Journal of

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Background: One of the main goals of health sector evolution plan is reducing the amount of out of pocket payment by patients receiving hospital services in public sectors. This study aimed to assess the amount of out of pocket payment by inpatients in public hospitals affiliated to Shahid Beheshti University of Medical Science in Tehran city in 2015.
 
Materials and Methods: In this cross-sectional study, 405 discharged patients from four public and teaching hospitals were selected using convenient sampling method. Data were collected using a researcher made checklist and investigating the hospital bills. In order to data analysis, descriptive statistics and regression analysis were utilized through SPSS Software version16.
 
Results:  The amount of out of pocket payment was 10.2 percent included 9.9 percent formal payment, 0.2 percent bought & brought goods and 0.1 percent informal payment. The most portion of the hospital costs was related to medical supplies and pharmaceuticals, surgeries services and hosteling with 32.6, 20.6 and 17.36, respectively. Type of hospital, having surgery, average length of stay, family size and gender had significant effect on the out of pocket payment amount (p ≤ 0.05).
 
Conclusion: The amount of out of pocket payment by inpatient in public hospitals was in accordance with goal of the health sector evolution plan, which reveals the appropriate government support. It is recommended to tailor and implement enormous plans regarding outpatients and private sector in national level to attain sustained reduction in out of pocket payment.

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Background: Length of stay is one of the most important and practical indices used in hospitals today which represents the performance and efficiency of the hospitals. This study aimed to identify the factors affecting length of stay in hospitals affiliated to Tehran and Iran Universities of Medical Sciences based on Hierarchical Analysis Technique.
Materials and Methods: This descriptive cross-sectional study was conducted in 2013. Study population consisted of 40 participants using purposive sampling method in the two groups including 13 matrons (nursing managers) and 27 supervisors (Clinical and educational) of hospitals affiliated to Tehran and Iran Universities of Medical Sciences. Data collection tool was the paired comparisons questionnaire which was confirmed validity by experts using Lawshe and reliability by Inconsistency Ratio. Data analysis was performed using Expert Choice software version 11.
Results: In general, in the studied hospitals, study results revealed that the "diagnostic, treatment and care methods (treatment efficacy)” with the mean of 21.4% and "admission and discharge in the end days of the week and the days off” with an average of 0.36 were the highest and the lowest priority is given to other factors affecting the length of stay of the patient,respectively.
Conclusion: Efficacy of provided treatment through using equipment, appropriate diagnostic and therapeutic procedures and factors related to hospital manpower were effective on length of stay in quantitative and qualitative dimensions. These important issues need more planning and pay attention by hospital officials.

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Background: Considering the key role of human resource management in health care organizations, assessing human resources and its pathology are essential. Therefore, this study aimed to evaluate human resources pathology in Imam Khomeini Hospital complex in Tehran.
Materials and Methods: The present study was conducted using descriptive-analytical method in 2016. In this research, 342 employees of Imam Khomeini Hospital complex were selected. The data were collected using a standard three-dimension questionnaire, then, descriptive (frequency, percentage, mean, standard deviation) and analytical statistics (Pearson Correlation Coefficient) were used to data analysis.
Results: Study results revealed that the highest and the lowest mean and standard deviation were obtained for the variable of motivation and job satisfaction (3.51 ± 1.02) and improvement methods (2.81 ± 0.84), respectively. Among all studied variables, behavioral (3.29) and contextual (2.91) factors scored the highest and lowest points respectively. Correlation between structural, behavioral and contextual with demographics revealed a statistically significant association with sex.
Conclusion: According to study findings, considering the importance and role in providing the desired services, human resource managers should pay special attention to identify all organizational factors, especially organizational culture, motivation and job satisfaction, employee training, job security and customer orientation.

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Background: In recent years, Hashemi Nejad Hospital was outsourced or insourced some of their services to private sector or will have decision to do it. Selection and assessment of suppliers in outsourcing of hospital services is a critical issue. In this study, selecting and evaluating suppliers for outsourcing services in hospitals was evaluated.
Materials and Methods: In order to achieve the goal, evaluating and selecting outsourcing service providers with studies and using opinion of the experts and medical experts, consisting of hospital manager, quality manager, HR managers, officials outsourced parts and other experts in this respect which includes 14 criteria. Identified criteria were clustered in three areas of service features, characteristics and criteria for communications suppliers in the supply chain; supplier selection problem is the problem multi-criteria decision. So, criteria were ranked and weighted using the Expert choice 11 software and AHP.
Results: Based on the study results, sub-criteria of the quality of service, management systems, customer care, and information security had greatest impact on the selection of suppliers and sub-criteria, geographic location, flexibility and problem solving had the lowest priority.
Conclusion: C supplier had the highest priority according to the communication criteria and A supplier had the highest priority according to two other criteria. In total, the supplier A had the first priority, supplier B had the second priority and supplier C had the third priority.

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Background: Hospital managers' success depends not only on internal of the hospital environment, but also on the external. Considering the importance of the social responsibility of hospitals as an external organizational issue, this study aimed to assess the importance of social responsibility and the implementation status of hospitals.
Materials and Methods: This analytical descriptive study was conducted in Kermanshah educational hospitals in 2016. The study population consisted of management team of each hospital in middle and first-line level, of which 150 were selected using census sampling method. The data gathering tool was a researcher-made questionnaire. Validity and reliability of the instrument was confirmed. Data analysis was performed using SPSS20 software, descriptive and inferential statistics.
Results: The mean score of importance and status of social responsibility implementation were high (86.20 ± 9.98) and moderate (60.62 ± 12.41), respectively. Among the domains, the highest and the least attention were paid to environment (11.65 ± 88.30) and suppliers (13.47 ± 81.48) domains, respectively. The highest level of accountability in patients was (68.87 ± 26/14) and the least was found in organizational processes (14.47 ± 42.02). There was a significant statistically difference in social status according to organizational status and employment type (p <0.05).
Conclusion: The results revealed that the rate of social responsibility of hospitals was moderate. It seems that providing a systematic assessment of managers performance and authorities, functional feedback and using the successful experiences of organizations in the field of social responsibility are necessary.
 

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Background: Physical and verbal violence against hospital personnel is very critical problems that could influence the quality of clinical and nursing cares. Today, problem prevention and identification of related factors with domestic violence against women have been considered as a health priority in many countries. Therefore, due to the importance of this issue, this study aimed to determine related factors with domestic violence against women in educational hospitals affiliated to Isfahan University of Medical Sciences.
 
Materials and Methods: This cross-sectional study was a descriptive-analytical one which conducted on 836 female employees using census method. Data collection performed using a researcher-made questionnaire. This questionnaire consisted of 34 items in four dimensions (physical, verbal and mental, sexual) and violence experienced by the husband. Data were analyzed using SPSS version 16 with descriptive statistics and analytic statistics such as Kolmogorov–Smirnov, ANOVA, independent t test, and Pearson correlation coefficient and multivariate regression.
 
Results: Study results revealed that verbal and mental (55.33%), physical (36.16%), and sexual (6.66%) violence were the most common type of violence against women, respectively. There was a significant statistically association between age gap, forced marriage, husband’s addiction, income and precedent violence Experience and violence against women.
 
Conclusion: This study presented prevalence and related factors of demotic violence among women. Therefore, it is imperative that health authorities, especially hospital managers, pay attention to this phenomenon assessing further investigation of factors related to violence against women in order to take the necessary steps to mitigate and reduce related factors using life skills workshop, training and counseling for couples.

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Background: Today, in order to reduce costs along with the realization of superior qualities, assignment of all or part of the responsibility for performing a specific organizational task outside the organization is a great importance. Therefore, this study aimed to assess the role of corporate culture on the quality of working relationships in outsourcing activities at Tehran University of Medical Sciences.
 
Materials and Methods: This research was a correlational study. The study population consisted of all the staff of the outsourced units of Tehran University of Medical Sciences. Staff who were in contact with outsourced units included 600 individuals. To collect data, a questionnaire based on Zoghbi et al study (2014) was utilized. Two hundred fourteen analyzable questionnaires were collected using multistage cluster sampling method.
 
Results: Structural simulation results with LISREL software revealed that corporate culture had a positive impact on the quality of working relationships during outsourcing of activities. Hierarchical culture was associated with adverse impacts on disruptions in customer service and orientation. Ethnic culture had a positive effect on both components. The market culture had a positive impact on obstruction and had a negative effect on customer oriented. Temporary culture had no significant impact on both of components.
 
Conclusion: given that the quality of working relationships between staffs of outsourced units and organizational staffs is of utmost significance for organizational productivity; the interest of managers affiliated to Tehran University of Medical Sciences regarding corporate culture, and also, strengthening hierarchical and ethnical culture is noteworthy to improve customer orientation and reducing disruptions in customer services.
 

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Background: Femoral fracture surgery is one of the most common and expensive surgical procedures and forearm fracture surgery is common performed by Ilam Imam Khomeini Therapeutic Center. This study conducted to analyze the difference in actual cost and global surgery tariffs in this hospital.Also, the related factors acutal cost of mentioned surgery were identified.
 
Materials and Methods: This cross-sectional and descriptive study was conducted on factors related to the actual costs of femoral and forearm fractures. The Activity-Based Costing approach identifies the related cost  associated with these surgeries in through six steps. Data analysis was performed using Excel 2016 software.
 
Results: The  avarage actual cost of the femur fracturs , the code 2 forearm and  the code 1 forearm were 953 thousand and 700 tomans, 444 thousand and 400 tomans and 337 thousand and 800 tomans , respectively. The actual cost of surgery for femoral fracture per unit surgery was 406,000 and 400 tomans lower than the Ministry of Health's tariff. But ,the real cost of the code 2 forearm was 33 thousand tomans higher, as well as the code 1 forearm 20 thousand tomans higher than the global tariff.
 
Conclusion: Overall,  there are significant differences between hospital costs and the Ministry of Health's global tariff. That can be corrected by improving the hospital's performance, as well as carefully examining the cost of global surgical procedures for amending the system of tariff regulation and make the actual amount closer to the tariff level.
 

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Background: The hospitals' reliance on insurer organizations' resources is increasing due to the growing number of insured persons. However, a relatively large share of these revenues cannot be collected for various reasons and is considered as hospital deductions from revenue. Hence, this study aimed to investigate the causes of hospital deductions from revenue and strategies to reduce them in hospitals affiliated to Iran University of Medical Sciences.
Materials and Methods: This qualitative study was conducted based on the phenomenological approach in 2017. Data was collected through semi-structured interviews consisting 17 finance experts in hospitals. Data analysis was performed using MAXQDA version10 and analytical framework of Gale et al. (2013).
Results: Based on the framework analysis, two themes were identified as the underlying causes of hospital revenue deduction including direct causes and root causes of revenue deduction. Also, in order to reduce revenue deduction strategies, eight themes were recognized including interaction with insurance organizations;  analysis, assessment, and feedback on revenue deficit; coordination and empowerment of employees; proper organization of human resources; strengthening regulatory system, motivational strategies; good planning  and creating an organizational structure.
Conclusion: The revenue deductions occur in all stages of converting services into income and the most important factor is lack of staff awareness and incentive to control deductions. Contributions of all process owners in the hospital and insurers and in particular the commitment of hospital’s senior managers are necessary to control the deductions.
 

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Background: Activity-Based Costing Analyzes the Activities Performed in the Service Delivery Process and Accurately Identifies Costs to Improve The Performance and Efficiency of The Delivery Units and Calculates the Cost of Each Activity by Identifying Services and Activities. The Purpose of This Study Was to Calculate the Cost of Radiology Services Based on Activity Based Costing Method In Firooz Abadi Hospital.
 
Materials and Methods: This is a descriptive retrospective study conducted in 2018. Data were collected through interview with Hospital officials, direct observation and from existing documents in hospital. Data entry was done through Excel software and analyzed Based on activity-based costing system in eight steps.
 
Results: Based on the Findings of this Study, Four Types of Imaging Services Were Commonly Found In Firooz Abadi Hospital. From Total Radiology Costs, 79.3% Were Estimated to Be Related to Direct Costs and 20.7% to Indirect Costs. Finally, the Cost Per CT Scan Service Was 725,133 Rials, Mammography 608,054 Rials, Radiology 809,165 Rials and Ultrasound Service 512,692 Rials.
 
Conclusion: Results of the Study Indicated that Direct Costs accounted for most Costs in Radiology Unit, So Improving Performance and Policies in Health System, Particularly in Human Resource Management, Service Consumption Standardization and Staff Training Suggested to Cost Reduction.
 

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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 and Aim: Conflict between health workers is an important problem in health care units around the world. The aim of this study was to identify the causes of conflict between nursing staff and other occupational groups in the hospital.
 
Materials and Methods: This descriptive-analytical study was conducted in 2018. A researcher-made questionnaire was used to collect data. The questionnaire was designed in two parts: demographic variables and causes of conflict between nursing and other occupational groups with a Likert scale of 5 points. 120 nursing staff of Ardabil University of Medical Sciences randomly selected were surveyed. Data were analyzed by SPSS software15 using descriptive and inferential statistical methods.
 
Results: The highest rate of conflict reported by nurses was related to the conflict with the group of managers (4.17±0.94) and the lowest rate was with administrative, financial and support staff (3.55±1.13). The most important reasons for conflict between nursing staff and different groups were: imposing non-specialist roles (such as completing doctors' documentation); perceived inequality in workload distribution; insufficient understanding of nursing work conditions; unreasonable differences in salaries and other benefits, and unfair distribution of manpower. There was also a statistically significant correlation between the level of conflict with marital status, work experience, age group (p <0.05).
 
Conclusion: The results of the present study showed the role of some factors causing conflict between nursing staff and other occupational groups. These findings could be a practical guide for hospital managers in making practical decisions and strategies for managing workplace conflicts.

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Background: Estimation of cost functions is an appropriate tool for optimal resource allocation in hospitals. The present study aimed at estimating cost function for hospitals affiliated to Shiraz University of Medical Sciences.
                                    
Materials & Methods: In the current cross-sectional study, inputs, costs and resources data for 28 hospitals were gathered from hospital statistics and information system. Required data were collected monthly for two years (2015-2016). Then, The Cobb-Douglas cost function was estimated using panel data analysis. STATA 14 was used for data analysis.
 
Results: Estimates showed that hospitals' cost elasticity concerning the inpatient and outpatient admission were 0.555 and 0.058 for large hospitals, and 0.769 and 0.099 for small hospitals (P<0.01). Among hospitals inputs, the cost of a physician with coefficient 0.175 in large hospitals and 0.481 in small hospitals (P<0.01) was most cost driver. In studied hospitals, average cost (36,406,480 Rial) was higher than marginal cost (26,548,020). Moreover, scale economies index were in small, large, and all hospitals were 0.868, 0.613 and 0.729, respectively. The number of active bed, length of stay and teaching activity had a positive effect on hospitals cost (P<0.01).
 
Conclusion: According to the findings, to control costs, the hospital should manage most cost drivers, such as physicians and pharmaceutical costs. Moreover, According to the average and final cost and scale economies index, hospitals should expand their service provisions with current inputs and resources in order to reach the optimum point of output.

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Background: The increasing prevalence of Covid 19 virus in the world has various consequences for people involved in the treatment process of patients with this virus. Accordingly, the main purpose of this study was to identify and prioritize the psychological consequences of Covid 19 virus in nurses.
Materials and Methods: This study is based on the applied purpose and in terms of how to collect data in the field of descriptive survey studies. The analysis approach in this study is mixed and a combination of qualitative and quantitative methods. The statistical population of this study consists of nursing professors and medical specialists of Lorestan University of Medical Sciences. Using purposive sampling method and according to the principle of theoretical saturation, 14 professors and specialists were included as the research sample. The statistical population of the quantitative ward also included the managers of hospitals providing services to coronary patients in Lorestan province, which were selected as a research sample by 35 people using non-probability sampling method. Identification of psychological consequences was performed using analysis of interview data with Atlas.ti software and prioritization of consequences using a triangular fuzzy method.
Results: Analysis of interview data led to the identification of 16 psychological consequences affecting nurses. Prioritization of these factors showed that depression, decreased concentration and apathy are the most important psychological consequences of Covid virus 19.
Conclusion: Developing supportive strategies to maintain the health of nurses should be a priority in future plans, and a separate part of the annual hospital costs should be allocated to this important matter.

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Introduction: The operating room is one of the most sophisticated workplaces, consisting of a vast array of electrical, gas and radiation equipment that are more susceptible to accident than other hospital departments. Therefore it is important to observe safety tips in this section. The purpose of this study was to evaluate the standard of safety in operating rooms of hospitals affiliated to Mazandaran University of Medical Sciences in 2019.
Method: This study was a descriptive cross-sectional study. The statistical population consisted of all operating rooms of hospitals affiliated to Mazandaran University of Medical Sciences. The tool used was a checklist that was completed by researchers by observation and interviewing on-site. Safety standards have been evaluated in terms of the physical space of the operating room, fire safety, personnel safety, patient safety, infection control. Data were analyzed by SPSS version 21.
Results: The operating rooms of university-affiliated hospitals were 80.10% secure in overall safety. The patient's safety area, with 83.34%, had the shortest distance from the standards and the infection control safety area, with 74.24%, had the highest distance from the standards. The highest and lowest scores were related to the safety standard related to the operating room of hospitals (2) and (1).
Conclusion: According to the findings, the operating rooms of the studied hospitals are generally in desirable compliance with safety standards. However, it is essential to pay attention to problem areas to increase the safety factor for staff and patients in the operating room, so appropriate remedial measures should be taken to ensure complete safety of the operating room for all components.

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Background: One of the fundamental changes in the health system of Iran in recent years is the "health system reform plan", that the effects of which should be examined from various dimensions. The purpose of this study is to determining the effect of health system reform plan on health indicators in population covered by Ahvaz University of Medical Sciences.
 
Materials & Methods: In this descriptive-analytical study, the data of the selected health indicators of Ahvaz University of Medical Sciences in the period before and after the health care system reform plan (from 2012 to 2018) was collected, described and analyzed with SPSS.
 
Results: The highest rate of change in mortality indices was between 2013 and 2015, orderly in U5MR, IMR & NMR, With the mean difference 13.282, 10.825 & 7.955 (P=0.001, P=0.002 & P=0.004). The highest rate of change in Care Coverage for Children Under-five, is between 2014 and 2015 with mean difference of 11.335 and about the Antenatal Care Coverage, between 2014 and 2017, with mean difference 10.050 (orderly p=0.002 & p>0.001). MMR was not significant.
 
Conclusion: The time trend analysis on health indicators confirms that the changes in the early years of the reform plan have been a lot, then it has slow down. Most of the change in health indicators is related to years of 2015 and 2016. The findings indicate that the latest health reform plan in Iran has improved the mortality indices (Reduce in NMR, IMR & U5MR), Care Coverage for Children Under-five and Antenatal Care Coverage (6+). Health reform plan has not affected on MMR.

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Background: Medical tourism has been considered in our country for many years. The arrival of international patients in the country will boost the medical tourism sector; however, the necessary infrastructure must be created for this. The guidelines for the establishment of the International Hospital Unit are one of the legal infrastructures for standardization in this field. Therefore, this study was conducted with the aim of strategic analysis of the establishment of an international patient unit in hospitals of Tehran University of Medical Sciences.
Materials & Methods: This combined study was performed in 2019 in three hospitals of Tehran University of Medical Sciences that had a license to operate this unit. In-depth interviews were conducted in each hospital with experts in this field. The data were then categorized into four categories of strengths, weaknesses, opportunities and threats, and according to the results of the SWOT technique, the necessary strategies were presented.
Results: There are opportunities including low cost of medical services in Iran, low value of Iranian Rial and political and religious ties with countries in the region. Significant threats also included the existence of professional competitors, the widespread activity of brokers, and the large number of trustees for the industry within the country. Finally, appropriate strategies were presented for each hospital.
Conclusion: This market in our country faces many threats and needs policies appropriate to the current situation with an immediate action. The results also showed that two hospitals are in a competitive state and one hospital is in a defensive state.

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Background
In today's medical information system, various data are stored to be analyzed or retrieved when necessary. Therefore, this study was conducted to determine the needs of stakeholders of athletes' medical information management system based on international standards.
 
Materials & Methods
The study population included athletes, clinical service providers and managers of sports medicine centers in Iran. In this study, comparison tables of selected countries were used to assess the needs of stakeholders and were quantitative-descriptive. To analyze the data obtained from the questionnaire, the number of answers obtained for each component was determined based on the Likert scale and according to the frequency of answers related to the options, the percentage of each was calculated and the components that were more than 50% were agreed upon.
 
Results
Findings identified the initial data set, general components of the system and the initial assets of the Athlete Sports Medicine Information System. The results showed that the highest collective agreement about the presence of drug allergies and diabetes in the family's history was in the individual health records of athletes and the lowest agreement was reached on how to join the team. Stakeholder needs, compared to selected countries, included more details, including mental health information, that were not given much attention in the selected countries' datasets.
 
Conclusion
Based on the findings, it seems that a person's access to sports medicine information is a key point and a person can see and receive their information, problems and related health needs in a patient-centered treatment.

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Introduction:The purpose of this study is Investigating the effect of strategic planning on human performance from the perspective of the staff of Shohada Tajrish Hospital in Tehran.
Materials and Methods: This research is applied-practical in terms of purpose and correlational in terms of nature and descriptive method. The statistical population of the present study includes all permanent staff of Shohada Tajrish Hospital. Using simple random sampling method and according to Cochran's formula, 184 people were selected as a statistical sample. In this study, the Strategic Human Resources Management Questionnaire and the Performance Questionnaire were used to collect data. Experts' opinions were used to confirm the validity of the questionnaire and SPSS software was used to assess the reliability. Cronbach's alpha was 0.868 and 0.751. SPSS software and simple linear regression were used to analyze the data.
Results: The results showed that planning, supply, development, performance management, reward and employee relations have a significant effect on the performance of employees of Shohada Tajrish Hospital in Tehran.
Conclusion: Since the results of the research indicate a very strong relationship between strategic human resource management and the performance of the organization in Shohada Tajrish Hospital, it is necessary to pay sufficient attention to human resource management in health centers. It is also necessary to pay special attention to categories such as human education and development, effective interaction and communication with employees, and hiring and hiring.

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Background and Aim: Today we are witnessing tremendous advances in medical data mining. The data, by analyzing and discovering the relationships between them, can lead to algorithms that help us prevent or treat many diseases. Meanwhile, genetic diseases have attracted a large part of the attention of the medical world because the birth of children with genetic disorders imposes a great financial, psychological and emotional burden on society. Therefore, the aim of this study is to present an algorithm as a secondary screening test before performing cell and molecular tests.
 
Material and Methods: In this study, 1000 cases of pregnant women who were in moderate or high risk group after screening tests were studied. Their clinical information was stored, missing data was deleted, and records were integrated. Then, using Clementine software, data mining and data correlation were performed, and finally a suitable algorithm for diagnosing the disease was performed. Genetic mutations were identified.
 
Results: By applying five algorithms, neural networks, support vector machine, binary decision tree, multiple decision tree and logistic regression on the data, it was found that the neural network algorithm with 97.522% accuracy has the highest success rate in Diagnosis of genetic-chromosomal diseases before birth.
 
Conclusion: The use of genetic algorithm as a screening test causes less people to be candidates for costly and dangerous cellular and molecular tests and can be used as a tool to help detect the disease. To be used in the medical world.