Journal of

Background and Aim: Plasma leptin, adiponectin (as theadipokines) and related obesity – HOMA index in the obese men are introduced as a predictive metabolic indicators for asthmatic individuals. However, under asthma conditions, role of cariometabolic variables interaction for altering clinical pulmonary indexes aren't clear. In the present study, the relationship between plasmatic adiponectin to leptin ratio (adipo/lep) with respiratory capacities & HOMA in the chronic asthmatic males are investigated.

Materials and Methods: Thirty nine obese males with mild to moderate asthma with an average age of 38±2.6 ys and BMI 31.4 ± 1.06 kg/m² voluntarly participated in this study. Baseline plasmatic leptin, adiponetin, insulin and glucose levels were determined after 10-12 hours fasting overnight. FEV₁/FVC, PEF% and FEF _25%-75% were determined by standard method. A pearson correlation test was used to analyse data.

Results: There were no significant correlation between WHR , BMI with metabolic risk factors (P>0.05). Relationship markedly observed among HOMA with adipo/ lep ratio and leptin levels respectively (P<0.05), Also a marked negative correlation between adipokine ratio and leptin level was obtained (P<0.05). From view of respiratory efficiency, FVC% and FEV₁/ FVC were maingly corrected with baseline leptin&adiponectin levels (P<0.05).

Conclusion: Inconclusion,it seems that adipo/lep ratio biomarker plays as a clinical diagnosis index for HOMA index than baseline leptin or adiponectin levels. However, these findings showed that FEV₁/FVC & adipo/lept ratios are accounted as valuable indicators for evaluating the obesity syndrome and pulmonary efficiency in the asthma disease.

Background and Aim: Purchasing hospital equipment is one of the most important decisions made by managers and health professionals. Gray systems theory is an approach to deal with issues under uncertainty conditions where decision makers are facing a small number of unspecified data. The purpose of this paper is to apply the gray theory for the purchase of anesthesia machine .

Materials and Methods: This study was a survey in which mathematical analysis was used. Data collection devices included documents, interviews and questionnaires. In order to solve multiple criteria decision making in uncertain conditions, a model based on gray system theory was used. Data analysis was performed using Excel software.

Results: The findings show that among anesthetic equipment bought by public and private hospitals, brand A is superior to other brands. However, the gray possibility degree for the other brands is significantly different from brand A.

Conclusion: In addition to helping to purchase anesthetic equipment for hospitals, the results of this study are also useful for companies manufacturing medical equipment to evaluate their situation in terms of the studied criteria and take appropriate measures to develop their strengths and improve their weaknesses.

Background and Aim: In attention to hospital beds serves as an invaluable resource in health system and necessity for appropriate hospital beds utilization through the reduction of patient inappropriate stay, this study aimed to assess the proportion and causes for hospital inappropriate stays. 
Materials and Methods: The proportion and causes for hospital inappropriate stays were analyzed in a cross-sectional survey using a sample of 1925 days of hospital stay based on the Appropriateness Evaluation Protocol. The study was conducted at the tertiary care University Hospital Shahid Beheshti, 510 – bed teaching hospital which is located in the central part of Iran.
Results: Hundred and twenty one days (6.3%) of 1925 days of patient hospitalization were inappropriate. There was relationship between inappropriate stay and patients’ age and types of insurance. Findings relating to analysis of patient non demographic causes revealed that among hospitals, physicians and patient causes, Hospital-related causes and Physicians related causes have the most impact 42 (33.1%) and 37 (29.1%) on patient inappropriate stay  respectively. 
Conclusion: AEP list of reasons provides base line data for performance improvement in health care organizations. For conducting improvement process, developing a multidisciplinary team under title of Utilization Review committee is recommended to pave the way for targeted interventions based on identified potential causes. 

Background and Aim: In attention to pressing need to cost containment and service efficiency, laboratory services serve as a central locus for controlling health care expenditure. This study intents to investigate proportion of laboratory utilization in Iran to pave the way for future interventions.
Materials and Methods: A cross-sectional study was conducted to investigate the proportion for laboratory utilization through the retrospective analysis of 384 medical records at the tertiary care Kashan University Hospital Shahid Beheshti. To pave the way for future intervention, over utilization tests were classified into two categories, inappropriate and resulted in laboratory errors.
Results: Nine thousand five hundred forty one laboratory tests were ordered, 2522 (26.40%) of the tests were inappropriate and 143 (1.5%) of the over utilization tests have occurred due to laboratory testing cycle errors. According to reviewers’ judegment relevancy to medical intervention was considered as the most accepted appropriateness criteria 5012 (52.53%) for laboratory tests 
Conclusion: Since, the laboratory tests over utilization is multifactorial, forming a multidisciplinary team including physicians, nurses, laboratory staff, medical education experts, health care management and health information technology staffs in terms of Utilization Committee to develop more targeted strategy based on root cause analysis of over utilization behavior seems necessary.