Journal of

Background and Aim: In a severely inflationary environment with unemployment, social problems increase and, therefore, high health care expenses are imposed on the society.

Materials and Methods: This was a correlational study. Panel data model and EVeiws 6 software were used in this study. The data were collected from the World Bank website. The required pre-tests, including F-Limer and Hauseman tests, were given to check the appropriateness of data and to determine a appropriate model. Following the pre-tests, the results were estimated in the form of a regression model.

Results: The results indicated that F-test and t-statistic were significant, and that R² statistic was high. In the three models, R² was 99%, 99% and 98%, respectively. Moreover, it can be said that employment is positively related with life expectancy, but negatively related with infant mortality and total fertility rate. Also, inflation is negatively related with life expectancy, but positively related with infant mortality, and total fertility rate. Finally, Gross Domestic Product (GDP) is negatively related with total fertility rate and life expectancy, but has no meaningful relationship with infant mortality (p = 0.31).

Conclusion: Employment, inflation and GDP are the variables that have the greatest impact on health indicators. however, life expectancy is more sensitive to explanatory variables.

Background and Aim: The study of human resources flexibility impact on hospitals performance indicators can be effective on hospitals performance improvements. The main purpose of this research is to investigate the relationship between human resources flexibility and hospitals’ performance indicators of Islamic Azad University.

Materials and Methods: The present research was a descriptive-analytical research that has been induced cross-sectionally in 2013. The statistical sampling has been selected randomly, and class assignment among 108 nurses, and supportive employees in five hospitals of Islamic Azad University. Data collection tools was hospital’s performance indicator forms, and flexibility questionnaire based on Right and Esnel. The process of data analysis has been done using SPSS software and by descriptive statistical indicators and correlation tests.

Results: The studied employees had low flexibility. The total studied hospitals were in undesirable situation from the perspective view of bed occupying and bed rotation ratio. Finally, there were not any meaningful relationship between human resources flexibility and hospitals performance indicators.

Conclusion: According to low flexibility of human resources of Islamic Azad University hospitals, the policies should be made in order to coordinate human resources process  with human  resources  flexibility strategies. Furthermore, human resource for the purpose of creating flexibility and hospital subsidiaries of Islamic Azad University performance improvements could be clearly effective in such hospitals situation promotion.

Background and Aim: Scientific and technological developments have promoted the status of organizational learning as a reasonable way to deal with the present changing circumstances. The development of organizational learning improves the performance of employees, and makes them feel satisfied. The aim of this study is to investigate the relationship between job satisfaction and organizational learning capabilities among the employees of Tehran hospitals.

Materials and Methods This descriptive, analytical study was conducted among 290 employees in 2014 in Tehran hospitals. For data collection, a three-part questionnaire (including demographic characteristics, Gomez`s Organizational Learning Capability Questionnaire and Minnesota Job Satisfaction Questionnaire) was given to 290 employees. Data were analyzed using the SPSS-20 software with Spearman test.

Results: Mean scores of organizational learning capability and job satisfaction were (3.03± 0.61) and (2.8± 0.61), respectively. Among the dimensions of organizational learning capability, the highest score pertained to systematic perspective (3.29± 0.78); regarding job satisfaction, the highest score was related to organizational climate (3.23± 0.1). The results showed that there was a significant correlation between the dimensions of organizational learning capability and job satisfaction. Also, a significant correlation was observed between organizational learning capabilities and job satisfaction.

Conclusion: Organizational learning improves the performance of employees and is positively correlated with their satisfaction. Also, employee satisfaction is one of the factors affecting their performance. Therefore, managers can make employees satisfied and develop their organization through improving organizational learning.

Background and Aim: In recent years, the family physician plan has been implemented as a main strategy of the health system in Iran. Therefore, the necessity to reform organizational structure based on new goals and strategies is felt more than before. The aim of this study is to review and summarize all cases about Iran’s organizational structure and its challenges in primary healthcare system.

Materials and Methods: This study is a systematic review. All relevant databases, bibliography of related papers, and laws were searched using appropriate search strategies and keywords. To evaluate the quality of selected papers, CASP tool was applied by two experts, and their choices were discussed to reach a final decision.

Results: Fourteen final cases were categorized in two groups: papers and upstream policies and laws. The results revealed the ineffectiveness of current organizational structure at different levels. The majority of the findings suggested proper reforms in the system. Centralization and delegation processes were the main dimensions studied.

Conclusion: Due to fundamental changes in goals and strategies, certain reforms in the organizational structure of health system in Iran are indispensable, especially at peripheral levels.

Key words: Primary Health Care System, Organizational Structure, Iran

Background and Aim: In recent years, the family physician plan has been implemented as a main strategy of the health system in Iran. Therefore, the necessity to reform organizational structure based on new goals and strategies is felt more than before. The aim of this study is to review and summarize all cases about Iran’s organizational structure and its challenges in primary healthcare system.

Materials and Methods: This study is a systematic review. All relevant databases, bibliography of related papers, and laws were searched using appropriate search strategies and keywords. To evaluate the quality of selected papers, CASP tool was applied by two experts, and their choices were discussed to reach a final decision.

Results: Fourteen final cases were categorized in two groups: papers and upstream policies and laws. The results revealed the ineffectiveness of current organizational structure at different levels. The majority of the findings suggested proper reforms in the system. Centralization and delegation processes were the main dimensions studied.

Conclusion: Due to fundamental changes in goals and strategies, certain reforms in the organizational structure of health system in Iran are indispensable, especially at peripheral levels.

Background and Aim: Chronic lymphocytic leukemia (CLL) is a lymphoprolifrative disorder, which is very heterogeneous in prognosis. Therefore, the analysis of the prognostic factors should be very helpful in diagnosing patients with a poor prognosis. The aim of this study was to determine the relationship between circulating Endothelial cells number with VWF levels along with the other hematological findings in CLL.

Materials and Methods: Peripheral blood samples were obtained from 30 CLL patients admitted to the hematology department of Firozgar hospital and 30 healthy subjects. The levels of CEC were measured by the presence of CD34 and VWF markers, and absence of CD45 marker, using flow cytometry. VWF levels was evaluated by ELISA.

Results: The CEC levels were significantly higher in blood of the CLL patients (0.64%), when compared to the controls (0.12%, P=0.002). The levels of plasma VWF were higher among high grade patients, when compared to controls and patients in lower grades. There was a negative correlation between CEC levels, and Hb concentration in the patients group (r=-0.47, P=0.01).

Conclusion: Although the levels of both CEC count and plasma VWF in patient with high grade CLL were increased when compared to patients with low grade, there was no significant correlation between these two parameters.

Background and Aim: Today, customer perception assessment as a way to measure satisfaction and expectations has an important role in improving the quality of services and organizational excellence. This study aims to measure customers’ perception at the Health Deputy of Iran’s Ministry of Health and Medical Education (MOHME).

Materials and Methods: This cross-sectional study was performed in 2012-2013. The population comprised the health deputies of medical universities, among which 13 of the universities were randomly selected. As the main customers of MOHME health deputy, these universities’ managers and experts were asked questions like a census. The data collection device was the national award standard questionnaire consisting of 2 sections and 26 questions. The data were analyzed by SPSS 18 with level.

Results: Of the 267 managers and experts, 147 (56.1%) were male. Many of them (57.3%) had a bachelor's degree. Most of them (91.6%) were employed in technical units. The average perceived level of managers and experts regarding their reputation and image was 3.3±0.7, production and service 3.1±0.7, support while and after providing services 3.0±0.7, and loyalty and honesty 3.3±0.8 out of a maximum 5 points, respectively. There was no significant relationship between administrators and experts’ perception level on the one hand, and individual and organizational factors on the other (P>0.05).

Conclusion: The study showed that customers’ perception of indices related to the quality of relationships, services and measures was at a moderate level. Therefore, it is recommended that the department of health should design and implement an appropriate intervention program for organizational excellence.

Background and Aim: Learning is essential in healthcare environments, where knowledge and skills are quickly outdated due to continuous advances in medical science. Organizational learning is a dynamic process that enables learning organizations to be campatible with change in good time. The aim of this study was to determine the status of organizational learning in an Iranian healthcare organization in Tehran, and to assess the extent to which this organization could be considered as a learning organization.

Materials and Methods: In this cross-sectional and descriptive study, 200 nurses were selected in an Iranian healthcare organization. Dimension Learning Organizational Questionnaire (DLOQ) was used to collect data to be analyzed using descriptive statistics methods by frequency, percentage, mean, and standard deviation.

Results: The mean overall score for organizational learning was 3.36±0.69. Among the various dimension of organizational learning, continuous learning had the highest average (3.44±0.39), and the empowerment had lowest amount (2.72±0.06).

Conclusion: The findings from this study provide useful information for these organization's managers regarding the areas where there is a need for improvement in OL and to make it a more LO.

Background and Aim: Nowadays, hospitals believe that applying the principles of management improve quality, and enhance competition and development. One of the ways to achieve these goals is the use of 5S. This study is aimed to determine and compare  supporting departments of Amir Alam Hospital before and after the implementation of 5S.

Materials and Methods: This descriptive analytical and cross-sectional study was conducted within three departments: Kitchen, laundry and the maintenance & repairs departments  of Amir Alam Hospital. Five checklists were designed for collecting information before and after the implementation of 5S within each department. Data analyses was performed using Wilcoxon test and SPSS version 19.

Results: Average rating after running 5S was more than before within the kitchen Section. However, there was a significant relationship before and after running 5S in only stage one and five. Within maintenance & repair and the Laundry departments, average rating after implementation of 5S was higher than using it before. In addition, all purposes with the exception of employees’ adornment, were statistically significant in all of five stages.

Conclusion: Implementation of 5S systems will contribute to increase in employees & patients’ efficiency and satisfaction, which in turn will lead to achieving higher productivity and economic growth. Therefore, we recommend other hospitals and departments to apply the concept of 5S.

Background and Aim: With regard to the effect of environmental health for employees, and with regard to the lack of a proper plan for identifying and controlling harmful occupational factors, it is necessary to create workplace health identification cards. The aim of this research is to design an identification card, which includes all the information about the workplace health of the employees of administrative section of a ministry, which could be updated in specific time intervals.

Materials and Methods: The present research was an applied, descriptive and  observational study which was conducted in 2015 in 100 work stations which were randomly selected in a governmental ministry through designing of two forms, including the information about workplace building, and the health information of the work station. The employees were also interviewed in order to collect data about each workstation regarding the machines for measuring the light, sound, temperature, ventilation, and rays. The opinions of four experts in the fields of environmental health, public health, occupational health, and civil health was used to analyze the data.

Results: A workplace health identification card was designed and determined through using the data obtained in this research. The following issues from this identification card, including standardizing the workplace of administrative employees, creating a data bank from the information, related to workplace health.

Conclusion: Workplace health identification card will be created and the standard management procedure will be designed for the purpose of health inspections of the workplace of administrative employees through the data extracted from this research.

Background and Aim: Caring about workers is important due to protect human capital and economic growth. Understanding health priorities is one of the main challenges of health management. The aim of this research was to priorities health promotion behaviors of female workers.

Materials and Methods: This study was conducted in 2012 and had a triangulation design with sequential qualitative-quantitative method based on "integrated model of planned behavior and self-efficacy". In the qualitative phase of the study, a content analysis approach was done  to develop the questionnaire, based on the model and psychometric properties were assessed. Then, the educational intervention was conducted in an experimental study with randomized sampling in 70 female workers (35 intervention group, 35 controls). The pretest and posttest was compared.

Results: Content analysis demonstrated 6 main themes, including the main constructs of the research model: attitude, subjective norm, perceived behavioural control, self-efficacy, intention and behaviour in 4 domain (nutrition, exercise, cervical and breast cancer screening, cope with stress). Scale level content validity index was 0.93. Confirmatory factor analysis showed CFI=0.97, GFI=0.95, IFI=0.96, NNFI=0.98, NFI=0.97, RMSEA=0.05. Concurrent validity versus the Health-promoting lifestyle profile II showed r=0.60. Cronbach alpha was 0.75–0.93 across the subscales. Test–retest reliability revealed no significant differences.After educational intervention there was a significant increase in attitude, subjective norm, perceived behavioral control, self-efficacy, intention and behavior of female workers in intervention group. Also, effect of intervention program was mostly in self-efficacy construct.

Conclusion: With regards to working conditions economic and socio-cultural barriers in female workers, health policy making is essential in this group to promote health

Background and Aim: Patient safety is a critical element of health care quality, and is a priority of health system that pursue to improve the quality of health services. This study aims to determine the attitude the nurses about patient safety in hospitals of Tehran University of Medical Sciences.

Materials and Methods: Nurses employed in 7 emergency and intensive care ward specialty and subspecialty hospital affiliated with Tehran University of Medical Sciences was invited to anonymously complete safety attitudes survey. Reliability of the questionnaires was evaluated by calculating Chronbach’s alpha. ANOVA were used to compare the score means between the wards. Spearman correlation test was used to analyze the correlation between the safety dimensions and the outcome variables.

Results: The results showed that the highest score was dedicated to stress recognition, and the lowest score was related to management perception and working conditions. No significant difference was between the perceptions of emergency department nurses and intensive care nurses with various aspects of safety culture in hospitals.

Conclusion: Patient safety status described as acceptable in emergency and intensive care wards. There is a need to understanding of the atmosphere and the culture of safety by hospital executives deeply.

Background and Aim: Evaluating and improving the employees’ quality of work life is one of the most important responsibilities of managers in each organization. The aim of this study was to design and prepare a questionnaire for evaluating the residents’ quality of work life and checking the validity and reliability of this tool.
Materials and Methods: We collected the questionnaires which were used for the employees’ quality of work life, and designed by Delphi method a comprehensive questionnaire for measuring residents’ quality of work life. This questionnaire was distributed two times with one-week interval between 14 residents of Tehran University of Medical Sciences and then the validity and reliability was assessed by α cronbach model. We used the 5 experts in the field of health care management, medical education and health economics to determine the validity of quality of working life questionnaire. The classification of cronbach's α for intra-rater reliability was: very good (0.9-1), good (0.8- 0.89), average (0.7- 0.79), bad (0.6-0.69) and very bad (under 0.59).
Results: The results of  αcronbach test for questions reliability and the result α cronbach test for internal consistency of each class of question indicated the rather high reliability and validity of these questions.
Conclusion: Regarding to the results of α cronbach test, we can deduce that our designed questionnaire encompass have satisfied validity and reliability and it can be used for future studies.

Background and Aim: Population aging in most of developed countries should be subjective to more attention, regarding health issues of aging group. Different organizations and institutions have launched several programs related to elderly center. This paper is aimed to compare performance of different programs of active organizations in the field of elderly care in Iran.
Materials and Methods: This overview of research, used library resources and online databases Proquest, Pub med, Science Direct, Ovid and Scientific Information databases using keywords that  Aged care services, relevant organizations, and Iran.
Results: There are various classifications of geriatric services. However, these services can be divided into three groups including infrastructure, social services, and health care and preventive services according to concept, level and type of services.
Conclusion: In Iran, agencies and institutions relevant to elderly, take measures to support elderly people given their current tasks and allocated budget. But, these measures do not seem adequate, because solving aging problem, as a problem with evident influences which its impacts will be intensified in future, requires responsibility and cooperation of more agencies and public institutions.

Background and Aim: The aim of this study was structural monitoring of the articles in knowledge and information science field in five Iranian journals. Today, the publication of papers constitutes one of the written scope among scientific broad cost productions.
Materials and Methods: The research method was analytical-survey. The articles were analyzed by the variables such as author distribution by sex, field of study, scientific notation, types of articles by original papers or translated papers, individual or group articles and their publication dates, and by statistical methods used in the articles in two periods from 2002-2006 and 2007-2011.
Results: The results showed that most of the articles were written as original. International cooperation between authors was minimal. Using qualitative research methods among the articles were low. Majority of the authors had masters degree. There was a significant relationship between the authors’ grades, number of authors and journals, and used statistical methods.
Conclusion: The written articles in the field of knowledge and information, followed by special patterns. The journals policies in publication of articles process is the most important issue. Also, lack of international cooperation between Iranian with foreign authors, type and format of the articles were similar according to mentioned variations.

Background and Aim: Inclusive implementation of Electronic Medical Records (EMR) is more serious because of physicians’ perception. This study was carried out to identify the effects of organizational contextual factors on physicians’ perception regarding EMR’s adoption in 2013 (The merger of Tehran University and Iran). 
Materials and Methods: This was a descriptive, analytical and cross- sectional study in which a sample of 270 physicians working in hospitals affiliated to Tehran University of Medical Sciences was selected. Physicians’ perception toward adoption of EMR has been assessed by Technology Acceptance Model or TAM questionnaire and organizational context variables. Collected data were analyzed by SPSS. The study model was tested by Structural Equation Modeling (SEM) and represented by AMOS. 
Results: The findings showed that perceived usefulness (PU), perceived ease of use (PEOU), management support, physicians’ involvement, physicians’ autonomy, and physician- patient relationship have direct and significant effect on physicians’ attitudes toward EMR adoption. However, training has no significant effect on TAM variables. Moreover, the results showed authorizing proposed conceptual path model explained about 56 percent of the variance of EMR adoption.
Conclusion: The present study revealed that organizational context factors had significant effect on physicians’ attitude toward EMRs’ adoption. The study clearly identified six relevant factors that affected physicians’ perception regarding EMR adoption. These factors should be considered when comprehensive implementation is pursued.  

Background and Aim: Employees’ silence is common in organizations, and is mostly neglected. Employees are indifferent towards their supervisors, work quality and organization. Organizational justice is a factor that can diminish employees' silence. The aim of this study was to determine the relationship between organizational justice and headquarters employees' silence in Kerman University of Medical Sciences (KMU).
Materials and Methods: This study was a descriptive-correlational and cross-sectional research. The population included all 400 employees at KMU headquarters, among whom 147 members were selected as the sample using Cochran’s formula. In this study, two questionnaires were used: organizational justice questionnaire with a reliability of 0.91 and employees’ silence questionnaire with a reliability of 0.92. For data analysis, Pearson and Spearman correlation, regression testing, by SPSS software were used.
Results: The findings showed that there was an inverse relationship between organizational, distributive, procedural, and interactional justice with employees' silence in Kerman University of Medical Sciences. The regression findings showed that the variable “distributive justice” had the strongest negative effect on employees' silence.  
Conclusion: Encouraging employees to provide positive ideas, identify the existing problems, and reduce undesirable behavior like employees' silence can make employees operate more efficiently. Organizational justice is based on fair treatment, and it determines the employees’ reaction to organizational decisions. Therefore, it can partly remove problems and lead to the decline of employees' silence.  

Background and Aim: Cancer disease is one of the main problems of Iranian health system. It is after Cardiovascular diseases and accidents, the third leading cause of death in Iran. In many countries, differences in socio-economic status have been linked with the incidence of disease, death and in general, health inequalities. The aim of this study is to determine the socioeconomic factors associated with the incidence of leukemia in Iran.
Materials and Methods: The present descriptive-analytical study was done with panel data modeling, including information related to 30 provinces of Iran from 2004 to 2009. Socioeconomic data were collected from provincial statistical yearbooks and data on age-standardized incidence rate (ASIR) of leukemia cancer per 100,000 populations were obtained from published reports by Iran Cancer Registry. 
Results: The results showed that the leukemia incidence in men and in women during the period under review has been upward. The highest and lowest incidence of leukemia was in Yazd and Sistan provinces, respectively. Direct relationship between unemployment rate, urbanization ratio, and human development index with cancer incidence rate was evident in this study.
Conclusion: The increase of leukemia cancer in Iran has been confirmed by the current study. Leukemia cancer was significantly higher among provinces with higher socioeconomic status. This should be considered for planning support.

Background and Aim: Computerized physician order entry system is the process of entering orders electronically. It is a replacement for manual system and is considered as a part of a clinical information system. The appropriate design of this system leads to the enhancement of its capabilities, ensures orders accurately and comprehensively, and transfers information to different parts rapidly. Therefore, transfer time and the error related to the wrong path or misinterpretations will be omitted; in the end, efficiency will increase. This study aims to present different perspectives on design principles of computerized physician order entry system for stakeholders.
Materials and Methods: In this review article, Google, Google Scholar, Pub Med, Web of Science and Scopus databases were searched with some keywords related to design principles of computerized physician order entry system.
Results: Based on the performed studies, factors such as inappropriate design of links, display page, set of orders content, drug database, structure of order environment, rules, formats, mechanism of getting reports of errors, and finally clinical decision support system have led to the decrease of doctors’ performance, increase of new errors, and reduction of patients’ safety.
Conclusion: Inappropriate design leads to the increase of new errors after the implementation of system; therefore, proper and principled design of this system can lead to the improvement of practitioners’ function, decrease of prescription errors and drug side effects, reduction of costs, efficiency increase, workflow 

Background and Aim: Brain tumors have remained as a significant cause of morbidity and mortality and are often refractory to treatment. The grading of brain tumor has an important implication in clinical management. Currently, magnetic resonance spectroscopy (MRS) is an important dimension in evaluating metabolites and grading brain tumors. The aim of this study is to evaluate metabolites in brain tumors and grading brain gliomas using HMRS (proton magnetic resonance spectroscopy).

Materials and Methods: Studies were performed using single voxel MRS, at a field strength of 3Tesla and pulse sequence using point resolved single volume spectroscopy (PRESS) with repetition time (TR) 1000-6000ms and echo time (TE) 36-136ms, and distinguished metabolites including Choline (Cho), Creatin (Cr), and N-acetyl aspartate (NAA) were detected.

Results: Thirty-seven cases (17 males and 20 females) had data which passed quality control. The patients’ age ranged from 7 to 81 years with a mean of 41.46±2.78. MRS data were processed using SYNGO software in terms of mean spectra and metabolite concentrations which were compared using minitab and SPSS. Significant differences were found in concentrations of key metabolites, and Cho/NAA and Cho/Cr ratios using t-test with a significance level (α≤0.05). In the assessment of age rate and tumor grading, the malignancies of brain tumors did not correlate with patients’ age and sex.

Conclusion: MRS can detect subtle differences between low-grade brain tumors in children and should form part of the clinical assessment of these tumors.

Background and Aim: Cosmetic surgery rhinoplasty, has dramatically been increased during the last two decades. This study aims to explore its effects on the quality of life of individuals gone under the surgery.

Materials and Methods: This was a descriptive and analytical study which was performed as a cross-sectional study. From all plastic surgery clinics in Teheran, 25 clinics were selected randomly as the site of study. In the next step 110 patients undergone rhinoplasty were selected randomly from these clinics. Collected data was analyzed by Spss17.

Results: Findings revealed that, the mean score of quality of life before and after surgery was statistically significant. While mean score of general benefits increased the score of social support and physical health was decreased after the surgery. The most motivating factors for surgery were external factors. In addition there was a positive correlation between quality of life and the time of interview. Also the mean cost of surgery was increased.

Conclusion: Overall quality of life among study population was decreased. It could be because of unnecessary surgeries, medical errors, and etc. The reduction for social support may be resulted from unacceptable consequences of rhinoplasty particularly in terms of appearance. Physical health of respondents was negatively affected by rhinoplastiy surgery. Malfunctions of upper respiratory system after rhinoplastiy surgery is known as the main reason for it. Correlations between the times of surgery and interview suggest a long term assessment of impacts of such surgeries.