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Nabeel Taher Jameel Alghanim, Hamed Jadooa Abbas, Hamid Choobineh, Ziba Majidi, Nasrin Dashti,
Volume 19, Issue 2 (7-2025)
Volume 19, Issue 2 (7-2025)
Abstract
Background and Aim: This study investigated the biochemical profiles of individuals with different stages of kidney disease, including those with kidney disease without hemodialysis, chronic kidney disease without hemodialysis, and individuals with renal failure undergoing hemodialysis treatment, to clarify the role of mineral markers, inflammation, and kidney function in the complications of this disease.
Materials and Methods: This case-control study was conducted with 180 participants aged 18 to 81 years in Iraq. Participants were divided into four groups: the case group (including individuals with kidney disease not on dialysis, chronic kidney disease not on dialysis, and kidney failure treated with dialysis) and the control group, which included healthy individuals. Blood levels of urea, creatinine, calcium, phosphorus, vitamin D3, parathyroid hormone (PTH), high-sensitivity C-reactive protein (hs-CRP), and cystatin C were measured.
Results: The results showed that the levels of blood urea, calcium, vitamin D3, cystatin C and hs-CRP were significantly different between the different groups. The mean creatinine in the non-dialysis kidney disease group (3.98±1.77 mg/dL) and non-dialysis chronic kidney disease (4.59±1.63 mg/dL) was different from the dialysis kidney failure group (11.03±3.35 mg/dL) (P=0.001), but there was no significant difference between the two groups of kidney disease without dialysis and chronic kidney disease without dialysis. The phosphorus concentration was significant in all groups (P=0.001) and the highest value was observed in the dialysis kidney failure group. The PTH level was not significantly different between the two groups of non-dialysis, but there was a significant difference compared to the dialysis kidney failure group (P=0.001). Cystatin C was not significantly different in the two non-dialysis groups, but was significantly higher (P=0.001) compared with the renal failure group on dialysis (7.06±1.61 mg/dL).
Conclusion: This study demonstrated that regular monitoring of biochemical biomarkers is essential for the timely diagnosis and effective management of kidney disease. It also highlights the importance of paying attention to metabolic and inflammatory abnormalities in patients with kidney disease (especially in patients on dialysis), including extensive changes in biochemical, hormonal, and inflammatory factors levels that often occur due to severe impairment of kidney function and the dialysis process.
Materials and Methods: This case-control study was conducted with 180 participants aged 18 to 81 years in Iraq. Participants were divided into four groups: the case group (including individuals with kidney disease not on dialysis, chronic kidney disease not on dialysis, and kidney failure treated with dialysis) and the control group, which included healthy individuals. Blood levels of urea, creatinine, calcium, phosphorus, vitamin D3, parathyroid hormone (PTH), high-sensitivity C-reactive protein (hs-CRP), and cystatin C were measured.
Results: The results showed that the levels of blood urea, calcium, vitamin D3, cystatin C and hs-CRP were significantly different between the different groups. The mean creatinine in the non-dialysis kidney disease group (3.98±1.77 mg/dL) and non-dialysis chronic kidney disease (4.59±1.63 mg/dL) was different from the dialysis kidney failure group (11.03±3.35 mg/dL) (P=0.001), but there was no significant difference between the two groups of kidney disease without dialysis and chronic kidney disease without dialysis. The phosphorus concentration was significant in all groups (P=0.001) and the highest value was observed in the dialysis kidney failure group. The PTH level was not significantly different between the two groups of non-dialysis, but there was a significant difference compared to the dialysis kidney failure group (P=0.001). Cystatin C was not significantly different in the two non-dialysis groups, but was significantly higher (P=0.001) compared with the renal failure group on dialysis (7.06±1.61 mg/dL).
Conclusion: This study demonstrated that regular monitoring of biochemical biomarkers is essential for the timely diagnosis and effective management of kidney disease. It also highlights the importance of paying attention to metabolic and inflammatory abnormalities in patients with kidney disease (especially in patients on dialysis), including extensive changes in biochemical, hormonal, and inflammatory factors levels that often occur due to severe impairment of kidney function and the dialysis process.
Mahnaz Moghadari Koosha, Iraj Salehi, Elaheh Mousavi, Mohammad Reza Safari, Nasim Alipour, Hossein Vakili Mofrad,
Volume 19, Issue 4 (11-2025)
Volume 19, Issue 4 (11-2025)
Abstract
Background and Aim: The hidden curriculum is considered the most powerful means of transmitting professional values. Given the critical importance of managing the hidden curriculum to institutionalize professional ethics and professionalism within health higher education institutions, the present study was conducted to explore the perceptions of operating room and anesthesia students and instructors regarding the impact of the hidden curriculum on the promotion of professional ethics.
Materials and Methods: This study was conducted using a qualitative approach based on conventional content analysis. The study population included final-year students and instructors from the operating room and anesthesia disciplines at Hamadan University of Medical Sciences. Participants were selected through purposive and theoretical sampling methods. Data were collected via in-depth, semi-structured interviews. Data saturation was achieved after conducting 24 interviews. The data analysis followed the qualitative content analysis approach proposed by Graneheim and Lundman (2004), and was carried out in seven steps: 1. familiarization with the data, 2. identification of meaning units, 3. initial coding, 4. formation of subcategories, 5. development of categories, 6. extraction of themes, and 7. final review.
Results: The content analysis of the interviews resulted in the identification of 456 initial codes. Following refinement and consolidation, these codes were organized into four overarching categories and ten subcategories. The main categories comprised: ‘Components of the hidden curriculum in professional ethics education’, ‘Mechanisms through which the hidden curriculum exerts influence’, ‘Consequences of the hidden curriculum’, and ‘Strategies for enhancing professional ethics’. The findings indicated that the hidden curriculum, manifested through the behavioral patterns of faculty members and instructors, organizational culture, and interpersonal interactions, plays a pivotal role in shaping students’ ethical attitudes and behaviors. Furthermore, the hidden curriculum, through processes of unconscious learning, reinforcement or erosion of formal values, and the manner in which rules are implemented, can yield both positive outcomes—such as the development of ethical decision-making skills—and negative outcomes, including diminished ethical sensitivity.
Conclusion: This study revealed that the hidden curriculum in operating room and anesthesia education functions as a dual-force phenomenon. On one hand, it fosters the development of professional ethics through constructive role modeling and authentic clinical experiences. On the other hand, it can contribute to ethical erosion by conveying contradictory messages and unhealthy norms. Achieving sustainable ethical learning requires active management of the hidden curriculum through three key strategies: aligning the formal and hidden curricula, empowering instructors as agents of ethical value transmission, and shifting the organizational culture paradigm toward learning from error.
Materials and Methods: This study was conducted using a qualitative approach based on conventional content analysis. The study population included final-year students and instructors from the operating room and anesthesia disciplines at Hamadan University of Medical Sciences. Participants were selected through purposive and theoretical sampling methods. Data were collected via in-depth, semi-structured interviews. Data saturation was achieved after conducting 24 interviews. The data analysis followed the qualitative content analysis approach proposed by Graneheim and Lundman (2004), and was carried out in seven steps: 1. familiarization with the data, 2. identification of meaning units, 3. initial coding, 4. formation of subcategories, 5. development of categories, 6. extraction of themes, and 7. final review.
Results: The content analysis of the interviews resulted in the identification of 456 initial codes. Following refinement and consolidation, these codes were organized into four overarching categories and ten subcategories. The main categories comprised: ‘Components of the hidden curriculum in professional ethics education’, ‘Mechanisms through which the hidden curriculum exerts influence’, ‘Consequences of the hidden curriculum’, and ‘Strategies for enhancing professional ethics’. The findings indicated that the hidden curriculum, manifested through the behavioral patterns of faculty members and instructors, organizational culture, and interpersonal interactions, plays a pivotal role in shaping students’ ethical attitudes and behaviors. Furthermore, the hidden curriculum, through processes of unconscious learning, reinforcement or erosion of formal values, and the manner in which rules are implemented, can yield both positive outcomes—such as the development of ethical decision-making skills—and negative outcomes, including diminished ethical sensitivity.
Conclusion: This study revealed that the hidden curriculum in operating room and anesthesia education functions as a dual-force phenomenon. On one hand, it fosters the development of professional ethics through constructive role modeling and authentic clinical experiences. On the other hand, it can contribute to ethical erosion by conveying contradictory messages and unhealthy norms. Achieving sustainable ethical learning requires active management of the hidden curriculum through three key strategies: aligning the formal and hidden curricula, empowering instructors as agents of ethical value transmission, and shifting the organizational culture paradigm toward learning from error.
Maryam Amirshekari, Seyyedeh Maryam Seyyedi, Faeze Fakhri, Mohsen Yaghmaei,
Volume 19, Issue 4 (11-2025)
Volume 19, Issue 4 (11-2025)
Abstract
Background and Aim: Shift handover is one of the key processes in clinical settings, during which patient care is transferred from one healthcare team to the next. Weaknesses in this process—particularly in high-pressure environments such as operating rooms—may lead to reduced quality of information transfer and staff dissatisfaction. This study aimed to determine the effect of the standard SBAR communication model on the quality of the shift handover process and the satisfaction of operating room personnel.
Materials and Methods: This quasi-experimental study with a pretest–posttest design was conducted in 2023 at Imam Khomeini Hospital in Jiroft. Sampling was performed using a census method, and a total of 66 operating room staff members participated in the study. The intervention consisted of a two-hour training session (including theoretical and practical components) on the SBAR model. Data were collected using the standard CEX checklist to assess handover quality and a modified version of the Petrovic questionnaire to evaluate staff satisfaction. The validity and reliability of the instruments were confirmed. Data analysis was performed using SPSS and paired t-tests. A significance level of less than 0.05 was considered.
Results: The study participants included 66 operating room staff members, comprising 39 women and 27 men, with a mean age of 30.2±2.45 years. The mean score of shift handover quality significantly increased after SBAR training, rising from 73.80±13.99 before the training to 102.18±10.69 after the training, which corresponds to an improvement of approximately 20.9% relative to the total score range of the instrument (P<0.001). Furthermore, staff satisfaction with the shift handover process also improved, increasing from 37.85±4.77 to 42.41±4.76, representing an improvement of approximately 11.4% relative to the total instrument score range (P<0.001). These changes indicate the positive impact of SBAR training on both the shift handover process and the staff experience.
Conclusion: The findings indicated that training and implementation of the SBAR model were associated with significant improvements in handover quality and staff satisfaction. These results suggest that using structured communication tools may help improve certain aspects of the handover process. However, due to the lack of a control group and the short follow-up period, it is not possible to draw firm conclusions about the long-term effects of the intervention. Therefore, SBAR-based training may be considered as a recommended option; however, further studies with stronger designs and in diverse clinical settings are needed to more accurately evaluate its outcomes.
Materials and Methods: This quasi-experimental study with a pretest–posttest design was conducted in 2023 at Imam Khomeini Hospital in Jiroft. Sampling was performed using a census method, and a total of 66 operating room staff members participated in the study. The intervention consisted of a two-hour training session (including theoretical and practical components) on the SBAR model. Data were collected using the standard CEX checklist to assess handover quality and a modified version of the Petrovic questionnaire to evaluate staff satisfaction. The validity and reliability of the instruments were confirmed. Data analysis was performed using SPSS and paired t-tests. A significance level of less than 0.05 was considered.
Results: The study participants included 66 operating room staff members, comprising 39 women and 27 men, with a mean age of 30.2±2.45 years. The mean score of shift handover quality significantly increased after SBAR training, rising from 73.80±13.99 before the training to 102.18±10.69 after the training, which corresponds to an improvement of approximately 20.9% relative to the total score range of the instrument (P<0.001). Furthermore, staff satisfaction with the shift handover process also improved, increasing from 37.85±4.77 to 42.41±4.76, representing an improvement of approximately 11.4% relative to the total instrument score range (P<0.001). These changes indicate the positive impact of SBAR training on both the shift handover process and the staff experience.
Conclusion: The findings indicated that training and implementation of the SBAR model were associated with significant improvements in handover quality and staff satisfaction. These results suggest that using structured communication tools may help improve certain aspects of the handover process. However, due to the lack of a control group and the short follow-up period, it is not possible to draw firm conclusions about the long-term effects of the intervention. Therefore, SBAR-based training may be considered as a recommended option; however, further studies with stronger designs and in diverse clinical settings are needed to more accurately evaluate its outcomes.
Parsa Farmahin Farahany, Maryam Amirshekari, Mohsen Yaghmaie,
Volume 19, Issue 5 (12-2025)
Volume 19, Issue 5 (12-2025)
Abstract
Background and Aim: Designing a standard surgical preference card and implementing it in the operating room environment can partially solve the problems related to the variety of surgical procedures and the preparation of tools and equipment required for each surgical procedure. The present study aimed to determine the effect of designing and implementing surgical preference card software on the clinical skills of operating room students at Jiroft University of Medical Sciences.
Materials and Methods: This study was a semi-experimental intervention study in which 70 operating room students from the 4th, 6th, and 8th semesters of the undergraduate operating room program were selected through a census method and were trained using educational software designed by the researcher. Before and after the training, their clinical skills were assessed using a researcher-made questionnaire and checklist. To confirm the validity of the questionnaires and the researcher-made checklist, the opinion of an expert panel (12 expert faculty members) and the consensus of peer reviewers were used. Then, the data were analyzed in SPSS software using descriptive statistics, paired t-test, nonparametric Wilcoxon test, and analysis of covariance test.
Results: According to the research findings, the use of the designed software was effective on the clinical skills of operating room students. Based on the results of the Willcocson tests, a significant difference was observed in the mean scores of the students’ clinical skills test before and after implementing the designed software. The results of the study showed that the clinical skill scores of the students increased after using the software. The maximum scores of the samples are calculated from 100 points. The average clinical skill score of the subjects in the study increased from 40.98 before the educational intervention to 92.36 after the intervention, and the students had a higher level of skill in preparing the items and tools needed by the surgical team in all three stages before, during, and after surgery. Also, in the study, no relationship was found between any of the demographic variables studied, such as age, gender, and academic semester, and the clinical skills of the study members (P<0/05).
Conclusion: Based on the results of the present study, the design and use of surgical preference card software in training procedure of operating room students has had an impact on improve their clinical skills. Therefore, the design and use of educational software in the field of anticipating the needs and preparing the requirements of each surgical procedure is recommended to all professors and officials in the operating room field.
Materials and Methods: This study was a semi-experimental intervention study in which 70 operating room students from the 4th, 6th, and 8th semesters of the undergraduate operating room program were selected through a census method and were trained using educational software designed by the researcher. Before and after the training, their clinical skills were assessed using a researcher-made questionnaire and checklist. To confirm the validity of the questionnaires and the researcher-made checklist, the opinion of an expert panel (12 expert faculty members) and the consensus of peer reviewers were used. Then, the data were analyzed in SPSS software using descriptive statistics, paired t-test, nonparametric Wilcoxon test, and analysis of covariance test.
Results: According to the research findings, the use of the designed software was effective on the clinical skills of operating room students. Based on the results of the Willcocson tests, a significant difference was observed in the mean scores of the students’ clinical skills test before and after implementing the designed software. The results of the study showed that the clinical skill scores of the students increased after using the software. The maximum scores of the samples are calculated from 100 points. The average clinical skill score of the subjects in the study increased from 40.98 before the educational intervention to 92.36 after the intervention, and the students had a higher level of skill in preparing the items and tools needed by the surgical team in all three stages before, during, and after surgery. Also, in the study, no relationship was found between any of the demographic variables studied, such as age, gender, and academic semester, and the clinical skills of the study members (P<0/05).
Conclusion: Based on the results of the present study, the design and use of surgical preference card software in training procedure of operating room students has had an impact on improve their clinical skills. Therefore, the design and use of educational software in the field of anticipating the needs and preparing the requirements of each surgical procedure is recommended to all professors and officials in the operating room field.
Pezhman Sadeghi, Nader Jahanmehr, Reza Rabiei,
Volume 19, Issue 5 (12-2025)
Volume 19, Issue 5 (12-2025)
Abstract
Background and Aim: Information systems serve different purposes in organizational and management hierarchies. The hospital intelligent management system is an analytical and decision-support management information system that provides information and important performance indicators for managers in hospitals. Considering the role of this system in increasing the efficiency and effectiveness and the lack of academic hospitals having the desired level of productivity, this research was conducted to investigate the effective factors in improving the acceptance of the intelligent hospital management system in the hospitals of Shahid Beheshti University of Medical Sciences (SBMU).
Materials and Methods: This descriptive and correlational research was conducted in 19 hospitals (12 teaching hospitals and 7 non-teaching hospitals) of Shahid Beheshti University of Medical Sciences in 2022. In this study, 126 senior and middle managers and experts of the productivity committee participated. The data of this study were collected Using the Unified Theory of Acceptance and Use of Technology(UTAUT) Questionnaire and for statistical analysis, SPSS software (statistical table and linear and multiple regression tests, sequencing, and chi-square) was used. The validity of the questionnaire was determined using the opinion of research experts and its reliability was also determined using Cronbach’s alpha coefficient (0.824).
Results: Most of the participants in the study were from teaching hospitals (63.2%) and were middle managers (50.8%). Behavioral intentions were identified as the most important factors in the use of system by senior and middle managers and experts of productivity committee (P<0.001). The effort expectancy had the greatest impact on the intention to use the system as compared to the expected components of Performance expectancy and social influence. Also, training and having educational programs on how to use the HIM and its applications can increase the intention and use of the HIM by employees (P<0.001).
Conclusion: Based on the results, the effect of the moderating variables in this study was insignificant. If senior managers and influential people encourage working with the system, and employees also make more effort to learn the system, and working with the system meets their expectations, employees will be willing to use the system. In other words, employees use the system when they believe that this system is user-friendly, valuable, and useful for them.
Materials and Methods: This descriptive and correlational research was conducted in 19 hospitals (12 teaching hospitals and 7 non-teaching hospitals) of Shahid Beheshti University of Medical Sciences in 2022. In this study, 126 senior and middle managers and experts of the productivity committee participated. The data of this study were collected Using the Unified Theory of Acceptance and Use of Technology(UTAUT) Questionnaire and for statistical analysis, SPSS software (statistical table and linear and multiple regression tests, sequencing, and chi-square) was used. The validity of the questionnaire was determined using the opinion of research experts and its reliability was also determined using Cronbach’s alpha coefficient (0.824).
Results: Most of the participants in the study were from teaching hospitals (63.2%) and were middle managers (50.8%). Behavioral intentions were identified as the most important factors in the use of system by senior and middle managers and experts of productivity committee (P<0.001). The effort expectancy had the greatest impact on the intention to use the system as compared to the expected components of Performance expectancy and social influence. Also, training and having educational programs on how to use the HIM and its applications can increase the intention and use of the HIM by employees (P<0.001).
Conclusion: Based on the results, the effect of the moderating variables in this study was insignificant. If senior managers and influential people encourage working with the system, and employees also make more effort to learn the system, and working with the system meets their expectations, employees will be willing to use the system. In other words, employees use the system when they believe that this system is user-friendly, valuable, and useful for them.
Hojjat Rahmani, Payam Bahadori, Hossein Dargahi, Mohammad Arab, Nasrin Abolhasanbeigi Gallehzan, Mohsen Mardali,
Volume 19, Issue 6 (3-2026)
Volume 19, Issue 6 (3-2026)
Abstract
Background and Aim: The occurrence of conflict of interest in the Iranian health system has a negative impact on the provision of efficient and effective health care and services to patients, the training and education of students in medical sciences. Despite the efforts made in the country’s health system to manage conflict of interest, this phenomenon is currently observed through various factors, including the inefficiency of the financial structure, lack of transparency, and the lack of an integrated health information system in Iran.
Materials and Methods: The present scoping review study that aimed to identify and determine conflict of interest management strategies in the Iranian health system in comparison with selected countries and to select appropriate strategies in 2024-2025 using the Arksey and O’Malley guidelines. All relevant articles and resources from 2007 to 2024 were extracted from national and international databases by observing the entry and exit criteria and by selecting Persian and English keywords. After screening steps using Prisma flowchart, 23 studies in English and Persian language from international and national databases, were analyzed.
Results: Findings from 17 international studies—most of which were conducted in the United States—along with 6 domestic articles, showed main strategies of Iranian conflict of interest which included participation, transparency, legal oversight, processes reform, restructuring and reorganization. Although, using collective campaigns for correction of process behaviors and decisions, definition of ethical ethic codes, and standardization may help implementation of these strategies. Also, the most common cause of conflict of interest in the health system is individual rather than organizational, which requires regulation, the use of legislative levers, and the transparency of financial relations in the health system.
Conclusion: Accurate identification of potential examples of conflict of interests among the agents of health care system by implementing information clarification, and using modern procedures may decrease the challenges in formulating and implementing strategies of conflict of interests among Iranian health care system. Although benchmarking from successful countries will be helpful in these countries. The implementation of these recommendations may face challenges within Iranian society, including resistance from certain professional groups, a lack of financial and technical resources, and the complexity and specific conditions of the health system. Therefore, a step-by-step approach to implementing policy recommendations for managing conflicts of interest in the health system should be considered.
Materials and Methods: The present scoping review study that aimed to identify and determine conflict of interest management strategies in the Iranian health system in comparison with selected countries and to select appropriate strategies in 2024-2025 using the Arksey and O’Malley guidelines. All relevant articles and resources from 2007 to 2024 were extracted from national and international databases by observing the entry and exit criteria and by selecting Persian and English keywords. After screening steps using Prisma flowchart, 23 studies in English and Persian language from international and national databases, were analyzed.
Results: Findings from 17 international studies—most of which were conducted in the United States—along with 6 domestic articles, showed main strategies of Iranian conflict of interest which included participation, transparency, legal oversight, processes reform, restructuring and reorganization. Although, using collective campaigns for correction of process behaviors and decisions, definition of ethical ethic codes, and standardization may help implementation of these strategies. Also, the most common cause of conflict of interest in the health system is individual rather than organizational, which requires regulation, the use of legislative levers, and the transparency of financial relations in the health system.
Conclusion: Accurate identification of potential examples of conflict of interests among the agents of health care system by implementing information clarification, and using modern procedures may decrease the challenges in formulating and implementing strategies of conflict of interests among Iranian health care system. Although benchmarking from successful countries will be helpful in these countries. The implementation of these recommendations may face challenges within Iranian society, including resistance from certain professional groups, a lack of financial and technical resources, and the complexity and specific conditions of the health system. Therefore, a step-by-step approach to implementing policy recommendations for managing conflicts of interest in the health system should be considered.
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