Journal of Medical Council of Iran
Year:2012 | Volume:29 | Issue:4|Papers Count:13

Background: family physician plan is one of the most important methods of improving access and equitable utilization of the health services. Implementing the referral system in this plan ensures proper utilization of health and hospital services. However, evidence suggests that the salient weakness of family physician plan is the failure of referral system. This study aims to identify existing challenges in implementing second level of referral system in family physician plan.Methods: Data were collected through semi-structured interviews. A purposive sample was identified according to predefined criteria. Data analysis was conducted using stages of framework analysis. According to a thematic framework, themes were set and key issues were identified.Results: Twenty two semi structured interviews were conducted. Four themes and thirty four subthemes describing challenges of the second level of the referral system in family physician plan were identified: challenges related to units or employees of second level of referral system, to units or employees of the first level of referral system, to management and to general public.Conclusion: Several factors influence referral system quality, especially at the second level, which are mutually in a cause and effect order. Therefore, any effort to improve the quality of the referral system at this level requires systematic and coordinated actions based on a deep understanding of obstacles and challenges.

Background: Internet is one of the most important tools to information access. Pattern of internet use in high school students and its safety in Tehran was studied.Methods: By stratified sampling all of 19 education districts were divided to three areas (North, Centre, and South). A cross-sectional study was conducted on 552 subjects according to subjects' distribution in each region. Questionnaire was validated by content validity and reliable by test- re- test. Trained interviewers collected data after provided written informed consent.Results: Mean age of subjects was 16.4±1.704, range (14-19) years. Pattern of internet use showed that: the most usable cite was music (45.3%) and favorite cites was image (41.7%) among subjects. 43% of subject were familiar to ban cites. Among 70/1% of subjects place of internet was at personal room and its location was at home (67.2%). 28.3% of subject used from internet at night and chat room and filter breaker. A significant difference was observed in filter breaker using and banned cite among boys 43.3% than the girls 31% and in internet using and eye pain among girls 18.1% than the boys 12.7% (p<0.001).Conclusion: Near to half of subject were familiar to ban cite. According to internet using pattern received of pornographic pictures or other ban cites was probably. Safety of internet using needs to more attention by family and community.

Background: Patients often suffer from inadequate treatment of postoperative pain. The aim of this study was to investigate patients’ satisfaction after postoperative acute pain management.Methods: In this prospective study, from September 2009 to Augest 2010, 1424 patients presented by general surgery, orthopedic, obstetric & gynecology, ophthalmology and neurosurgery specialists to acute and chronic pain service of Imam Hossein Hospital.A satisfaction questionnaire with 26items was given on discharge to this patients, were asked to fill out it and then collected by ward nurse.Results: Patients’ satisfaction was high in 1421 (99.8%) and moderate in 3 (0.2%). Financial patients’ satisfaction was moderate in 980 (68.8%) and low in 444 (31.2%). Patients’ satisfaction of products support was high in 1418 (99.6%) and moderate in 6 (0.4%).Conclusion: Patients’ satisfaction was high for acute & chronic pain service, and low for the costs. So, more studies and efforts are needed to make improvements in the cost-related problems of postoperative acute pain management.

Background: Emergency Departments (ED) are the heart of hospitals and they have unique and essential position in health care systems. In ED, the actions should be fast, high quality and effective. So we decided to evaluate the ED in which the Emergency Medicine attending and residents are working and compare the ED with Ministry of Health standards.Methods: In this descriptive cross-sectional study, 7 governmental hospitals in Tehran which had Emergency Medicine residents and specialists system assesed and compared with standards of Ministry of Health.. The SPSS software was used for analysis. Frequency tables and bar chart were achieved by this software.Results: Considering the 19 main factors, 91.85% of standards were protected. In one of the hospitals the whole standards were protected and the lower rate of protection was 75 per cent. Three parameters (clerk WC, medical documents and emergency drugs) were perfect in all of hospitals but isolation room and physical architecture gained lower rate. (71.4 & 80.71 per cent respectively)Conclusion: With regard to Ministry of Health standards, it seems the conditions of EDs are favorable but these standards are not perfect and should be revised. Also application of Emergency Medicine specialty in ED might result in improvement of standards.

Background: One of the leading causes to orchiectomy is the testicular torsion. It seems that early diagnosis and surgical exploration improve testis salvage after testicular torsion.Methods: To assess the delay cause of orchiectomy our patients included in a Cross sectional hospital-based research. In all patients with suspected testicular torsion scrotal exploration were done in Shahid Labbafinejad Hospital over 1 year period.Results: Of Forty patients underwent surgery, 28 (70%) had testicular torsion and then 10 (25%) required orchiectomy. Delay in presentation to the hospital and misdiagnosis by general practitioners were the two main causes of delay leading to orchiectomy in patient with testicular torsion.Conclusion: Orchiectomy rate due to testicular torsion is high. To reduce it we suggest to evaluate our general population education and medicines programs.

Background: AIDS is spreading around the globe very rapidly and still there is no absolute treatment for it. Although patients with this disease are in need of routine dental care, previous studies has shown that many dentists refuse to treat them in their office. So the objective of this study was to determine the knowledge, attitude and practice of general dental practitioners concerning with HIV positive patients in Qazvin.Methods: fifty-one general dental practitioners working in Qazvin were selected for this descriptive-analytic study. In order to evaluate their practice, the examiner pretended to be disguised herself as a HIV+ patient and made appointments to visit them at their dental clinics. Than for the assessment of their knowledge dentist were asked to fill out some HIV-related questionnaires. Statistical analysis was performed using SPSS software.Results: 30 dentists (71%) were in a average level of knowledge with a mean of 59.5%+_15.1%. Although, 36 (70%) of dentists refused to treat HIV+ patients,but only 13(32%) of them expressed their reluctances in questionnaires.Conclusion: No statistically significant relationship was found between knowledge, attitude of dentists and their practice, regarding HIV+ patients.

Leptospirosis is a bacterial zoonotic disease caused by spirochaetes of the genus Leptospira that affects humans and a wide range of animals. The disease was first described by Adolf Weil in 1886, reported as an "acute infectious disease with fever and jaundice". Outbreaks of leptospirosis are usually caused by human exposure to water or soil contaminated with the urine of infected animals through broken skin especially mucosal surfaces. Direct contact with infected animals may also be significant (slaughterhouse workers, veterinary surgeons)or in certain occupations, e.g. workers in rice fields or those who swim in infected surface water or adventure sports in tropical regions. Patients may appear as asymptomatic, mildly ill or toxic. High fever, chills, myalgias particularly prominent in the paraspinal and calf muscles and intense headache are among the first flulike symptoms that may appear. Later in severe disease, jaundice, meningitis and renal failure can develop. Cardiovascular problems are also possible. Diagnoses procedures include testing serologically with a panel of different strains. It is also possible to culture the microorganism from blood, serum and fresh urine. Hygienic methods such as avoidance of direct and indirect human contact with animal urine are recommended as preventive measures. The main preventive measure for leptospirosis is to create awareness about the disease and its prevention.Treatment for leptospirosis is based on antibiotic therapy allied with supportive care. There are no clinical examples of drug resistance developing. This review article also presents survey and the disease burden in Giulan.

Diabetic foot ulcer is one of the most important chronic complication of diabetes, which led to prolonged hospitalization and finally amputation of the foot, has psychological and economic burden to individuals and families and the health system. Ischemia, Neuropathy and infection are three pathological factors which lead to diabetic foot complications. Although all diabetic foot ulceration are not preventable; physician knowledge, clinical examination of foot problems, treatment of small lesions, patient education and appropriate foot wear recommendation reduced the number of foot ulcer associated to diabetes.Components of basic concepts of the diabetic foot treatment including the infection control, establishing appropriate arterial blood flow and removing pressure and stress from painful areas (Offloading). Along with standard treatments, there are supplementary therapies which accelerate the wound healing process such as novel dressings including hydrogel, Platelet-rich plasma (PRP), growth factors, stem cells, HBOT, VAC, and new herbal therapy (AngiparsTM).For compiling of current article, we have searched related sources through the databases of PubMed, Ovid, Google Scholar, Elsevier, Up To Date, Cohrane Library addition to printed journals in this field.Conclusion: It could be concluded that although various developments have been made in the field of diabetic foot ulcers has been made, most of them had the relative effects and complement each other’s, more effective treatments would be considered necessary.

Left main coronary artery divides to left anterior decending artery and circumflex artery. Total occlusion of left main coronary artery without extensive MI and cardiogenic shock is rare finding.Patient is a 55 year male that admitted to hospital with severe chest pain. Last year he had a history of exertional anyina. In morning day of hospitalization have severe long about one hour chest pain associate with nausa sweating. Patient in duration of hospitalization have recurrent angina that relief by sublingual nitrate. so patient candied for coronary angiography. coronary angiography was done and showed total occlusion of left main that filled from RCA. Patient candied for CABG.Total occlusion of left main coronary artey without cardiogenic shock and death is rare finding. this phenomena when occurred that occlusion is chronic and associated with well-developed collateral from RCA.This situation may be presented with stable angina. this patient so have one year ago stable angina. mainstay treatment for total occlusion of left main coronary artery is CABG.