Background AND Objectives: Neglect of God may cause adverse emotions, unhealthy lifestyle, AND high-risk behaviors. Such a spiritual vacuum, damages the bio-psycho-socio-spiritual health of individuals. Study was conducted to design AND validate the spiritual health consulting model for health promotion in clients. Methods: In this qualitative study, universal models of nursing care, prominent models of health training, AND theories of motivation were content analyzed. Considering the constructs of spiritual care model of Sound Heart, after adopt appropriate themes AND clinically use of prominent models, spiritual health consulting model was developed using the three-step theory synthesis of Walker AND Avant. Results: Sensitizing AND informing clients of consequences of unhealthy lifestyle, high-risk behaviors, AND adverse emotions, with a sense of perceived threat, motivate clients to modify themselves. The modification of four spiritual relationships (with the nature, people, himself, God), besides the use of subjective norms, result in the behavioral intention, making clients determined to modify their behaviors. Family’ s cooperation, spiritual advisers’ behavior as a role model, AND self-control training can facilitate the implementation of the consulting by creating a sense of self-efficacy AND increasing client’ s self-esteem. Conclusion: Failure to pay attention to the lack of spirituality may threaten psycho-socio-spiritual health of clients AND cause social crises. Spiritual advisers are required to maintain AND promote the spiritual health in clients based on a community oriented AND holistic model.

Background: The benefits of addressing behavioral health issues in inpatients have been well documented. However, these problems are not frequently recognized by physicians during the hospitalization of patients in general hospitals. Objectives: This study described the current statusANDmedical diagnosesmadein psychiatric CONSULTATIONs to inpatients admitted to general hospitals affiliated to Babol University of Medical Sciences, North of Iran. Methods: This cross-sectional observational research was carried out at Babol University of Medical Sciences from 2019 to 2020. All psychiatric CONSULTATIONs for patients hospitalized in different departments of two general hospitals affiliated to this university for 6 months were included. The mental disorders diagnosed for patients were recorded by a psychiatrist according to the diagnostic AND statistical manual of mental disorders (DSM-5) criteria. Results: A total of 266 patients with a mean age of 51. 21 ,16. 95 years were examined. Most of the consults were requested by the departments of cardiology (39. 5%) AND neurology (16. 2%). According to the psychiatric visits, 32. 3%, 51. 1%, AND 15. 4% of the patients had no, one, AND two concomitant psychiatric disorders, respectively. Mental disorders were found to have a significant association with gender (P < 0. 001), admission department (P < 0. 001), comorbid malignancies (P = 0. 011), cardiovascular disorders (P < 0. 001), need for surgical intervention (P = 0. 018), a history of substance use (P = 0. 001), AND reasons for consult request (P < 0. 001). Conclusions: Mental disorders, especially mood AND anxiety disorders, were identified in approximately 70% of CONSULTATIONs. Therefore, requesting a timely psychiatric CONSULTATION can lead to better managing hospitalized patients.

Background: The recently developed policy of the family practice program in rural regions of Iran faced some challenges such as inefficient REFERRAL system. The health insurance organizations (purchaser) AND health policy makers are concerned about the high rate of patient REFERRALs from family physicians to specialists due to imposing unnecessary services AND costs.Objectives: This study examined utility of the theory of planned behavior to explain intention of Iranian family physicians to reduce REFERRAL rate of patients with respiratory diseases to medical specialist.Patients AND Methods: An exploratory cross-sectional study, employing a correlational design directed by the theory of planned behavior was conducted. A questionnaire was developed based on an eliciting study AND review of literature. One hundred AND seventy-four family physicians working at primary care centers in two provinces of Iran completed the questionnaire (response rate of 86%).Results: The finding revealed that intention of family physicians to reduce REFERRAL rate of patients to specialists was significantly related to two theory-based variables of subjective norms (r=0.38, P<0.001) AND perceived behavioral control (r=0.43, P<0.001), AND not to attitudes. A stepwise regression entering direct measures of the theory variables explained 35% of the variance on the intention, with perceived behavioral control being the strongest predictor. Adding background variables to the model achieved further 5% by variables of practice size AND past REFERRAL rate behavior.Conclusions: The results indicated that psychological variables of the theory of planned behavior could explain a noticeable proportion of variance in family physician's intention to decrease the rate of referring patients with respiratory diseases to medical specialists. The intention is primarily influenced by normative AND control considerations. These findings contribute to a better understANDing of REFERRAL decisions by family physicians AND are of great value in developing interventions to reduce the variation in REFERRAL rate of patients to medical specialists at primary care health centers.

intruction: Training AND consulting attachment behavior may promote bonding between mothers AND infants. The aim of this study was to determine the effect of CONSULTATION in primi-parous mothers on Maternal-Fetal Attachment (MFA) in 2015 in Hamadan city, IranMethods: This study was a rANDomized clinical trial. Subjects were 110 nulliparous women in 30-32 weeks of gestational age. Participants were rANDomly assigned to two experimental AND control groups (each group: n=55). The collected data included demographic information as well as stANDard Cranley’s questionnaire information to measure the MFA. Before the CONSULTATION, questionnaires were completed by both groups. Then, four weekly group sessions during a month were conducted in the case group, while the control group only received routine care. Two weeks after the CONSULTATION, the two groups were re- examined. The averages of score changes in maternal- fetal attachment between the two groups as well as within groups were compared.Results: After CONSULTATION, there was a significant difference between case AND control groups on the mean of MFA scores. The mean of MFA significantly increased in the case group (P<0.001). However, no significant change was observed in the control group.Conclusions: CONSULTATION of the MFA behavior can be used to promote mother- fetus relationship during prenatal care.

Background: Family physician is introduced as a cost-effective approach to promote health equity. More than half a century after the beginning of the family physician program, health systems of different countries have gradually implemented this program in different ways according to the needs of society, policies, resources AND internal infrastructure. The purpose of this article is to review the experience of family physician program in Iran AND selected countries AND to introduce appropriate strategies for the future. Methods: This study is a descriptive comparative study. Information was extracted by querying keywords including family physician, family medicine, health system, Iran, USA, UK, Canada, Turkey, Malaysia, China AND in scientific databases. In addition, data from the World Health Organization AND health systems of the selected countries were used. Results: The history AND development of the family physician program, as well as the duration of training in the United States, the United Kingdom, Canada, Turkey, Malaysia, China AND Iran were described. Conclusion: Although there are similarities in the principles of family physician in most countries, differences exist in policies, strategies AND methods of implementation AND financing. Developments were made to upgrade the REFERRAL system AND strengthen the position of family physician, with the aim of adapting the program to the needs of the people AND solving problems AND challenges.

Background: Improving the family medicine program requires a deep understANDing of the matter. This study has been conducted to integrate global experiences in the field of REFERRAL system AND family medicine in selected countries. Methods: In this comparative study, leading countries in the field of REFERRAL systems AND family physicians such as the United Kingdom, France AND Italy, as well as countries with a similar situation to Iran such as Turkey, which have begun similar reforms in their health system at the same time as Iran were selected to be reviewed. Results: Presented in four parts, the results of this study consist of the REFERRAL condition in the selected countries, financing AND methods of the payment, advantages of the REFERRAL AND family physician systems, AND also strengths, weaknesses, opportunities AND challenges of implementation system AND family physician in the five selected countries. Conclusion: A high percentage of public health needs can be covered in the form of primary health services AND by first-line health care providers. The way to achieve this goal in many countries has been to restrict free access to specialized services in the form of a family physician AND REFERRAL system. Informing AND sensitizing family physicians about the financial consequences of their decisions AND involving them in cashier affairs, as well as empowering them at the first level of the REFERRAL system to provide primary care AND dealing with mistakes of their own AND their peers at the first level of primary care comprise the most effective AND efficient ways in effective implementation of this program.

Background AND Aim: Oral health neglect could be an indicator of more serious mistakes in medicine. This study was conducted to assess the REFERRAL pattern AND attitude of physicians towards oral medicine specialty, AND their performance in dealing with oral lesions. Materials AND Methods: In this cross-sectional study, validated questionnaires were administered among 180 medical practitioners with different specialties working in Yazd, Iran. The questions were about the REFERRAL pattern, attitude towards oral medicine specialty, AND their performance in dealing with oral lesions. Data were analyzed using the Chi-square test, paired t-test, ANOVA, AND Pearson’s correlation test (alpha=0.05).  Results: Of all, 81.1% of the participants had at least one encounter with an oral lesion. One hundred respondents (82.6%) were aware of oral medicine as an independent specialty. The most referred cases were oral lesions in pregnant women (59%), followed by oral ulcers, AND red-white lesions (54.1%). The mean score of REFERRAL pattern had no significant association with specialty, gender, age, experience, AND workplace, but the highest score was acquired by surgeons. The difference in attitude based on specialty was significant (P=0.02), AND the highest score was acquired by ENT specialists. Males had a significantly more positive attitude towards oral medicine specialists. There was a significant positive correlation between practice AND attitude (P=0.001, r=0.285). Conclusion: Considering the unfavorable attitude AND poor practice of medical specialists, it is time to reiterate AND enhance the knowledge of physicians about oral medicine specialty.

Introduction: Burn injuries are under-appreciated trauma, associated with substantial morbidity AND mortality. It is necessary to refer patients in need of specialized care to more specialized centers for treatment AND rehabilitation of burn injuries. This systematic review aimed to assess the adherence to REFERRAL criteria for burn patients. Methods: An extensive search was conducted on Scopus, PubMed, AND Web of Science online databases using the relevant keywords from the earliest to October 7, 2021. The quality of the included studies was assessed using the appraisal tool for cross-sectional studies (AXIS tool). Results: Among a total of 7, 455 burn patients included in the nine studies, 60. 95% were male. The most frequently burned areas were the hANDs (n=3) AND the face (n=2). The most AND least common burn mechanisms were scalds (62. 76%) AND electrical or chemical (2. 88%), respectively. 51. 88% of burn patients had met ¸,1 REFERRAL criteria. The overall adherence to the REFERRAL criteria for burn patients was 58. 28% (17. 37 to 93. 39%). The highest AND lowest adherence rates were related to Western Cape Provincial (WCP) (26. 70%) AND National Burn Care Review (NBCR) (4. 97%) criteria, respectively. Conclusion: The overall adherence to the REFERRAL criteria for burn patients was relatively desirable. Therefore, well-designed future studies are suggested in order to uncover approaches to improve adherence to REFERRAL criteria for burn patients.

Introduction: Dermatological diseases constitute 5-8% of all emergency department (ED) visits. However, little is known about these patients. The aim of this study is to determine the epidemiologic characteristics of patients admitted to ED with dermatological complaints. Methods: This is a retrospective cross-sectional study conducted in the EDof a university hospital. Patients over 18 years of age who presented to EDwith the following complaints were included in the study: rash, pruritus, AND edema sensation in the throat or shortness of breath due to an allergic reaction. Demographics, chief complaints, final diagnoses, triage categories, CONSULTATIONs AND hospitalization rates were obtained through computerized database of the hospital. Results: 859 patients were included in the final analysis. 511 (59. 5%) patients were female AND the mean age of patients was 39. 03§ 15 years. The most common complaint AND final diagnosis were skin rash with pruritus (50. 9%) AND urticaria with drug eruptions (84. 5%), respectively. Two patients (0. 2%) had an emergent triage category. 804 (93. 6%) patients were discharged from ED, while 55 (6. 4%) received CONSULTATIONs, resulting in 19 (34. 5%) hospitalizations. Conclusion: Most of the patients admitted to ED with dermatological complaints are non-urgent AND can be treated as outpatients. However, physicians should be alert for emergent causes, as well.

Introduction: 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.Methods: 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.Results: 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%) didn't return to their family physicians because of lack of knowledge.Conclusion: The performance of the REFERRAL system in family physician program is not as expected AND requires improvement.