Hospital

Selecting Differentiated Costs between primary PCI and Thrombolytic Therapy using Hybrid of Genetic Algorithm and Decision Tree Approach

MohammadMehdi Sepehri

Background: Myocardial Infarction (MI) is the most common cause of death in developed and developing countries. Based on World Health Organization prediction, MI will be the leading cause of death in the world up to 2020. The main goal of acute myocardial infarction therapy is reperfusion which is performed by two treatment approaches, although these two methods use for unique complication treatment but they are different in treatment cost and quality; Since the costs of health care is growing, this study aimed at identifying affected differentiated costs among patients with acute MI with the purpose of providing a framework to compare two treatment methods.

Materials and Methods: In presented model in current study, with the purpose of select affecting cost attributes utilized hybrid of Genetic algorithm and decision tree approach as a new method and compare its result using random method.

Results: Study result presented classifies error reduction up to 0.2 compare with random method error. Then, based on selected attributes, presented a framework comparing two treatment methods. Also, in the majority of direct cost and total cost, Primary Angioplasty was cost effective more than Thrombolytic Therapy, but in indirect cost, we achieved some results dissimilar to physicians' expected results such as kidney failure.

Conclusion: Suggested approach in this research can be a guidance to physicians and insurances institutes in acute myocardial infarction treatment policies.

Informal Payments in Health Sector and Policies to Deal With (A Review Study)

Arash Rashidian

Background: Informal payments are paid to individuals /health care providing organizations offering as cash or non-cash and are formed out of formal payment channels. This study aim at identifying the types of informal payments, causes, effects and policies to deal with them.

Materials and Methods: This study was a review one and relative published articles identified by searching valid database ( Medlib, SID, Pub Med, Science Direct and Google Scholar)using keywords with their equal in Persian (informal payment and unofficial payment) and 128 articles were extracted. The articles refined step by step. In conclusion, 20 articles were selected according to study aims.

Results: The study findings consist of five main sections including the definition and form of informal payments, the existent causes of informal payments, effects of informal payments, statistics of informal payments in Iran and the world and policies to dealing with this important issue.

Conclusion: Due to the high prevalence of informal payments and severe negative effects on justice and respectable governance, policy-makers should focus on this issue and reduce its effects. Although, strategies to control informal payments are limited but strategies including regulation payment and medical tariffs, regulating power abuse, providing incentives and increasing responsibility of healthcare professionals, and changes in public perception are proposed.

Coordination of Patient Transfer Process and Role of the Center for Treatment Guidance and Information of Tabriz University of Medical Sciences

nesa kavakebi

Background: Patient transfer requires the wide variety of functions such as collaboration, appropriate communication and coordination between hospitals and the Center for Treatment Guidance and Information (CTGI). This study aimed at determining the influencing factors in the coordination of patient transfer and also explaining the situation of the CTGI in patient transfer process coordination.

Materials and Methods: This study was a qualitative study (phenomenology) conducted using three Focus Group Discussions (FGD) and thirty interviews with participants who were involved in the process of patient transfer in a referring hospital, six patient receiver hospitals and CTGI in Tabriz. Purposive sampling was used to select study participants. Data was analyzed using content analysis.

Results: The effective factors of the patient transfer coordination were categorized in four main themes including weakness in the exchange of clinical information, data constraints, legal protections weakness and guidelines implementation and lack of clinical empowerment in managing patient. Eighteen sub-themes were identified which include legal protections weakness and guidelines implementation in center for treatment guidance as sector problems.

Conclusion: There are some problems in coordination of patient transfer process which is relate to non adherence a specific procedure for admission , ineffective interactions and information exchange. In order to achieve uninterrupted medical treatment, the patient transfer coordination should be improved. The center for treatment guidance and information should be obtained its position as a supervising authority.

Health - related Quality of Life among Nurses in Zahedan University of Medical Sciences Hospitals

Hossien Ansari

Background: There is close relationship between quality of life and human health. Since, nurses as the most important health Provider group, they should have a desirable quality of life. This study aimed at evaluating the quality of life and related variables among nurses in Zahedan University of Medical Sciences hospitals.

Materials and Methods: In this descriptive analytic study the Iranian version of SF-36 was utilized to assess nursing quality of life. Data analyzed using Stata version 12. logistic regression was used to determine quality of life predictors.

Results: Three hundred women nurses (77.9%) with mean age of 31.6 ± 6/6 years were assessed. The mean of work experience was 7.55± 6.8 years. The most quality of life score was related to Physical domain (39.6 ± 11.8) and social function had the least score(8.2±6.7). Logistic regression analysis revealed marital status, overtime work, working shift Pattern and work experience were quality of life predictors (P<0.05).

Conclusion: Study results represented undesirable quality of life among nurses. Low quality of life can affect services quality of nursing. Nursing administrators can improve nursing quality of life by setting up and adjusting overtime set up and adjust overtime shift based on work experience .

Evaluation of Human Errors Using Standardized Plant Analysis Risk Human Reliability Analysis Technique among Delivery Emergency Nurses in a Hospital Affiliated to Tehran University of Medical Sciences

Adel Mazloumi

Background: Recently, considerable attention has been paid to medical errors in health care system. Taking into account that nurses spend more time with patients in comparison with other staff, they are more prone to human errors. The present research conducted to investigate nurses' errors in delivery emergency ward in a hospital affiliated to Tehran University of Medical Sciences.

Material and Methods: In the present coss-sectional study,at first, task analysis was conducted to nursing proffession using Hierarchical Task Analysis (HTA) technique by FGD. In next step, the Human Error Probability (HEP) was determined utilizing SPAR-H method and dependences of performance-shaping factors (PSFs) and action and diagnosis activities were identified. Finally, after determinig dependency level, the final diagnosis HEP was calculated and risk assessment level was carried out using the risks' probability and intensity tables.

Results: According to the results, four groups of studied tasks, the lowest errors were belonged to "working with serum pumping machine'' subtask with the error level of 0.055 and the highest error probability related to '' transfusion of blood products'' subtask with the error rate of 0.78. Moreover, special responsibilities of the wards had the highest level of undesirable risks.

Conclusion: In the present study, the analysis of identified errors reveals due to high work demand, insufficient time and the need for accurate administrative monitoring and providing required arrangements, the main causes of errors can be attributed to high level of stress and complexity in the tasks of delivery emergency ward.

The Relationship of Emotional Intelligence and its Dimensions on Communication Skills among Emergency Unit Nurses

mahdi kouchakzadeh

Background: The emotional intelligence of nurses has several effects on their behavior skills. In this study, the relation between Emotional Intelligence (EI) and Communication Skills (CS) among emergency unit nurses was assessed.

Materials and Methods: In the descriptive analytical study, 253 nurses of fifteen IUMS hospitals were selected using census sampling method. The Golmans instrument for EI assessment and self -administered CS questionnaire filled by study participants. Validity and reliability of the questionnaire confirmed. SPSS software version 18 utilized to analysis using ANOVA, Spearman correlation test and Pearson correlation coefficient.

Results: mean of total EI estimated 78.31 which the highest and lowest score were in self-cognitive dimension (20.83) and self-management dimension (18.19) respectively. The total mean of CS was 70.90. There was a significant statistical correlation between EI and CS (r=0. 775, p<0.001). Moreover, there was a significant statistical correlation between CS and four dimensions of EI.

Conclusion: Based on study results, emotional intelligence and its dimensions had positive effect on communication skills among emergency unit nurses. Hospital managers can reinforce emotional intelligence by providing educational sessions. They should promote communication skills in emergency unit nurses and provide improvement emergency services quality.

Surveying The Standard of Outpatient Visit Time among General Hospitals: A case study in Qazvin

edris hasanpoor

Background: one of the most essential components in patient- physician relationship is the length of visit. Short time visit can affect visit quality and patient- physician relationship. This study aimed at comparing specialists visit length with standards in general hospitals of Qazvin.

Materials and Methods: This cross-sectional study conducted in general hospitals of Qazvin in 2013. 428 patients were randomly selected to participate who were referred to the outpatient clinics of selected general hospitals. Studied specialties were including Internal Medicine, Surgery, Pediatrics and Obstetrics and Gynecology. In order to data collection, a Checklist including physician and patient related items was used and data analysis performed using SPSS version 19.

Results: The study results revealed the mean score of outpatients' visits length was 4.67±2.43 minutes which had a significant difference from standards (p<0.0001).Higher mean score was relate to pediatrics (2.55±7.08) and the lower one was internal physicians (1.82±3.93).

Conclusion: In this study, Visit time in developed countries was lower than developing ones. Several factors were identified which affect visit time. Thus, decision makers should use the results to improve outpatients visit quality.

Evaluating the Users' Interaction Problems with Physiotherapy Information System

Reza Khajouei

Background: Physiotherapy information system is one of health information systems which used to increase the efficiency and effectiveness of physiotherapy department. Studies have revealed due to usability problems, users' interaction with some information systems is complicated. This study aimed at evaluating users' interaction problems with physiotherapy information system.

Materials and Methods: This study was a cross-sectional and descriptive one which performed using heuristic evaluation method; the users' interaction problems of a physiotherapy system among 105 hospitals were identified, classified and rated based on their severities by three evaluators. Data were gathered using a data collection form designed in Excel software.

Results: In this study, 82 unique interactive problems identified which majority of them 28% (n=23) were related to unconformity of system design with real world conventions with major mean severity of the problems. The lowest numbers were related to the problems including lack of guidance, system documentation and error prevention with major and minor severity respectively.

Conclusion: A number of systems, which are used in many health care centers such as assessed system in this study suffer from several problems which endanger user interaction about the systems can lead to error and patients' harm. To identify and eliminate this type of problems, it is recommend that usability evaluation of these systems to be carried out regularly to enhance users' satisfaction, workflow improvement and patient safety.

Assessing the Risk Factors of Phlebitis Incidence Related to Peripheral Catheter ((An Analytical Study

Zohreh Kalani

Background: Using vein by Peripheral Catheter is one of the important ways to provid water, electrolytes, medications and nutrients to patients in hospitals and other therapeutic centers. Phlebitis is an important complication of using peripheral cannula. This study performed to determine the incidence of phlebitis related to peripheral cannulae, and its effecting factors.

Materials and Methods: This prospective and analytical study was conducted in adult's medical- surgical units of Shahid Sadoughi Yazd. Two hundred ninety seven cannulae of 297 patients were assessed. Phlebitis was identified by the presence of at least two following symptoms including local pain, redness, swelling, warmth and palpable venous cord.

Results: The mean of patients' age was 40.82±19.48 (12-91 yrs.). The phlebitis incidence rate was 14.1%. Some factors such as smoking (P=0.007), diabetes (P=0.001) had positive and significant association with phlebitis incidence rate. Odd Ratio for smoking and diabetes were 3.107(CI=1.310-7.372, 95%) and 3.736(CI=1.736-8.039, 95%) respectively.

Conclusion: Study findings revealed that overall incidence rate of phlebitis compare with other similar studies was low. Study results indicated high phlebitis incidence in smokers, diabetic patients, and elder patients which can be prevented by considering phlebitis incidence in impatiens.

Nursing Medication Errors: Causes and Solutions (A Review Study)

Ebrahim jaafaripooyan

Background: Patient safety is one of the key principals to the trust in any health care system nowadays. Medication errors, as a key safety threatening factors, could increase patients’ length of stay and healthcare costs in hospitals and might lead into injury and finally death. Therefore, this study seeks to compare the incidence and proposed solutions of Iran and selected countries in order for preventing medication errors.

Materials and Methods: This applicable study is a review article searching in such databases as SID, IranMedex, Pubmed, and Scopus to identify and select its related papers. At last, 25 studies were considered for this study.

Results: According to the results of studies, shortage of nurses, nurses’ inexperience, job stress, physicians’ handwriting and lack of information on medications were the highly frequent incidence causes. Training courses on medicine dispensing and hands-on training were the most important solution.

Conclusion: Given the existing gap between the medication errors incidence rate of Iran and selected countries, the latter’s experiences such as transparency and responsibility and active role of hospital pharmacies could be utilized by the former.

Efficacy analysis using Pabon Lasso Model and comparing with national standards of educational hospitals affiliate to Qom University of Medical Sciences

Abolfazli Mohammadbeig

Background: The Pabon Lasso graphical Model is a method to determine hospital efficacy as one of the most important part of health system in developing countries. This study aimed at assessing the efficacy analysis using Pabon Lasso Model and comparing with national standards of educational hospitals affiliate to Qom University of Medical Sciences.

Materials and Methods: This descriptive study conducted in educational hospitals of Qom University of Medical Sciences in 2011 - 2013. Data collected by approved forms of Health Ministry and three indicators including bed occupancy percentage, bed turnover rate, and average length of Stay were calculated for each hospital using Pabon Lasso model. One sample t-test conducted to data analysis.

Results: The mean of bed occupancy and bed turnover was 76.9±9.8 and 100.6±35.4 respectively which were significantly higher than national standards. In addition, the average length of Stay was 3±1.1 days that were similar to standard. The Highest efficacy calculated for IZ hospital and lowest efficacy observed in KA and NE hospitals. Moreover, ZA Hospital can achieve excellent efficacy in 2013.

Conclusion: The mean of bed occupancy and bed turnover assessed very desirable and higher than national standards. Moreover, only IZ and ZA hospitals had excellent efficacy based on Pabon Lasso model.

Comparative study of the relationship between job satisfaction and burnout among Nurses in Public and Private Hospitals in Shiraz City in 2012

hojat habibi

Background: Based on increasing the privatization in hospitals, conducting researches in various fields of private hospitals and comparison with public hospitals is greatly felt.This study aimed at investigating the relationship between job satisfaction and burnout among employed nurses in selected public and private hospitals in Shiraz city.

Materials and Methods: This was a comparative-correlational study. The study population was composed of employed nurses in public and private hospitals in Shiraz city in 2012. sample size was estimated 320 using Cochran formula. The questionnaire of Spector job satisfaction” and “Maslach burnout” were used for data collection. Study conducted in two private and two public hospitals in Shiraz and data gathered randomly among nurses. In order to analysis descriptive and interfere statistics including mean and standard error, Pearson correlation coefficient, MANOVA and independent t- test.

Results: There was a significant and negative relationship among job satisfaction and three dimensions of job burnout in both public and private sectors (p<0.001). In addition, the results revealed that there was a significant difference among the emotional exhaustion and depersonalization between private and public sectors (p<0.05). However, there was no significant difference between job satisfaction and reduced productivity performance of these two sectors.

Conclusion: According to the findings, by increase in the nurses' job satisfaction, particularly in the public sector, the adverse effects of burnout can be prevented.