Journal of

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Background: Communication is one of the central concepts and an integral part of the nursing profession. This study aimed to determine the effect of communication skills training of nurses on patient satisfaction with nursing staff services in teaching hospitals affiliated to Shiraz University of Medical Sciences.
 
Materials and Methods: The Comparative study carried out in 2017. The research population included nurses from educational hospitals and patients referring to them. Four hundred patients were selected through convenience sampling method and one hundred trained nurses and one hundred untrained nurses were randomly chosen. The data collection instruments were a standard questionnaire. Data were analyzed in SPSS₂₃ using T-test, ANOVA, Tukey test, and Pearson correlation coefficient at α = 5% level.
 
Results: Mean scores of nurse-patient commination and satisfication of nursing services among patients under care of trained nurses were 93.5 ± 21.08 and 176.24 ± 22.14 and mean score of patients under care of untrained nurses the scors 81.76 ± 18.83 and 166.36 ± 41.10, respectively. A significant direct correlation was found between nursing-patient commination score and patient satisfaction score (P= 0.023, r= 0.681). Patients under the care of trained nurses were more satisfied with nursing services than those served by untrained nurses (P= 0.012). The results revealed that patient satisfaction had a significant relationship with age (P<0.001) and marital status (P₌0.031).
 
Conclusion:  Implementation of communication skills training courses for nurses leads to improved patient satisfaction. Hospital directors are recommended to consider holding regular communication skills training courses for their nursing staff.

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Background: The admission unit is the main entrance of the hospital and the first patient communication with the hospital is through this unit. The waiting time of patients, which is one of the main consequent of this unit, is not only one of the important factors affecting the satisfaction of the patients, but also is one of indicators of the quality of service of the hospital. This study aimed to provide scenarios at reducing patients’ waiting times.
 

Materials and Methods: This research in terms of methods and goals was a descriptive and an applied one, respectively. This study performed on 110 patients who had been admitted to the Mohb-e-Mehr hospital during 70 days and were uniformly trained on all days of the week. Information was also obtained using observation and data recording in prepared forms. The simulation model was designed and implemented with the Arena 14 software.

Results: Based on research findings, the para-clinical unit and the waiting room for hospitalization were two main bottlenecks in the studied system. In order to solve the problem, for each of the above units, a scenario designed and simulated. The implementation of these tests revealed that the proposed scenarios in comparison with the existing conditions had better results in reducing the waiting time and also increasing the number of admitted patients.

 
Conclusion: Improvement of the therapeutic processes will occur through the recognition of the hospital services system and analysis of the bottlenecks and its weakness points. According to the results, an increase in the number of para-clinical unit staff and hospital beds improves the hospital admission function. The implementation of mentioned scenarios reduces waiting time for patients by about 78% and reduces the waiting time for emptying the bed by about 50%.

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Background:  Development of the tourism sector and health tourism specifically can improve the Non-Oil GDP. In this regard, in accordance with the policies of the Ministry of Health and Medical Education, international patient department establishment has been facilitatated health tourism development in the affiliated hospitals. This study aimed to evaluate the performance of international patient department  and its effect on the attraction of medical tourists among hospitals affiliated to Medical Sciences Universities in Tehran City.
Matrials and Methods: This analytical cross-sectional study was designed and conducted in 2017. Study population consisted of all hospitals affilliated to  Tehran University of Medical Sciences (TUMS), Iran University of Medical Sciences (IUMS) and Shahid Beheshti University of Medical Sciences (SBMU). In this study,  hospital entrance criteria was certified by the Health Tourism Department of MOHME. Data was collected using the health tourism assessment checklist which approved by the MOHME. SPSS version 24 utilized to data analysis using descriptive and Inferential statistics.
Results: The study results revealed that  the overall performance of international patient department was evaluated at a desirable level (87.5 score) in hospitals of Tehran city.  Hospitals had the highest rank of hoteling indices (95/100), in compliance with the regulations and functional indicators gained 87.03 and 82.2 score, respectively.  Also, data analysis highlighted that there was no significant difference between hospitals of TUMS, IUMS and SBMU. The establishment of international patient department had no effect on health tourists attraction.
Conclusion: Considering the purpose and mission of international patient department to facilitate the provision of quality and satisfactory services in health tourists, management and oversight mechanisms for the standards implementation such as patient admission, follow up in the origin country and development of hospital marketing policies in order to attract international patients and increase hospital incomes are recommended.

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Background: Brand loyalty is one of the most important factors in maintaining and success of huge organizations such as hospitals. This study aimed to survey the factors that affect the patients’ loyalty to hospital brands in teaching hospitals affiliated to Shiraz University of Medical Sciences (SUMS).
 
Materials and Methods: This cross-sectional descriptive-analytic study conducted in 2017. The study population consisted of 385 clearance patients who were admitted to educational hospitals in Shiraz using stratified sampling method in February 2017 to March 2018. Information was collected using a researcher-made questionnaire and data analyzed by descriptive statistics, T-test, ANOVA, and multiple regressions using SPSS version 23 at a significant level of α = 5%.
 
Results: Patients’ satisfaction (β=0.333, P<0.001), trust in brand (β=0.265, P=0.007), and commitment (β=0.181, P=0.011) had a direct and positive effect on the patients’ loyalty to the hospital brand.
 
Conclusion: According to this study results, hospital managers should pay an attempt to inform the patients about their treatment procedure, follow up the patients’ health after discharge, and increase the communication between personnel and patients. These could contribute to better image and experience for patients resulting in loyalty to the hospital brand.
 

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Background: with increasing demand for treatment, patients are monitored with help of Internet of Things(IOT). Patient's monitoring devices and technologies include heart rate measurement, blood pressure measurement, blood glucose and other vital signs. The purpose of study is to provide a model of clustering patient physical monitoring gadgets and apps in Healthcare Internet of Things (HIOT) environment using data mining techniques, so based on the needs and characteristics of the user, the more appropriate results of choosing technologies acquired.

Materials and methods: This study is a review and functional since its result. The data includes 6 unique features of 60 selected technologies including function, price, connectivity route, power supply, location and type of use that has been extracted from R&D and advertising sites of technologies and also relevant articles. data analysis method is clustering technique and K-medoids algorithm. to identify the most effective features, random forest algorithm has been used.

Results: the proposed clustering model takes into account 6 as inputs and clusters gadgets and apps in accordance with selected characteristics as the model outputs. clustering problem data is clustered in 4 categories.  Silhouette index is 0.45, which indicates the validity of the model. The type of application and then the price had the greatest impact on clustering.

Conclusion: By this model, patients or users can find the most appropriate technology based on the type of disease and other effective features, such as price. So with accurate physical and momentary monitoring, disease progression decrease and prevention of disease will improve.

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Background: Nosocomial Infections (Nis) Are Regarded As The Most Common Complications Of Health Cares. These Infections Affect Patient’s Safety in Developing and Developed Countries. The Aim Of This Study Was To Epidemiology and Determine the Causes of Nosocomial Infectioin Teaching Hospital of Tehran In A Teaching Hospital In Tehran.
Materials and Methods: This Cross-Sectional, Descriptive And Analytical Study Was Designed In 2019 At A Teaching Hospital Affiliated With Iran University Of Medical Sciences. The Nosocomial Infection Registry Data between 2017 and 2018 Was Used. The SPSS24.0 Software Package Was Used To Analyze Data Into Descriptive (Frequency, Percentage, Mean and Standard Deviation( And Analytical) ANOVA) Statistics.
Result: The Most Frequent Type of Infections Were Urinary Tract (39.76%), Ventilator Associated Events (20.92%), Bloodstream (20.71%), Respectively. Skin and Soft Tissue Infections (0.7%) Had The Lowest Prevalence. The Highest Incidence Of Nosocomial Infection Was In The ICU With 200 Patients And The Lowest Incidence Was In The ENT With 23.1 Patients And The Overall Incidence Of Nosocomial Infections Was 84.9 Patients Per 10,000 Patient-Days.

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Background: Information technology application in health care is increasing. The aim of  this study, is to introduce a scientific model for designing an electronic system for managing patient transfer.
Materials and Methods: This study is an exploratory qualitative study. At first a review of literature was carried out for identifying clinical, managerial and process indicators necessary for patient transfer. Then 30 experts, who had vast experiences on patient transfer, were selected using purposive sampling approach and their informational needs were extracted using focus group discussion and semi-structured interviews. Then clinical indicators extracted from literature review and informational needs collected from interviews were distributed among 51 experts in the form of Delphi questionnaires. Process indicators were also distributed among 35 experts to summarize all necessary indicators for designing patient transfer system. At the final step an expert panel approved the model.
Results: Thirty eight process indicators and 249 clinical and managerial components were finalized for designing the system. The process indicators were used for designing “monitoring and reports sections” of the system. The clinical indicators were used for designing “main sections” of the system including request for patient transfer, automatic algorithm for selecting destination hospital, information flow cycle, communicating clinical data and documentation. Final model also includes user interfaces relevant to responsibility of the user.
Conclusion: The proposed model, which contains necessary indicators for patient transfer, can communicate clinical information among hospitals and by providing proper infrastructure, will be able to improve patient transfer process.
 

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Background: Hospitals play a key role in ensuring community health. Among the hospital departments, the surgery room accounts for a significant portion of the cost and revenue of the hospital. Surgery timing is important to increase the efficiency of operating rooms. The purpose of this study was to optimize surgical hall scheduling based on discrete event simulation model.
Materials & Methods: This cross-sectional study was performed in the summer of 2018 in the operation room of one of the hospitals in Tehran. As people entered the operation room, their information about the cause and condition that caused the surgery, the type of surgery (elective or emergency) the time of being in the operation was recorded by details. Data analysis was performed SPSS software and simulation of therapeutic system was performed  Arena software.


Results: By analyzing the input data of 625 patients during three months, more than 60% of patients were men and less than 40% were women. The first entry into the surgery room for the selected patients was at 7:10 am and the last was at 5:00 pm. Of the eight scenarios presented, two arrival rate correction scenarios (noon arrival distribution) and a combined scenario (noon queue correction and patient adding) resulted in the greatest reduction in waiting time.


Conclusion: The results of this study showed that changing the distribution of patients 'arrival to hours with less input time can decrease patients' waiting time and increase the efficiency of surgery room.

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Background and purpose: Electrocautery is a very important tool in surgery. Electrocautery burn is a common side effect of operation surgeries. Quality management is a useful strategy for improving the quality and safety of hospital services. The objective of this study was to examine the impact of quality management on reducing electrocautery burns.
 
Materials and methods: A participatory action research was conducted in the operating theatre of a hospital in Tehran, Iran, in 2013 and 2014. A quality improvement team was established in the hospital operating theatre. The quality improvement team using an 8-step quality management model, standardized working processes, identified quality goals for the processes and improved them until achieved the quality goals. Data on electrocautery burns was collected before and after the intervention and compared.
 
Results: Electrocautery burn rate was 0.40% in 2012. A wet patient due to sweating or washing during the surgery, in-appropriate patient position, faulty earth well, faulty anti-static mattress and long usage of electrocautery devices were the main reasons of electrocautery burn injuries. Accordingly an action plan was developed and implemented for preventing and reducing electrocautery burns. Consequently, electrocautery burn rate was reduced to 0.21% and 0.02% in 2013 and 2014. Electrocautery burn was significantly reduced by 95% in two years.
 
Conclusion: Electrocautery burns can be easily prevented using the quality management strategy. Implementing an appropriate quality management model appropriately in a supportive environment enhances the safety of hospital services.

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Introduction: Hemodialysis is one of the effective therapies in patients with chronic renal failure. Along with increasing life expectancy as a benefit of this treatment; this type of service can threaten the quality of life of recipients. Therefore, the present study was conducted to investigate the effectiveness of emotional schema-based therapy on improving the quality of life of dialysis patients.
 
Materials and Methods: The current semi-experimental, applied study was designed and implemented as pretest-posttest research with a control group. All outpatients treated with dialysis instrument in medical centres affiliated to Tehran University of Medical Sciences in 2009-2010 were the statistical population of the study and the quality of life questionnaire related to kidney patients used for data collection. After the research team performed the treatment protocol in 8 sessions of 90 minutes in the intervention group, the research data were analyzed using SPSS24.
 
Results: The results of the study showed that the treatment protocol based on emotional schema therapy influence all aspects of quality of life and increase the mean score compared to the pretest. Also, there is a significant difference between the groups, both in the general dimension and specific dimension of dialysis patient's quality of life.
 
Conclusion: As the study findings show, it can be stated that emotional schema therapy is effective in improving the quality of life of dialysis patients and can be used as a useful intervention to improve the quality of life of patients.

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Background: thousands of people die or suffer from irreversible damage due to lack of timely and adequate services in medical centers. This research seeks to identify and prioritize factors affecting the demand for patient transfer and provide the most effective measures to facilitate this process.
Materials and Methods: This research is combined in terms of method and inductive research in terms of type of research. The population of study is the senior and middle managers of Guilan University of Medical Sciences who were selected as a sample member using purposive sampling method. The factors affecting patient transfer demand were identified using qualitative data obtained from exploratory studies, then these factors were prioritized using fuzzy Delphi method.
Results: In the first part, a set of factors affecting the demand for patient transfer were identified, and in the second part, the importance and priority of these factors were determined. The results of the research showed fourteen main factors, including disproportionate distribution of specialized human resources, ineffective planning, inefficient management, and inefficiency of human resources.
Conclusion: Inefficient organizational processes and organizational structures along with real needs have been identified as reasons for patient transfer demand,which requires special attention of supervisors and management of organizational development and administrative transformation of universities. It seems that the formation of a special monitoring and planning working group to remove obstacles in a centralized manner at the highest organizational level and a special look at the reports of the care monitoring center as the most effective measure can be used to manage the dispatch process, planning, Monitor and remove obstacles.

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Background and purpose: Inter-hospital transfer refers to the transfer of patients to receive diagnostic, therapeutic and paraclinical services that can prevent more injuries or more effective treatment. The present study was designed with the aim of collecting and analyzing information related to sent patients and identifying the factors that cause the transfer of patients.
Methods: This cross-sectional study was conducted on 11,362 patient referral forms registered at Gilan University of Medical Sciences. Data were analyzed by Spss statistical software version 22 and Chisquer statistical test.
Results: The amount of patient transfer requests in 1401 compared to 1400 has increased by 9%. There is a relationship between the demand for transfer of patients with inappropriate distribution of specialized human resources, lack of demand feedback mechanisms, ineffective planning of nursing staff and residency of doctors in the hospital of origin, inefficient management of resources and equipment, lack of diagnostic, medical and pharmaceutical facilities, as well as with the seasons of the year. There is significant (p>0.05). There is a significant relationship between non-acceptance of patients and the lack or lack of beds needed by the patient in the destination hospital (p<0.05).
Conclusion: Improper distribution of specialized manpower according to the needs of the region, ineffective planning of resident guards, inefficient management have been identified as the main reasons for the demand for patient transfer. Forming a special working group to identify, evaluate, plan and monitor the removal of obstacles in a centralized manner and forming quality improvement circles can be a solution.

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Background and purpose: The emergency department of a hospital is akin to its heart, where smooth operations can save many lives. This research aims to reduce patient waiting time in the emergency department using simulation techniques.
Methods: This descriptive-analytical study was conducted cross-sectionally in 2019 at the Qaim Hospital in Mashhad. The study focused on accurately modeling the patient flow process in the emergency department using simulation techniques and Arena software. Key performance indicators such as patient waiting time, number of discharged patients (system output), length of stay, resource efficiency, and improvements in the emergency department were evaluated.
Results: The simulation model's results indicated that the laboratory, specialist doctor examination, and pharmacy departments had the longest waiting times in this department, respectively.
Conclusion: To reduce patient waiting times and improve conditions, the most effective and cost-efficient solution is to add a laboratory technician to the laboratory department during the [15-23] shift at Qaim Hospital in Mashhad, which is projected to decrease patient waiting times by 66 minutes.

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Background and Purpose: Infections related to inadequate healthcare practices can have adverse effects on healthcare systems. This study aims to identify the gap between the current handwashing practices and standard levels by determining the frequency of handwashing among staff at Shahid Modares Hospital in Tehran.
Methods: This descriptive cross-sectional study was conducted in the wards of Shahid Modares Hospital between 2018 and 2019. The tool comprised two parts: job information and hand hygiene practices at different times and specific actions. Observers directly monitored all staff in each shift using a headcount method. Each column represented the hand hygiene compliance score of a specific professional group, allowing simultaneous performance evaluation.
Results: Out of 640 observed instances, 202 involved the use of disinfectants, 255 involved handwashing, 111 involved glove use, and in 71 instances, hand hygiene was not observed. The highest compliance occurred when staff intended to contact the patient's body, while the lowest compliance was observed after performing surgery on the patient.
Conclusion: Given the significant role of nurses in therapeutic interventions, multifaceted training interventions, the drafting of hand hygiene policies, and increasing awareness among department officials should prioritize this group of employees. These measures aim to bring practices closer to desired standards and prevent unwanted consequences.

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Background and purpose: The physical and environmental characteristics of hospital spaces play a crucial role in influencing patient stress levels, particularly before and after surgery. This study aims to examine the impact of architectural elements in hospital environments on reducing stress among surgical patients, contributing to the enhancement of healthcare environments and patient well-being.
Methods: This descriptive-analytical study was conducted in the general surgery department of Razi Hospital. Data were collected through a structured questionnaire administered to patients before and after surgery. The validity of the questionnaire was assessed using Smart PLS 3 software, and reliability was measured using Cronbach's alpha. The collected data were analyzed using structural equation modeling.
Results: Among male patients, sensory elements had the greatest effect on reducing stress before surgery, while form-based elements had the least impact. After surgery, sensory elements remained the most influential, whereas spatial configuration had the least effect. Among female patients, symbolic components (e.g., cultural and religious symbols) had the most significant impact before and after surgery, while form-based elements had the least influence.
Conclusion: The gender of patients and the physical design of hospital spaces significantly influence stress reduction among surgical patients. Designing hospital environments with calming elements such as soothing colors, natural light reflections, relaxing sounds, pleasant scents, and culturally relevant symbols can enhance the overall patient experience and improve recovery outcomes.

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Background and purpose: As part of Iran’s Health System Transformation Plan (HSTP), the first service package aimed to reduce out-of-pocket expenses for hospitalized patients in hospitals affiliated with the Ministry of Health and Medical Education. This study evaluates the effectiveness of the policy in reducing patient payments at teaching hospitals under Golestan University of Medical Sciences.
Methods: This descriptive-analytical cross-sectional study was conducted between 2021 and 2022. A total of 384 participants—including healthcare workers, medical staff, and physicians—were randomly selected from teaching hospitals affiliated with Golestan University of Medical Sciences. Data were collected using a 35-item researcher-designed questionnaire, validated by experts, with a Cronbach's alpha reliability score of 0.83. Data analysis was performed using SPSS version 22, Kolmogorov-Smirnov tests, and a one-sample t-test.
Results: Indicate a gap of -0.11 between the current situation and the desired outcome of the HSTP’s first axis (reducing patient payments). Analysis using the gap analysis matrix revealed that the primary shortcoming is in regulatory oversight.
Conclusion: While the Health System Transformation Plan has successfully reduced out-of-pocket expenses for hospitalized patients, it has not fully met the program’s intended financial relief targets. Further policy adjustments are required, particularly in expanding universal insurance coverage and ensuring adequate financial resource allocation to improve accessibility and affordability for patients.

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Background and purpose: Given the interdisciplinary nature and multiple stakeholders involved in electronic prescribing systems, their implementation process encounters numerous complexities. This qualitative study aimed to explore and clarify the challenges associated with electronic prescribing and prescription dispensing systems.
Methods: A qualitative content analysis was conducted in 2021 (Iranian calendar: 1400). Data were collected through semi-structured interviews with 25 key informants from the treatment management sector and affiliated hospitals of Tehran University of Medical Sciences. The collected data were analyzed using conventional content analysis methodology facilitated by MAXQDA 10 software.
Results: Approximately 350 initial codes were identified, which were categorized into four main themes with eight sub-themes: policy preparation (establishing a policy secretariat and achieving political consensus), policy formulation (developing policy content and advocacy), policy implementation (planning and executing policies), and policy evaluation (monitoring and evaluating policies).
Conclusion: Ensuring public health remains the ultimate goal of the healthcare system. Electronic transformation, particularly in establishing electronic health records, can significantly improve healthcare service quality. Integrated policymaking among the various institutions involved, enhancing technical and procedural infrastructure, human resource training, and societal cultural readiness are essential factors for the effective implementation of electronic prescription systems and the enhancement of healthcare quality.

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Background and purpose: Developing countries strive for solutions to attract medical tourists. Digital marketing is explored here. The aim is to assess digital medical marketing criteria and their relation to health tourist acceptance in selected Tehran hospitals in 2022.
Methods: A descriptive-analytical approach using mixed methods. Qualitatively, through text review, digital medical marketing criteria were identified using fuzzy Delphi, resulting in 5 factors and 61 concepts. Quantitatively, after distributing questionnaires among 30 experts, 25 valid questions were retained. The sample included 125 experts from health tourism units and hospital staff. Kendall's correlation and Chi-square tests were run via SPSS 18.
Results: Identified criteria encompassed multilingual websites, content, digital systems, human resources, and health tourist attraction. Kendall's correlation indicated significant relations with human resource performance (r=0.413), website content (r=0.247), and digital systems (r=0.235) significantly influencing tourist attraction (p<0.01). Chi-square tests revealed significant differences in multilingual websites, website content, digital systems, and human resource performance impacting health tourist attraction (p<0.01).
Conclusion: Iran's medical tourism benefits from enhancing service quality, website content, human resource performance, and digital systems, leading to increased health tourist attraction.