Journal of

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Background and Aim: Peptic Ulcer Disease (PUD), which is a prevalent disease, can have a considerable impact on patients' quality of life (QOL). The aim of this study was to explore the factors related to QOL based on PRECEDE Model in patients with PUD in Sanandaj, Iran.

Materials and Methods: A non-probability sample of 120 outpatients with PUD, referring to Beasat Hospital, in the city of Sanandaj participated in the study. The study took place between March and June of 2009. A descriptive, cross-sectional design was employed and the data were collected using a survey questionnaire based on PRECEDE model, consisting of QOL, Health Status, predisposing, reinforcing and enabling factors and self-management behaviors constructs. The data collected by interview and analyzed by SPSS v. 11.5. The statistical analysis of the data included Pearson correlation, t- test, one-way ANOVA and linear regression.

Results: Health status (p<0.01), reinforcing (p<0.01) and enabling (p<0.05) factors and knowledge (p<0.05) as a predisposing factor were related to quality of life of peptic ulcer patients. Moreover, health status (p<0.05) and social support as a reinforcing factor (p<0.01) had significant relationships with self-management behaviors. Finally, all of PRECEDE variables accounted for 68.9% of the variation of quality of life in PUD patients.

Discussion and Conclusion: With respect to the results of this study, preparing an educational program to promote self-management behaviors and quality of life in peptic ulcer patients is proposed. It was concluded that the PRECEDE Model may be used in developing countries, like Iran, as a framework for planning intervention programs in an attempt to improve the quality of life of patients with PUD.

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Background and Aim: Managers today work in a dynamic environment. Their role in creating quality is  essential. Today paying attention to the quality of goods and services is the first Paiority in heath care organizations which is in with contact  peoples lives. Total Quality Management has undergone vast changes in health care management. The aim of this study is  to determine the top (chief) and middle managers knowledge and attitude on the feasibility of applying Total Quality Management in hospitals of Tehran University of Medical Science in 2009.

Materials and Methods: This is a descriptive - analytic research. The study population consists of top and middle mangers of Tehran University of Medical Science in 2009. For data gathering , we have used a  questionnaire  which consisted of 46 questions. We assessed its validity by expert team and its reliability by subsample method (CI95%). Then the data were analyzed by SPSS  software. The descriptive results(consist of mean, median, mode, std deviation, variance, range, maximum and minimum) and analytical results(consist of  bivariate and Pearson tests) were obtained.

Results: The total mean of the top and middle managers knowledge for TQM is  73.24% and is in good range. The total mean of the top and middle managers attitude about TQM is 79.76% and is good and near to excellent range.There is a meaningful relation between top and middle managers knowledge and attitude  for TQM. In total the coordination of the top and middle managers ideas for TQM is near to the each other and is good to applying it in hospitals.

Discussion and Conclusion: Total Quality Management is a new idea that is vital for organizations, especially for hospitals. Results of this survey show that top and middle managers knowledge and attitude are in good range but it needs promotion and continual teaching because when the knowledge and attitude change, the behavior of this managers also change and finally the behavior of all the employees in hospital will change. Also the goals of TQM  that are the consent of the patients, employees and society and high quality of services will be acceptable and remain for promotion of good health in the society.

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Background and Aim: The provision of high-quality services is considered as a prerequisite to the success of responsible organizations. Using SERVQUAL model, the present article seeks to delve into the quality of services provided in outpatient clinics as judged by patients in case-study hospitals throughout Tehran.

Materials and Methods: This is a cross-sectional descriptive research in which 242 subjects were studied at the outpatient clinics under investigation throughout Tehran using a standardized questionnaire named SERVQUAL (1988).

Results: The results of a t-test revealed a meaningful difference between the patients' perception and their expectation about 5 factors (tangible elements, reliability, assurance, accountability and collaboration) affecting the quality of services in clinics. The patients rated ‘assurance' as the most important factor (4.41) and ‘accountability' as the least important of the 5 factors (2.21).

Conclusion: The results indicate that the application of SERVQUAL model enables hospital managers to evaluate the quality of services as evaluated by patients as their most important clients and enhance the quality of such services through proper planning and removal of deficiencies.

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Background and Aim: Over the past decade, the number of private centers providing health care services in Iran has had a continuous growth and the highly competitive market in private hospitals industry has caused increasing pressure on them to provide services with a higher quality. The purpose of this study was to assess the quality of services being provided in private hospitals of Tehran as judged by patients.

Materials and Methods: This cross-sectional study was conducted in 2010 in Tehran. The study sample comprised 983 patients, randomly selected from 8 private hospitals. The survey instrument was the standard SERVQUAL questionnaire. Wilcoxon, t-test, and Kruskal-Wallis tests were used for statistical analyses.

Results: The total mean scores of patients' expectation and perception were 4.92 and 4.02, respectively. The highest figures were related to the tangible factors dimension and the lowest ones to the empathy dimension. The differences between the perception and expectation for all the 22 items and the 5 dimensions were found to be statistically significant(p< 0.001).

Conclusion: SERVQUAL is valid and reliable in hospital settings as a standard tool for the assessment of quality. The results of the present study have revealed the areas that need to be improved as far as the patients are concerned. Measuring the opinion of patients can help facilitate the provision of hospital services, and improve the quality of such services and patients' satisfaction.

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Background and Aim: Quality of printed papers in 4 four medical journals affiliated to one of the universities of medical sciences in Iran was assessed based on methodological and statistical methods.

Materials and Methods: In this cross sectional study conducted in 2010, out of all articles published between the years 2002 to 2008 in one of the universities of medical sciences for affiliated journals that were equal to 1568, a sample of 162 articles were selected with Multi-stage stratified sampling method . For data collection, standard questionnaire was used to develop an information form. One sample t-test and Kruskal-Wallis test were used to compare scores from different parts of article.

Results: Cross sectional studies with 61.7% (100 papers) formed most of studies. Median of authors and number of references for each article were 3 and 19, respectively and 10% of articles had more than 35 references. Material and methods with 3.53 points from 4 points (88.2%) earned the mighest score which was of high quality and conclusion achieved the lowest score. Also p-value has been reported correctly in 102 articles (81.6%). In 95 articles (58.6%) results were not compare with the similar internal articles whereas only in 21 articles (13%) comparison was not made with similar external researches.

Conclusion: The present study showed that the overall quality of the medical articles is not desirable. Hence, employing experts in research methods and statistics in various medical studies can improve the quality of articles in this branch of science.

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Background and Aim: Health information System (HIS) is a comprehensive software used to unify and transfer hospital data effectively. It is vastly employed to improve input quality, decrease data-transfer time, increase satisfaction level, promote health services quality, and minimize hospital costs.

Materials and Methods: This is an applied-descriptive study. The research population consisted of 120 HIS users who worked before and after the HIS application at Masih-Daneshvari Hospital. For data collection purposes, a questionnaire was used. The data were then analyzed with SPSS software, and descriptive and inferential statistical methods.

Results: According to data analysis, the application of the existing communication system among the different sections and wards was very good (81%), the accessibility to patient medical information and facilitating treatment processes were good (44% and 61%, respectively), and the analysis of budgeting data (11%), the possibility of clinical researches (19%), the presentation of guides for operators (18%), and the accessibility to statistical and financial data (17% and 22%, respectively) were assessed as poor.

Conclusion: The results of this survey show that the application of Hospital Information System has a positive effect on accuracy, facility, and treatment processes, and emphasize the importance of programming to enhance the quality of hospital services.

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Background and Aim: Increase in life expectancy is associated with non-communicable diseases. This study is aimed to survey the effect of chronic diseases on the quality of life among the elderly people in elderly care centers in the East of Tehran in 2011.

Materials and Methods: This is an analytical study in which 424 people were randomly selected. They were members of elderly care centers and were 60 years of age or higher. The data collection instruments were a standard quality-of-life questionnaire(SF36) and a chronic diseases record checklist. The data were collected in an interview. For data analysis purposes, Independent T-Test, ANOVA, and Pearson correlation coefficient were used.

Results: The mean age of participants was 67.34±7.16. Some 92.2% of patients were suffering from at least one chronic disease, and there was a significant statistical difference between the mean points of all aspects of quality of life of those suffering from chronic diseases and those without a history of chronic diseases(P<0.001). Moreover, there was a significant relationship between the quality of life on the one hand and gender, marital status, economic status, and education on the other(P<0.05).

Conclusion: The findings show that an increase in the number of chronic diseases leads to a decrease in the quality of life, and that the application of appropriate educational and interventional approaches can help take effective steps to enhance the old people's health.

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Background and Aim: The present case study aims to investigate the impact of service quality on patients' loyalty to the services rendered in outpatient clinics of the studied hospitals throughout Tehran.

Materials and Methods: This is a descriptive-analytical survey in which 242 outpatients referring to the studied hospital clinics in Tehran. For data collection purposes, the standardized SERVQUAL questionnaire(1988) and for the measurement of loyalty for service quality, the standard questionnaire for customer's behavioral tendencies(Zitamel and Berry, 1996) were used. Regarding the validity of the questionnaire, its content validity was confirmed and its reliability was approved through test-retest method and Cronbach's alpha coefficient. For data analysis, Pearson correlation test was employed.

Results: The results revealed that there was a positive and meaningful relationship between the quality of services and the patients' loyalty in Tehran clinics. The most important aspect of loyalty was complaining behavior.

Conclusion: Hospital managers should enhance their understanding and awareness to maintain, and even improve, the patients' loyalty to their services and should do their best in this regard. Hospital employees should be aware of the patients' expectations and act beyond it. Finally, they should know that rendering services to patients is teamwork and that the key to providing patients with good services lies in their satisfaction with the quality of services they receive.

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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.

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 Background and Aim: The purpose of the present study was to assess and prioritize the factors affecting the quality of services of pharmacies in Bushehr using Kano model and TOPSIS method and to provide practical strategies for quality improvement in the current situation.

 Materials and Methods: This Study was practical and descriptive. The samples contained the pharmacies customers and visitors in 1390 and the data were obtained using questionnaires measuring the quality of service and standard (Kano). Finally, the indicators were prioritized by applying the technique of group decision-making (TOPSIS).

 Results: According to the TOPSIS prioritization, Uni-dimensional requirements (10 requirements), basic requirements (6 requirements), attractive requirements (8 requirements), and finally, requirements of indifference (3 requirements) had the greatest impact on improving the quality of services in pharmacies in Bushehr, respectively, based on the Kano model.

 Conclusion: Strong and positive correlation among the indices of the quality of services in the pharmacies and customer’s satisfaction was observed, Planning to improve the services would lead to satisfaction improvement.

 

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Background and Aim: The Internet is an essential tool to access information in the new era, and the quality of information obtained from the web is very important. The purpose of this study, therefore, is to investigate the familiarity with and the application of criteria used to assess the quality of such data at Gonabad University of Medical Sciences. Materials and Methods: This survey study was done in the second semester of academic year 2012-2013. The population of the study consisted of all 235 bachelor students at Gonabad University of Medical Sciences. A five-item questionnaire based on the Likert scale was used for data collection the reliability and validity of this questionnaire had been determined by similar studies. The data were analyzed using SPSS software version 20 and descriptive statistics. Results: The results of this study revealed that most of the students paid much attention to the relevance of information (59.1%). Value-addedness (47.7%) and understandability (44.7%) enjoyed the next highest priorities. Consistency (19.1%) and credibility (12.8%) had the lowest priorities among students in terms of interest and application. Conclusion: The findings of this study showed that the students of Gonabad University of Medical Sciences did not pay attention to all information quality criteria in the web rather, they paid more attention to the relevance and valueaddedness of the information while searching the web.

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Background and Aim: Given the increasing growth of new technologies in health care and their rising cost, the necessity of concentration on assessing new technologies and their potential role in quality of health care is more crucial. The aim of this study was to investigate the role of health technology assessment (HTA) in improving healthcare quality and offer the best evidence for decision makers.

Materials and Methods: The study was based on systematic review of papers in health technology assessment via searching in databases such as Pubmed, Cochrane and other HTA related databases. The search has covered the period between years 2000 to 2013. Studies analyzed by narrative synthesis method.

Results: Related studies show that assessing new technologies has potential role in quality improvement of healthcare. HTA can boost the competition among companies which this in turn increases the quality of technologies and ultimately enhances the quality of health services and stakeholders satisfaction.

Conclusion: HTA may increase quality of healthcare services through facilitating a move towards evidence-based decision-making, providing safe health care and increasing patients’ trust and satisfaction to clinical procedures and team members.

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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.

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Background and Aim: Cancer is one of the stressful problems of humans life. The concept of cancer will included a complex problems such as cancer pain, physical and psychological, social, and cultural pains. The aim of this study was to determine the relationship between the physical environment of hospital and quality of life in cancer patients.

Materials and Methods: In this mixed study (qualitative – quantitative), 60 cancer patients referred to Imam Khomeini hospital of Ardabil and Shahid Beheshti hospital of Hamadan in 2013 were selected randomly. The data were collected by interview and observation and using the SL-36 quality of life questionnaire and also structured questionnaires was used.

Results: The analysis confirmed that images of natural scenes and artificial plants in hospital rooms increase the quality of life. See watching the outside plant, even outside the room, increase the quality of life.

Conclusion: This study confirms the quality of life increasing properties of natural elements in healthcare environment.

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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.

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Background and Aim: In health sector, improving quality of treatment services and patient safety are considered as vital. The objective of this study was to determine the relationship between the quality improvement and patient safety (QPS) and the hospital performance indicators. 
Materials and Methods: In this descriptive analysis research, the statistical population included managers, matrons,  one of the members of the quality improvement committee and one of the clinical governance office members of Shahid Beheshti University of  Medical Science teaching hospitals (N=44). In order to evaluate QPS, data were gathered through questionnaire and the hospital performance indicator data were gathered through interview and observation. Also independent T test was used to determine the relationship between the quality improvement and patient safety and performance indicators.
Results: All five areas of (QPS) including leading and planning, designing clinical and managerial processes, collecting the data, analyzing the data and improvement were significant in QPS score and   according to independent T-test, the relationship between (QPS) and bed occupancy percentage, average length of inpatient stay, bed turnover interval, bed turnover rate and gross death rate was significant (p-value<0/05).
Conclusion: Considering (QPS) standards can improve hospital performance indicators.

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Background and Aim: One of the main steps of optimization process in diagnostic imaging is quality control of X-ray devices. If the control quality process and the quality of X-ray equipment are not ensured through a systematic procedure, it can increase the risk of unnecessary exposures among the population. Therefore, this study can reduce the risk of unnecessary exposures in the entire population. 
Materials and Methods: In this study, six quality control tests including voltage measurement accuracy test, time accuracy test, output repeatability test, output to time linearity test, output to milliamp linearity test, and radiation quality measurement test were evaluated in all centers of Ilam in accordance with what the international Atomic Energy Agency and the Atomic Energy Organization of Iran has presented. 
Results: The result showed that diagnostic X-ray devices available in Ilam had a relatively good quality in all quality control tests that were done except the associated with the radiance quality of (HVL). However, almost all these devices need to add additional filters to the X-ray tubes to resolve error in their HVL. 
Conclusion: Adding additional filters to radiology devices in Ilam Province and modifying the thickness of filters seem to be necessary and desirable which will prevent the unnecessary increase in patients' dose. The accurate and regular implementation of quality control tests in imaging wards should change into a culture. On the other hand, the relevant organizations which have the great responsibility to protect people against radiation are recommended to monitor and supervise radiology centers more accurately and responsibly to repair diagnostic radiation devices.

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Background and Aim: Growing the number of private institutions offering health care and fierce competitive market conditions in the private hospitals industry cause to pressure these hospitals to provide high-quality services. The purpose of this study was to examine the effect of service quality on patient satisfaction in private hospitals of the Guilan province. 
Materials and Methods: Based on standard model of Büyüközkan et al (2011) a new dimension professionalism to SERVQUAL model was added that has used six dimensions including tangibles, reliability, responsiveness, assurance, empathy and professionalism as the dimensions of service quality. The number of samples was 360 patients hospitalized in four private hospitals and a standard questionnaire was used to assess the quality of services. Pearson Correlation Coefficient and Simple and Multiple Linear Regression was used to analyze the data and then by using ANOVA and Duncan’s and by Fuzzy Analytical Hierarchy Process technique, ranking of private hospitals was performed.
Results: Four dimensions: tangibles, responsiveness, empathy and professionalism on patient satisfaction have been found to be effective while Components of trust and assurance in private hospitals of the Guilan province had no significance effect.
Conclusion: Based on the effects of service quality dimensions except trust and assurance recommend that hospitals can increase patient satisfaction if they pay special attention to patient in empathy, updating facilities and technology in tangibles, fast response to patient in responsiveness, employing professional and skilled human resources in professionalism dimensions.

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Background and Aim: To improve the quality of laboratory services, World Health Organization (WHO) introduced ISO15189 standard. So, this study aimed to investigate implementation of the standard at Mycobacteriology Research Center (MRC) and determination of its adaptation.
Materials and Methods: At the first step, 12 organizational blocks of the laboratory was assessed by completion of the standard questionnaire. By implementation of the software and audit surveillance the second step was completed. Consequently, the given results were analyzed using SPSS Version 16. 
Results: By implementation of Quality Management System (QMS) at the three known focal points (pre analytical¸ analytical and post analytical), MRC was scored 80–100% points during 2013-2014; whereas previous QMS of the national reference TB laboratory (NRL) ranged from 48% to 79%
Conclusion: This study was the first of our knowledge in stepwise implementation of ISO15189 standard in Iran. Internal evaluation of the standard, our NRL ranked as a 5 star laboratory. We seeked international evaluation to accreditation of the national reference TB laboratory.

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