Hospital

Designing an Efficient Method of Multi-Stage Compression of Mammography Images for Optimal Storage, Transmission and LM Algorithm

Background: In the telemedicine process, using digital techniques in disease diagnosis caused to have felt needs of archiving and storing patient information and high bandwidth in data transfer.

Methods: This study aimed at introducing an efficient way of multi-stage compression of mammographic image data based LM algorithm and artificial neural networks. At First, data derived from mammographic images given to multi-layer neural network has achieved the possibility of forming with minimum damage and high degree of compaction in the first layer.

Results: The compression process of the mammography images was implemented using images of 128 women aged 46.41±6.55 yrs with BMI 36.78 ±5.5 from three specialized clinics in Sabzevar. The analysis yielded a mean square error (MSE) of 4.24 with the highest difference ratio of 33.46 and compression ratio of 8: 1in the output of the algorithm. The system performance based on the accurate design of the software was acceptable therefore; it demonstrated high efficiency in practice.

Conclusion: The diagnosis in the discovery stage is highly consistent with the diagnosis in real based on reliability of software output in the compression and release, and considering the fact of mammographic images are not completely degraded during compression; therefore, this system has the capacity to be implemented achieving mammography images in hospitals and justify its application.

Clinical Audit of Hand Hygiene Process of Nurses in a General Hospital in Tabriz city

yeganeh partovi

Background: consideration of hand hygiene can reduce health care infections effectively. Prevalence of poor hand hygiene consideration will lead to enhance morbidity, mortality and costs. This study aimed at assessing hand hygiene process of nurses by clinical audit method in a selected general hospital in Tabriz.

Materials and Methods: this study was an interventional one using clinical audit method which was conducted during seven months in surgery, internal, child and women units in a selected general hospital in Tabriz in 2013-2014. The study was carried out on nurses in all shifts (morning, evening and night). Study instrument were monitoring performance checklist and hand washing observation. Checklist was developed by WHO and Ministry of Health guideline.

Results: the total number of situation in pre-intervention was 252 which increased to 336 by the interventions implementation. The overall rate of compatibility of hand hygiene process with standards was 59.94% in pre-intervention which promoted to 80.56% after intervention implementation.

Conclusion: This study reveals using clinical audit is a method to improve quality of hand hygiene process.

Nursing Occupational Hazards of the Emergency Department in Teaching Hospitals affiliated to Tehran University of Medical Sciences

mohammad panahi

Background: Nurses are the largest group of health care providers and emergency department is known as a high risk ward in terms of occupational injuries. The aim of current study is to make out nursing occupational hazards in the emergency department among teaching hospitals affiliated to Tehran University of Medical Sciences.

Materials and Methods: The study carried outed on 250 emergency department’s nursing staff of hospitals affiliated to Tehran University of Medical Sciences. A valid and reliable questionnare used for data gathering by Simple random sampling method. Data analysed using descriptive snd inferential statistics.

Results: The level of mean and SD of occupational injuries (2.87 ± 0.55) was assessed moderate. Among occupational hazzards, Psychosocial and institutional (3.58 ± 0.47) and Ergonomic (3.57 ± 0.71) ones were the most prevalent occupational hazards respectively and chemical hazards were the least important source of occupational injury. There was a statistical significant association of occupational injuries and variables such as hospital, years in practice, educational level, type of employment and training courses in occupational hazards (P<0.05).

Conclusion: Nurses exposes a range of risk factors in different domains regarding occupational injuries. With the purpose of eliminating the risk factors, it needs to run various strategies in different domains. Applying ergonomic approaches, developing appropriate educational programs, providing adequate training in this area, etc., can result in reduceing occupational injuries and increasing their productivity.

Clinical Risk Assessment of Intensive Care Unit using Failure Mode and Effects Analysis

Mohammad Arab

Background: The goal of clinical risk management is to improve the quality of health care organization’s services and to ensure patients' safety. Thus, this study has identified and evaluated the potential failures by Failure Mode and Effects Analysis (FMEA) approach to eliminate errors occurrence of an Intensive Care Unit (ICU) in a hospital in Tehran city.

Materials and Methods: This study is a descriptive one in which data were gathered qualitatively by direct observation, document review, and Focus Group Discussion (FGD) with the process owners in an Intensive Care Units (ICUs) of a Tehran non-governmental hospital in 2014. According to FMEA method, quantitative data analysis was carried out based on failures’ Risk Priority Number (RPN).

Results: By FMEA, 378 potential failure modes in 180 ICU tasks were identified and evaluated. Then, with 90% confidence, 18 failure modes with RPN≥100 are identified and analyzed as non-acceptable risks totally.

Conclusion: Identifying 18 failures as non accepted risk from identified 378s, and identifying causes, analyzing and then suggesting correction actions reveals the FMEA high capability to identify, evaluate, prioritize and analyze potential failure modes in a such complex and critical hospital ward(ICU).

Health Record and Provided Services Recording among Centers Implementing Rural Family Physician and Insurance Program in Northern Provinces of Iran

Seiyed Davoud Nasrollahpour Shirvani

Background: One of the key duties of family physician is to form health records and provided recording services. This study conducted to form health records and aevaluate health records in family physician program in Northern Province of Iran.

Materials and Methods: This cross-sectional study was carried out in second half 2011. 139 of centers implementing family physician program in three provinces of Golestan, Mazandaran and Gilan were selected using systematic random sampling, and assessed performance recording of all family physicians. A self- designed questionnaire was used which the validity and reliability of were confirmed. Data were analyzed by SPSS₁₈ at the significant level of p<0.05.

Results: Out of the 189 assessed family physicians, the profile of patients referred to the second level and its results were recorded in referral record forms by 43 physicians. Out of 1890 studied families, 1559 families had health record which had filled 892(57%) health record completely. Out of 5869 assessed family members, 4229 patients were examined periodically by their family physician at least once and 1919(46%) results filled entirely. during 559 were reported with health records, among which 892 were filled out completely. There was a significant difference between referral record rates to registered specialist between the Northern Province of Iran (P=0.001).

Conclusion: The quantity and quality of health record formation was not in the expectation level as well and appropriate interventions are needed.

Measuring of Nutritional Department's Standards (HACCP) at Teaching Hospitals of Kermanshah University of Medical Sciences

Abolghasem Pourreza

Background: nutrition department is one of the most important sectors of hospital to improve the patients' health and satisfaction. Lack of standards obsevance causes nosocomial infections and develops health risks. Establishing HACCP standards, many existing shortcomings will be omitted in the hospital nutrition department. This study aimed at assessing the mentioned nutritional standards system in the hospital nutrition department.

Materials and Methods: This cross - departmental study was conducted at Kermanshah University of Medical Sciences' teaching hospitals in 2013. HACCP questionnaire was used. Data collection performed using observation, interviews and questionnaire filling in from hospitals' nutrition department.5-point likert scale used which rating scale was from 1(lowest) to 5(highest).in order to data entry and analysis SPSS software version 18 utilized using tables, graphs and Kruskal-Wallis test.

Results: The mean score and percentage of five areas of HACCP standards were 3.58 and 70.23% respectively which were desirable in seven studied hospitals. There was no significant statistical relation between the mean scores of hospitals in the standards.

Conclusion: Although, the situation was assessed desirable, because of the importance of nutrition department, observance of optimum standards and quality improvement can prevent potential infections in food preparation and distribution and result in patients and staff satisfaction.

Assessing the Relation Between Social Support and Depression among Patients Undergoing Hemodialysis in Kerman City

neda asadi

Background: Depression is a common disorder with incremental trend among patients with hemodialysis. This study conducted in order to determine correlation between social support and depression among patients undergoing hemodialysis of Kerman city.

Materials and Methods: This study was a cross-sectional one. 182 hemodialysis patients referred to health centers of Kerman were selected by census sampling method. data was collected Using questionnaires including demographic information, Beck's Depression Questionnaire (BDI) and Social Support Questionnaire (ESSI: Enriched Social Support Instrument) and analyzed by SPSS software version 17 utilizing descriptive statistics (mean and standard deviation) and Pearson Correlation Coefficient test.

Results: 68.1% of the subjects had some degree of depression. Also, 83% of participants reported good social support. Furthermore, Assessing the relation between depression and social support revealed an inverse relationship between depression and social support (P =0.005), increasing social support occurred decreasing depression as well.

Conclusion: Study results indicated high prevalence of depression among the patients. It seems special attention in should be paid to psychological issues in hemodialysis wards. Nurses can prevent depression incidence by recognizing high risk individuals in term of perceiving social support among these patients.

Estimating the Number of Nurses in Poisoning Department of Shiraz Selected Hospital Using Linear Programming Technique (Simplex): A Case Study in Shiraz general Hospital

fateme Setoodehzadeh1

Background: Approximately, more than 60 percent of the hospital costs allocate to hospital human resources. The study aimed at determining the number of nurses in the poisoning department of a general hospital in Shiraz.

Methods: This study was an applicable one based on hospital information. Study population was patients who referred to a hospital poisoning department of Shiraz in 2012. The medical records were checked up. Monthly stratified data was obtained from the statistics office and patient records (physician's orders and nursing notes) using a monthly systematic data collection randomly. Linear programming techniques using lingo version 8 software were performed to data analysis in order to calculating appropriate number of nurses.

Results: Two nurses in morning, two in evening, three in night and seven in all shifts were at least required nurses in the poisoning department of the general hospital. The number of available nurses was more than estimated number in the department.

Conclusion: The numbers of nurses were over the approximated number in the department in morning and evening shifts. Besides, the estimated of nurses from quantitative methods such as linear programming were lower than those calculated experimentally by nursing managers. It is recommended to Hospital administrators considering these techniques calculation to achieve appropriate distribution of staff in departments.

Situation Analysis of Performance Accountability in Teaching Hospitals Affiliated to Tehran University of Medical Sciences

seyed hesam Seyedin

Background: hospital is one of the most key institutions in the modern health care system and accountability is the most essential organizational functions. Accountability strengthens the main factors to responsibility regarding functions by pushing them up. This study aimed at assessing the situation analysis of performance accountability in teaching hospitals affiliated to Tehran University of Medical Sciences

Materials and Methods: This descriptive and analytical study performed at 12 teaching hospitals of Tehran University of Medical Sciences in 2013. Data collection performed by performance accountability checklist. Analysis was done by SPSS software version 19 using descriptive and analytical statistics test (Pearson correlation coefficient).

Results: In general, the condition of accountability for hospitals' performance (Mean =1.5 from 2) measured "good"(moderate to high). Strategic planning dimension achieved the highest score (Mean±SD:1.85±0.21) and Stakeholder Participation had the lowest score (Mean±SD: 1.12±0.46). There was a positive significant correlation between all variables (except Motivation) and performance accountability.

Conclusion: Weakness in any part of performance can affect other parts and have negative impact on total hospital performance. Mentioning the current situation of accountability for hospitals' performance and its importance, reinforcing weak dimensions and addressing deficiencies in performance accountability should be consider as managers' top priority.

Effect of Health Promoting Hospitals' Standards on Hospital Performance A Case Study in Fatemieh Hospital in Shahrod

leila Riahi

Background: Hospitals are best places to provide preventive and health promotion services along with healthcare services. These studies aimed at determine the effect of establishing health promoting hospitals’ standards on hospitals indicators in Fatemieh hospital.

Materials and Methods: This is a comparative study which was conducted in Fatemieh (case) and Khatamolanbia (control) hospitals in 2013. The standards of health promoting hospitals as an independent variable were established in Fatemieh hospital. Data related to indicators of leaving hospital with personal satisfaction, Cardio pulmonary Resuscitation (CPR) and neonatal mortality were collected in both hospitals in second half of 2012 and first half of 2013. SPSS version 16 used for data analysis and Chi-square and Fisher exact tests were utilized. The results were shown by comparative tables.

Results: The neonatal mortality rate before and after the intervention was 7.28 and 14.03 in case hospital, while this rate was 5.26 and 10.83 in control hospital respectively. The percentage of leaving hospital with personal satisfaction before and after interventions was 3.43% and 2.93% respectively in case hospital and success of cardiopulmonary resuscitation in this group was 56.1% and 61.3% correspondingly. There was no significant relation between establishing standards of health promoting hospitals and indicators of leaving hospital with personal satisfaction and neonatal mortality in Fatemieh hospital, while significant relation was obtained between promoting of cardiopulmonary resuscitation indicator and standards of health promoting hospital in mentioned hospital(P=0.001).

Conclusion: Initial results revealed that establishment of health promoting hospitals’ standards had positive effects in Fatemieh hospital and lead to improve a number of indicators.

Assessing the Relation between Organization Climate and Job Nature with Staffs’ Job Motivation in Isfahan Hospitals

Background: Staffs’ Job motivation is one of the most important factors in goals achievement in organization. As a result, considering effective factors of staffs’ motivation is one of the main tasks of organization managers. The aim of current study is to assess the relation between organization climate and job nature with staffs’ job motivation in Isfahan hospitals.

Materials and Methods: this study was a descriptive and correlation one. The study population included all staff of total Hospitals in Isfahan city. The Sample size was estimated to 141based on Cochrane. Three questionnaires including organization climate, Job nature and job motivation were used. Data analysis was performed by SPSS software version16 using Pearson correlation coefficient test, linear regression, one- way ANOVA and LSD tests.

Result: the study result revealed a significant positive correlation relation between organizational climate and job motivation (0.42), and Job nature and job motivation (0.36) (P<0.01). Furthermore, organizational climate (0.18) and Job nature (0.13) are predictors of f job motivation. One-way ANOVA test indicated there were significant statistical differences between job motivation and employment.

Conclusion: With regard to the impact of organizational climate and Job Nature in job motivation, managers should pay more attention to these two valuable factors.

Assessing the Rate and Type of Nurses' Medication Errors A Case Study in a Non-Public Hospital

mahboubeh Asadi

Background: Patient safety is one of main indicators in quality control of health services. The most prevalent threatening cause of patient safety is medical errors especially medication errors. This study aimed at assessing the rate and type of nurses’ medication errors.

Materials and Methods: This study was a descriptive – analytical one which performed in a non-public hospital in East North Country. The studied hospital has 180 active beds in the fields such as general surgery, obstetrics and gynecology, infants, cardiology, angiography, CCU, ICU, and NICU. Due to limited population, all the nurses in the hospital (97 nurses) were participated in the study. The instrument was a self-designed questionnaire which was composed of two main parts (demographic data and medication errors information). Its reliability and validity was confirmed. Data were analyzed by SPSS software version 15 using t- test and ANOVA.

Results: Among the studied nurses, 76 nurses (78.3%) were female and 21 (21.7%) were male. The mean of age and work experience of participants were 29.3 and 8.7 respectively. The most frequent of medication errors included medication without prescription 136(23.7%), lack of attention to medical complications 134(23.4%), Giving the medication at the wrong time 128(22.4%). The lowest common of medication errors reported as using expired date medication4(0.7%), wrong medication 5(0.9%) and non administered medication 6(1.1%).

Conclusion: The nursing managers should be consider more attention to reduce medication errors by implementing Training classes, improving nurse's processes and promoting attitudes towards importance of patient safety.

Assessing the Medical Tourism Center Service Quality in Tehran City Using Fuzzy SERVQUAL Approach

hassan kavyani

Background: in recent decades, Medical Tourism Industry has been mentioned by local countries because of its benefits such as high profits, more jobs creation and other benefits. High medical services quality is one of the most important factors developing this industry in health care centers. Therefore, concerning this issue this study assesses the provided medical services quality to the foreign patients by Medical Tourism Centers in Tehran city.

Materials and Methods: This study was an applicable and descriptive in term of purpose and nature repectively. This study conducted to assess provided services quality by Medical Tourism Centers evaluating 154 impatient foreign patients using SERVQUAL approach in ten swlwcted hospitals during March to April in 2014. Graded Integration method and terms of fuzzy set were performed considering complexcity and ambiguity in conceptualizing and weighting dimensions and indices.

Results: there was a negative gap and dissatisfaction in all dimensions and indices among foreign patients in the significant level p<0.05 except physicions and profession medical staff.

Conclusion: Considering the moderate situation of physicians and profession medical staff, modern medical facilities and equipment and appropriate medical costs comparing to services are the main factors of Medical Tourism Industry development, it is possible to enlarge Iran’s bazar portion of Medical Tourism Industry.

Assessing the association of Organizational Cultures ' Dimensions and Knowledge Management in Health Care Educational Organizations

farshad tavakoli

Background: Knowledge management plays an imperative role in the success of organizations. Many factors such as organizational culture affected on knowledge management. Therefore, this study aims at investigating the association between dimensions of organizational culture with knowledge management.

Materials and Methods: A cross-sectional descriptive analytical study was conducted in 2013. Three hundred twenty two employees of three hospitals related to the Zahedan University of Medical Sciences selected through a stratified-randomized sampling. Standard instrument of organizational culture and a self-designed questionnaire of knowledge management were used for data collection. Collected data was analyzed using SPSS version 18 by descriptively and inferential statistics methods.

Results: study results indicated that there was a positive and significant association between organizational culture and knowledge management. Also, results on other objectives pointed out a positive and significant association among dimensions of organizational culture (clan, market, adhocracy) and knowledge management. There was a negative and significant relation between organizational bureaucratic culture and knowledge management.

Conclusion: Organizational culture is one of the most important tools of a successful implementation of knowledge management in organizations. Modifications of organizational culture in health care teaching hospitals of Zahedan University of medical sciences should be set towards establishing knowledge management considering organizational tribe culture and organizational adhocracy culture more than other cultures.