ابراهیم میکانیکی

Monitoring and evaluation of family physicians′ performance are applied to identify strengths, design and implement improving projects, and also to determine the performance indices. The present study aimed to assess the process, tool and results of seasonal monitoring of family physicians performance in northern provinces of Iran.
This cross-sectional study was conducted in the second half of 2012. Study population and samples were all the 47 district health networks in Golestan, Mazandaran and Gilan provinces. Data-collecting instrument was a researcher-made questionnaire consisting of 3 parts and 32 questions and the data were collected through interviews and observation of documents. Data were analyzed by SPSS17.
From 47 cities studied, 36 cities (77%) underwent seasonal monitoring during four seasons of 2011 and the first and second seasons of 2012. 43 cities (92%) underwent seasonal monitoring by a team from headquarter units. 28 cities (60%) used Excel software for the calculation of seasonal results. Monitoring checklists for 32 cities (68%) were exactly the same as national guidelines while the other 15 cities used different checklists. None of the cities analyzed and interpreted the seasonal performance scores of family physicians in terms of their personal characteristics. Feed back of patient refer to second health service level, laboratory, radiology, average cost and drug list were not performed in all the cities.
The monitoring process and instrument of family physicians′ performance were not complete in all the cities and need to be reviewed and improved.

The members of local Organizations in rural regions of Iran can have an effective role in the improvement of health programs due to their resources and logistical influence. Favorable collaboration of them needs sufficienet familiarity and information about the objectives and principles of health programs. This study was Performed to asses the level of familiarity in members of local organizations about the Family Physician (FP) Program and Rural Insurance in Northen Provinces of Iran. This Cross-Sectional Study was Performed in the Second half of the year 2012. % 25 of health Centers doing FP Program in three Provinces of Golestan, Mazandaran, Gillan (totally 139 Centers out of 552 units). In each selected center, available members of dispute resolation council, village coucil, health council, village magor, school manager and native teacher were enrolled in the research. A researcher- made questinnaire which its validity and reliability were Confirmed was used for data gathering. Data analysis was Performed by SPSS17 with Significant level of P<0.05. 521 (84.7%) individuals (out of 601 members of local organizations) were male. The age range was 19-81 years. Mean and standard deviation of participants age was 45±9.7 years. 47.1% of persons had academic education level. Out of total score 27, mean and SD of the familiarity in village magor was 12.4±4, in health council’s members 11.6±3.7, in village council’s members 11.4±4.1, in school managers 10.6±3.3. in dispute resolation council’s members 10.5±5.1 and in native teachers was 8.8±4.9. There were significant relationships between the level of familiarity and being participated in trustees council of the health center, sex and the work type of local organization (p<0.05). There were no signification relationships between the level of familiarity, education, the prevince of living and the marriage status (p>0.05). This Study Showed that the level of familiarity of members of local organizations in rural regions of Iran is not sufficient and interventional Programs must be Planned and Performed for improvement.

One of the duties of family physician is to form health records and recording the provided services. The present study was conducted to evaluate health records in family physician program in Northern Province of Iran. This cross-sectional study was carried out in 2011. 139 of centers implementing family physician program in three provinces of Golestan, Mazandaran and Gilan were selected through systematic random sampling as the study samples, and recording the performance of all family physicians was evaluated. For data collection, a researcher-made questionnaire was used, the validity and reliability of which were confirmed. Data were analyzed by SPSS18 at p<0.05 as the significant level. Out of the 189 family physicians studied, the profile of patients referred to the second level and the associated results were recorded in referral record forms completely by 43 physicians. Out of 1890 families studied, 1559 were reported with health records, among which 892 were filled out completely. Out of 5869 families studied, 4229 patients were examined at least once by their family physician during the periodic examination; 1919, patients were found with complete records respectively. There was a significant difference between rates record of referral to a specialist registered in the Northern Province of Iran (P=0.001). The quality and quantity of health record formation as well as the records of services provided have not been according to the expectations and appropriate interventions are therefore needed in this regard.

The risk of high blood pressure increases to a great extend with increasing age which, in turn, raises the risk of retinopathy. Given the high prevalence of ophthalmic complications in the advanced ages, there is a growing need for public health and medical services. This study aims to determine the frequency of hypertensive retinopathy in the elderly, in Amirkola town. This cross-sectional study was performed on all patients aged 60 or above, residing in Amirkola town, Iran. All the patients were referred to the eye clinic of Ayatollah Rouhani Hospital during 2011-2012. Comprehensive ophthalmic examinations were performed by an ophthalmologist. Based on the obtained definitive evidence and photographic findings, various degrees of hypertensive retinopathy in one or both eyes were detected and assessed. Among the 505 studied patients, 65 patients (12.9%) were suffering from hypertensive retinopathy. About 10 (15.4%) patients were suffering from high blood pressure for more than ten years. Moreover, 55 patients (84.6%) had hypertension for less than 10 years (p<0.0001). A total of 18 patients (27.7%) had history of hyperlipidemia, while 47 patients (72.3%) had no history of it (p=0.005). The obtained results of our study indicated that the frequency of hypertensive retinopathy in the elderly patients was high. Therefore, monitoring blood pressure and serum lipids on a regular basis in the elderly is highly recommended.

Introduction & Family physicians (FP) are responsible for providing services through the appropriate management of the personnel in the healthcare team. This study evaluated the satisfaction of healthcare personnel from the performance of rural family physicians in the northern provinces of Iran. This cross-sectional study was carried out in winter 2013 and 25% of centers providing rural insurance and family physician program (139 centers) in three provinces of Golestan, Mazandaran and Guilan were selected by systematic random sampling. All healthcare staffs with at least one-year work experience were enrolled by census method. For data collection a researchermade questionnaire was used that validity and reliability of it was confirmed in advance. Data were analyzed using SPSS 17 at p<0.05 as the significant level. From the 561 subjects, 380 (67.7%) were females. The majority of the participants (48%) had a bachelor’s degree. The average level of satisfaction scores from FPs performance were 3.7±1, 3.5±1, 3.7±1, 3.9±1.1 and 3.5±0.9 in the field of health management (of 5 score), external cooperation, health promotion, prevention and health service provision and health care referral, respectively. There was a significant difference between the level of satisfaction of healthcare staffs among the northern provinces of Iran (P=0.006). The satisfaction of healthcare staffs from FPs performance has been slightly higher than the average level, so appropriate interventional programs should be established and implemented to maintain and improve the functional level of the FPs.

To get intersectoral collaborations is one of the strategies considered for the goal of health for all by the year 2000 which has been emphasized in the 21th century again. If the members of local Organizations are more satisfied, they will collaborate in the improvement of health programs more. This study was performed to assess the Satisfaction rate of the members of local organizations about the health services of health units in Rural regions of Northern Provinces of Iran. This Cross-Sectional study was performed in the second half of the year 2012. %25 of health Centers doing FP Program in three Provinces of Golestan, Mazandaran, Gillan (totally 139 Centers out of 552 units). In each selected center, available members of dispute resolution council, village council, health council, village major, school manager and native teacher were enrolled in the research. A researcher- made questionnaire which its validity and reliability were Confirmed was used for data gathering. Data analysis was Performed by SPSS17 with Significant level of P<0.05. Mean of satisfaction level about health home was 4.3± 0.6 about health center was 3.7 ± 0.7 (out of total score 5). The lowest satisfaction level was related to incomplete services provided and high service costs. There were significant relationships between the level of satisfaction in the members of local Organizations about health home in Northern Provinces of Iran (p=0.005). There were no significant relationships between the work type of local organizations and general satisfaction rate of health home and health center (p=0.149 & p=0.893). The results of this study showed that the overall satisfaction level of local organizations about the service provided at the first level was favorable, therefore healthy system must explore this positive potential for improvement of health status.

Participation of people and local organizations can be achieved by activities of the Board of Trustees and health volunteers. This study was conducted to evaluate the participation rate of local organizations in health centers performing rural insurance and family physician program in the Northern provinces of Iran. This cross-sectional study was conducted during the second half of 2012. Twenty five per cent of health centers performing family physician program in three provinces of Golestan، Mazandaran، and Gillan (139 centers out of 552 ones) were selected randomly from certain clusters of the study. In each selected center، participation rate of local organizations were evaluated. A validity and reliable researcher-made questionnaire was used for data gathering. Data were analyzed in the SPSS-18 with significant level of p<0. 05. Fifty seven health centers out of 139 ones (41%) had established a Board of Trustees. The Board of Trustees establishment was more in the Northern provinces (p=0. 001). In 61 health centers (43. 9%)، health volunteers were employed with a more significant employment rate in the Northern provinces (p=0. 001). The mean request rate of health homes and health centers from local organizations to take part in health problem solving were 2. 7 ± 1. 6 and 1. 7 ± 1. 3 times، respectively. The request rate for providing resources and facilities in performing health interventions were 1. 8 ± 1. 3 and 1. 1 ± 1. 0 times، respectively; and the request rate for participation in formal meetings were 3. 1 ± 1. 7 and 1. 9 ± 1. 3، respectively. The request rates of health homes for providing resources and participation in formal meetings were significantly different in the provinces (p=0. 009 and p=0. 005، respectively). This study showed that a large number of health centers did not follow community participation measurements. Interventional programs should be planned and conducted to improve community participation in health centers.

Abstract Satisfaction has been a concept of high importance in today's health care services and is considered as one of the criteria in evaluating the quality of services. The present study has been conducted to evaluate the satisfaction level of patients with rural insurance in terms of the first and second levels of health services presentation in northern provinces of Iran. This cross-sectional study was conducted in the second half of the year (2012); 139 centers (25%) implementing rural insurance and family physician program were selected through systematic random sampling as the research samples and 6 out of 8 patients with insurance, who received required services after being referred to the second level by FPs, were evaluated. Data-collecting instrument was a researcher-made questionnaire, and the validity and reliability were confirmed. Data were analyzed by SPSS17 statistical software at the significance level of p<0.05. From the 955 patients who received services after referral to the first and second levels, 752 patients (78.7%) were female. The mean age of patients was 40.2±15.6 years and the mean referral of patients during the 9 months of (2012) was found to be 8±8.4 to home health and 6.4±6.6 to healthcare centers. Out of the 5 scores for level of patients satisfaction, 4.5±0.5, 4±0.7 and 4±0.8 were allocated to home health, healthcare centers, and second level hospitals and specialists, respectively. There was an inverse relationship between the overall satisfaction and education level and a direct relationship between satisfaction and age, number of referral to home health and healthcare centers (P<0.05). A significant difference was observed in the mean level of patients′ satisfaction with second level hospitals and clinics in northern provinces of Iran (P<0.05). However, no significant difference was found in the patients’ satisfaction level between home health and healthcare centers (P>0.05). The results showed a high level of satisfaction in patients with rural insurance. While maintaining and improving the existing condition, it is proposed that satisfaction levels of patients with other health insurances be compared and evaluated.

Purtscher's retinopathy occurs with sudden loss of vision. In this article, a case of post-partum Purtschers-like retinopathy was investigated.Case Report: The patient was an 18-year-old woman who presented with severe bilateral loss of vision, three days after childbirth. No systemic abnormalities were observed except preeclampsia. The results of ophthalmoscopy and fluorescein angiography, multiple superficial white patches within the retina, and small superficial indicated retinal hemorrhage simulating Purtscher's retinopathy. After eight weeks, visual acuity had significantly improved without any treatment.Embolic occlusion of the precapillary arterioles is the most likely pathogenesis. Also, improvement of visual outcomes may be seen in patients with post-partum Purtschers-like retinopathy.

Background and

Health care system is organized at three levels in order to increase efficacy and effectiveness and create justice and also people availability. Considering the three levels of primary health care، access of people to specialized services through referral system is possible. With regard to the importance of referral system in family physician program، this study was performed to evaluate the function of referral system and network system in Northern provinces of Iran.

This analytic study was performed in autumn and winter of 2012. Twenty five percent of health centers (139 centers from 552) which implement the family physician program and rural insurance coverage by medical universities of Golestan، Mazandaran، Babol and Guilan were randomly selected. In each center، 7-8 patients who were referred to level 2 by their family physician and received necessary services were evaluated. They were at their homes at inquiry time.

From 963 patients who received the level 2 services، 687 cases (71%) were females and 276 (29%) were males. Three hundred and twenty cases (33%) had referral form from health house. Only 299 (31%) persons referred to the centers because of diagnosis of family physician and in 161 (17%) of cases، the family physician had a role to choose a specialist of level 2. For 155 (16. 1%) of cases، the specialists wrote the results of their evaluation in feedback form. Only 149 (15. 5%) of patients returned to their family physicians. Six hundred ninety-seven (79. 6%) of patients did not return to their family physician because of lack of knowledge.

The results of this study showed that many principles for referral system from level 1 to higher levels and vice versa are not considered that require education، reformation and intervention in this field.

Successful implementation of FP program and rural insurance requires continuous collaboration among the intersectoral and intrasectoral organizations. FPs’ satisfaction from related institutions can lead to more motivation، longer activity and better services in the organization. This study was performed to evaluate the level of FPs’ satisfaction in Northern provinces of Iran. This cross-sectional study was performed in winter 2013. Totally 139 health centers from 552 which implement the family physician program and rural insurance coverage in Mazandaran، Golestan and Guilan provinces were randomly selected. In each center all of available FPs included. A researcher-made questionnaire was used for data gathering. In this questionnaire، personal characteristics with 10 open and closed questions، satisfaction from human and physical resources available at the first level، the function of health center of the city، the function of specialists at the second level، the performance of underlying population of intersectional organizations were asked through 34 questions with Likert scales. Validity and reliability of the questionnaire were approved. Mean of the level of 188 FPs’ satisfaction about health team، equipment and facilities in the centers (of 5 score) was 3±0. 6، underlying population was 2. 8±0. 8، intersectoral collaboration was 2. 8±1، the function of district health center was 2. 7±0. 9، the function of specialists was 2. 1±0. 9. The level of FPs’ satisfaction from the specialists of the functional second level showed a significant difference in the Northern provinces of Iran (p=0. 001). There was not a significant relationship between age، underlying population، recorded services، the number of replacements and the level of FP''s satisfaction. The results of this study showed that the level of FPs’ satisfaction was moderate; therefore، interventional program at different levels should be planned and implemented to protect and promote it. Keywords:

The national rural family physicians and insurance plan، as one of the major reforms of the health system implemented since 2005، need to be supplied with the resources and facilities required. In this regard، the present study was carried out to evaluate the quantity of essential resources and requirements provided in family physician program in the northern provinces of Iran.

This cross-sectional study was conducted in the second half of 1391; 25% of centers implementing rural insurance and family physician programs in three provinces of Golestan، Mazandaran and Gilan –a total of 139 centers out of 552 centers performing the program– were selected through systematic random sampling as the study samples. A researcher-made questionnaire was used for data collection، the validity and reliability of which were confirmed. Data were analyzed by tests of chi-square and Kruskal– Wallis.

Out of the 139 centers studied، 48 centers (34. 2%) had public pharmacies، 62 centers (44. 6%) had private pharmacies، among which 72 centers had a total of 279 items of drugs. 133 centers (96%) had injection and dressing room facilities، 84 centers (60%) had oral health unit (30. 2%) and 42 centers (30. 2%) had an active lab unit; 138 centers (99%) were found with at least one normal-operating computer، 135 centers (97%) with at least one oxygen capsule، 131 centers (94 percent) with emergency tralee and at least one intact tracheal tube، 129 centers (93%) with at least one intact four (dry heat)، 92 centers (66%) with a normal ECG. Out of the 188 family physicians working in the study centers، 140 physicians (74%) had separate rooms (clinics)، 165 physicians (88%) had a normal desk، 144 physicians (76%) had a normal otoscope، 71 physicians (38%) had an intact ophthalmoscope and 131 physicians (66%) had a normal-operating computer. There was a significant difference in the levels of some resources and facilities provided in the northern provinces of Iran (p<0. 05).

The study findings confirmed that enough facilities and equipments are not provided in a number of centers implementing the program، and effective measures should be taken to supply these items.

Background and Macular edema is a common causes of visual imparity in diabetic patients. Several studies to evaluate ways to prevent and slow down its progression have been done. This study to determine serum lipids، accelerate the creation and macular edema was performed. Blood serum lipids in 180 diabetic patients referred to eye clinic of Shahid Beheshti Hospital was evaluated. Data obtained from patients were classified in three groups: diabetic retinopathy without macular edema (group 1)، patients with mild diabetic retinopathy with macular edema (Group 2) and patients with diabetic retinopathy with macular edema and hard exudates (group 3). Then laboratory values were collected and analyzed by version 18 statistical software spss. For data parametric ÂNÔVÂ test and then Tukey test was used. P. value less than 0. 05 were considered significant. Total cholesterol in groups 1، 2 and 3 were 402. 53 ± 95. 202، 213. 52 ± 17. 204 and 201. 113 ± 74. 228، respectively (P>0. 05). The mean HDL in groups 1، 2 and 3 were 586. 15 ± 25. 44، 920. 22 ± 32. 47 and 009. 11 ± 49. 48، respectively. The mean VLDL in groups 1، 2 and 3 were 396. 22 ± 09. 37، 238. 20 ± 85. 36 and 127. 15 ± 51. 33، respectively (P>0. 05). The mean TG in groups 1، 2 and 3 were 911. 227 ± 74. 212، 448. 109 ± 43. 187 and 741. 238 ± 28. 218، respectively (P>0. 05). The mean LDL level in group 3 (132. 33 ± 53. 75) was statistically higher than group 1 (113. 39 ± 38. 48) and group 2 (113. 08 ± 42. 08) (P<0. 05). Çonclusion: The results of this study showed that، serum LDL، the intensity of macular edema and hard exudates plaques، are associated.

Subarachnoid hemorrhage due to head trauma, rupture of brain aneurysms, etc can be associated with vitreous and retinal hemorrhage and is named Terson’s syndrome and has no adverse effect on visual prognosis and survival if there is no injury to optic nerve and if the brain hemorrhage is initially remove by neurosurgeon. We report two cases of Terson's syndrome with different visual acuity. CASES: Two men of Terson’s syndrome due to car accident that suffered from subarachnoid hemorrhage with decreased vision 2-3 months ago and in fundoscopy examination had retinal hemorrhage especially in the subarachnoid space presented to Farabi eye clinic. Terson's syndrome was characterized by presence of subarachnoid hemorrhage and retinal hemorrhage. They had been operated by neurosurgeon and after improvement of their consciousness, noticed unilateral or bilateral severe visual impairment. The unilateral one best corrected vision (BCVA) was 10/10 in right eye and HM (hand motion) in left eye. The left eye underwent standard 3 port pp.Vit X and the BCVA reached 8/10. The other had bilateral NLP (no light perception) most probably due to optic disc problem. Terson’s syndrome should be considered in patients who had previous subarachnoid hemorrhage and are referred to eye clinic because of loss of vision. Eye surgery is utilized if decreased vision is due to vitreous and subhyaloidal hemorrhage and not due to optic nerve injury and with proper operation the prognosis is good.