Payavard Salamat

Determination of Dimensions and Items of Outpatient Service Quality for Ahvaz Hospitals

Mohammad Qolipour

Background and Aim: Assessing service quality is one of the basic requirements to develop outpatient service. There is no valid and reliable tool to measure quality of outpatient service, therefore this study was performed to determine dimensions and items for assessing service quality of outpatient in Iran.
Materials and Methods: To determine dimensions and items of the outpatient service quality, a cross-sectional study was conducted with participating of 550 outpatients referred to Ahvaz hospitals in year 2015. To determine content validity, the Delphi technique (3 rounds) with participating of 8 quality experts was used. Construct validity of the tool was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach's alpha coefficient. Data were analyzed by Excel, Spss, and Lisrel softwares.
Results: The content validity of tool with CVI=0.94 was confirmed. According to exploratory factor analysis, the hospital outpatient service quality tool included 36 items and 11 dimensions (choosing the service provider, communication and interaction, having authority, continuity of service, quality of facilities and basic amenities, respect, immediate and timely attention, safety, prevention, access and reliability). Construct validity of the tool was confirmed based on the goodness of fit quantities of model (RMSEA=0.007, CFI= 0.99, GFI=0.95).

Conclusion: The results of study showed that the outpatient SERVQUAL tool with 36 items and 11 dimensions was a valid and reliable tool to measure quality of outpatient service in Iranian hospitals.

Nurses’ Knowledge, Attitude and Performance Towards the Principles of Islamic Ethics in Nursing Care in Tehran University of Medical Sciences

Nikzad Eisazadeh

Background and Aim: Nurses’ knowledge, attitude and performance towards the principles of Islamic ethics are remarkable in nursing care in Tehran University of Medical Sciences (TUMS).
Materials and Methods: In this cross-sectional study, the knowledge, attitude and performance of 551 nurses were evaluated based on their age, sex, education, and type of employment in TUMS hospitals (by a valid questionnaire). All data were analyzed by SPSS. In this study, a questionnaire was designed through a Focus group discussion and then its validity was evaluated. Moreover, the reliability of the questionnaire was estimated by test-retest method.
Results: Our study showed that female sex, work experience of 15-20 years, type of employment, and higher education were associated with a higher level of knowledge, attitude and performance towards principles of Islamic ethics. Also, according to our analysis, there was a significant relationship between age and level of knowledge, attitude and performance of the principles of Islamic ethics (p<0.05) especially at the age of 40's.

Conclusion: Based on the results of this study, there is a significant relationship between educational indices and work experience, and the age of nurses with the level of knowledge, attitude and practice regarding the principles of Islamic ethics. It is suggested that educational courses about Islamic ethics be presented based on nurses’ educational levels and age.

Determining Factors on Hospital Discharge Process Via Data-Mining Method Administered at Shahid Modares Hospital, Tehran

Farhad Ghaffari

Background and Aim: Over the recent years, patient discharge process time has been an important issue focused by so many officials. Therefore, the present study is aimed to identify the main factors with regard to the discharge process and selecting the best data-mining algorithm.
Materials and Methods: The population in question is all the patients discharged from Modarres Hospital during the first three months in the year 2014. Sampling wasn’t carried out but the number of observations has reached over 1060. Data was gathered via the researcher’s checklist while the relation between dependent and independent variants was examined and identified through T-test, Pearson Correlation Test and one-way analysis of variance. Data Mining Algorithms, in this study, were as follows: Neural Network, Support Vector Machine, Decision Tree, Simple Linear Regression.
Results: The average discharging process in the present study was 246.96 ± 3.25, which shows that among main factors concerned with discharging process, bedridden ward is considered as the most crucial. Also, according to the algorithms employed in this study, Decision Tree, with Correlation Value=0.30 and Root-Mean Square Error=103.29, was the best algorithm.
Conclusion: Results show that Data-Mining Algorithms can be employed to identify crucial factors regarding the whole discharging process and the most important factor during discharge process variable is hospitalization.

Challenges of Strategic Planning in Welfare Organization

Fataneh Amini

Background and Aim: Strategic planning has an important role in achieving competitive advantage for nonprofit organizations. However, some strategic plans fail. The present study aimed to investigate challenges of strategic planning in Welfare Organization.
Materials and Methods: A qualitative approach was used for this case study. In-depth semi-structured interviews were conducted with 12 senior and middle managers who were members of the strategic planning committee. Content analysis method was used for data analysis, and 7 themes and 16 sub-themes were identified from the data.
Results: Lack of justification of the strategic planning, the strategic planning model, inappropriate composition of the strategic planning team, the structural and managerial changes of the Welfare Organization, time limitation, insufficient training, and budget constraints were the main challenges of strategic planning in the Welfare Organization.
Conclusion: If the strategic planning challenges are not managed well, more problems are expected to occure during the implementation of the strategic plan. Senior managers’ commitment, strong management and leadership, participative corporate culture, education and training, staff empowerment, and provision of required resources will facilitate strategic planning implementation in organizations.

Investigating and Comparing Safety Level of Thyroid and Eye Effective Radiation Dose in Cranial Multi Slice CT Scans

Fereshteh Mohammadi

Background and Aim: CT scan as a medical imaging modality delivers high radiation dose to the patients. Since eye and thyroid are two radiosensitive organs in this study, those effective doses were evaluated in brain CT scan. Using TLD as dosimeter.
Materials and Methods: This cross-sectional study was carried out in three selective hospitals in Rasht in September and October in year 2016.TLD was used as personal dosimeter. To measure the effective dose, TLDs were put on the patient’s eyes and thyroid and the mean effective dose was evaluated in brain CT scan. Results were analytical using SPSS software and Anova (P<0.05).
Results: The mean effective doses of eyes and thyroid in three hospitals with codes of H1, H2 and H3 were obtained as 2.66±2.04 mSv and 0.03±0.009 mSv, 1.80±1.11 mSv and 0.03±0.02 mSv, 1.94±0.95 mSv, 0.04±0.01 mSv, respectively. We found significant differences between effective doses of the eyes and thyroid in the three hospitals (p<0.05). Despite the difference in effective doses between right and left sides of eyes and thyroid, we didn't find any other significant differences.
Conclusion: The most important factor affecting patient radiation dose is the way CT scan examination is performed.

Comparison of Data Classification Algorithms to Determine the Type of Neonatal Jaundice

Parinaz Tabari

Background and Aim: Neonatal jaundice is a matter that is very important for clinicians all over the world because this disease is one of the most common cases that requires clinical care. The aim of this study is to use data classification algorithms to predict the type of jaundice in neonates, and therefore, to prevent irreparable damages in future.
Materials and Methods: This is a descriptive study and is done with the use of neonatal jaundice dataset that has been collected in Cairo, Egypt. In this study, after preprocessing the data, classification algorithms such as decision tree, Naïve Bayes, and kNN (k-Nearest Neighbors) were used, compared and analyzed in Orange application.
Results: Based on the findings, decision tree with precision of 94%, Naïve Bayes with precision of 91%, and kNN with precision of 89% can classify the types of neonatal jaundice. So, among these types, the most precise classification algorithm is decision tree.
Conclusion: Classification algorithms can be used in clinical decision support systems to help physicians make decisions about the types of special diseases; therefore, physicians can look after patients appropriately. So the probable risks for patients can be decreased.

Dimensions and Requirements of Professionalism in Health Sector: A Comparative Study

Karamollah Daneshfard

Background and Aim: Conditions, advantages and limitations of professional ethics have not been discussed. The present study aimed to determine the framework, dimensions and requirements of professional ethics in selected countries in order to review their experiences.
Materials and Methods: The present study was comparatively conducted in 2017. Considering inclusion criteria in designing study including purposeful and specified activity in terms of professional ethics, five countries of United Kingdom, Malaysia, Japan, Turkey and United States of America achieved the conditions to enter the study. For data analysis, comparative tables were used which included dimensional comparison obtained from professional ethics development study in the selected countries.
Results: Medical and nursing associations and headquarters units in Ministries of Health, prepare appropriate utilization of professional ethics principles. Using temporary or permanent and regular committees in line units, also includes other characteristics of attention to the professional ethics concept in the selected countries. In Malaysia and Japan, professional ethics is taught in different courses and majors.
Conclusion: Applying professional ethics concept requires information transparency and factors such as education, organizational structure set up and their establishments and institutionalizing must should be discussed more and to be localized on the basis of the countries situations.

Serotyping and Multiple Antibiotic Resistance Patterns of Shigella Sonnei Isolated from Diarrhea in Children’s Medical Center of Tehran

Mohammad Mehdi Soltan Dallal

Background and Aim: In today’s world, antibiotic resistance is inevitable. This has been the case since the discovery of antibiotics. The aim of this research is to study serotyping and multiple antibiotic resistance pattern of Shigella sonnei isolated from diarrheal stool of patients hospitalized in Children’s Medical Center in Tehran.
Materials and Methods: In this descriptive study, 600 diarrheal stool specimens were obtained from patients hospitalized in Children’s Medical Center in Tehran over a period of twelve months. The stool samples were collected in Cary-Blair transport medium and transferred to the laboratory. The identification was carried out according to the standard cultivation method, and the antibiotic susceptibility test was performed by Kerry Bauer disk method according to with CLSI procedure.
Results: Out of 600 samples, only 18 (3%) were found to be contaminated with Shigella sonnei. The results of antibiotic resistance patterns of these isolates showed that they were resistant to tetracycline; streptomycin, clindamycin and cortimoxazol. Furthermore, 66.67% of isolates had multiple resistance to tetracycline, cortimoxazol, streptomycin, ticarcillin and clindamycin antibiotics.
Conclusion: The results of this study showed that multiple resistance of Shigella sonnei to tested antibiotics is increasing. This is alarming; necessary steps should be taken to prevent such a phenomenon.

Designing and Creating Personal Electronic Health Records for Thalassemia Major Patients

Marjan Ghazisaeedi

Background and Aim: Thalassemia is a chronic disease which is extremely expensive, complex and debilitating. The management skill of thalassemia patients should be enhanced to minimize the risk of disease complications. The main purpose of this study was to develop personal electronic health records for thalassemia major patients.

Materials and Methods: This is a developmental applied study which was conducted to develop a personal electronic health record for thalassemia major. First, a questionnaire was prepared to determine the data elements and was filled by Hematology and Oncology professionals in the country (110 persons). Then, based on the results of needs analysis, the system was designed using PHP programming language and MySQL database and was evaluated by 50 thalassemia patients who referred to the Thalassemia Clinic of Bu Ali Sina Hospital of Mazandaran University of Medical of Sciences during the second half of the month of Aban. Finally, a standard questionnaire of usability and user satisfaction assessment was distributed among them.
Results: Usability evaluation of the system showed that patients evaluated the system at a good level with a mean rating of 7.91 (out of 9 points).

Conclusion: The web-based systems can be used to help thalassemia patients to control injection and reduce the complications of the disease and to promote health.

The Relationship between Organizational Innovation and Creativity among the Staff of TUMS General Hospitals

Hossein Dargahi

Background and Aim: Creativity and innovation are considered among the most important factors that help an organization survive. Therefore, it seems necessary to examine the status of this important issue in healthcare organizations such as hospitals. The present study was conducted to determine the relationship between organizational innovation and creativity among the staff of teaching hospitals of Tehran University of Medical Sciences (TUMS).
Materials and Methods: This descriptive-analytical and cross-sectional study was conducted on 285 staff members of TUMS selected teaching hospitals in 2015. To collect the required data, demographic data form, organizational creativity
questionnaire and Martin Patchen’s innovation questionnaire were used. Data were analyzed in SPSS software version 21, using descriptive statistics, t-test, ANOVA and Pearson correlation analysis at a less-than-0.05 significance level.
Results: The organizational creativity rate for the studied staff showed an average of 2.99±0.80, assessed at middle and lower middle levels and the organizational innovation rate showed an average of 19.37±3.71, assessed as middle and upper middle. A statistically significant relationship was observed between organizational creativity and organizational innovation (p=0.02, r=0.20).
Conclusion: The results suggest that an increase in creativity leads to an increase in innovation. Therefore, to survive and maintain a competitive advantage to provide more desirable treatment services at a high quality, hospital managers are required to use their best effort and expenditure so that they can enhance innovation within their organizations.

Systematic Review and Meta-Analysis of the Quality of Life in Iranian Elderly People Using LEIPAD Questionnaire

Masoumeh Erfani Khanghahi

Background and Aim: With the increasing number of elderly people, quality of their life is important . The purpose of this study was systematic review and meta-analysis of the quality of life in elderly Iranians using LEIPAD questionnaire.
Materials and Methods: Required information was searched on internet using terms such as quality of life, LEIPAD, elderly, older people, aging, older Age from databases of PubMed Scopus, Elsevier, Google Scholar, and Persian equivalents of SID, Medlib, IranDoc, MagIran, IranMedex from 2000 to 2015, has been searched. The criteria for entering the study were: published articles in Persian and English languages, and mentioning at least the total score of quality of life Meta-analysis software: CMA: 2 was used.
Results: From three hundred and forty eight articles found, 8 articles finally entered the study. In general, the results showed that the overall average quality of life of older people was [52.2-64.7 95% CI] 10.1 ± 58.5. The average overall quality of life of the elderly in the community was 15.5 ± 57.6. The average overall quality of life for the elderly in nursing homes was 29.7 ± 60.1. Aspects of self-care and mental dimension had higher scores. sexual functioning , depression and anxiety scores were lower.
Conclusion: The results showed that quality of life in elderly Iranians is average, therefore planning and effective interventions are needed. More attention to aspects of sexual functioning and depression and anxiety in the planning and intervention is necessary

Systematic Review of Medical Tourism in Iran and Case Study of Tehran University of Medical Sciences

Azadeh Chatrooz

Background & Aim: Planning in medical tourism is important. This study was conducted to assess factors, elements and development plans of medical tourism and situation study and analysis of Tehran University of Medical Sciences (TUMS).
Materials and Methods: This mixed method study was conducted in 2017. In systematic review, published studies searched between years 2006 to 2016. In the second phase, medical tourism data of TUMS explored as retrospective cross sectional and expert viewpoint analysis in medical tourism concept.
Results: 39 published articles were assessed. According to results, admissions and total payment of foreign patients in all hospitals of TUMS in 2016 were 21788 and around 18.5 billion Tomans respectively.
Qualitative results showed that, there were not transparence program and suitable physical area and TUMS needs to comprehensive planning, supportive infrastructure of foreign patients, correction of transportation system and improve marketing.
Conclusion: Despite the history of TUMS hospitals in attraction of foreign patients and analyzing it, there were many limitations to achieve good situation. Although assessing patients viewpoints can provide a platform to solve problems and limitations according to priorities.