Journal of

Background and Aim: Plasma leptin, adiponectin (as theadipokines) and related obesity – HOMA index in the obese men are introduced as a predictive metabolic indicators for asthmatic individuals. However, under asthma conditions, role of cariometabolic variables interaction for altering clinical pulmonary indexes aren't clear. In the present study, the relationship between plasmatic adiponectin to leptin ratio (adipo/lep) with respiratory capacities & HOMA in the chronic asthmatic males are investigated.

Materials and Methods: Thirty nine obese males with mild to moderate asthma with an average age of 38±2.6 ys and BMI 31.4 ± 1.06 kg/m² voluntarly participated in this study. Baseline plasmatic leptin, adiponetin, insulin and glucose levels were determined after 10-12 hours fasting overnight. FEV₁/FVC, PEF% and FEF _25%-75% were determined by standard method. A pearson correlation test was used to analyse data.

Results: There were no significant correlation between WHR , BMI with metabolic risk factors (P>0.05). Relationship markedly observed among HOMA with adipo/ lep ratio and leptin levels respectively (P<0.05), Also a marked negative correlation between adipokine ratio and leptin level was obtained (P<0.05). From view of respiratory efficiency, FVC% and FEV₁/ FVC were maingly corrected with baseline leptin&adiponectin levels (P<0.05).

Conclusion: Inconclusion,it seems that adipo/lep ratio biomarker plays as a clinical diagnosis index for HOMA index than baseline leptin or adiponectin levels. However, these findings showed that FEV₁/FVC & adipo/lept ratios are accounted as valuable indicators for evaluating the obesity syndrome and pulmonary efficiency in the asthma disease.

Background and Aim: Knowledge management is effective in promoting organizational structure, level of services, and universities competency power. The present study was aimed to assess knowledge management effective factors including information technology, organization culture, human resources, and librarians' skills among university librarians in Urmia.

Materials and Methods: This analytical survey was conducted on 102 university librarians in Urmia. The data were collected using a questionnaire where its validity and reliability was confirmed by specialists’ overviews and Cronbach's Alpha (0.94). In order to analyze the data, first the middle of the effective factors of knowledge management was estimated. Next, synchronic effect of the variables was estimated via multinomial logistic regression. Also Chi-square was used to assess the relationship between majors and sex factor of the librarians considering their perspective on knowledge management.

Results: Organizational culture, information technology and human resources are the most effective factors to knowledge management circulation. Also the median degree of the knowledge management process includes knowledge creation and reservation and knowledge sharing and employing which was 2/7 and 2/2 respectively.

Conclusion: Knowledge management is an important factor in human resources and competency environment of organizations. Libraries can with launching of knowledge management circulation, earn some promotions, for example: saving research and development costs, capacity increasing, employers’ job satisfaction, maintenance of competency environment and etc.

Background and Aim: Analysis of functions enables organizations to identify their special capabilities and weak points accurately and thus they can enhance capabilities and reduce impacts of threats and obstacles through such analysis. The main goal of this work is investigation of status of Weisbord Model's variables (6 variables) as functional dimensions of management in hospitals of Tehran University of Medical Sciences.

Materials and Methods: This was a descriptive - analytical study. The study population consisted of 384 staffs from hospitals of Tehran University of Medical Sciences. Standardized questionnaire for organization recognition was used for data collection. Descriptive statistics (frequency distribution, frequency percentage) and inferential statistics (Pearson correlation coefficient and significance level) were used for statistical analysis and data analysis was run using SPSS software.

Results: The results showed that there is a significant difference (p=0.0001) in hospitals in terms of the internal situation. Internal situation of all hospitals in the study was evaluated as favorable condition by obtaining 94.5 score out of 125. Among the hospitals, Hashemi-Nejad Hospital with highest score (113) showed the better condition and Rasoul Hospital had the lowest score (87) and lower condition as compared to other hospitals.

Conclusion: Necessity of systematic perspective in designing and development of fair compensation mechanism with presence of representatives of employees is an action which can considerably influence improvement of current situation in the hospitals and facilitates achieving predetermined goals of the organization

 Background and Aim: Strategic thinking plays a very important role in guarding organizational survival and increasing development in today's dynamic and changing environment. One of the elements of strategic thinking is systemic thinking, which forms the conceptual framework to solve issues in an organization. This study aims to determine the ability of Tehran University of Medical Sciences (TUMS) senior managers to stick to systemic thinking based on Friedrik Goldman’s model.

Materials and Methods: This is a cross-sectional, descriptive- analytic study conducted on a sample of 100 TUMS senior managers in 2010. The data collection instrument was a standard questionnaire on systemic thinking, the response rate of which turned out to be 97%. The reliability and validity of the questionnaire were confirmed prior to its distribution. SPSS software was used for data analysis. To this end, single sample t-test and Friedman statistical methods were also applied.

Results: The findings revealed that the ability of systemic thinking was optimal among most TUMS senior managers.

Conclusion : Enhancing and strengthening systemic thinking among TUMS senior managers are suggested, especially regarding omniscient and multi-end approach.

 Background and Aim: To optimize emergency services depend s on appropriate management structures and efficient and effective information system design . This study aim ed to investigate emergency department staff's information needs of emergency information system and to design a conceptual model of these needs.

 Materials and Methods: This descriptive study was performed among nurses and emergency medicine professionals working in emergency units of 9 hospitals affiliated to Tehran and Shahid Beheshti U niversities of M edical S ciences . Data w ere collected by interviewing 25 staff members in the emergency department , model d esign by RUP method and UML language and questionnaire d istribution among 315 staff members in the emergency department. Data collected were analyzed by descriptive statistics and SPSS.

 Results: Most nurses and emergency medicine physicians believed that multiple data elements such as time of patient’s first visit and procedure , t he latest status of patient, medical procedure taken , and paraclinical procedure taken must exist in the emergency information system . Also 68.3% (108) of them agreed with the relationship between data elements required in the clinical practice process .

 Conclusion : It is concluded that the presence of identity , clinical , and paraclinical data in emergency information systems can produce an electronic medical record. According to these data, elements can improve the coordination between the hospital emergency and pre- hospital rescue teams , controlling of victim status , access to patient reports and quality of service to patients.

Background and Aim: Peripheral and intermediate laboratories have an important role in diagnosis, treatment and prevention of tuberculosis. Today, without these laboratories, maintaining health and preventing the spread of tuberculosis is not possible. The aim of this study was Evaluation of manpower, equipment and quality control standards in peripheral and intermediate laboratories assessment checklist within seven selected provinces in year 2011.

Materials and Methods: This study was a cross-sectional survey. In this study eighty tow peripheral and intermediate laboratories from seven selected provinces were studied in year 2011. A standardized checklist was used to assess peripheral and intermediate laboratories.

Results: The result showed that Esfahan with 20 labs and 8870000 population had the highest number of labs and coverage people between other provinces. Khorasan Razavi with an average of 263 per month has the highest number of admission number and Golestan, with an average of 139 positive cases per month, had the highest number of positive cases between other provinces. In 82 labs 117 laboratory technicians were engaged providing services to patients.

Conclusion : The results of this study showed that conditions of most peripheral and intermediate laboratories are optimum and nearly standard. Control and evaluation of peripheral and intermediate laboratories, expert personnel, facilities and equipment are necessary to improve the TB control program in the country.

Background and Aim: Transforming government hospitals into autonomous units improved hospitals. This study was performed to evaluate the responsiveness of board of trustees hospital according to the world bank’s organizational reform model (Preker Model) in isfahan city.

Materials and Methods: The study was a qualitative research method. In this research, depth and semi-structured interviews were carried out and purposive sampling was used.

The study population were top managers of Amin and Alzahra hospitals . Sampling was started with the first participant until saturated level of information, participants completed the 8 cases.

Results: According to interviews, the current role and contribution of non-university institutions (e.g. municipalities representatives) in hospital board of trustees is neither bold nor transparent. These hospitals can address minimum changes in their mechanisms of accountability after developing board of trustees.

Conclusion : It is rational for hospitals as they undergo organizational reform and developing board of trustees, to have more rights for decision making. Further more, their accountability mechanism should change accordingly.

Background and Aim: Having a preparedness program for earthquake in hospital, with regard to its function for victims of accidents, is very important. The main objective of this study was evaluation of effective factors on the rate of preparedness of Tehran University of Medical Sciences’ teaching hospitals, to deal with earthquake danger of earthquake .

Materials and Methods: This cross-sectional analytical survey was performed in the follow ing hospitals: Sina, Farabi, Roozbeh, and Razi. Data was collected by checklists and questionnaire. Data analysis was performed using statistical software (SPSS19) and Pearson correlation , ANOVA, t-test statistical tests.

Results: The most and the least preparedness against earthquake was in disaster management and construction mitigation plan fields respectively. Relationship between the field of hospital curriculums with construction mitigation plan (p= 0/045 and r=0/644) and hospital environmental health action plan (p=0/048 and r=0/636), was significant.

Conclusion : Average of Hospitals preparation against earthquake was evaluated in an intermediate level (51.81percent). Due to the significant relationship between education and other fields that are listed above it is suggested that in addition to short-term training programs, non-structural retrofitting of hospitals should be considered as a priority.

 Background and Aim: Information technology acceptance model predicts acceptance based on end-users' perceived usefulness and ease of use of technology for a specific purpose. The aim of this study is to understand nursing staff’s adoption of clinical information systems based on information technology acceptance model.

 Materials and Methods: This descriptive- analytic study was conducted on 316 nurses in hospitals affiliated with Semnan University of Medical Sciences (SUMS) and those affiliated with the Social Security Organization (SSO). The data collection tool was a valid and reliable questionnaire . The d ata were analyzed by descriptive statistics, Mann-Whitney and chi-square tests .

 Results: Some 73 % of nurses agreed that the nursing information system provides them with correct information. Besides, 55.7% of nurses had accepted the information system. The results showed that male nurses had admitted clinical information systems more than female ones (P<0.05). Moreover, nurses who were aware of their duties towards the computer program or those who were aware of the goals of computer applications had adopted information technology more (P <0.05).

 Conclusion : Most of the nurses had accepted the clinical information system in their daily work. However, issues such as inadequate number of computers , content design, system c apability problems, and nurses' computer skills and knowledge should be seriously examined . Moreover, several interventions should be planned and developed in technical and individual areas such as enhancement of nurses' IT knowledge , teamwork culture , organizational position , team cooperation, and updating and upgrading the network.

Background and Aim: Employees suggestion plan (ESP) is designed to encourage and improve employees’ participation in developmental planning. The establishment of this system needs cultural, individual and structural preparedness. This study is aimed to determine organizational preparedness in Tehran University of Medical Sciences (TUMS).

Materials and Methods: This research was a cross-sectional, descriptive and analytical study conducted in TUMS headquarters in Tehran, Iran. The heterogeneous sample of this study consisted of 155 employees. They were asked to fill out a researcher-made questionnaire to assess their attitude towards organizational preparedness for ESP establishment. The validity and reliability of the questionnaire were confirmed. The data were analyzed by SPSS, and descriptive results were presented. The data were also analyzed by Friedman and ANOVA statistical methods.

Results: Most of the employees had a positive attitude towards the existence of individual and cultural preparedness for ESP establishment in TUMS. However, they believed the desired structural preparedness for this process did not exist.

Conclusion : The desired organizational preparedness for ESP establishment exists in TUMS, although structural preparedness is not desirable. Therefore, it is suggested that necessary modifications should be made in TUMS organizational structure for effective ESP implementation.

Background and Aim: Despite all inherent advantages of information technology in health sector, its implementation still faces many problems. One of the most important barriers is people’s resistance. This study was carried out to survey the factors affecting the acceptance of information technology by Health Information Management (HIM) staff of Tehran University of Medical Sciences (TUMS) hospitals based on Technology Acceptance Model (TAM) in 2011.

Materials and Methods: It is a descriptive-analytical survey. The population of the study consisted of the HIM staff (363 members) of TUMS hospitals. As the sample, 123 employees were selected. The data gathering tool was a questionnaire the validity and reliability of which were confirmed. The data were collected and analyzed by SPSS software, descriptive statistical methods and Spearman Test.

Results: The results showed that there was a positive direct relationship between perceived ease of use (PEOU) on the one hand and the staff’s attitude and their application of IT on the other hand (R=0.14, P= 0.05 R=0.36, P=0.05). Also, perceived usefulness (PU) had a significant direct effect on the staff’s attitude and their application of IT (R=0.22, P= 0.05 R=0.37, P=0.05).

Conclusion : Perceived ease of use (PEOU) and perceived usefulness (PU) are the factors affecting the acceptance of information technology by the HIM staff of TUMS hospitals. Therefore, it is suggested that the above two principles be considered when designing and implementing the IT systems.

Background and Aim: Development of information and communication technology has led to enormous changes in different areas. Electronic medical records system is valuable to access patient data in hospitals. This study aimed to investigate and compare the educational hospitals of Uemia University of Medical Sciences in case of technical, organizational and legal to establish the system.

Materials and Methods: The study was a descriptive cross-sectional study. The study population consisted of 98 senior and central managers. In this study population census was used and the entire population were considered as the sample. A questionnaire was used for data collection, which included two sections in order to determine the level of research community awareness and to analyze the standards related requirements for the implementation of the system. Validity and reliability were assessed and the data was analyzed by SPSS.

Results: Sample awareness in 5 hospitals of this study was moderate. In terms of requirements, there was a significant difference between the means of Electronic Medical Records in terms of three variables between hospitals "D" and the rest of the hospitals. And no significant difference was seen among other hospitals.

Conclusion : Three hospitals, "a", "c" and "b", among five studied hospitals are in preparation for the deployment of electronic medical records. Other two hospitals were not prepared. However, the implementation of electronic medical records, increases health care quality, patient safety and patient care and also decreases health costs. So it is suggested that hospitals do necessary efforts to establish EMR.

Background and Aim: The Effectiveness and success of an organization depends on two factors one is the employees’ Performances and the other is the level of understanding between managers and employees in prioritize of different job motivators. The aim of this study was to determine factors that affect staffs’ performances in Qazvin teaching hospitals based on the Herzberg’s theory.

Materials and Methods: This research was a descriptive study. To achieve the main aim of this study, one hundred and ten employees were selected through a multi- stage sampling method .In this study, for data collection a self-report questionnaire was used. The five-point Likert scale was used to determine the degree of importance of any hygiene and multinational's factors affecting the performance of the employees.

Results: Among hygiene factors, the prevailing place was for Job security with an average 4/39 and then followed by a suitable salary with an average 4/38 of 5 scores. Among multinational's factors, job responsibility with an average 4/38 and job interest with an average 4/38 were placed as the most important factors in employees’ performance. %70/8 employees mentioned that two factors of suitable salary and job security are the most important obstacle for improvement of employee’s performance.

Conclusion : The data of this study reveals that, Attention and Planning in providing

 proper salary and job security as hygiene factors and sense of responsibility and success as motivational factors, may play a more effective role in improving employees’ performance than any other factors.

Background and Aim: FRBR is one of the models considered in cataloging and work-to-work relationships are introduced as types of bibliographic relationships present in this model.

This study examines the distribution of dispersion relationships in medical subject areas based on FRBR model in Persian medical sources published from 2006 to 2010.

Materials and Methods: This study is a descriptive survey . Data were obtained from Iranian OPAC ( online public access catalog) . To determine the areas of medical sciences, both LC (Library of Congress) and Dewey Classifications were applied. For data analysis, Excel 2007 was used. Using descriptive statistics, the researcher presented the results in the form of tables and graphs.

Results: According to Dewey Classification, ‘diseases’ was the subject area having the highest number of bibliographic relationships and the lowest frequency belonged to ‘experimental medicine’. The analysis based on LC Classification, however, showed that ‘internal medicine’ had the highest number of bibliographic relationships Botanic, Thomsonian, Eclectic Medicine, Chiropractic and Alternative medicine subject matters had the lowest bibliographic relationships.

Conclusion : Distribution of work-to-work bibliographic relationships in Persian medical sources based on Dewey and LC Classifications is heterogeneous. Despite the obtained apparently heterogeneous results, such a difference cannot be due to differences in the frequency of bibliographic relationships of medical topics because the classification criteria of medical sciences are different in these two systems.

Background and Aim: Collaboration within and between healthcare teams facilitates effective healthcare provision. Fundamental strategies in effective healthcare services focus on collaboration and teamwork. This study was an attempt to assess reliability and validity of Team STEPPS Teamwork Attitudes Questionnaire (T-TAQ) in Iranian context.

Materials and Methods: This cross-sectional survey was conducted in Iran in 2012. Delphi method was applied and the questionnaire was submitted to 11 experts in 2 rounds to determine its face and content validity. Besides, it was translated and back translated to determine external validity. To estimate the reliability of the instrument, test-retest method was used. A sample of 67 medical and nursing senior students was stratified from Tehran University of Medical Sciences (TUMS). T-TAQ is a questionnaire having 30 questions in 5 themes. The obtained data were analyzed by SPSS13.

Results: The content, face and external validity of the tool were approved by Iranian experts. Meanwhile, applying Cronbach's alpha, total reliability was estimated to be 0.80 moreover, the ICC turned out to be 0.8.

Conclusion : Since the validity and reliability of this instrument are confirmed in an Iranian context, it can be used to measure attitude regarding teamwork in this context.

Background and Aim: Recognition of expectations and perceptions of customers is essential for quality improvement . The aim of this study was to determine the quality gap of educational services in the viewpoints of Tehran University of Medical Sciences (TUMS) educational administrators, faculty members and medical students.

Materials and Methods: A cross-sectional study was carried out at TUMS in 2012 among educational administrators, faculty members and students of medicine. A total of 384 students, 384 faculty members and 83 administrators were selected randomly. The five-dimensional SERVQUAL questionnaire was applied for data collection. The educational services quality gap was determined based on the differences between administrators , faculty members and students΄ perceptions and expectations. Descriptive and analytic (one-way ANOVA) statistics were performed using SPSS v.18.

Results: The results show that there is a negative quality in all five dimensions of educational services quality. Among all three groups of students, faculty members and administrators, the maximum means of quality gap pertained the dimension of “responsiveness” (-1.42,-1.17,-1.09, respectively) the minimum figures, however, were related to “confidence” (-1.07,-0.87,-0.77, respectively).

Conclusion : In all aspects, students, faculty members and administrators’ expectations were higher than their perception of the current situation. To reduce the gap, it is recommended that attention be paid to all aspects of service quality, particularly to the responsiveness dimension. Also, better planning to serve employees and enhancing their communication skills are suggested as ways to reduce the educational services quality gap.

Background and Aim: If the evaluation is done from the perspective of users, Successful development of measures and features related to use and implementation of hospital information system and identify areas that need further consideration is to be provided. The main purpose of this study was assessment the views of physicians and nurses of hospital information system identify the effective criteria for the use of it and their satisfaction.

Materials and Methods: Present research is a descriptive cross-sectional study and was applied in public- education hospitals of Tehran University of Medical Sciences in 2012- 2013. The main tool was a questionnaire prepared by reviewing relevant literature in databases Iranmedex, Magiran, SID, PubMed, Science direct, Google scholar, and surveys by experts. In order to determine the validity, a questionnaire was distributed among 5 experts in the area of ​​information technology. After completion of the questionnaires, results were analyzed using software SPSS17.

Results: Information systems in half of the hospitals surveyed from the perspective of research community have an average of 30 - 60 percent capabilities in order management. Also users in all surveyed hospitals with more than 43 % agree the ease of using hospital systems.

Conclusion : User satisfaction is a guarantee for the implementation of information system. To improve the situation and move towards the ideal condition we suggest users needs in hospital information systems should be considered. Also design and system should be Compatible with the skills and knowledge of users as possible.

 Background and Aim: Evidence Based Medicine (EBM) is the explicit use of current best evidence in making decisions about the care of individual patients. Hospital information system (HIS) can act as a bridge between medical data and medical knowledge through merging of patient's data, individual clinical knowledge and external evidences .The aim of this research was to determine the Capability to establish EBM by HIS.

 Materials and Methods: This descriptive cross-sectional study was carried out on HISs of 30 hospitals from March to October 2011. Data were collected using a researcher- constructed checklist including applicant’s background information as well as information based on research objectives. Validity of the checklist were assessed by the qualified specialists and then the data were analyzed using descriptive statistics and SPSS software.

 Results: HISs lacked the essential components for providing access to CDSS, Reference databases and internet-based health information in 19, 16 and 20 hospitals were 63.3%, 53.3% and 66.7%, respectively. Twenty-two hospitals (70%) had more than two-thirds of the essential components to access clinical and administrative data repositories 23 hospitals (76.7%) had at least one essential component to access contextual and case specific information.

 Conclusion: The Capability of HIS is better in order to place EBM in having access to the clinical and administrator data repositories while it needs more attention in other areas.

 Background and Aim: Since employees satisfaction have important effects on achieving the goals of organizations and also organizational justice is a key factor in employees satisfaction, The aim of this study was to determine the relationship between organizational justice and organizational citizenship behavior in selected hospitals of Tehran University of Medical Sciences.

 Materials and Methods: This study was a descriptive and cross-sectional analysis. The study sample was composed of 312 employees from selected hospitals of Tehran University of Medical Sciences by cluster Stratified Random sampling. Data collected by using two questionnaires: Moorman& Niehoff Organizational Justice and Yaghoobi Organizational Citizenship Bahavior. The questionnaires reliability was supported and based on Cronbach s Alfa (OJ=94%, OCB=93%) and questionnaire validity was confirmed by specialist point of view. Data was analyzed by SPSS 18 software.

 Results: The result of analysis revealed that Hasheminejad hospital had the highest score of organizational citizenship behavior in all dimensions except for altruismin dimension. The score in each of the dimensions for organizational justice except for interactional justice in Hasheminejad hospital were the highest There was significant relationship between organizational justice and organizational citizenship behavior in the following dimensions: Altruism, Conscientiousness, Courtesy, Sportsmanship (p=0/0001). 

 Conclusion: As shown, there was a relationship between organizational justice and all aspect of organizational citizenship behavior in selected hospitals and also there was a positive relationship between involving staffs in organizationl activities with facilitating achievement of organizational goals and improvement of hospital performance, Therefore, strategies should be adopted in line with organizational justice to increase citizenship behavior.

 Background and Aim: X-Ray departments are among the most essential and expensive parts of any healthcare organization. Meanwhile, the proper application of hospital information systems (HIS) leads to the quality enhancement of health services and to the cost reduction of medical departments. The purpose of this study is to evaluate the knowledge of radiology department staffs in hospitals affiliated to Hamadan University of Medical Sciences (HUMS) about HIS applications.

 Materials and Methods: In this descriptive research (2012), the knowledge of radiology department staffs in HUMS hospitals was studied using a two-part questionnaire including a demographic part and standard items to evaluate the HIS knowledge of radiology department staffs. Finally, the obtained data were analyzed statistically by SPSS (version 17).

 Results: The results showed that 3.8% of staff members had a weak awareness, 65.4% an average awareness, and 30.8% a good awareness about HIS applications. Perfect awareness was not observed in this study.

 Conclusion: According to the results of this study, running related and up-to-date courses for staff members working in radiology departments is recommended.