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Maryam Aghajarinezhad, Yahya Salimi, Shahab Rezaeian, Ghobad Moradi, Mehdi Moradinazar, Fatemeh Khosravi Shadmani, Roya Safari_ Faramani, Mitra Darbandi, Farid Najafi,
Volume 17, Issue 2 (5-2023)
Volume 17, Issue 2 (5-2023)
Abstract
Background and Aim: All people living in a society are not equally at risk of COVID-19 infection and hospitalization. The current study is aimed to determine the factors related to COVID-19 infection and hospitalization among participants of Ravansar Non-Communicable Disease (RaNCD) cohort study.
Materials and Methods: The present study was conducted between 28th February, 2020 to 27th November, 2021. Data from the RaNCD study, morbidity and hospitalizations cases (extracted from the medical care monitoring system, SAMA system and the handwritten list of the health department) and positive serological results were used. For the case-cohort study, 626 confirmed and/or probable cases and 2107 randomly selected participants as sub-cohort were recruited. For the case-control study, 188 COVID-19 hospitalized patients from RaNCD (as cases) and 632 positive outpatients identified as controls. Data were analyzed using Cox and logistic regression, respectively.
Results: In case-cohort study, the hazard ratio of COVID-19 among people living in rural areas, in smokers and those in middle socioeconomic status was, 0.37 (0.24, 0.58), 1.50 (1.07, 2.11), as compared to the reference groups. While the hazard ratio of people aged 46-64 and those ≥65 years old, as compared to the reference group within the first year, was 3.47 (1.76, 6.86) and 6.45 (2.80, 14.85), the corresponding value after one year was 2.23 (1.13, 4.40) and 3.52 (1.53, 8.10), respectively. The hazard ratio among those with at least one comorbidity was 2.45 (1.53, 3.92) in the first year of study and after one year decreased to 1.82 (1.14, 2.92). In addition, moderate and vigorous physical activity decreased the hazard ratio. In case-control study the odds ratio of hospitalization increased by 0.03% (1.03(1.01, 1.05)) with an increase of one year in age and in people with at least three comorbidities was 2.43 (1.24, 4.73) times of those without comorbidity.
Conclusion: Overall, one year after starting the study the decrease in hazard ratio of COVID-19 was significant. Increase in age and having comorbidities are factors that increased the odds ratio of hospitalization. Such people can be considered for the next waves of COVID-19 prioritized for health care and booster vaccination.
Materials and Methods: The present study was conducted between 28th February, 2020 to 27th November, 2021. Data from the RaNCD study, morbidity and hospitalizations cases (extracted from the medical care monitoring system, SAMA system and the handwritten list of the health department) and positive serological results were used. For the case-cohort study, 626 confirmed and/or probable cases and 2107 randomly selected participants as sub-cohort were recruited. For the case-control study, 188 COVID-19 hospitalized patients from RaNCD (as cases) and 632 positive outpatients identified as controls. Data were analyzed using Cox and logistic regression, respectively.
Results: In case-cohort study, the hazard ratio of COVID-19 among people living in rural areas, in smokers and those in middle socioeconomic status was, 0.37 (0.24, 0.58), 1.50 (1.07, 2.11), as compared to the reference groups. While the hazard ratio of people aged 46-64 and those ≥65 years old, as compared to the reference group within the first year, was 3.47 (1.76, 6.86) and 6.45 (2.80, 14.85), the corresponding value after one year was 2.23 (1.13, 4.40) and 3.52 (1.53, 8.10), respectively. The hazard ratio among those with at least one comorbidity was 2.45 (1.53, 3.92) in the first year of study and after one year decreased to 1.82 (1.14, 2.92). In addition, moderate and vigorous physical activity decreased the hazard ratio. In case-control study the odds ratio of hospitalization increased by 0.03% (1.03(1.01, 1.05)) with an increase of one year in age and in people with at least three comorbidities was 2.43 (1.24, 4.73) times of those without comorbidity.
Conclusion: Overall, one year after starting the study the decrease in hazard ratio of COVID-19 was significant. Increase in age and having comorbidities are factors that increased the odds ratio of hospitalization. Such people can be considered for the next waves of COVID-19 prioritized for health care and booster vaccination.
Majid Babaei, Shila Hasanzadeh, Sadeq Rezaei, Davoud Alirezazadeh Sadaghiani, Mohammadreza Sheikhy-Chaman,
Volume 17, Issue 2 (5-2023)
Volume 17, Issue 2 (5-2023)
Abstract
Background and Aim: As a result of the COVID-19 pandemic, the global and Iranian economies have been affected in various ways. The tax sector seems to have reacted relatively quickly to this pandemic. This study examined the impact of the COVID-19 pandemic on tax revenues in West Azerbaijan Province.
Materials and Methods: This descriptive-analytic and cross-sectional study was conducted in the second half of 2021. Primary data for 17 cities of West Azerbaijan Province were provided by the General Administration of Tax Affairs of this province in the form of 9 variables in Excel Format. The data were related to 2019 (Before the COVID-19 pandemic) and 2020 (After the COVID-19 pandemic). The data were analyzed by SPSS using descriptive statistics (Frequency, Percentage, Median, Interquartile range) and analytical statistics (Wilcoxon signed rank test) at a 5% significance level.
Results: Based on the descriptive results, the COVID-19 pandemic caused an increase in the tax revenues of West Azerbaijan province in the fields of government employees’ salary tax, stock transfer tax, inheritance tax and stamp duty tax and a decrease in these revenues in the areas of private employee’s salary tax, income tax on legal entities, business income tax, property transfer tax and value-added tax. Based on the analytical results, the impact of this pandemic on the private employee’s salary tax (P=0.003), income tax on legal entities (P=0.019), business income tax (P=0.013), property transfer tax (P=0.015) and value-added tax (P=0.001) was found to be negative and significant. Furthermore, the effect on stock transfer tax (P=0.030) and inheritance tax (P=0.001) was positive and significant. On the other hand, the impact of this pandemic on government employees’ salary tax (P=0.287) and stamp duty tax (P=0.356) was not statistically significant.
Conclusion: The COVID-19 pandemic hurt most of the tax revenue sectors. To compensate for the decreased income in vulnerable sectors, the government must develop international trade with comprehensive support from the non-governmental sector while creating new tax lines. Also, stabilizing the financing cycle and designing mechanisms to prevent tax evasion, especially in high-paying jobs, can be fruitful.
Materials and Methods: This descriptive-analytic and cross-sectional study was conducted in the second half of 2021. Primary data for 17 cities of West Azerbaijan Province were provided by the General Administration of Tax Affairs of this province in the form of 9 variables in Excel Format. The data were related to 2019 (Before the COVID-19 pandemic) and 2020 (After the COVID-19 pandemic). The data were analyzed by SPSS using descriptive statistics (Frequency, Percentage, Median, Interquartile range) and analytical statistics (Wilcoxon signed rank test) at a 5% significance level.
Results: Based on the descriptive results, the COVID-19 pandemic caused an increase in the tax revenues of West Azerbaijan province in the fields of government employees’ salary tax, stock transfer tax, inheritance tax and stamp duty tax and a decrease in these revenues in the areas of private employee’s salary tax, income tax on legal entities, business income tax, property transfer tax and value-added tax. Based on the analytical results, the impact of this pandemic on the private employee’s salary tax (P=0.003), income tax on legal entities (P=0.019), business income tax (P=0.013), property transfer tax (P=0.015) and value-added tax (P=0.001) was found to be negative and significant. Furthermore, the effect on stock transfer tax (P=0.030) and inheritance tax (P=0.001) was positive and significant. On the other hand, the impact of this pandemic on government employees’ salary tax (P=0.287) and stamp duty tax (P=0.356) was not statistically significant.
Conclusion: The COVID-19 pandemic hurt most of the tax revenue sectors. To compensate for the decreased income in vulnerable sectors, the government must develop international trade with comprehensive support from the non-governmental sector while creating new tax lines. Also, stabilizing the financing cycle and designing mechanisms to prevent tax evasion, especially in high-paying jobs, can be fruitful.
Fatemeh Setoodehzadeh, Azar Abolpur, Kosar Rezaei, Mehdi Mohammadi, Mohammad Khammarnia, Farnaz Keykhah, Mostafa Peyvand,
Volume 17, Issue 3 (8-2023)
Volume 17, Issue 3 (8-2023)
Abstract
Background and Aim: Children’s health is important as the future builders of society. Many children under 5 years of age around the world and in Iran have growth disorders. Due to the importance of growth disorder and its impact on the development, learning and future of the child, the present study was conducted with the aim of determining the frequency of deviations from the growth curves of children under 5 years of age and related factors in Zahedan city.
Materials and Methods: This case-control study was conducted in 2020 in Zahedan. The study population included all children under 5 years old, born in Zahedan between 2013 and 2020 that 784 of whom were selected by random sampling method. To determine the factors related to growth disorder multiple logistic regression analysis was used and to check the significance level, chi-square test and Pearson correlation were used. In this research, the data were analyzed with SPSS software.
Results: The results of this research showed that 54% of the boys and 51.20% of the girls had growth disorders. Between child growth disorder and maternal chronic disease (P<0.05), maternal body mass index (P<0.05), Maternal weight gain during pregnancy (P<0.05), distance between births (P<0.05) maternal urinary tract infection during pregnancy (P<0.05), mother’s age (P=0.006), mother’s education (P<0.05), birth weight (P<0.001), birth order (P<0.05), father’s occupation (P<0.05) and father’s education (P<0.05) a significant association was found. In the present study, the average birth weight in children with growth disorders was 2.75±0.58 and in healthy children was 2.95±0.57, and this difference was statistically significant (P=0.001). The average age of mothers of children with growth disorders was 29.19±6.07 and the average age of mothers of healthy children was 27.98±6.10, this difference was statistically significant (P=0.006).
Conclusion: Growth disorder is a multi-causal complication. Risk factors can be corrected and prevented by developing health education and increasing mothers’ awareness and knowledge. Also, the father’s job and literacy are effective in the child’s growth disorder, so Increasing community health literacy and encouraging fathers’ learning and literacy can partially prevent growth disorders in children.
Ali Mohammad Mosadeghrad, Parvaneh Isfahani,
Volume 17, Issue 3 (8-2023)
Volume 17, Issue 3 (8-2023)
Abstract
Background and Aim: Induced demand is the provision of healthcare services to patients by the influence of healthcare providers. Induced demand causes excessive use of health services, increases the waiting time for receiving health services, increases the price of health services, increases the costs and reduces the efficiency of the health system. Policymakers and health managers should take measures to reduce induced demand. Hence, they should understand the reasons for induced demand in the health system. Therefore, this research aimed to identify the reasons for induced demand in the health system.
Materials and Methods: This research was carried out using the scoping review method. All published articles and documents about the reasons for induced demand in the health system until June 21, 2023 were searched in nine databases and Google Scholar search engine. Finally, 38 articles were selected and reviewed. The data were analyzed by thematic analysis method and using MAXQDA10 software.
Results: Thirty-eight studies about the reasons of induced demand in the health system were published between 1974 and 2021. The number of researches in this area has been growing since 2011. Overall, 32 reasons for induced demand in the health system were identified and grouped into three categories: macro (health system), meso (health care organization) and micro (provider and receiver of health services). The most frequent reasons for healthcare induced demand in the literature include inappropriate policies, insufficient monitoring, inappropriate payment system, large number of physicians, lack of attention to clinical guidelines, financial motivation of healthcare providers, patient insurance coverage, unreasonable patients’ expectations, inappropriate price of health services, the complexity of the health service and patients’ inadequate medical knowledge.
Conclusion: Induced demand has negative effects on the health system and will lead to an increase in health costs, waste of health resources, a decrease in the efficiency of the health system, and finally, a decrease in people’s access to essential health services. Several factors at different levels of the health system lead to induced demand for health services. Therefore, interventions should be systematically applied at three levels of the health system, healthcare organizations, and providers and recipients of health services to prevent and reduce healthcare induced demand.
Materials and Methods: This research was carried out using the scoping review method. All published articles and documents about the reasons for induced demand in the health system until June 21, 2023 were searched in nine databases and Google Scholar search engine. Finally, 38 articles were selected and reviewed. The data were analyzed by thematic analysis method and using MAXQDA10 software.
Results: Thirty-eight studies about the reasons of induced demand in the health system were published between 1974 and 2021. The number of researches in this area has been growing since 2011. Overall, 32 reasons for induced demand in the health system were identified and grouped into three categories: macro (health system), meso (health care organization) and micro (provider and receiver of health services). The most frequent reasons for healthcare induced demand in the literature include inappropriate policies, insufficient monitoring, inappropriate payment system, large number of physicians, lack of attention to clinical guidelines, financial motivation of healthcare providers, patient insurance coverage, unreasonable patients’ expectations, inappropriate price of health services, the complexity of the health service and patients’ inadequate medical knowledge.
Conclusion: Induced demand has negative effects on the health system and will lead to an increase in health costs, waste of health resources, a decrease in the efficiency of the health system, and finally, a decrease in people’s access to essential health services. Several factors at different levels of the health system lead to induced demand for health services. Therefore, interventions should be systematically applied at three levels of the health system, healthcare organizations, and providers and recipients of health services to prevent and reduce healthcare induced demand.
Omid Ali Gholami, Jamil Sadeghifar, Bahareh Kabiri, Shabnam Ghasemyani, Sadegh Sarhadi, Reza Jorvand,
Volume 17, Issue 4 (10-2023)
Volume 17, Issue 4 (10-2023)
Abstract
Background and Aim: Health literacy is recognized as a key determinant of health and is a central focus of public health policy strategies. The present study aimed to assess the health literacy level and identify the factors influencing it among the clients of comprehensive health service centers in Ilam city.
Materials and Methods: In 2022, a descriptive-analytical study was conducted to examine 429 clients aged 18-65 years who visited comprehensive selected health service centers in Ilam city. For adults the data collection tool used was the Helia health literacy questionnaire. Sampling was conducted in nine clusters, with each cluster consisting of 50 samples. The data was analyzed using SPSS software, which included descriptive statistical tests, Pearson’s correlation coefficient, and one-way analysis of variance, with a significance level set at 0.05.
Results: Based on the results, the average health literacy score was 80.16 ± 16.50. In terms of health literacy, 18.97% of people had inadequate or not very adequate health literacy, while 44.39% of the participants had excellent health literacy. The average health literacy scores across different dimensions are as follows: access to health information 65.74, comprehension of information 81/81, reading information skills 12.74, evaluation of information 05.75, and decision making and behavior based on information 61.92. A significant relationship was observed between job, education, and income variables and various dimensions of average health literacy (p-value≤0.001). However, there was no significant relationship between general health literacy and age, gender, and place of residence (P≤0.05).
Conclusion: The results of the present study demonstrate that vulnerable groups have significantly lower literacy levels. Furthermore, given the impact of education on enhancing people’s health literacy, it is advisable to leverage mass media, social networks, and educational centers to enhance literacy levels as a potential factor in community health.
Aeen Mohammadi, Fatemeh Manafi, Farangis Shoghi Shafagh Aria, Rita Mojtahedzadeh,
Volume 17, Issue 4 (10-2023)
Volume 17, Issue 4 (10-2023)
Abstract
Background and Aim: Social accountability is defined as identifying social problems and needs, planning for resolving them and evaluating the effect of the plans. Considering the vital role in providing public health, the universities of medical sciences are the most important ones for fulfilling this mission and directing their education, research and service activities toward addressing health concerns of the community. Despite of these attempts, social accountability has not realized completely and satisfying yet. The aim of this study was exploring factors affecting social accountability and community-based medical education in universities of medical sciences from Iran’s educational development authorities’ view point.
Materials and Methods: This was a qualitative study performed by Education Development Center of the Ministry of Health and Medical Education in November 2022. Participants were 68 managers of Education Development Centers and 323 managers of Education Development Offices of schools and hospitals of universities of medical sciences in Iran. Participants were assigned to 8 focus groups. Conventional content analysis was used to extract the categories and subcategories.
Results: At the first step 541 codes were extracted which were integrated in to 86 ones after defining similarities. These codes then were categorized into 18 sub-categories and 6 categories, namely “Curriculum” including: curriculum revision, approaches, credits and longitudinal themes and new disciplines, “Community-based education” including: educational fields and creating the foundation, “Students” including: students as teacher, educating students and graduates, “Faculty members” including: faculty members’ services, motivation and compensation and administration, “Evaluation” including: student assessment and program evaluation, and “Management” including: management and leadership, organizations, Interdepartmental communication and research.
Conclusion: In this study a comprehensive collection of factors affecting SA in universities of medical sciences were identified and categorized. These factors that are compatible with medical education context in Iran can be used by top managers and educational administrators as a framework for short and long-term planning.
Alireza Hajizadeh, Reza Hafezi, Mrs Maryam Tajvar,
Volume 17, Issue 5 (12-2023)
Volume 17, Issue 5 (12-2023)
Abstract
Background and Aim: Futures studies are constantly evolving and help organizations and individuals for better identification of future events, opportunities, and threats. In the field of health, futures studies are also applied for better prediction of health issues in future, control of unpleasant condition and preparing for pleasant future in health system. The purpose of this study is to conduct a scoping review of the futures studies accomplished in the field of health in Iran,
Materials and Methods: This study is a scoping review, conducted based on the Arksey and O’Malley framework with 6 steps including research question identification, related study identification, study selection / screening, data segmentation, summarizing and reporting results and providing guidance and recommendations n. National and international databases and search engines including PubMed, Web Of Science (WOS), Scopus, ProQuest, SID, Magiran, IranDoc and Google Scholar were searched using related keywords. After removing duplicate articles, the remaining articles were screened according to inclusion and exclusion criteria. The results of the selected articles were finally categorized, summarized and reported based on the mentioned steps.
Results: Among of 6691 articles identified, 30 articles reached the final synthesis stage. The articles were classified into forecasting, foresighting, and mixed categories, with the scenario writing method being the most widely used and applied in 20 studies. Also, studies were classified in scope of nature based on quantitative or qualitative and time horizon. Types of futures studies methods in Iran, in the fields of public health, medicine, science and technology, financing, prescription, health tourism, diet, human resources, aging, Covid-19 epidemic, health policy, hospital and macro level of health system were used.
Conclusion: The use of futures studies methods in a targeted manner and on the issues of Iran’s health system can play an effective role in knowing the future for more informed decision-making and planning in order to build a desirable future. The results of this review showed that scattered studies have been conducted with futures studies methods in the field of health, among which the scenario writing method has received more attention.
Zahra Khaje, Kamran Yazdani, Ibrahim Abdollahpour, Mohsen Mohammadi, Saharnaz Nedjat,
Volume 17, Issue 5 (12-2023)
Volume 17, Issue 5 (12-2023)
Abstract
Background and Aim: Alzheimer’s is a chronic disease that causes cognitive disabilities, thinking, personality changes and disruptions in daily activities. Due to these disorders, patients need long-term care. Most care for Alzheimer’s patients is done at home by family members, which makes home caregivers mentally, physically, emotionally, socially and financially vulnerable. Health personnel have a key role to play in providing information and guidance and helping the family control these conditions. The purpose of this study was to examines the level of knowledge and attitude of health workers and determines the related factors.
Materials and Methods: This research is a cross-sectional study to evaluate the level of knowledge and attitude of health workers about Alzheimer’s disease and its related factors. All 260 health workers of Gorgan and Kordkuy districts were studied by census method to assess their knowledge and attitude about Alzheimer’s disease and its related factors. ANOVA and T-tests were used to determine the relationship between the independent variables and the dependent variable. Variables whose significant level of correlation with response variable was less than 0.2 in bivariate analysis were entered into the regression model and finally multiple linear regression was used to determine the factors related to level of knowledge and attitude.
Results: The mean level of knowledge was 46.73% (95% CI, 45.46 to 48.16) and the mean level of attitude was 55.61% (95% CI, 54.63 to 56.74). The results show that those with a history of previous education, a history of caring for Alzheimer’s patients, a higher level of work experience in the health care system, and having a female gender and be married have higher levels of knowledge and those with a history of previous education and Sistani descent had a higher attitude.
Conclusion: In general, the mean level of knowledge was 46.73(0-100) and the mean level of attitude was 55.61(0-100). Factors such as: gender, work history in the health system, history of participating in educational workshops, history of caring for sick patients, and marital status were related to the level of knowledge and factors such as ethnicity and history of participating in the training workshop were related to the level of attitude of the health care providers.
Mohammad Hossein Sadeghian, Parviz Jahan, Mohammad Aarefi,
Volume 17, Issue 5 (12-2023)
Volume 17, Issue 5 (12-2023)
Abstract
Background and Aim: Aluminum phosphide poisoning is one of the fatal poisonings in Asian countries, including Pakistan and India, which requires urgent treatment. Since one of the most important symptoms in patients poisoned with aluminum phosphide is cardiovascular manifestations; it seems that electrocardiogram and echocardiographic changes are one of the important things that need to be measured in patients poisoned with this substance. Therefore, the study was designed to investigate electrocardiogram and echocardiographic changes in patients poisoned with aluminum phosphide.
Materials and Methods: The present study was conducted cross-sectionally 2019-2021 on 107 patients poisoned with aluminum phosphide who referred to the poisoning emergency of Baharloo Hospital in Tehran. All patients were included in the study due to taking tablets, solution or inhalation of aluminum phosphide. Finally, the patients› information was collected based on the variables investigated in this study including age, gender, poisoning dose, time interval between taking pills and admission to the hospital, systolic blood pressure level, electrocardiogram and echocardiography changes.
Results: The mean systolic blood pressure was 107 mmHg at the beginning of the study that changed to 103 mmHg after 24 hours. In addition, the mean diastolic blood pressure was 71.19 mmHg at the beginning of the study that changed to 68.66 mmHg after 24 hours. The blood pH of the patients at the beginning of the study and after 24 hours, was 6.99 and 7.39, respectively (P-value= 0.081). The mean EF was 40.68at the beginning of the study which, on average, changed to 46.57 mmHg after 24 hours (%5.21 increase, P-value= 0.029).
Conclusion: The results of the present study showed that extensive changes in the echocardiography of the heart, especially the left ventricular ejection fraction, as well as the patient›s ECG could indicate the severity of heart poisoning in patients poisoned with aluminum phosphide.
Rasul Bidel Nikoo, Shila Hasanzadeh, Mohamad Jebraeily, Naser Masoudi, Bahlol Rahimi, Farshad Faghisolouk,
Volume 17, Issue 6 (2-2024)
Volume 17, Issue 6 (2-2024)
Abstract
Background and Aim: Traffic accidents in Iran are one of the main causes of mortality and morbidity, identifying the factors related to these accidents can be useful in the prevention and proper management of traffic accidents. The purpose of this study was to determine the epidemiology of trauma caused by traffic accidents in Imam Khomeini hospital in Urmia during 2017-2022.
Materials and Methods: The current research is a cross-sectional descriptive study that was conducted on patients hospitalized due to traffic accidents in Imam Khomeini hospital in Urmia for five years. The required data included demographic characteristics and information of the injured (role of the injured, time of the accident, location of the accident, type of vehicle, damaged area, and condition of the injured during discharge), which was extracted from the trauma registration system of Urmia University of Medical Sciences. After collecting the data, it was entered into SPSS 16 software and described through frequency distribution table and central and dispersion indices
Results: In this study, out of 2086 injured cases, 74.40% (1552 people) were male. The average age of the injured was 34.49 ± 18.47 years. The type of accidental vehicle of most of the injured was motorcycle with 56.70% (998 cases). The most injured were drivers with 52.73% (1100 cases) and among them 57.45% (632 people) were motorcycle riders. 34.08% (711 cases) of injuries to body parts were in the head, neck and face.
Conclusion: The results of this research showed that most of the injured in traffic accidents are young motorcycle drivers and the most injuries were related to the head and neck area. Therefore, by knowing the risk factors and the impact of each of them on the outcome of traffic accidents, it is necessary to carry out appropriate interventions to prevent the risky behaviors of young drivers and create a culture of observing safety tips. Also, in the health system, the necessary preparations in terms of manpower and medical equipment should be made to manage the treatment of injuries caused by traffic accidents.
Soraya Sayar, Sara Noruzi, Seyed Mohammad Hossein Javadi, Mohammad Sabzi Khoshnami, Sanaz Dehghani, Maryam Pour Hosein, Mahnaz Zamyadi,
Volume 17, Issue 6 (2-2024)
Volume 17, Issue 6 (2-2024)
Abstract
Background and Aim: Considering the role of social workers in the health system, the success and stability of organ transplantation, prevention of re-hospitalization of patients and reduction of imposed costs, this study aims to design a protocol for the specialized interventions of social workers in Iran’s medical centers in the transplant process and to create uniformity in practice. Comprehensive services have been provided to patients and their caregivers.
Materials and Methods: The study was conducted in two phases of resource review and qualitative. In the resource review phase, reliable databases were examined, and in the qualitative phase, in order to collect information from Delphi techniques and focused group discussion with the presence of fifteen officials and social workers working in the country’s hospitals and experts and experts. The areas of health and treatment assistants of the Ministry of Health, university professors, medical staff and experts in the field of transplantation and organ donation were carried out. The protocol was sent to eight experienced experts for final review and evaluation, and they were asked to review the protocol in terms of the goal and scope of interventions, stakeholders, development steps, clarity of presentation, accessibility and non-dependence in writing according to the checklist to evaluate.
Results: In this study, the work process of social workers was drawn in three stages before, during and after transplantation. Also, various roles were considered for social workers in three stages of work, including the role of defender, supporter, case manager, resource mobilizer, trainer, consultant, evaluator and guidance. Interventions such as finding informational support, facilitating the patient hospitalization process, providing psychosocial support to the family with the aim of empowering them for post-transplant care, providing counseling to family members to deal with stress and improving mental health of the patient, providing economic support, Accomodation conditions are provided through hospital companions and communication and interaction with the treatment team, including the doctor, in order to respond to the needs of the family, facilitate treatment and on time discharging.
Conclusion: the protocol of specialized interventions of social workers in the transplantation process created a new step and a different look at psychosocial support in transplantation and coordination teams, so that social workers in the field of organ donation and transplantation and working with caregivers, families and the survivors of the patients arrived.
Mehdi Raadabadi, Zahra Tolideh, Zahra Shoara, Zahra Yeganeh, Jamil Sadeghifar, Khalil Momeni,
Volume 18, Issue 1 (3-2024)
Volume 18, Issue 1 (3-2024)
Abstract
Background and Aim: There is limited evidence about the effect of the corona disease epidemic on the efficiency of hospitals in Iran. This study was conducted with the aim of investigating the effect of the Covid-19 epidemic on the productivity of public hospitals in Ilam province.
Materials and Methods: This retrospective descriptive research has investigated the performance of 9 hospitals in Ilam province during a four-year period(1397-1400) based on the Pabon Lasso graphic model. The desired data were extracted from the HIS system of the hospitals and the key performance indicators of BOR, BTR and ALOS were calculated. The Pabon Lasso diagram was drawn with Excel software.
Results: The results showed that the bed occupancy percentage in teaching hospitals is significantly higher than non-teaching hospitals (P<0.05). Based on the results, the percentage of bed occupancy and the rate of bed rotation after the covid 19 pandemic has decreased significantly (P<0.05). The average length of the stay of patients also increased after the pandemic (P<0.05). Overall evaluation of hospital efficiency based on the Pabén Lasso model shows that the frequency of hospitals located in Nakara district has decreased from 4 hospitals before the pandemic to 3 hospitals, although hospitals in Kara district have not changed during this period.
Conclusion: Most of the researched hospitals, especially non-teaching hospitals, have low bed occupancy. Weakness in the service delivery chain, especially diagnostic services and specialized and super-specialized services, is one of the main reasons for this situation. Moving towards a change in the way hospitals are managed and having more flexibility in the structure and implementation in the short term and prioritizing large hospitals with a complete chain of services can lead to a way out of the current inefficient situation.
Materials and Methods: This retrospective descriptive research has investigated the performance of 9 hospitals in Ilam province during a four-year period(1397-1400) based on the Pabon Lasso graphic model. The desired data were extracted from the HIS system of the hospitals and the key performance indicators of BOR, BTR and ALOS were calculated. The Pabon Lasso diagram was drawn with Excel software.
Results: The results showed that the bed occupancy percentage in teaching hospitals is significantly higher than non-teaching hospitals (P<0.05). Based on the results, the percentage of bed occupancy and the rate of bed rotation after the covid 19 pandemic has decreased significantly (P<0.05). The average length of the stay of patients also increased after the pandemic (P<0.05). Overall evaluation of hospital efficiency based on the Pabén Lasso model shows that the frequency of hospitals located in Nakara district has decreased from 4 hospitals before the pandemic to 3 hospitals, although hospitals in Kara district have not changed during this period.
Conclusion: Most of the researched hospitals, especially non-teaching hospitals, have low bed occupancy. Weakness in the service delivery chain, especially diagnostic services and specialized and super-specialized services, is one of the main reasons for this situation. Moving towards a change in the way hospitals are managed and having more flexibility in the structure and implementation in the short term and prioritizing large hospitals with a complete chain of services can lead to a way out of the current inefficient situation.
Marziyeh Najafi, Roya Rajaee, Hojjat Rahmani, Behrooz Pouragha, Nazanin Sheikh Mohammadi, Ghasem Rajabi Vasokolaei,
Volume 18, Issue 1 (3-2024)
Volume 18, Issue 1 (3-2024)
Abstract
Background and Aim: Patient falls are common in hospitals, leading to financial loss and potential harm to patients, staff, and the organization. They can often be prevented with proper planning. This study aims to identify strategies to prevent patient falls and provide evidence to develop safety initiatives.
Materials and Methods: Our review used the Arksey and O’Malley scoping review model to identify strategies for preventing patient falls. We conducted searches with relevant keywords in the PubMed and Web of Science databases until May 25, 2024. In the final stage, we consulted with 18 experts using the Delphi method to gather their opinions. The data were analyzed using the thematic analysis method.
Results: Out of the 4202 studies initially found, 19 articles were chosen. The solutions to prevent patient falls can be grouped into six general categories: planning (which includes quality improvement programs, establishment of patient safety culture, patient fall prevention guidelines and programs), physical space (involving patient room design and the location of treatment staff), equipment (such as monitoring and alarms, pressure sensors, and standard beds), human resources (including communication networks between nurses and other treatment staff, as well as factors like self-efficacy and responsiveness of nurses, and their motivation and job satisfaction), training (covering education and patient participation, training of nurses and treatment staff, and electronic training), and control of executive processes (involving evaluation of risk factors and process control). The highest level of agreement among the members was on the equipment dimension (9.76), and the lowest was on the human resources dimension (8.65).
Conclusion: Patient falls are a common safety concern in hospitals and can be prevented with proper planning. Each hospital should use a combination of prevention methods tailored to its specific conditions.
Materials and Methods: Our review used the Arksey and O’Malley scoping review model to identify strategies for preventing patient falls. We conducted searches with relevant keywords in the PubMed and Web of Science databases until May 25, 2024. In the final stage, we consulted with 18 experts using the Delphi method to gather their opinions. The data were analyzed using the thematic analysis method.
Results: Out of the 4202 studies initially found, 19 articles were chosen. The solutions to prevent patient falls can be grouped into six general categories: planning (which includes quality improvement programs, establishment of patient safety culture, patient fall prevention guidelines and programs), physical space (involving patient room design and the location of treatment staff), equipment (such as monitoring and alarms, pressure sensors, and standard beds), human resources (including communication networks between nurses and other treatment staff, as well as factors like self-efficacy and responsiveness of nurses, and their motivation and job satisfaction), training (covering education and patient participation, training of nurses and treatment staff, and electronic training), and control of executive processes (involving evaluation of risk factors and process control). The highest level of agreement among the members was on the equipment dimension (9.76), and the lowest was on the human resources dimension (8.65).
Conclusion: Patient falls are a common safety concern in hospitals and can be prevented with proper planning. Each hospital should use a combination of prevention methods tailored to its specific conditions.
Ali Mohammad Mosadeghrad, Mahdiyeh Heydari, Mahya Abbasi, Mahdi Abbasi,
Volume 18, Issue 2 (12-2024)
Volume 18, Issue 2 (12-2024)
Abstract
Background and Aim: Health insurance organizations play an important role in increasing people’s access to health services and protecting them financially against catastrophic health costs. Iran Health Insurance Organization (IHIO) is one of the largest public health insurance organizations in Iran, which faces many challenges. The purpose of this research is the strategic analysis of health financing performance of IHIO.
Materials and Methods: This qualitative research was conducted using interpretive phenomenology method through using semi-structured interviews with 25 managers and employees of IHIO. In addition, relevant documents and archival data of IHIO were collected and analyzed. Thematic analysis method was used to analyze the data.
Results: Overall, 19 strengths, 24 weaknesses, 14 opportunities, 37 threats and 43 solutions were identified for the health financing system of IHIO. Increasing the coverage of health services, correcting the information databases of the insured and electronic prescribing were the most important strengths, and inappropriate pooling of financial resources, incomplete risk pooling, high administrative costs, and inefficient control were the most important weaknesses of IHIO. The most important opportunities for IHIO include the government’s support for universal health coverage and emphasis on primary health care, legal support for consolidating health insurance funds and improving the health technology assessment system in the country. The main threats to IHIO include political and economic unstability, low health insurance premiums, decisions without scientific support and insufficient enforcement of laws. Finally, solutions such as modernizing the tax system, increasing the health literacy of the community, reducing bureaucracy, increasing transparency and accountability, and reforming the monitoring and evaluation system were identified to strengthen the performance of the financing system of IHIO.
Conclusion: Iran’s health insurance organization is facing numerous structural, contexual and process challenges that have reduced its productivity. Decrease in revenues, increase in costs and decrease in efficiency have caused problems in the financing performance of this organization. Recognizing the weaknesses and challenges of financing performance and applying corrective interventions is the first step in strengthening the sustainability of health financing of IHIO.
Materials and Methods: This qualitative research was conducted using interpretive phenomenology method through using semi-structured interviews with 25 managers and employees of IHIO. In addition, relevant documents and archival data of IHIO were collected and analyzed. Thematic analysis method was used to analyze the data.
Results: Overall, 19 strengths, 24 weaknesses, 14 opportunities, 37 threats and 43 solutions were identified for the health financing system of IHIO. Increasing the coverage of health services, correcting the information databases of the insured and electronic prescribing were the most important strengths, and inappropriate pooling of financial resources, incomplete risk pooling, high administrative costs, and inefficient control were the most important weaknesses of IHIO. The most important opportunities for IHIO include the government’s support for universal health coverage and emphasis on primary health care, legal support for consolidating health insurance funds and improving the health technology assessment system in the country. The main threats to IHIO include political and economic unstability, low health insurance premiums, decisions without scientific support and insufficient enforcement of laws. Finally, solutions such as modernizing the tax system, increasing the health literacy of the community, reducing bureaucracy, increasing transparency and accountability, and reforming the monitoring and evaluation system were identified to strengthen the performance of the financing system of IHIO.
Conclusion: Iran’s health insurance organization is facing numerous structural, contexual and process challenges that have reduced its productivity. Decrease in revenues, increase in costs and decrease in efficiency have caused problems in the financing performance of this organization. Recognizing the weaknesses and challenges of financing performance and applying corrective interventions is the first step in strengthening the sustainability of health financing of IHIO.
Hanie Pooshideh, Jalal Jafarzade, Ali Heidarpour, Mojtaba Taghizade Armaki, Saeid Mahdavi Omran, P.h.d Firoozeh Kermani, Mohsen Karami,
Volume 18, Issue 2 (12-2024)
Volume 18, Issue 2 (12-2024)
Abstract
Background and Aim: Cockroaches are potential carriers of a wide range of pathogenic microorganisms (fungi, bacteria and parasites). Considering the importance of these insects in the transmission of pathogenic fungi and their impact on the health of hospitalized people, the aim of this study was isolation and molecular identification of pathogenic fungi from the external and internal surfaces of cockroaches collected from three educational hospitals of Babol city, Mazandaran Province, Iran.
Materials and Methods: Cockroaches were caught by a sterile manual method and after washing to remove surface contamination with 70% ethyl alcohol for 2min, 100 µL of the solutions from the external and internal parts of cockroaches were cultured on Sabouraud’s dextrose agar with 0.05% chloramphenicol and incubated at 30 °C for 3 weeks. The different yeast and filamentous colonies were distinguished using standard mycological methods. The PCR-RFLP method and the restriction enzymes Msp I and Bln I were used for the differentiation of Candida species, and the restriction enzyme Alw I for Aspergillus species.
Results: A total of 85 fungi species/genera were isolated from all 50 studied cockroaches, including German cockroaches 15 (30%), American cockroach 20 (40%) and brown 15 (30%), which included 52 isolates from external surfaces (61%) and 33 isolates from internal surfaces of cockroaches (39%). Of the total number of 49 filamentous fungi, Aspergillus fumigatus 16 (32.65%) and out of the total number of 36 yeasts identified, Candida albicans 14 (38.89%) were the most common fungi isolated in this study. Other filamentous fungi and yeasts isolated from cockroaches include Aspergillus niger 11 (22.45%), Aspergillus flavus 8 (16.32%), Penicillium 4 (8.2%), Rhizopus 3 (6.1%), Cladosporium 3 (6.1%), Mucor 2 (4%), Alternaria 2 (4%), Candida parapsilosis 6 (16.67%), Candida krusei 12 (33.33%), Candida glabrata 3 (8.33%), and Candida tropicalis 1 (2.78%) were isolated.
Conclusion: Considering the isolation of several fungal species from cockroaches and their importance in the possible mechanical transmission of common fungal infections in hospitals, these insects can be a source of continuous transmission of infection, if there is no regular preventive disinfection of the hospital environment.
Materials and Methods: Cockroaches were caught by a sterile manual method and after washing to remove surface contamination with 70% ethyl alcohol for 2min, 100 µL of the solutions from the external and internal parts of cockroaches were cultured on Sabouraud’s dextrose agar with 0.05% chloramphenicol and incubated at 30 °C for 3 weeks. The different yeast and filamentous colonies were distinguished using standard mycological methods. The PCR-RFLP method and the restriction enzymes Msp I and Bln I were used for the differentiation of Candida species, and the restriction enzyme Alw I for Aspergillus species.
Results: A total of 85 fungi species/genera were isolated from all 50 studied cockroaches, including German cockroaches 15 (30%), American cockroach 20 (40%) and brown 15 (30%), which included 52 isolates from external surfaces (61%) and 33 isolates from internal surfaces of cockroaches (39%). Of the total number of 49 filamentous fungi, Aspergillus fumigatus 16 (32.65%) and out of the total number of 36 yeasts identified, Candida albicans 14 (38.89%) were the most common fungi isolated in this study. Other filamentous fungi and yeasts isolated from cockroaches include Aspergillus niger 11 (22.45%), Aspergillus flavus 8 (16.32%), Penicillium 4 (8.2%), Rhizopus 3 (6.1%), Cladosporium 3 (6.1%), Mucor 2 (4%), Alternaria 2 (4%), Candida parapsilosis 6 (16.67%), Candida krusei 12 (33.33%), Candida glabrata 3 (8.33%), and Candida tropicalis 1 (2.78%) were isolated.
Conclusion: Considering the isolation of several fungal species from cockroaches and their importance in the possible mechanical transmission of common fungal infections in hospitals, these insects can be a source of continuous transmission of infection, if there is no regular preventive disinfection of the hospital environment.
Malihe Ghanaatjoo, Nader Jahanmehr, Dr. Hamed Dehnavi, Aida Samadi,
Volume 18, Issue 2 (12-2024)
Volume 18, Issue 2 (12-2024)
Abstract
Background and Aim: The increase in the amount of information and the need for their daily monitoring have led to the development of tools called management dashboards that have the ability to analyze graphical data. In addition to preparing quick reports in different time frames and user-specific format, the dashboard can be useful for providing dynamic updated information for accurate decision-making and quick response to changes.
Materials and Methods: The current research was carried out in the form of qualitative studies and participatory action research method in 9 steps. In this applied and developmental research that was conducted cross-sectionally using the data of the first half of 2022, 11 members of the leadership team of a super-specialized children’s hospital were selected as research participants. The data collection tool was an interview using a questionnaire to determine the importance of indicators and a usability questionnaire (usability) of the dashboard based on three independent variables (usefulness, ease of use and satisfaction). The Excel file of data needed for the dashboard was collected from the HIS system of the hospital, and the dashboard was designed with Power BI software, and the capabilities and access levels of users were determined based on their duties. Data analysis was done using descriptive statistics and Excel software version 2016.
Results: In the stage of determining key performance indicators, out of 39 indicators selected by the research team, 22 indicators scored an average score of 4 or higher (from 5 points) and 21 indicators were able to be implemented. The data repository in Excel format was used as an intermediate environment. The dashboard was displayed on six pages (indicators related to the performance of inpatient beds, mortality, emergency and other indicators) and the capabilities of each page were determined. After implementing the dashboard and determining the access levels of users, obtaining a high score from the questions of the usability questionnaire (5 out of 7 points) and obtaining an average score of 71.8 out of 5 questions related to usefulness variables, 70.5 out of 8 questions related to ease of use. And 71 out of 3 questions related to the satisfaction variable showed that the dashboard designed for the hospital had high usability.
Conclusion: Hospital management dashboard information can be a basis for informed decision-making to achieve benefits such as identifying the best performance, improving performance quality, making faster decisions, reducing errors, improving capacity management and work flow, allocating resources and planning for growth and development.
Materials and Methods: The current research was carried out in the form of qualitative studies and participatory action research method in 9 steps. In this applied and developmental research that was conducted cross-sectionally using the data of the first half of 2022, 11 members of the leadership team of a super-specialized children’s hospital were selected as research participants. The data collection tool was an interview using a questionnaire to determine the importance of indicators and a usability questionnaire (usability) of the dashboard based on three independent variables (usefulness, ease of use and satisfaction). The Excel file of data needed for the dashboard was collected from the HIS system of the hospital, and the dashboard was designed with Power BI software, and the capabilities and access levels of users were determined based on their duties. Data analysis was done using descriptive statistics and Excel software version 2016.
Results: In the stage of determining key performance indicators, out of 39 indicators selected by the research team, 22 indicators scored an average score of 4 or higher (from 5 points) and 21 indicators were able to be implemented. The data repository in Excel format was used as an intermediate environment. The dashboard was displayed on six pages (indicators related to the performance of inpatient beds, mortality, emergency and other indicators) and the capabilities of each page were determined. After implementing the dashboard and determining the access levels of users, obtaining a high score from the questions of the usability questionnaire (5 out of 7 points) and obtaining an average score of 71.8 out of 5 questions related to usefulness variables, 70.5 out of 8 questions related to ease of use. And 71 out of 3 questions related to the satisfaction variable showed that the dashboard designed for the hospital had high usability.
Conclusion: Hospital management dashboard information can be a basis for informed decision-making to achieve benefits such as identifying the best performance, improving performance quality, making faster decisions, reducing errors, improving capacity management and work flow, allocating resources and planning for growth and development.
Kourosh Abbasiyan, Mohammad Alimoradnori, Mohammad Bagher Karami,
Volume 18, Issue 2 (12-2024)
Volume 18, Issue 2 (12-2024)
Abstract
Background and Aim: Managers, as the main decision-makers in facing various internal and external organizational problems, play a significant and determining role in the success or even failure of an organization. If competent and experienced managers are positioned at the top of organizations, the success of these organizations in achieving their goals will be guaranteed and an organization can achieve maximum efficiency with minimal resources. The aim of this study was to design a model of managerial competencies for hospital managers.
Materials and Methods: This qualitative research was conducted from year 2020 to 2022. After reviewing studies related to the topic, the extracted competencies were given to 19 experts consisted of relevant academic faculty members and managers with experience in the healthcare system and hospitals. Eventually, a managerial competency model was formulated through the use of the Delphi method and expert panel discussions. Collected data were analyzed in Excel software.
Results: The developed model in this research for the concept of hospital managers’ competencies includes 33 managerial competencies of hospital managers in four main management functions (planning, organizing, leadership and control) and managerial roles, which starts from literature review and performing two Delphi steps and implementing two expert panel plans. In the competency of hospital managers model, the planning dimension consists 4 components, organizing consists 4 components, leadership consists 12 components, control consists 4 components, and managerial roles consists 9 components. Strategic thinking, which is a subset of planning, has the highest weight (0.495) and highest rank among other components, and continuous improvement, which is a subset of managerial roles, has the lowest weight (0.033) and lowest rank among other components.
Conclusion: This study proposes an exclusive and comprehensive model, utilizing practical techniques as a suitable solution for evaluating the managerial competencies of hospital managers. The proposed framework in this study can serve as a standard performance assessment tool for evaluating managers.
Materials and Methods: This qualitative research was conducted from year 2020 to 2022. After reviewing studies related to the topic, the extracted competencies were given to 19 experts consisted of relevant academic faculty members and managers with experience in the healthcare system and hospitals. Eventually, a managerial competency model was formulated through the use of the Delphi method and expert panel discussions. Collected data were analyzed in Excel software.
Results: The developed model in this research for the concept of hospital managers’ competencies includes 33 managerial competencies of hospital managers in four main management functions (planning, organizing, leadership and control) and managerial roles, which starts from literature review and performing two Delphi steps and implementing two expert panel plans. In the competency of hospital managers model, the planning dimension consists 4 components, organizing consists 4 components, leadership consists 12 components, control consists 4 components, and managerial roles consists 9 components. Strategic thinking, which is a subset of planning, has the highest weight (0.495) and highest rank among other components, and continuous improvement, which is a subset of managerial roles, has the lowest weight (0.033) and lowest rank among other components.
Conclusion: This study proposes an exclusive and comprehensive model, utilizing practical techniques as a suitable solution for evaluating the managerial competencies of hospital managers. The proposed framework in this study can serve as a standard performance assessment tool for evaluating managers.
Fateme Hami Kargar, Narges Nikkhah Ghamsari, Mohammad Ganji,
Volume 18, Issue 3 (5-2024)
Volume 18, Issue 3 (5-2024)
Abstract
Background and Aim: Breast cancer treatment is associated with changes in women’s bodies. Changes that are related to their femininity in addition to the appearance aspect and can face challenges in the part of women’s identity that is related to their body. This research deals with the process of changes in women’s physical identity in the context of culture and society
Materials and Methods: A qualitative method was used for the research, and in this regard, in-depth and semi-structured interviews were conducted with 15 women from Tehran who had undergone treatment for breast cancer, along with 5 companions who were alongside the patients during their illness, and 3 surgical doctors. The interviews focused on the experiences, emotions, and actions of the women in response to bodily changes. Sampling was conducted through purposive and snowball sampling methods. The thematic analysis technique developed by Braun and Clarke was employed for analyzing the interviews.
Results: The participating women were aged 27 to 65 years, with 8 holding bachelor’s degrees or higher. Seven women were housewives, 8 were employed, and 13 had undergone mastectomies. The main themes identified include changes in the female body, societal challenges, disruption of body image, support and companionship, economic constraints, and the redefinition of body image. These themes explain the process of women’s coping with bodily changes. Following bodily changes, women face challenges from society. Society judges women’s bodies after these changes and views them negatively. Furthermore, women experience dissatisfaction with their bodies, perceiving them as inadequate for fulfilling feminine roles and responsibilities as wives and mothers. However, over time, through acceptance of the changes and body management, women strive to reconstruct their body image. In addition, the women’s economic situation and the support and companionship of those around them—manifesting as acceptance of the bodily changes and emotional support—can facilitate the acceptance of these changes.
Conclusion: Given the importance of the body in defining femininity, women, after experiencing breast cancer, face not only the suffering of the disease but also identity challenges. Therefore, breast cancer treatment, alongside clinical interventions, requires societal awareness of how to interact with affected women.
Materials and Methods: A qualitative method was used for the research, and in this regard, in-depth and semi-structured interviews were conducted with 15 women from Tehran who had undergone treatment for breast cancer, along with 5 companions who were alongside the patients during their illness, and 3 surgical doctors. The interviews focused on the experiences, emotions, and actions of the women in response to bodily changes. Sampling was conducted through purposive and snowball sampling methods. The thematic analysis technique developed by Braun and Clarke was employed for analyzing the interviews.
Results: The participating women were aged 27 to 65 years, with 8 holding bachelor’s degrees or higher. Seven women were housewives, 8 were employed, and 13 had undergone mastectomies. The main themes identified include changes in the female body, societal challenges, disruption of body image, support and companionship, economic constraints, and the redefinition of body image. These themes explain the process of women’s coping with bodily changes. Following bodily changes, women face challenges from society. Society judges women’s bodies after these changes and views them negatively. Furthermore, women experience dissatisfaction with their bodies, perceiving them as inadequate for fulfilling feminine roles and responsibilities as wives and mothers. However, over time, through acceptance of the changes and body management, women strive to reconstruct their body image. In addition, the women’s economic situation and the support and companionship of those around them—manifesting as acceptance of the bodily changes and emotional support—can facilitate the acceptance of these changes.
Conclusion: Given the importance of the body in defining femininity, women, after experiencing breast cancer, face not only the suffering of the disease but also identity challenges. Therefore, breast cancer treatment, alongside clinical interventions, requires societal awareness of how to interact with affected women.
Mohammadreza Asghariyan, Farzad Firouzi Jahantigh,
Volume 18, Issue 3 (5-2024)
Volume 18, Issue 3 (5-2024)
Abstract
Background and Aim: The emergency department of the hospital is considered one of its main entrances; which has provided health care and treatment for critical and non-critical patients and faces various health and treatment restrictions, but the main emphasis is always on resource limitations. Many simulation projects were implemented in hospitals and first in emergency departments with the aim of increasing productivity. The present research is a general description of the patient’s movement flow and length of stay in the emergency department of a selected specialized hospital in Zahedan city. The aim of the current research is to prevent care complications, reduce waiting time and patient stay in the emergency department, present a simulation model and improve it based on discrete-event simulation.
Materials and Methods: Using the data bank of the emergency department system based on the required data and also through the in-person observation of the data related to the duration of the patient’s stay in the emergency department, including the arrival time, waiting time, The type of services provided to the patient, the time of service and the time of departure were collected and checked and confirmed by experts related to this field so that it has the highest level of reliability with the facts. The data were designed in Excel software, and then data analysis and simulation model creation were done using Aren V14 software, and according to the results, the effect of the proposed solutions was evaluated.
Results: The findings of the present research showed that the longest queue created in the emergency department of the selected specialized hospital in Zahedan city is related to medical examination and additional tests. By implementing the simulation model and testing different solutions, solution 3, which means adding one nurse to nursing consultation and one person to radiology, has the most optimizing effect on the performance of the system at different levels of the patient admission process. and the cost of its implementation is more than solutions 1 and 2. This solution created a 14% decrease in the average length of stay and a 28% decrease in the average duration of additional tests.
Conclusion: The use of queuing models and simulation techniques improve the performance of the system and their implementation has significant effects on reducing the waiting time and length of stay of patients in the emergency department, increasing the quality level of the process of monitoring patients. It leads to optimal management of resources and increased productivity.
Fatemeh Soofiabadi, Alireza Shahraki, Mohebali Rahdar,
Volume 18, Issue 3 (5-2024)
Volume 18, Issue 3 (5-2024)
Abstract
Background and Aim: Given the high sensitivity of the medical field, a mistake can cause irreparable damage to human society. For this reason, finding the symptoms of the disease and the relationships between them to facilitate the improvement of diseases is inevitable. Therefore, the aim of the present study was to first identify the symptoms of neurofibromatosis type 1 by specialists, then determine the relationship between the symptoms and the degree of their impact on each other in order to determine the most important criterion in improving the disease.
Materials and Methods: The present study is of a developmental-applied type in terms of its purpose and of a descriptive-survey type in terms of its data collection method. The case study of the present study is spinal disorders, of which neurofibromatosis type 1 has been diagnosed as one of them based on the opinion of experts. Neurofibromatosis type 1 is a genetic disorder that causes tumors in the nervous tissue. Accordingly, in the present study, the criteria, which are the symptoms of the disease, were first determined using the opinion of a group of experts and the implementation of the fuzzy Delphi method. In the next step, a model for the causal relationships between the symptoms of the disease is presented. For this purpose, a fuzzy cognitive map is drawn using MATLAB, FCMapper and Pajek software, then backward and forward scenarios are presented for neurofibromatosis type 1 and the disease improvement scenario is determined.
Results: The results showed that hormonal changes, flat brown spots on the skin, freckles in the armpit and groin area, soft bumps on the face or under the skin, high blood pressure, respiratory problems, bumps on the iris of the eye (Lish nodules), tumor in the optic nerve-ocular glioma, short stature, bone deformity, learning disabilities-attention deficit hyperactivity disorder (ADHD) and larger than average head size are ranked first to twelfth, respectively. The causal relationships between the symptoms showed that the criterion of hormonal changes has the greatest impact on the criterion of freckles in the armpit or groin area; Therefore, if the hormonal changes criterion improves, neurofibromatosis type 1 will also improve.
Conclusion: The findings of this study have helped the medical community to have a better understanding of the symptoms of the disease so that doctors can improve their prevention and care recommendations based on the severity of the symptoms of the diseases.
Materials and Methods: The present study is of a developmental-applied type in terms of its purpose and of a descriptive-survey type in terms of its data collection method. The case study of the present study is spinal disorders, of which neurofibromatosis type 1 has been diagnosed as one of them based on the opinion of experts. Neurofibromatosis type 1 is a genetic disorder that causes tumors in the nervous tissue. Accordingly, in the present study, the criteria, which are the symptoms of the disease, were first determined using the opinion of a group of experts and the implementation of the fuzzy Delphi method. In the next step, a model for the causal relationships between the symptoms of the disease is presented. For this purpose, a fuzzy cognitive map is drawn using MATLAB, FCMapper and Pajek software, then backward and forward scenarios are presented for neurofibromatosis type 1 and the disease improvement scenario is determined.
Results: The results showed that hormonal changes, flat brown spots on the skin, freckles in the armpit and groin area, soft bumps on the face or under the skin, high blood pressure, respiratory problems, bumps on the iris of the eye (Lish nodules), tumor in the optic nerve-ocular glioma, short stature, bone deformity, learning disabilities-attention deficit hyperactivity disorder (ADHD) and larger than average head size are ranked first to twelfth, respectively. The causal relationships between the symptoms showed that the criterion of hormonal changes has the greatest impact on the criterion of freckles in the armpit or groin area; Therefore, if the hormonal changes criterion improves, neurofibromatosis type 1 will also improve.
Conclusion: The findings of this study have helped the medical community to have a better understanding of the symptoms of the disease so that doctors can improve their prevention and care recommendations based on the severity of the symptoms of the diseases.
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