Mohammad Mohseni

Outpatient waiting time in health services and teaching hospitals: a case study in Iran.

Background: One of the most important indexes of the health care quality is patient’s satisfaction and it takes place only when there is a process based on management. One of these processes in the health care organizations is the appropriate management of the waiting time process. The aim of this study is the systematic analyzing of the outpatient waiting time. Methods: This descriptive cross sectional study conducted in 2011 is an applicable study performed in the educational and health care hospitals of one of the medical universities located in the north west of Iran. Since the distributions of outpatients in all the months were equal, sampling stage was used. 160 outpatients were studied and the data was analyzed by using SPSS software. Results: Results of the study showed that the waiting time for the outpatients of ophthalmology clinic with an average of 245 minutes for each patient allocated the maximum time among the other clinics for itself. Orthopedic clinic had the minimal waiting time including an average of 77 minutes per patient. The total average waiting time for each patient in the educational hospitals under this study was about 161 minutes. Conclusion: by applying some models, we can reduce the waiting time especially in the realm of time and space before the admission to the examination room. Utilizing the models including the one before admission, electronic visit systems via internet, a process model, six sigma model, queuing theory model and FIFO model, are the components of the intervention that reduces the outpatient waiting time.

Using creative problem solving (TRIZ) in improving the quality of hospital services.

TRIZ is an initiative and SERVQUAL is a structured methodology for quality improvement. Using these tools, inventive problem solving can be applied for quality improvement, and the highest quality can be reached using creative quality improvement methodology. The present study seeks to determine the priority of quality aspects of services provided for patients in the hospital as well as how TRIZ can help in improving the quality of those services. This Study is an applied research which used a dynamic qualitative descriptive survey method during year 2011. Statistical population includes every patient who visited in one of the University Hospitals from March 2011. There existed a big gap between patients’ expectations from what seemingly is seen (the design of the hospital) and timely provision of services with their perceptions. Also, quality aspects of services were prioritized as follows: keeping the appearance of hospital (the design), accountability, assurance, credibility and having empathy. Thus, the only thing which mattered most for all staff and managers of studied hospital was the appearance of hospital as well as its staff look. This can grasp a high percentage of patients’ satisfaction. By referring to contradiction matrix, the most important principles of TRIZ model were related to tangible factors including principles No. 13 (discarding and recovering), 25 (self-service), 35 (parameter changes), and 2 (taking out). Furthermore, in addition to these four principles, principle No. 24 (intermediary) was repeated most among the others. By utilizing TRIZ, hospital problems can be examined with a more open view, Go beyond The conceptual framework of the organization and responded more quickly to patients ’ needs.

Cost of Illness of Tuberculosis in Tehran in the Year 2011

Aim: Present study calculates and analyzes Cost of illness of tuberculosis in Tehran. Patients and methods: This study was a descriptive analytical study conducted among 121 patients in two stages in 2011. In the first stage, questionnaires were collected by reviewing patient records and phone interviews with patients. The second stage deals with the calculation of costs. For cost calculation, we used incidence based and bottom-up approach, and for calculating indirect costs, human capital approach was used. The vision used for this study was community-based in which all costs are included. Result: The average costs per patient were calculated to be as follows: 28,467,737 Rials(2588 dollars) for direct medical costs, 1,011,360 Rials (92 dollars) for indirect medical costs and 5,533,020 (503 dollars) Rials for indirect costs. On the whole, average costs per patient was 35,056,170 Rials most of which were related to hospital costs (62/11%). Also, the average time away from work was 47 days. Cost calculated for all patients with tuberculosis in Tehran in 1390, including indirect costs caused by premature deaths of patients, was 101,900,501,328 Rials (9,263,681 U.S.

Analysis of social functions in Iran’s public hospitals: pattern of offering discounts to poor patients

) Conclusion: To sum up, in Tehran in 2011 on average every day about 279,179,456 Rials (25,380 dollars) was spent on TB patients. Moreover, heavy costs caused by TB, which are usually imposed to the households in two or three months, have significant effect of decreasing households’ quality of life which calls health policy makers’ attention.

Cochlear implantation in children with auditory neuropathy spectrum disorder: A multicenter study on auditory performance and speech production outcomes

Purpose Exemption from hospital charges may appear as an essential policy in order to support the poor. Such policies can function for the fulfillment of governments’ social- and justice-based responsibilities in public hospitals. The purpose of this paper is to investigate the pattern of offering discounts to the poor and the effect of Iran’s recent Health Sector Evolution Plan on it. Design/methodology/approach The authors conducted analytical research longitudinally on the data related to cash discounts offered to the poor within a teaching hospital. Data were collected through the period of four months, September to December 2013, before the establishment of the Health Sector Evolution Plan, and in the similar months through 2014, after the establishment of the Health Sector Evolution Plan, in order to compare the amount of cash discounts. The type of insurance, length of stay, amount of discounts offered to patients, and total costs of hospital charges were studied and compared by referring to the social working department. Data were analyzed using the χ2-test, Mann-Whitney U test, ANOVA, and regression analysis aided by SPSS 20. Findings The number of patients offered discounts or exempted from payment in 2014 reduced compared to the number in 2013. The highest rate of demand for discounts was related to patients covered by Emdad Committee followed by those who had no insurance. The ratio of discount to cost in the oncology ward was higher than other groups. Originality/value The results of the present study can contribute to the plans of health system policy makers in organizing measures for supporting poor patients toward accessing healthcare services.

Randomized Clinical Trial Comparing Bucket Handle and Cartilage Tympanoplasty Techniques for the Reconstruction of Subtotal or Anterior Tympanic Membrane Perforation

OBJECTIVES To evaluate the auditory performance and speech production outcome in children with auditory neuropathy spectrum disorder (ANSD). The effect of age on the outcomes of the surgery at the time of implantation was also evaluated. METHODS Cochlear implantation was performed in 136 children with bilateral severe-to- profound hearing loss due to ANSD, at four tertiary academic centers. The patients were divided into two groups based on the age at the time of implantation; Group I: Children ≤24 months, and Group II: subjects >24 months. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated after the first and second years of implantation. The differences between the CAP and SIR scores in the two groups were assessed. RESULTS The median CAP scores improved significantly after the cochlear implantation in all the patients (p value < 0.001). The improvement in the CAP scores during the first year in Group II was greater than Group I (p value: 0.007), but the improvement in CAP scores tended to be significantly higher in patients who were implanted at ≤24 months (p value < 0.001). There was no significant difference between two groups in SIR scores at first-year and second-year follow-ups. The evaluation of the SIR improvement revealed significantly higher values for Group I during the second-year follow-up (p value: 0.003). CONCLUSION The auditory performance and speech production skills of the children with ANSD improved significantly after cochlear implantation, and this improvement was affected by age at the time of implantation.

A National Document for Child Nutrition in Iran: A Vital Need

Objective The purpose of the study is to compare the clinical outcome of the two techniques of Bucket Handle Tympanoplasty and Cartilage Tympanoplasty in achieving success in graft survival as well as acceptable auditory results. 60 patients who suffered chronic otitis media with anterior perforation of the tympanic membrane were chosen. The patients were randomly assigned using Block Randomization Method of two groups including patients who underwent Bucket Handle Tympanoplasty (n = 30) or those that underwent Cartilage Tympanoplasty (n = 30). The patients were followed up for 1, 3, 6, and 12 months postoperatively. Results The mean PTA was lower in Bucket Handle Tympanoplasty group as case group compared to Cartilage Tympanoplasty group as the control (P = 0.023). No significant statistical differences had identified passing through the time, in terms of PTA outcome (P Value = 0.547) and SRT outcome (P Value = 0.352), between Bucket Handle Tympanoplasty group and the Cartilage Tympanoplasty group. In total, postoperative tympanic membrane perforation was found in 10.0% of patients in Cartilage Tympanoplasty group and 13.3% in Bucket Handle Tympanoplasty group with no difference (P = 0.500). Conclusions Hearing improvements in both methods were similar. Registration Number The trial is registered with IRCT2016022626773N1.

Palatal tremor with audible click

Children constitute a significant percentage of the world population, and their health and its promotion are important health priorities of all societies [1]. Malnutrition in early years of life can cause delayed body growth, stunting and decreased mental development in children, and causes repeated treatment-resistant infections in them [2]. Underand over-nutrition are both linked to various adverse health conditions. Insufficient supply of nutrients during fetal growth and in the first 2 years of life may significantly increase the risk for obesity and non-communicable diseases [3]. During the recent years, global efforts to tackle the issue of child malnutrition have resulted in new policies, initiatives as well as a real sense of urgency [4]. In 2012, the World Health Assembly in a resolution endorsed the comprehensive implementation plan on maternal, infant, and young child nutrition [5] which includes 6 global targets by 2025. These 6 targets include 40% reduction of the global number of stunted children under 5 years, 50% reduction of anemia in women of reproductive age, 30% reduction of low birth weight, no increase in childhood overweight, the increase in the rate of exclusive breastfeeding in the first 6 months up to at least 50%, and finally the reduction and maintaining of childhood wasting to less than 5% [6]. The World Health Organization in the report on global nutrition targets for 2025 stated that all countries need to examine inequalities among populations and identify priority actions for particular vulnerable or marginalized groups, where there are clusters of large numbers of wasting children. Such an equity-oriented approach is both morally necessary and a prudent investment strategy [7]. Special attention to international targets, plans and resolutions to increase equity in access, and economic equity may reduce gaps between the provinces in the country in regard with the prevalence of malnutrition. The National document for Nutrition and Food Security can be considered as the most comprehensive existing document among current documents in Iran. In this document, the roadmap for the Vision 2025 was drawn up emphasizing prevention and control of nutritional risk factors for non-communicable diseases such as reduction of sugar, salt and fat consumption, increase of the consumption of fruits and vegetables, and promotion of nutritional literacy and culture among people. The review of content of the nutrition policy documents in Iran showed that there is no comprehensive and valid document specific for children, and nutrition policies are limited to those for all age groups in the National document for Nutrition and Food Security. Given the importance of ages under 5 years in children and the importance of nutrition in these ages, a particular document is needed. Actions implemented to acceptable reduction of the prevalence of malnutrition among children under 5 years of age should be based on significant causing factors and evidence-based interventions. Selective interventions should focus on real needs of children, mothers, and the society. In remote and deprived areas, supportive tools to improve health and economic status are needed, and supporting pregnant women and their children is of great importance. Furthermore, cultural and economic potentials and capabilities in each region should be taken into account in order to select and implement policies. The ultimate document should be developed based on these points and also international evidence and experiences, policies analysis and previous documents in the field of food and nutrition, experts’ opinions, and intersectoral stakeholders.

The structure of the pharmaceutical market in Iran using concentration indices

Palatal tremor and myoclonus are the terms used for rhythmic bilateral movements of palate due to excitability of brainstem. It encompasses two types of essential palatal tremor (EPT) and symptomatic palatal tremor (SPT). The main feature of EPT is an audible click in the ear due …

Investigation of the relationship between organizational learning and organizational citizen behavior among the staff of teaching hospital.

Background and objective The efficiency and function of the pharmaceutical sector, as a vital portion of the health system, have a significant effect on intermediate and final indices of health. In this research, the structure of the pharmaceutical market in Iran was examined through the calculation of concentration indices in 2011. Methods In this cross-sectional study, the needed data was gathered from the Food and Drug Administration in the year 2011. Data were analyzed using SPSS software version 20 and Microsoft Office Excel software. Finally, two common measures of market concentration, the Concentration Ratio and the Herfindahl-Hirschman Index, were calculated. Results The largest and the smallest shares of the industry were 5.57% and 0.01%, respectively. The average industry share was 1.09%. The share range was calculated to be 5.56%. The Herfindahl-Hirschman Index was 248.5, which indicates a very low concentration of the pharmaceutical market in Iran. Also, based on the Concentration Ratio of 4 companies (18.39%), the concentration of the pharmaceutical market has been too low. Conclusion The pharmaceutical market in Iran has a very low concentration and it does not have an exclusive mode in terms of market structure. Therefore, it can be attributed to the competitive model. The policy makers in this area can use this characteristic as a leverage to improve efficiency, fairness, revenue and health indices.