مجله تحقیقات نظام سلامت حکیم
سال سیزدهم شماره 1 (پیاپی 48، بهار 1389)

This study was designed to evaluate academic achievement and its indicators among Iranian postgraduate students who had been awarded governmental scholarship to continue their studies abroad in the field of medical sciences. Self-administrative questionnaires were distributed among eligible ex-students who studied abroad between 1997 and 2003 and their supervisors, via email. Their lists and contacts were received formally from the ministry of health and medical education and were verified and updated by their sponsored universities in Iran. Overall, ex-students believed that they were successful however, they mentioned that their achievements would have increased if they had more experience in the beginning of their studies. Their supervisors mentioned that only 10% of their ex-students had capacities less than the average. The main achievement indicators were being updated about advances in their scientific fields, and obtaining information in relevant scientific fields. Regarding the most important factors in their successes, ex-students pointed to their personal determination and perseverance, and the scientific level of their departments and college. Supervisors believed that their Iranian students were ethical, intellectual and reliable, whilst they had weaknesses in English writing and reading skills, and leadership competence. Although the students evaluated themselves successful and their supervisors almost agreed, but it seems that it is necessary to pay more attention to students’ English skills and research management to improve their academic achievement. Besides, evaluation of students’ progress and their academic achievement based on indicators that are more objective is recommended.

Cigarette is the most common and cheapest addictive substance associated with physical, financial, familial and social harm. Khantezian self-medication hypothesis proposes that many people smoke because of low distress tolerance and emotional dysregulation. However, there is no research concerning this issue in Iran. The present study aims at analyzing the relation among distress tolerance, emotional regulation and smoking dependence. 118 male smoker students from University of Tehran were chosen as samples. They were B.A. students of psychology, Law and Political Science fields being 18 to 27 years old. The rate of smoking dependence among them was assessed by Fagerstrome Nicotine Dependence Test (FTND). The distress tolerance rate and emotional regulation was also assessed by Simons and Gaher Distress Tolerance Scale (DTS) and Difficulties in Emotion Regulation Scale (DERS). The data was analyzed by analysis of variances, multiple regression and Pearson`s correlation coefficient. There was a significant negative correlation between distress tolerance rate of the students and their nicotine dependence (r=-0.711, p<0.01). There was also a significant positive correlation between the students’ emotional dysregulation and their nicotine dependence (r=0.856, p<0.01). The results indicated that lack of emotional clarification, difficulties in impulse control and appraising and absorbing distress, predict a significant percent of dependence variance (p<0.01). There is a significant correlation between distress tolerance, emotional regulation and smoking dependence. The results are parallel with the addiction self-medication theory.

Referral system has an important role in cost reduction and patient access to more specialized services. Regarding the importance of the referral system in family physician program, this study was performed to evaluate performance of the referral system in Iran University of Medical Sciences. This descriptive- analytic study was performed in 2009. 27 health care centers (52%) in which the family physician program was implemented and rural insurance was covered by Iran University of Medical Sciences in Shariar, Robatkarim, Karej, Savojbalagh and Nazarabad distric were randomly selected. In each center 7- 10 patients who were referred to level 2 by their family physician and received necessary services were evaluated. From 225 patients who received level 2 services, 137 cases (60.9%) were female. 78 (34.7%) were referred form health houses. 146 persons (64.9%) referred with the will of family physician and in 79 cases (35.1%), the family physician had the role to choose a specialist of level 2. For 68 cases (30.2%), the specialists wrote the results of their evaluation in "feedback form". Only 57 patients (25.4%) returned to their family physicians. 127 patients (75.6%) didnt return to their family physicians because of lack of knowledge. The performance of the referral system in family physician program is not as expected and requires improvement.

Iran has recently experienced a significant increase in the number of publications in the field of medical sciences. This has made authorship and other related ethical issues very important. Our aim was to explore the perception of Iranian researchers and medical journal editors about authorship and related ethical issues in medical publications.

A questionnaire was sent to editors of Iranian medical journals through e-mail, which included questions about definition of authorship, compliance of Iranian researches with this definition, possible reasons for the incompliance and their suggestions for improving the compliance.

Out of the 112 responses received, 52% agreed with the authorship definition suggested by the International Committee of Medical Journal Editors and they considered it applicable in Iran as well. They believed that this definition is applied in less than 50% of Iranian publications the most important reasons are: authors’ egocentricity (71%), pressures and limitations imposed by supervisors and line managers (50%), and unfamiliarity with the related principles and regulations. The most frequent suggested punishments were a formal warning and preventing the author from the benefits of the paper. Designation and implementation of appropriate regulations (52%), educational programs (39%), and other preventive actions (39%) were considered as the most important strategies for reducing this problem.

Most of the respondents agreed with the international standard definition of "author" and found it appropriate for Iran. They believed that implementation of relevant regulations, in addition to educational programs and appropriate rewards and punishments can improve compliance with these standards.

Patients who leave hospital against medical advice may be at risk of adverse health outcomes and readmission. In this study we examined reasons of discharge against medical advice (DAMA) in University hospitals of Kashan University of Medical Sciences and Health Services in a six month period in 2008. We conducted a descriptive-cross sectional study on 865 patients who left the hospitals against medical advice. Patients were selected by systematic random sampling, data was gathered by telephone survey with a valid (split-half, r =0.78) and reliable (face and content) structured questionnaire consisting of four sections of: reasons related to patient's problem, personnel's problems, hospital conditions and demographic data. Data were analyzed using descriptive statistics methods. Of 865 patients, 829 (95.84%) responded 460 (55.5%) were male. 506 (61.04%) of DAMAs were due to patients problems, 207(24.96%) were due to personnel's reasons and 116 (13.99%) were due to hospital conditions. There was a significant difference among the gender of patients discharged against medical advice in the group of reasons relating to personnel (P<0.01). Most DAMAs were from Emergency ward (30.28%). The total rate of DAMA was 10.3% (9.9% -10.75%, α = 0.5). D AMA rate was high and the most common reasons were patient's problems. Employing clinical social workers in wards, increasing patients’ knowledge about adverse effect of DAMA, planning outpatient services for those who leave against medical advice and providing convenient environment for patients in the hospital are recommended solutions to decrease DAMA.

Quality management improves longstanding satisfaction of the customers. FOCUS-PDCA is one of the methods of quality management and process improvement which was designed by American hospital association in 1989. This case study explores the implementation and evaluation of continuous quality improvement (CQI) in primary health care system of East Azerbaijan Province. CQI was implemented with institution of steering committees, creation of learning networks, cascade education of employee, and improvement of key processes. 260 improved processes in health houses, health centers and district health centers in 2001- 2002 were evaluated by a specific checklist, assessing process type, improvement team, tools that were used, community participation, amount of improvement, measurement indicator and improvement strategy. Assessment of the processes five years after implementation of quality management showed that organization culture was in concordance and alignment with quality. The biggest change was seen in staff participation, effective communication, team work, acceptance of criticism, attention to the voice of customers and process standardization. CQI changed traditional literature of managers and employees and expanded the use of quality, and customer and process based management to the service delivery point. The average number of the people participated in each teams was 5.8. In 43% of the projects, the improvement teams used control charts. For establishing CQI culture in any organizations, it is necessary to educate the service providers about it. FOCUS-PDCA is a simple method for performance improvement which can be easily taught to managers and staff.

Clinical practice guidelines are formatted texts that are prepared in a systematic approach to help clinical decision making in special conditions. The aim of these guidelines is to prepare clear recommendations with definite goals to influence the audience, mainly the physician. In this study, the appropriate approach for adoption of clinical practice guidelines in the national health system is defined based on the experienced project in the Iranian national health system in 2005-2007 which yielded in 20 national guidelines for primary care physicians. The process of adaptation consists of three stages. The first one is the preparing stage which consists of the steps necessary for starting the process of adaptation and is composed of 5 sub-stages. The second stage is writing and editing the questions, which consists of selecting and preparing a number of questions and then searching the resources and finding the guidelines. This stage consists of 12 sub-stages. The 3rd stage is the finalizing stage which consists of 3 sub-stages and includes getting feedbacks, consultation, updating and finalizing the guideline draft. Using c linical practice guidelines, especially when they are prepared by adoption method, can increase the quality of care in health care systems. Of course it needs extensive planning and coordination in different parts of the system fortunately promising approaches have been taken in our country in recent years.