علیرضا ظهور

In this paper, an integrated approach including QFD and FMEA is proposed in healthcare systems. The main objective is to improve the quality of healthcare services and activities in order to maximum customers’ satisfaction and minimize costs. To develop the mentioned approach following stages have been done:1- Identifying the most importance service characteristics with regard to customer expectations. 2- Identifying the most importance measurable functions and activities and their target values with regard to the service characteristics determined from pervious stage. 3- Identifying the relative potential failures and their importance rate with regard to the output of previous stage. After determining the most important functions to carry out into the system, some potential failures will be happen into the system. The occurrences of these failures decrease the quality of healthcare services and finally the customer satisfactions. Then, to prevent the occurrence of them, the relative failures and their weights are identified in this stage. 4- To complete the proposed approach and also increase the customer satisfactions more, the corrective and preventive actions to prevent the failures from happening are suggested by the FMEA team. To understand the proposed structure, an illustrative example has been surveyed in this paper. Due to the space limitation, a small part of information is given. In this example, customers consist of patients and their families, doctors, hospital manager, employers, assurance concerns and government. The main results of the paper are the following: Identifying the different group of customers by the excellent approach, determining the importance rate of customer's requirements by means of the correlation rates between customer's requirements, identifying the qualitative functions and activities and also calculating the target value for healthcare, determining the potential failures and their weights with regard to the importance rate of healthcare functions and using the FMEA tool in healthcare systems to increase the customer satisfaction. Hospitals and other healthcare systems have problem creating and improving the quality in their systems. As the service systems have special characteristics, considering the QFD and FMEA models like what is done in industrial systems is impossible to create and improve the quality in such systems. Also, due to high healthcare services costs, there is a high competitive between healthcare system to provide services to meet the customer's requirements. Therefore, in this paper, an integrated approach in the healthcare system in accordance with QFD/ FMEA is suggested.

In addition to the socio-economics costs, Diabetes is a major cause of illness and death at all groups. Diabetes affects over %10 of adults in the world. Despite promising trend in improving many aspects of health Care and treatment in the last decade in our country, little attention has been paid to the subject of registering Diabetes on an international standard. Quality improvement of treatment, identifying high risk groups, controlling, preventing and evaluating of diabetes, would materialize only when the national Diabetes Registry System is established and its data are collected and completed on time. The aim of this study was to suggest Diabetes registry system in Iran, to meet the health and medical needs. This Comparative Cross-sectional study was conducted to evaluate the developed national diabetes registry systems in 2003. In this study national diabetes registry system in Britain and USA was evaluated by library resources, Websites and Email communication with internal and external specialist. Suggestions were made on the basis of economic cultural and geographic situations. These axes included aims, structures, data elements, registration, data collection processing, and classification and control of quality of system. The results show that in order to optimize the diabetes registry system, structure, data elements, information gathering process, main goals, registration criteria, Classification systems and quality control mechanism of the current national diabetes registry system should be reevaluated. Considering the results and international diabetes institutes recommendation, the decrease in poor registry and increase in quality can be the advantages of model suggestion in comparison with the country's current system.

Nowadays, various tools are used in health informatics; the type of these tools should be related to the patient's and healthcare provider's needs. Hospital websites are suitable systems for data exchange and communication between patient and healthcare providers. This study performed for analysis and evaluation of structure and content of websites of the educational hospitals in Iran. In a descriptive study, 8 Iranian educational hospital websites were analyzed for structure, content and related links by using 4 researcher made check lists The average score was 12/30 for structural analysis. 5.75/15, 2.6/19, and 2/24 were calculated scores for of, content analysis of homepage, ";about us"; page, and other links, respectively. In general, the structure of Iranian educational hospital websites is at medium level and their content is at very weak level.

Taking the importance of end-user's satisfaction in the overall success of a HIS, this study was performed to assess their attitudes in different hospitals in Tehran. Interviews were made with officials of 20 hospitals in Tehran. Research tool was a questionnaire in 8 parts. Sixty three officials entered into the study. The average age was 40.7 years and 62.1% were male. 80.5% of the respondents indicated that they were satisfied or very satisfied with HIS in their hospitals.In general several factors found to be important to the HIS users. These were: better communication and quicker and more effective access to data, reports and outputs, organization management, resources, proper training for managers and users, compliance assessment inside the organization, ease of learning and implementation, effective support, and ease of use. The development of hospital information systems in Iran is in its early stages and despite their considerable progresses during recent years, they still require more investment in order to satisfy the administrator's and end user's expections.

Trauma is the fourth cause of death at all age groups with socio-economic costs which caused more than 6 million deaths in the world in 2000. Despite promising trend in improving many aspects of health case and treatment in the last decade in our country, little attention has been paid to the subject of registering trauma on an international standard. Effective practical research specially in quality improvement of treatment, defined causes of trauma, control, prevention and evaluation of effectiveness of programs, would materialize when the national trauma registry system is established and its data is collected and completed on time. Considering the absence of an appropriate national trauma registry system in Iran, and the necessity to create an appropriate model, conducting this research was urgently felt. This comparative cross-sectional study was conducted to evaluate the developed national trauma registry systems in the world and to suggest an appropriate model for Iran national trauma registry system in the years 2002-3. In this study, national trauma registry systems in the world were evaluated via library resources, web sites and e-mail communication with internal and external specialists. Iran national trauma registry system axes was presented based on economical,cultural and geographical situations. This model was evaluated by Delphi technique at 3 stages. At the first and the second stages, semi-structured interviews were used. The validity of the questionnaires and data collection was evaluated. At the third stage, specialists were invited to discuss suggested model completely. After data analysis, the final model was presented. A model suggested for Iran national trauma registry system was in seven main axes. The results showed that in order to optimize the infrastructure of Iran trauma registry system, structure, data elements, information gathering process, main goals, registration criteria, classification system and quality control mechanism of the current national trauma registry system should be re-evaluated. According to international trauma research institute’s suggestions, increase in registry and quality control mechanism, could be considered as advantages of the suggested model in comparison with the present system in the country.

Few studies concerning the effects of Opioid drugs on the function of immune system have been conducted and conflicting results have been reported. This study evaluates the in-vitro immune responses of drug abusers and investigates the pattern of production of IFN-? and IL-10, which represents the subsets of CD4+T-helper cells. Blood samples were taken from healthy drug addicted volunteers. Blood samples were also taken from healthy individuals with no history of drug abuse as control. Cell culture was performed in whole blood culture assay. Diluted blood samples were stimulated with phytohemagglutinin (PHA) and lipopolysaccharide (LPS) and the supernatants were collected to measure the Cytokine production. The results demonstrated that a significant decrease in IFN-? production and increase in IL-10 production in Heroin addicts, whereas the production of these Cytokines in Opium addicts was not significant different from those in control group. The results indicated a significant decrease in mitogenic responsiveness of T-cells in Heroin addicts relative to control group, whereas mitogenic responsiveness of T-cells in Opium addicts was not significantly different from control group.

Information documented in the medical records includes demographic Factors, history, examination and treatment. Information documented in the health record file has impressive Effect on the quality of care and treatment of patients. The pieces of information concerning patients who need operation are completed in special operation sheet htat should be exact, on time and complete.

The present study was carried out by a cross-sectional method during the spring of 2003 to compare the completion of special operation sheets among two medical teaching hospitals (Imam Khomeini and Motahari) affiliated to Uromia University of Medical Sciences. In this study special operation sheets of 200 files in every hospital (total 400 files) were reviewed. The collected data were analyzed by SPSS program and using Chi square and T tests.

the proportion of items completed on the pre- operation care sheet, anesthesia sheet, operation report sheet and recovery room sheet subsequently %66, %42, %79 and %65 in the hospitals. Overall special operation sheets in Imam Khomeini hospital were more complete than Motahari Hospital (%69 versus %59).

Low proportion of sheet completion in the hospitals studied necessitates the use of electronic record systems, recruiting medical records university graduates, encouraging efficient personnel and having workshops to upgrade the completeness and accuracy of documentations of information in files.