پزشک

 Considering the increase in the number of genetic disorders among human diseases and the importance of genetic counseling in prevention and the role of physicions in providing counseling, this study aims to determine the evaluation of the knowledge, attitude and performance of health specialists regarding the referral of necessary cases to genetic counseling and genetic tests were done in Bushehr in 2020.

 This research was a cross-sectional descriptive analytical study that was conducted using a questionnaire containing demographic information and questions in three areas of knowledge, attitude and performance of doctors regarding the referral of necessary cases to genetic counseling and testingin Bushehr with the participation of 95 doctors. Spearman, U-Man-Whitney and Kruskal-Wallis correlation tests and Tukey's Post Hoc test were used for data analysis.

The average scores of doctors' knowledge, attitude and performance were 70.30 ± 7.45, 89.21 ± 10.77 and 38.25 ± 20.60, respectively, which indicates good knowledge and attitude and poor performance of doctors in this field. There was a significant difference in the performance score among doctors of different disciplines. A statistically significant relationship was obtained between knowledge and performance, attitude and performance and between participation in the genetics training course and performance.

 According to the findings of the study, holding effective and practical training courses, preparing a referral guide for doctors and establishing a standard genetic services center to improve the status of genetic counseling in Bushehr in order to control and prevent these diseases seems necessary.

The process by which family physicians refer patients to specialized levels of the healthcare system is presented. In other words, the referral system can assure us that the clients of health care services are optimally allocated at the specialized level of services. In addition to providing proper time and providing proper health care for health benefits. The referral process is a specialized outpatient consulting process that determines the course and communication of the individual in three levels of the health system to provide the integrity and continuity of services this study aimed to determine the quality of referral and feedback forms in the medical family physician of Mazandaran province in 2019.

This descriptive cross-sectional study was conducted to examine the form of insurance referral of social security insurance by physicians of urban families and feedback from experts. After receiving the code of ethics and obtaining permission from the relevant organization the researcher paid the social security organization 1397 issued by the physicians in the province. The statistical population consisted of all forms of reference and the feedback from experts to the social security insurance organization to get the right According the report of the department of medical record department of the social security insurance organization of Mazandaran province in1397 has been handed over to that organization in a total of 151075 reference sheets completed to obtain the right of the specialists. the collected data were entered into Excel software for statistical analysis was performed in descriptive statistics using central dices (mean, median, mode) and dispersion index(variance, standard deviation, range of changes, coefficients of variation ) for quantitative variables, and index, percentage, and prevalence for qualitative data. The data were analyzed by using spss-25 software.

The study of 3200 cases of referral and referral forms of family physicians and specialists showed that among the Physicians 2321(72.5) were male and 879(27.5) were female. The patient's records in 586(%18.3) were incomplete. Clinical findings Were found in 98(2.7%) cases and paraclinical findings were incomplete in 22 cases (0.7%) and complete in 171 cases (5.3%). in 884 cases (27.6%) the papers were illegible the cause of referral was written in 560(17.5%). the reason for further referral in 187 cases (5.8%) was written by experts. In addition, 1454 cases (45.4%) of the return sheets completed by specialists were illegible.

The results obtained in this study show that the status of the quality of completion of the referral form by the family doctors and also the status of providing feedback by the specialist doctors are not suitable. to improve this situation the implementation of face-to-face and non-face-to-face training programs for both groups and using electronic referral forms can be put on the agenda.

The pediatric palliative care (PPC) includes active care of the child's body, soul, and mind, as well as family support. The purpose of this study was to develop a model for providing pediatric palliative care based on the point of views of the Irania nurses and the physicians in Iran. The objective of this descriptive analytic study was to develop a model for PPC and to confirm each of the factors presented in the model. Factor analysis was performed using Keizer-Meier (KMO) and Bartlett (BT) tests. A researcher-made questionnaire was used to measure the necessity of providing PPC services. This questionnaire contained 28 questions in three areas or factors (9 items about the children, 12 items related to the family issues, and 7 items related to national health), and the statistical analysis was done by using SPSS 21. The item "Attention to moral concepts in dealing with the family at the family level" had the highest mean score (4.4±0.28). The items "Trying to have a peaceful death in the end stages of life in the child's area" and "Benefiting from equal palliative services at the national level", respectively with average scores of 4.2±0.52 and 4.1±0.4 in the ranks, at the second and third of this necessity. The PPC model was developed based on the results of this questionnaire. According to the result of the questionnaire items used in this study, the palliative care necessity model was developed. It is also concluded that providing PPC in Iran is necessary.

Triage is the process of assessing and categorizing patients to improve management and service delivery. A reliable triage system should be capable of accurately identifying patients who require immediate medical attention. The emergency severity index (ESI) is currently the most widely used method for triage, and it is a validated triage system. This study aimed to assess the ability of emergency department nurses to triage patients utilizing ESI.

A cross-sectional study was conducted on 272 patients who were referred to the emergency department (ED) of Shahid Bahonar Hospital of Kerman in July 2022. The triage of the patients was performed by emergency nurses, and the results were compared with those determined by physicians. Cohen's kappa coefficient was evaluated between the two groups (nurses and physicians) to determine the inter-rater agreement.

The triage group was correctly identified for 72.1% (196) of the 272 patients, while 13.6% (37) were under-triaged and 14.3% (39) were over-triaged. The priority was accurate for only 56.6% of patients, and 7.1% of patients received a lower priority. The agreement level between the two groups was 60.5% (95% CI: 0.532-0.677) measured by the kappa coefficient.

In this study, the agreement that was found in terms of patients’ triage was average. Although the triage was more inefficient than risky, long-term training programs are highly recommended for enhancing the accuracy of the triage.

Cutaneous leishmaniasis is a highly prevalent zoonotic disease in Iran. Physicians play a crucial role in the prevention, control, and treatment of this disease. Therefore, this study was conducted to assess the knowledge, attitude, and practice of physicians working in the health system regarding cutaneous leishmaniasis in two endemic areas in the southeast of Iran.

This descriptive-analytical study was conducted between May and December 2023. The study included all physicians working in comprehensive urban and rural health service centers in Zahedan and Mirjaveh counties that were selected through the census method. A researcher-made questionnaire was used to collect the data, and statistical analyses were performed using SPSS software. The Mann-Whitney test and multiple regression model were utilized for the analytical statistics with a significance level of 0.05%.

A group of 57 physicians responded to the questionnaire. The average knowledge score of physicians regarding cutaneous leishmaniasis was 19.63 ± 4.9 (out of 34), the average attitude score was 76.75 ± 7.75 (out of 95), and the average practice score was 9.18 ± 2.41 (out of 14). Both the knowledge and practice of physicians had a significant relationship with the patient's visit history and the type of health center. Additionally, participation in retraining courses was found to have a significant relationship with their knowledge, attitude, and practice.

Physicians exhibited moderate practice and good attitude towards cutaneous leishmaniasis, however, their knowledge was weak. Therefore, implementing appropriate retraining programs is necessary to enhance their knowledge.

Optimal collaboration between members of the patient management team; especially physicians and nurses; can effectively prevent stress by creating an appropriate moral atmosphere that leads to the improvement of the quality of care.This study aimed to determine the attitude of nurses and physicians toward physician-nurse collaboration working in the neonatal intensive care units of the teaching hospitals in Tehran, the capital of Iran.

In this descriptive and analytical study, carried out in the neonatal intensive care units of the teaching hospitals in Tehran in 2018-2019, 234 physicians and nurses, selected by the available sampling method, participated in the study. Data were analyzed by SPSS V21 software with T-test, Pearson, and Anova.

The mean attitude score of nurses was 24.15 with a frequency percentage (40.25%) compared to physicians' 25.70 with a frequency percentage (42.80%) (P<0.05). The highest average score in the questionnaire was related to teamwork and information sharing among physicians and nurses, 6.75 and 8.73 respectively. A significant relationship was found between nurses' attitudes toward work experience, working hours, and liability insurance (P<0.05).

The attitude of the nurses and physicians about physician-nurse collaboration in this study was revealed to be unsatisfactory. One of the important reasons for the negative score of the attitude of nurses and physicians towards collaboration may be the point that sufficient importance is not given to the role of nurses in patient management. It is therefore recommended to identify factors affecting the improvement of collaboration, as well as maintaining enough weight to the role of nurses in patient management by further studies.

Many people want to be successful, but few have a comprehensive definition of success. As a result, their actions are directed in different directions, some towards success and many others away from success. Based on this, the aim of the current research was to design a model of a successful doctor based on goal and professional orientations. This qualitative research was conducted using the seven-step method of Sandelovski and Barroso. The metacomposite team consisted of three experts in curriculum planning and one expert in metacomposite research. 17 related research sources were the basis of the analysis, the result of which is the extraction of 12 types of goal and professional orientation. The validity of the data was confirmed by using the techniques of reliability, transferability and alignment of data and trustworthiness of the data was also confirmed by the accurate guidance of the flow of information collection and alignment of researchers. The results showed that the model of a successful doctor can be divided into two main themes: goal orientation (including proving one's ability to others, the desire to perform difficult tasks beyond one's current ability, making every effort to avoid failure, etc.) and orientation Professional (including diagnosing the disease, paying attention to the symptoms of the disease, making the right decision, etc.) Based on the results of the research, on the one hand, educational planners can have a wide range of experiences, on the other hand, many psychological factors such

Since the rules and conditions of the criminal and civil responsibility of the doctor in the current laws of Iran are collected in a unified law, i.e. the Islamic Penal Code approved in 2012, in some writings, the aforementioned rules are mixed. Despite this, the said rulings are independent of each other and there is no connection between them. Therefore, the necessity and importance of the present research is evident. This research, especially emphasizing the common nature of the institution of dowry, confirms the fact that most of the rulings of dowry follow the rules of civil liability.

The present research was compiled with the qualitative research method and content analysis and by collecting information from library sources and referring to laws and legal articles.

The results of the research indicate that the Islamic Penal Code approved in 2013 is in harmony with the legal principles and jurisprudence foundations in the position of separating the boundaries of two types of civil and criminal responsibility of the doctor towards the patients: separating the nature and effects of the patient’s consent from the condition of the doctor’s acquittal. And paying attention to the difference in the concept of fault in criminal and civil law is one of the strengths of the law.

By criticizing and analyzing the legal thoughts about the legal responsibility of doctors, it seems that some of the rules of the civil liability of doctors have been mixed with the punishments. In addition, the provisions of the law are flawed and ambiguous in some cases: it is objectionable to apply imprisonment in the case of the patient’s death due to medical malpractice, if the doctor’s malice or the commission of a criminal offense is not evident. Therefore, the application of Article 616 of the Penal Law approved in 2006 is excluded from cases of civil fault and in these cases only the guarantee of ransom is established. In addition, the defects and ambiguity related to the determination of illegitimate medical practices can be resolved by passing special laws.

The early mobility of a patient hospitalized in the intensive care unit (ICU) is a very complicated issue and requires coordination between the departments and between all ICU staff, including physicians, nurses, and physiotherapists. Early mobilization program is safe and feasible and has positive results for the patient, medical staff, families, and health system. The present study aims to determine the barriers to early mobility of patients admitted to the ICUs of hospitals in Kohgiluyeh and Boyer-Ahmad Province, Iran.

This is a descriptive cross-sectional study conducted in 2020-2022. The study population consists of the ICU staff of hospitals in Kohgiluyeh and Boyer-Ahmad Province, including physicians, nurses, and physiotherapists. Sampling was done by a census method. The data were collected using a demographic form and a researcher-made questionnaire of early mobility barriers of ICU patients and analyzed in SPSS software, version 18 using descriptive and inferential statistics.

In the present study, 174 nurses, physicians, and physiotherapists answered the questionnaire, where 57.8% were female and 59.8% were single. Among the barriers to early mobility, the patient-related barriers had the lowest mean (0.411±0.108) and cultural barriers had the highest mean (0.478±0.146).

It is necessary to investigate the barriers to early mobility of patients admitted to the ICU of study hospitals, especially the cultural barriers. In this regard, there is a need to design a clinical protocol to manage and reduce these barriers.

 Considering the importance of physician-nurse relationship in emergency departments and its role in improving the quality of services, patient satisfaction, job success and staff satisfaction, this study was conducted to investigate nurses' attitude about the professional doctor-nurse relationship and career success of the nurses in emergency departments.

 This study is a descriptive study in which 197 nurses working in the emergency departments of hospitals affiliated to Tabriz University of Medical Sciences participated. Data collection tools included demographic characteristic; physician-nurse professional communication questionnaire and nurses' career success questionnaire. The collected data were analyzed using descriptive and inferential statistical tests with SPSS ver.21 statistical software.

  The findings showed that the mean (SD) of the professional physician-nurse relationship from the perspective of participating nurses was 3.07 (0.54). Cooperating dimension with the mean score of 3.34 (0.79) had the highest score and imposing opinions and tasks dimension with the mean score of 2.62 (0.85) had the lowest score. Also, the mean (SD) score of nurses’ career success was 4.21 (0.40) with the highest mean in the dimension of system assistant 4.33 (0.55) and the lowest mean in the effective dimension 4.08 (0.41).

Considering the importance of the professional physician-nurse relationship, it is necessary to pay more attention to the effective factors in its promotion by implementing interventions such as professional communication skills training and effective interaction in strengthening the professional relationship of the treatment team.

Practical Implications: 

 The results of this study can be used to improve professional communication between health care team members and their work success. As a result, in addition to increasing job satisfaction and improving the psychological condition of personnel, the safety of patients will also be increased and the amount of injuries caused by communication defects will be decreased.

The article "Referral to the patient for permission to receive treatment" is one of the articles on jurisprudential maps and medical law. The subject matter of the present study is not limited in scope to the patient's initial objection, inability to express the patient's consent, or satisfaction; Rather, the argument for the patient's recourse to permission with a general approach is based on the acquittal of the physician and the hospital or their guarantee,

The researcher uses a descriptive-analytical method to strengthen the legal structure of doctors and hospital managers and with a new insight into the second paragraph of Article 308 BC, intends not to refuse treatment by a doctor if the patient consents to the previous permission,

Physician liability and penal policies towards those whose sole purpose is to treat patients are far from fair; Therefore, by reviewing the laws and replacing the civil liability of the government, we can strengthen the responsible, feeling and committed medical community.

As a result, doctors have cited the reasons for preventing self-harm and the prohibition of induction of death, the rule of medicine and the moral responsibility of the physician for not referring the patient after the initial (former) permission;, patients, by arguing for self-domination. Therefore, it is appropriate for the legislator to remove the government's liability for the physician's actions or for not seeking permission from the contract to resolve disputes over the physician's discharge or guarantee.

This study aimed at examining the convergence of calculated HEART pathway by physician and nurse along its utility to predict the 3-month occurrence of major adverse cardiac even (MACE) in patients with chest pain admitted to emergency department (ED).

The HEART pathway is a tool to predict MACE in patients with chest pain admitted to ED, to help risk stratification for early discharge and reduce unnecessary cardiac tests.

In the present study, a diagnostic tool was evaluated. Ninety-seven ED patients with acute chest pain, hospitalized in Rajaie Cardiovascular Medical and Research Center, were recruited prospectively. Risk stratification was performed by an ED nurse, a cardiology resident, and a cardiology attending physician. The correlation and the 3-month MACE outcomes were analyzed. 

Pairwise agreements were excellent between the raters. The Intraclass Correlation Coefficient (ICC) among raters were 0.84 (95% CI: 0.73–0.97) and thus, overall agreement was excellent. The HEART pathway score showed a high predictive power (AUC: 0.85 for 3-month MACE). For a cut-off score of 4, sensitivity, specificity, and negative predictive values were 87.5, 58.9, and 95.8 percent, respectively.

The HEART pathway score predicted effectively 3-month MACE in patients with acute non-traumatic chest pain. The high agreement among the three different raters suggests that nurses might use efficiently the score.

A good and healthy communication between the physician and patient and the therapeutic staff is the basis of good medical care, and communication skills play an important role in patient's satisfaction and their treatment. The aim of this study was to explore the physicians' communication in public hospitals of Yazd city using phenomenological methods.

This qualitative research was conducted using the phenomenology method from January 2021 to August 2022. The location of the study was 2 hospitals affiliated to Shahid Sadoughi University of Yazd. The statistical population included general practitioners and specialists from the government hospitals of Yazd city. Among these doctors, 12 people who had a working experience of more than 11 years and were willing to cooperate with the researcher were selected as the sample using a selective and purposive method. Data were collected through interviews. Lincoln and Guba criteria were used to assess validity and reliability of the research, and these data were analyzed by NVIVO 11 software.

Results demonstrated that physicians' communication pattern consisted of 11 sub-themes: psychological factors; family factors; lack of skills; information disorders; challenges related to patients, colleagues, and medical profession; hospital environment; social harm; and religious factors. These sub-themes were categorized into five main themes: environmental, individual, communicative, cultural, and professional aspects.

Establishing a proper relationship between the patient and physician is the essential component of a high quality medical care. Improving this relationship will cause patient's more commitment to the treatment, more satisfaction with the medical team, and less medical errors and complaints.

Access to healthcare is a fundamental right of every individual, regardless of their geographic location or socioeconomic status. In many countries, deprived areas often face a shortage of physicians and other healthcare professionals. This study aimed to investigate the approaches essential to attract and retain physicians in the deprived and rural areas.

The present study is a systematic review using appropriate keywords in Persian and English language. The main databases including Google Scholar, Scopus, Web of Science, PubMed, SID, and IranMedex were searched from May 2005 to September 2022 in both languages. Different approaches implemented by countries to attract and retain doctors were classified using thematic analysis.

A total of 18 articles were selected for inclusion in the study. Educational, regulatory, motivational, and personal and professional support drivers have been used to attract and retain physicians. The successful interventions implemented were mainly educational and supportive; such as admitting native medical students, providing relevant curricula on working in the deprived and rural areas, and conducting training courses in these regions. Those studying the topics and courses related to serving in the rural areas during their academic education or internship and residency programs had served more time in these areas. Assimilating the topics related to providing services in rural areas into the curriculum, holding fellowship courses and related graduate studies, awarding scholarships to the physicians working in deprived areas, providing free amenities, reducing working hours, and considering special holidays are considered among the recommended solutions.

Various drivers were used for attracting and retaining physicians in the deprived and rural areas. Besides, the challenge to retain doctors in such areas was fairly common. Most countries have put more priority on the use of financial incentives, nevertheless, a combination of interventions was preferred. It is worth mentioning that a range of economic, political, and social factors could play a key role in the success of recommended interventions.

Since professional development is one of the goals of any medical school, an essential element in this regard will be the evaluation of professional behavior which is important as one of the most important competencies in the medical profession. Therefore, the present study was conducted with the aim of determining the level of observance of behavior and professional commitment of specialized physicians from the perspective of patients in 2020.

This descriptive study was performed on 150 patients admitted to Imam Khomeini Hospital in Tehran who were selected by simple random sampling. Data collection tools included two sections: demographic variables and 18-item 5-point Likert scale professional behavior and commitment. Data were analyzed using descriptive statistics, Pearson and Spearman correlation tests and multiple linear regression.

The mean and standard deviation of the score of the instrument for observing the behavior and professional commitment of specialized physicians from the patients' point of view was 70.55 ± 9.68 with the lowest score of 49 and the highest score of 90. More than half of the patients 67.3% (101 people) determined the level of professional behavior and commitment at a good level and 32.7% (49 people) at a moderate level.

  Based on the results of this study, professional commitment and behavior are at a good level. The lowest level of compliance was related to not accepting responsibility for diagnostic and treatment errors. Therefore, the relevant authorities should pay attention to identifying the causes of these shortcomings and taking measures to gain experience from the errors.