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Volume 3, Issue 12 (1 2003)
Abstract
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Volume 7, Issue 3 (1 2008)
Abstract
H Emami,
Volume 8, Issue 3 (7 2010)
Abstract
Background: As in many countries, Medical Education (ME) is offered in three levels including Undergraduate ME, Graduate ME, and Continuing ME. Information theology development has provided a suitable chance for ME. E-learning in ME is growing more and more. The present study seeks to determine the key success factors (KSF) in E-learning in medical fields.
Material and Methods: KSF has been scrutinized in the literature following of which, and due to similarity, a classification with seven groupings was established including institutional factor, technology, interested parties, information knowledge, methods and approaches educational resources, and environmental factors. Through a questionnaire, the data were gathered from the information technology (IT) directors in all medical universities throughout the country. The data collected were subjected to factorial analysis. Data from heads of educational groups were obtained through focus group discussion. Cronbach reliability coefficient was calculated for questionnaire used. Factorial analysis was used to identify meaningful KSF. T-Test, and one-way variance analysis as well as Pearson's correlation were used. The analysis was conducted with SPSS software.
Results: The preparedness factors were analyzed through group discussions with the heads of the academic departments under the study. By factorial analyses, five factors were found. Fisher Exeact Test was used to compare the obtained ratios in 5% curve whose results showed that among the three factors including legal and technical environment, specialized hardware and software, and high speed internet, performance interest and potentials showed a significant difference (p=0.002). A p=0.011 was found for the authorities' interest and financial and non-financial rewards. No other significant differences were found anywhere else.
Conclusion: Appropriate strategies to coordinate and aligned with the conditions that must be taken, including some of them can be cited : Document Perspective drawn by the Ministry of Health, Content production (medical, etc.) to the appropriate shape, Develop technical and communications infrastructure, First e-learning development in the field of basic science And then as a complementary training in Clinical Science, Develop and build information literacy skills among teachers and students And encourage them in this area, Platforms and create the appropriate structures and interactions necessary, Despite the virtual library, Drawing rules for the protection of creators and owners of content rights education, Culture correct and appropriate, Private sector participation in developing e-learning and ..so on
Azra Ramezankhani, N Markazi Moghaddam, A Haji Fathali, H Jafari, M Heidari Mnfared, M Mohammadnia,
Volume 8, Issue 3 (7 2010)
Abstract
Background: Operating room efficiency is a major determinant of hospital cost. Maximizing throughput, while maintaining quality, is therefore paramount to maintenance of financial viability. Cancellation of surgery may increase a hospital's cost and affect the efficiency of operating room and waste of resources. This study was conducted to determine the rate and causes of canceled surgeries, and identifies areas for improvement in a teaching hospital in Tehran.
Material & Methods: We carried out a descriptive study of the reasons for canceling scheduled operations. Data were collected during 9 consecutive months. The reasons for cancellation were identified by theatre staff. We grouped all the reasons into 13 reasons. Other necessary information like operated surgery was obtained from IT department. Descriptive statistics (frequency, percentage, 95% confidence interval) were used to analyses of data. Statistical analyses were performed using SPSS and Excel Microsoft office.
Results: in this study, 18.2% of the 3381 scheduled operation were canceled on the day of surgery, 32.1% of them because of vascular surgery, followed by orthopedics (18.7%), general surgery (15.5%) and nose and throat surgery (13.7%). The common reasons for cancellation were lack of theatre time, clinical change in the patient's condition, lack of paraclinic tests and consultant's report on patient flow problems, blood preservation, drug and necessary equipment for surgery.
Conclusion: This study demonstrated that most cancellations of scheduled operation are due to hospital deficiencies and medical team reasons that most of them are preventable. Several changes like better infrastructural facilities, enhanced interdepartmental communication are suggested to try and reduce the cancellation rate.
Ali Ardalan, Arezu Najafi, Anita Sabzghabaie, Vahid Zonoobi, Saeed Ardalan, Hamidreza Khankeh, Gholamreza Masoumi , Mohsen Abbasi, Amir Nejati, Mehdi Zahabi,
Volume 9, Issue 3 (7 2011)
Abstract
Background: vulnerable events could damage structural, non structural and functional components of hospitals that might lead to community crisis, accordingly. Risk assessment is the first step to develop of a hospital disaster plan. In this study, a primary phase of developing a local tool for Iran's hospital disaster risk assessment entitled "Hospital Safety Index (HSI)" was conducted by World Health Organization originally.
Materials and Methods: First, the original index was translated into Farsi in five forms and 145 items. Then a group of four experts from the fields of medicine and engineering assessed the items one-by-one for their relevance and applicability. Revised edition tested three times at Shariati hospital in Tehran. An expert panel also evaluated the feature and content validity of the index. They also weighted the items as well.
Results: Test-retest of the index by two independent research groups found 93% of agreement. Furthermore, 244 points were revised or added to the original edition. The most important changes included: Combining instruction parts with related items for increasing educational properties, completing the list of hazards, developing a plan to analysis, and to present a quantitative and graphic of the model and finally to prepare an educational package as well.
Conclusion: Persian version of HSI, in response to needs of Iranian's health system, represents a rapid no-expensive tool for screening disaster risks at hospitals based on an international template that was tested in several countries. Based on this study, the Farsi index would be evaluated in more hospitals around the country. The assessment results will provide Iranian's health system with evidence-based information for more effective allocated resources and interventions evaluating.
Roohollah Askari, Hamid Reza Dehghan, Mohammad Amin Bahrami, Fatemeh Keshmiri,
Volume 9, Issue 3 (7 2011)
Abstract
Background: The hospitals are the most significant providers of health care services. According to more health funds spending by hospitals, economic management in hospitals is necessary. Determining the causes and rates of insurance under reimbursement bills was the objective of this study.
Materials and Methods: This research is a descriptive cross-sectional survey was done in 2008. The samples of study were the al records' patients who undertaken of social security insurance system in the teaching hospitals of Shahid Sadoughi University of Medical Science. The data complied in SPSS 16 software and then analyzed.
Results: In this study, 9.8% cases of all hospitalization bills were deducted. The highest rates of under reimbursement bills was in Afshar hospital (12.7%), followed by burn hospital (12.5% ), Shahid Sadoughi hospital (10%), and Shahid Rahnemoon hospital (8.2%). The highest rates of under reimbursement bills imposed to the surgeon fees (28.4%), treatment fees (15.06%), and medicine (14.3%) costs. However assistant surgeon fees had no under reimbursement. The most important causes of under reimbursement were defects in the insurance records of patients and noncompliance with insurance organization regulations.
Conclusion: Training of human resources and optimized use of hospital information systems could be helpful to hospitals for reducing insurance reimbursement to ultimately improve hospitals to financial statements.
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Volume 10, Issue 1 (21 2011)
Abstract
A Tol, A Pourreza, E Tavasoli, A Rahimi Foroshani,
Volume 11, Issue 3 (20 2012)
Abstract
Background: Health literacy is the degree to which individuals have the capacity to obtain, process, and understanding basic health information and services needed to make appropriate health decisions. The aim of this study was to assess relationship between health literacy and knowledge of women with type 2 diabetes.
Materials & Methods: In this cross sectional survey, 160 women with type 2 diabetes were selected by convenience sampling method. Data collected by using a STOHFLA standard questionnaire and knowledge was measured by self-administrated questionnaire. Obtained data analyzed by SPSS16 software in two categories of descriptive and inferential statistics (Chi-square and Pearson coefficient).
Results: The mean age of studied population was 52.73±8.56 years old. The means of health literacy and knowledge was 40.57±15.87 and 21.52±2.94, respectively. There was a relation between occupation, education and family history with knowledge and health literacy score, and also between incomes with knowledge. There was reverse significant relation between age and disease duration with knowledge and health literacy.
Conclusion: Results indicated that patients did not have the appropriate knowledge in type 2 diabetes, as well as health literacy which was also moderate. These results confirmed the need to develop of education for improving and increasing the appropriate knowledge and health literacy among studied women.
M Zagheri Tafreshi, M Rassouli, M Pazargadi, F Yaghmaie, Ah Barbaz,
Volume 11, Issue 3 (20 2012)
Abstract
Background: The first step of developing a proper model for delivering nursing care in hospitals will be identifying relevant components to apply a model. The aim of this study was identify relevant components to apply nursing care models in Shahid Beheshti University of Medical Sciences training hospitals.
Materials & Methods: This study was a qualitative research which was conducted by using content analysis approach. Participants were 6 faculty members and nurse managers of Shahid Beheshti University of Medical Sciences selected by purposeful sampling frame. Data gathered via semi-structured interviews and analyzed by thematic analysis.
Results: In this study, extracted themes included caring based on client satisfaction, nurses' knowledge and skills, importance of cooperative care, quantity and expertise of nurses, efficient supervision on nurses' performance, and strategies of health system in higher level. These themes were categorized in three dimensions including structure, process and outcome.
Conclusion: Findings of this study would be used for developing a nursing care models in Shahid Beheshti University of Medical Sciences hospitals in future research.
H Dargahi, F Forouzanfar, M Bakhtiari, Z Rajabnejad,
Volume 13, Issue 1 (6-2014)
Abstract
Background: Nowadays Medical devices have an important role in diagnosis, treatment, rehabilitation of patients and also in medical education. However, in the recent years usage and maintenance of these devices have not been in a good situation in developing and even some developed countries. Therefore fundamental changes and reprocessing has begun among management and usability of medical devices in these countries. This research is aimed to determine the management situation with the approach of usability evaluation in order to change and reprocess the management system among Tehran University of Medical Sciences general teaching hospitals at 2012-2013.
Materials& Methods: This study was a descriptive and cross sectional research among eight general teaching hospitals of Tehran University of Medical Sciences in 1391. The research tool was a self-made check list consisting of 38 questions about medical devices management condition and Nielsen questionnaire about usability of these devices which were completed by head nurses of CCU, ICU and OR departments with the help of medical devices supervisor in 56 departments of these hospitals. Data were collected and analyzed by SPSS software.
Results: We found that medical device management and the usability of these devices were not in a good situation in these hospitals as well as usage of electronic information technology.
Conclusion: Regarding the results of this research specially in the usability of medical devices, we recommend that users and supervisors of medical devices should be trained about usability criteria and evaluation procedures of these criteria, and the relationship between management styles and applications of quality improvement and pay attention to reprocessing of medical devices management among hospitals administrators and healthcare policy makers to select and purchase the best devices.
A Hajihasani, M Mohammadzadeh, H Zeraati, M Rahbar, M Alavimoghaddam, M Sabzi, S Ghoorchian, A Ramezani, M Soltandallal, M Douraghi,
Volume 13, Issue 1 (6-2014)
Abstract
Background: Non-fermentative, gram-negative bacilli (NFGNB) have emerged as a factor of
nosocomial infections and mortal epidemics . Hospital environment is one of the most important
sources of NFGNB`s colonization and diffusion. This study is aimed to assess the frequency of
NFGNB in various wards of selected hospitals of Tehran.
Materials & Methods: 469 samples were randomly selected from various wards from two hospitals
during a period of 11 weeks. All isolations had been identified using standard microbiological,
biochemical and phenotypic tests. The data were analyzed by SPSS software (version 11.5).
Results: Fifty three specimens were positive for NFGNB. Stenotrophomonas maltophilia and
Burkholderia cepacia complex were found as predominant bacteria in hospital I(28%) and II
(28.6%).The highest rate of NFGNB isolated from surfaces was 60.3% .The pediatric ward was
identified as the most contaminated ward (50%).
Conclusion: Several genus of NFGNB are found in hospitals. Therefore, identifying other NFGNB`s
genus and training health care staff are of prime importance. NFGNB`s distribution depends on type of
ward, surface, and equipment. Periodic sampling of hospital environment can be effective against
spreading infection.
E Zarei , F Farzianpour , B Pouragha , P Abbasi Borogeni , M Mohammadzadeh ,
Volume 13, Issue 2 (8-2014)
Abstract
Background: Identification of development needs is a first important step in a systematic management development effort. This study aimed at assessing management development needs from the viewpoint of middle managers of hospitals affiliated to Tehran University of Medical Sciences. Material and Methods: This cross-sectional study was conducted in the hospitals affiliated to Tehran University of Medical Sciences. The population study was 227 of middle managers employed in 16 hospitals. Data were collected using a 42-items questionnaire which its reliability and validity was confirmed. Data were analyzed using main components analysis in software SPSS17. Results: designing and innovation indicator among managerial roles, human skills indicators in managerial skills, psychological abilities among managerial talents, social trust in personal characteristics, comprehensive thinking indicator in philosophic mindedness and leadership in managerial knowledge components were the most important from the perspective of the middle managers Conclusion: managers play the specific managerial roles in order to perform their managerial tasks. They need to develop administrative skills, abilities, knowledge, personality and philosophic mindedness to play the best managerial roles.
Seyed Omid Khalilifar , Bayram Nejati Zarnaghi, Mohammad Bakhtiari Aliabad, Ameneh Valadkhani,
Volume 13, Issue 4 (3-2015)
Abstract
Background: Today, one of the effective ways of providing services is contracting with outside of organization and outsourcing.
Objective: The current study aimed to investigate effect of outsourcing on performance of nutrition unit in studied hospitals.
Methods: The current descriptive – analytical study performed in 2013, in two non-military hospitals and two military hospitals. 602 patients and 930 personnel were selected by simple randomized sampling. Data gathering performed by Patient and personnel satisfaction questionnaire, check list of kitchen's hygiene condition and check list of assessing the time spent by hospital manager for nutrition unit. Data on personnel cost were collected through accounting department. Data analysis performed by spss19 software.
Findings: Patient and personnel satisfaction with food services of non-military specialized hospital (4.03±0.45) were more than military specialized hospital (p= 0/03 for patients & p= 0/021 for personnel) and in non-military general hospital were more military general hospital (p= 0/039 for patients & p= 0/028 for personnel). Hygiene condition of non-military hospitals kitchen was better than military hospitals, the time spent by hospital manager for nutrition affairs in military specialized hospital was 1.5 times more than non-military specialized hospital and in military general hospital it was 6.5 times more than non-military general hospital. Personnel cost in nutrition unit of military hospitals were 1.5 times more than non-military hospitals.
Conclusion: Regarding the positive impact of outsourcing on performance of nutrition unit in hospitals, it is recommended that this strategy be applied in nutrition unit of military hospitals.
Dr Abbas Ziari, Dr Kambiz Abachizade, Dr Maryam Rassouli, Dr Mohamad Ali Haidarnia, Dr Mariam Mohseny,
Volume 13, Issue 4 (3-2015)
Abstract
Background:
Different approaches have been suggested to improve the quality of health care and the clinical governance is one of the main models. In the country, Clinical governance is initiated as a national model in 2009 and hospitals were forced to implement it. Only two hospitals of Shahid Beheshti University of Medical Sciences were approved according to evaluation of clinical governance implementation. This study aimed to describe and explain the barriers of clinical governance implementing in educational hospitals of Shahid Beheshti University of Medical Sciences.
Materials and methods:
In this qualitative study, conventional content analysis has been done. Twenty five participants involved in implementing clinical governance, including nurses, physicians, managers and the experts of hospitals and Ministry of Health, have been selected through purposive sampling method and interviewed in a semi-structural way till data saturation. Data were collected and analyzed simultaneously. Member check and peer check have done for data rigor.
Result:
Nine themes include human resource challenges, financing resource shortage, incomplete records and documentation systems, inappropriate organizational culture, lack of awareness of managers and employees, incomplete documented policies and procedures, inappropriate monitoring and evaluation, lack of inter-sector coordination and weak leadership were obtained and were placed in two domains input and process.
Conclusion:
The findings of this study indicate that there are several barriers for implementing clinical governance in hospitals that there is need to prioritize needs and to provide them appropriate solutions.
Leila Azimi, Nader Markazimoghaddam, Khalil Rostami, Atefe Talebi, Atoosa Eskandari, Abdallah Mirzaiy, Mohammad Esmail Azimi,
Volume 15, Issue 2 (6-2016)
Abstract
Background: Nowadays, Patient Safety is considered as a fundamental concept of the healthcare system. Hence, recognizing the effective factors such as illegible orders, dosage errors, and drug usage can reduce serious side effects leading to the patients' disability, prolonged hospitalization and even death.
Materials and Methods: This descriptive-analytical study performed as a cross-sectional one. 1800 inpatient records selected in a teaching hospital during one year. The physician first order was examined through a self-adminstrated checklist including physicians’ ID and workshifts, and variables like legibility and recorded dosage. Data analysis conducted via SPSS using descriptive statistics and analytical statistics tests.
Results: Among 1800 studied records, there were 66.3% recorded by male, 17.6% illegible, 3.2% with no stamp, 8.2% without signing, 11.9% without time and 4.9% with no date.23% of physician records didn't have coherence and logical sequence, 69.5% did not indicate to the primary items, 17.8% with no medicine dosage, 21.8% without pharmaceutical forms, 11.5% with no usage time, 25.9% without usage method, 14.3% had scribbles and 13% were devoid of numbering. Also, there were a significant relation between demographic variables and some medical recording errors.
Conclusion: it is necessary to endeavor physicians in patient records documentation improvement and can be used some strategies such as educating the newly arrived residents, considering commendatory techniques and record periodic evaluation.
Hamid Ravaghi, Sima Rafiei, Maryam Mohseni, Peigham Heidarpour, Mohammad Arab,
Volume 15, Issue 3 (8-2016)
Abstract
Background: Clinical Governance (CG) is a framework which obligates heath care system to responsiveness regarding maintaining and improving health care services' quality. Purpose of this study was to exists challenges in Clinical Governance establishment evaluation based on national assessors' aspect.
Materials and Methods: This qualitative study was conducted with national assessors' participation of Clinical Governance plan in 2014.Data collection was carried out using face to face interviews with assessors and analyzed based on content analysis.
Results: Three main themes were categorized including problems related to clinical governance standards, Existing challenges in assessment process and recommendations to improve quality assessment process.
From the assessors' aspects, the main existing challenges were lack of knowledge and adequate skills in some assessors towards CG, lack of sufficient accordance among assessors team, resistance of some universities and health care systems, lack of existing comprehensive guidelines with the purpose of responsiveness in related ambiguity in assessment and direction process among assessors.
Conclusion: Reinforcement of quality improvement culture in hospitals and increasing susceptibility in plan continuation, correct assessors election and ensuring about knowledge in responsibilities, updating assessors' training and putting to use equal indices in improving clinical governance assessment can be a considerable assist to improve assessment process and resolve related problems.
Dr. Sima Marzban, Mahshid Moeini Naini, Sayed Hossein Ardehali, Jaber Hekmatyar, Aliamir Savadkouhi,
Volume 16, Issue 1 (4-2017)
Abstract
Background: Injuries related to failures and errors due to clinical interventions in patient hospitalization period in hospital are the main reasons of mortality and mortality in worldwide. This study tries to identify and description ICU care failures and assessing the causes of risks, Severity, Occurrence and identifying risk probability ratio and risk prioritizing using FMEA method.
Materials and Methods: This study was carried out in order to evaluating existing situation using Failure Mode and Effect Analysis and utilizes volere logic to plan the patient safety management system. This study performed in the intensive care unit of Loghman Hakim hospital in Iran.
Results: Study finding revealed sixteen routine failures and its priorities which the five main issues were documented as error in decision phase for patients admission or in-admission (PRN 1000), error in discharge time of patient from ICU (PRN 1000), insufficient infection control (PRN 1000) and error in clinical ordering and prescriptions (PRN 800).
Conclusion: The main requirements of the patient safety management identified as planning standards and clinical guidelines, developing evidence based admission and non admission indicators, enacting infection control rules and education of anticipating standards places, hand washing and disinfecting instrument and equipments.
Mohammad Mehdi Ghaemi, Hamid Moghaddasi, Alireza Kazemi,
Volume 16, Issue 1 (4-2017)
Abstract
Background: Despite the fact that only one-third of chest pains occur due to heart diseases, still physicians have tendency to admit most of these patients to reduce risk of negligence and its consequences.Clinical decision support systems (CDSS) enable physicians to distinguish better cardiac from non-cardiac chest pain. This study reviewed articles which focused on this issue.
Materials and Methods: Google scholar and PubMed database were targeted for search. Out of ninety primary matching articles based on the title, abstract and keywords, 28 full texts were relevant which were included in this study.
Results: Included articles were classified into two categories such as managing hospital resources and increasing the accuracy of diagnosis. Study results in the first categoryshowed decrease in both reception and referral time up to 30% and length of hospital stay up to 26% using CDSS. In the second category, the highest reported accuracy of diagnosis was 97% and the maximum sensitivity and specificity were 100% and 89.43% respectively. Even though, the results of a study revealed that the accuracy of decision support system in diagnosing cardiac chest pain was better than the compared cardiologists.
Conclusion: Considering the role of CDSS in managing hospital resources and improving accuracy of diagnosing cardiac chest pain, it is suggested that emergency wards and cardiac screening centers equipped by these systems.
Dr Ehsan Zarei, Dr Behrooz Pouragha, Dr Soheila Khodakarim, Alireza Moosazadeh Nasrabadi,
Volume 16, Issue 3 (11-2017)
Abstract
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.
Dr Nader Tavakoli, Milad Amini, Dr Mahsa Mahmodinejad, Mohammad Veisi, Dr Hasan Amiri, Yousef Sadat, Ali Tahmasebi,
Volume 17, Issue 1 (5-2018)
Abstract
Background: Assessment of appropriate and inappropriate services offered at the hospital is a very important topic to improve resource allocation. Thus, this study performed to assess inappropriate admission and length of stay to modify extra costs and effective resource management.
Materials and Methods: This study was a descriptive-analytic one which conducted as a cross sectional study in the first half of 2017. The Appropriateness Evaluation Protocol(AEP) was used to collect data. A total of 420 patients hospitalized in Haft Tir and Firoozgar Hospitals were selected using stratified sampling method. collecting data was analyzed using descriptive and analytical statistics by SPSS18.
Result: 391 individuals were admitted appropriately and 29 were classified as inappropriate admission. The rate of inappropriate admission estimated about 7% in the hospitals. female Sex, type of admission, the length of admission and place of patient residence had effect on prediction of inappropriate admission rate (p ≤ 0.05).
Conclusion: Considering the high percentage of inappropriate admission and stay length of patients as well as high costs of health services in these hospitals, the problems can be greatly reduced using proper planning, admissions management between the hospital units.
