge of indications of a number of medical imaging modalities among 270 medical students during their externship or internship periods. Knowledge scoring was performed according to a descriptive international grade conversion [fail to excellent] using Iranian academic grading [0 to 20]. In addition, we estimated the cost for incorrect selection of those modalities according to public and private tariffs in US dollars. The participation and response rate was 200/270 [74%]. The mean knowledge score was fair for all modalities. Similar scores were excellent for X-ray, acceptable for Doppler ultrasonography, and fair for ultrasonography, CT scan and MRI. The total cost for non-indicated requests of those modalities equaled [dollar sign]104303 [public tariff] and [dollar sign]205581 [private tariff]. Medical students at Shiraz University of Medical Sciences lacked favorable knowledge about indications for common medical imaging modalities. The results of this study have shown a significant cost for non-indicated requests of medical imaging. Of note, the present radiology curriculum is in need of a major revision with regards to evidence-based radiology and health economy concerns

Knowledge and practice of medical students on healthy lifestyle: a cross-sectional study in Shiraz

Background: Physicians are one of the most important groups directly associated with public health and their health related lifestyle has a significant impact on their patient's behaviors. Several studies showed that the majority of medical students did not have appropriate and healthy behaviors. The aim of this study was to determine the prevalence of risky lifestyle knowledge and behaviors among Shiraz medical students

Methods: This cross-sectional survey was conducted in 2011. Using a stratified random sampling method, 400 medical students were selected to fill in the questionnaires. The questionnaire contained 33 questions including demographic data, healthy lifestyle knowledge and behavior [including physical activity, fruit and vegetable consumption, water drinking, etc], perception of stress and student's health information resource. The association between demographic factors and participants' knowledge, practice and stress score was determined. The correlation between the participants' knowledge and behavior scores was calculated

Results: The mean knowledge and attitude scores were 2.8 and 3.6, respectively. In 40% of knowledge and 80% of practice questions, the percentage of the correct answer was below 50%. There was a significant correlation between the participants' knowledge and behavior scores [P<0.05]

Conclusion: This study raises the voice of concern with medical students' knowledge and behavior on healthy lifestyle measures. There is a need for re-thinking, planning and reviewing these concepts of pure reason which is essential in their future professional career. Health considerations, health surveillance and care systems which are based on evidence, reasonability and rationality still have to be paramount

Study of antibiotics self-medication at primary Health Care Centers in Shiraz, Southern Iran

Background: Nowadays, self-medication of therapeutic agents is of global concern particularly in developing and underdeveloped countries. Some studies conducted in Iran showed that the frequency of self-medication was significant

Objective: This research was conducted to estimate the prevalence of arbitrary use of antibiotics in Shiraz community with special interest in its determinant factors

Methods: This cross-sectional study was conducted in Shiraz, in 2009. Approximately 710 out of all patients referred to all health care centers in Shiraz were selected to fill out a questionnaire containing 23 questions divided into two parts. The frequency of self-medication according to demographic factors was described and the association between independent variables and self-medication was analyzed

Results: The frequency of self-medication in this study was 44.5% and the request to prescribe antibiotics by the patients was 53.5%. Amoxicillin was the most widely used drug by the participants. There was a significant association between age and gender with self-medication. The frequent cause for self-medication was common cold. Approximately, 74.4% of the participants reported their previous experience as the main reason for self-medication

Conclusion: The results of this survey demonstrated the high frequency of self-medication in Shiraz. Socio-cultural determinants are the etiologic factors for self-medication. Policy makers are recommended to provide community-wide educational programs to make people aware about the adverse effects of self-medication. There was a significant association between age, gender and education with self-medication and governments could pay more attention to these factors for designing the interventional programs

Knowledge, attitudes, and practices regarding pandemic H1N1 influenza among medical and dental residents and fellowships in Shiraz, Iran

Influenza disease is one of the oldest medical problems that can cause severe illness and high mortality rates, worldwide. In flu pandemics, medical and dental students' knowledge, attitudes, and practices [KAP] is critical to save patientslife.The aim of this study was to determine the score of KAP toward the Pandemic H1N1 and their predictor factors among the medical and dental residents and fellowships of Shiraz University of Medical Sciences, Iran. In 2009, 125 participants were recruited in a convenient sampling cross-sectional survey. Self-reported questionnaire were used and results were analyzed applying appropriate statistical tests. The mean score of participants' knowledge, attitude and practice were 22.6, 21.1 and 26.5 respectively. Participants practice had significant linear positive correlation with knowledge and attitude. Also, their age was significantly and directly correlated to knowledge and practice. The educational major, age, and sex were significant predictors of responder's knowledge score and age was the only significant predictor of both attitude and practice scores. High knowledge is not sufficient lonely for improve attitude and practices. It seems that traditional educational models are not efficient and governments should emphasize to advanced and motivational education methods including health belief model and motivational interview at postgraduate levels. Perhaps younger students, dentists and males have less motivation to change their attitude and behavior, so we can focuses our interventions in these groups

Are the pPredictors of hookah smoking different from those of cigarette smoking? report of a population-based study in Shiraz, Iran, 2010

The aim of this study was to determine the prevalence of tobacco use and effect of lifestyle factors on cigarette and hookah use among adult re sidents of Shiraz, Iran. In 2010, 1,000 participants were recruited in a multistage, random sampling cross-sectional population-based survey. Response rate was 98%. Prevalence of cigarette smoking was 9.7%. Among cigarette users, 12.6% reported smoking <1 year; 13.4% smoked 1-2 years and 73.9% smoked>2 years. Almost half of those surveyed [48.9%] smoked <10 cigarettes per day [cpd]; 28.4% smoked 10-15 cpd; 14.8% smoked 16-19 cpd, and 8%>20 cpd. Almost a quarter [20.4%] of the cigarette smokers tried to quit in the past year. Being male, married, aged 37-54, having higher perceived levels of stress, a non-manual occupation, and sedentary lifestyle were positively associated with cigarette smoking. Manual labor occupations, housewife/jobless status, and going frequently to restaurants were positive predictors of hookah smoking. Compared to cigarettes, hookah smoking was more prevalent among Iranian adults. Prevalence of hookah smoking in women approximated that of men, whereas cigarette use was 31 times more common in men. Cigarette and hookah smoking were associated with less healthy lifestyle habits in both men and women