Journal of

Background and Aim: Today, psychological diseases like so many diseases, have an old history. Clinical Information System of psychological diseases resulting from war is a part of the information management system of mental illnesses, due to the management of mental patients from the war. This study is aimed to compare information management of psychological diseases in American, Australia and England with Iran.

Methods and Materials: This research is a study. At first, the existing situation was studied in three Psychiatric Centers in Ahvaz and Tehran with the use of a cheek list. Then information system of psychological disease has been studied in elected countries and based on the need of our own country, proposing practical solutions for Iran.

Results: The results of this study showed that there was no a information system of psychological disease in Iran. Also, four factors of this system including (goals, content structure, informational elements, information registration criteria) are reviewed in four selective countries.

Discussion and Conclusion: The design and implementation of this system in psychiatric centers is recommended to set two main goals including quality control and cost control in Iran.

Background and Aim: The benefits of a unique computerized medical records and communication equipments is utilized to collect, storage, process, extract and relate to patient care information and management information. If this utilization is in accordance with the needs of managers and staff of medical records, many of the nation's health system problems will be dissolved. Information systems in health supply system by compiling, analyzing and publishing data provide utilization of information improve the health of the society. The purpose of this study is to investigate the process of clinical information systems in general hospitals of Tehran University of Medical Sciences based on available clinical information system in these hospitals.

Materials and Methods: This descriptive study is an application study that conducted in order to determine the process of clinical information system in general hospitals of Tehran University of Medical Sciences based on available clinical information in these hospitals. The required data have been collected by a valid and reliable questionnaire. Descriptive statistics were used to analyze data.

Results: With regard to the current condition and the importance of survey of the process of clinical information system in the studied hospitals, the authors provided the desired checklist in general hospitals with studying the related system in America, Australia and England countries, on the basis of country requirements in the form of clinical information system processes. We studied clinical information system processes in departments of admission, filling and retrieving, statistical and coding and also soft wares in this department.

Discussion and Conclusion: It is necessary to create a coordinated and integrated clinical information system with suitable process and empower experts in the field of proper use of data with regard to the position of information system in each organization and its fundamental role in the adoption of accurate policies. We found that relative frequency of clinical information system processes is more than 60% in this department and clinical information system elements was observed 75% in all the departments except admission.

Background and Aim: Waiting time is one of the factors affecting patient satisfaction of service quality which is offered. In This Study waiting times referred to some clinics like Shahid Dastani integrated clinical training center, treatment and researching center like Shariati Hospital was performed.

Materials and Methods: Six sigma model in four stages together with qualitative and quantitative methods was used in this study. The study population consisted of the all patient referred to specialist clinics like Shahid Dastani during every week. We selected 10% of all patients as a sample size referred to specialist clinics (n= 266). Data were collected by interviewing and filling the checklists using a stopwatch. Measured waiting times were registered in a blank form. Data entry and analysis were performed using SPSS.

Results: Mean and standard deviation of waiting time were 121± 33.73 minutes. The most important processes from referred entrance to leaving the physician's office consisted of comprehensive workflow processes, overall workflow, times forming, funds, medical records, previous bloom times, refunds and discount at all costs, and complaints.

Conclusion: The first three factors of prolonged time form health care providers and referees view are simultaneous increase in the number of referees, physicians being on time and shortage of doctors. This collection extends the time of giving services by clinice, providing human resources and modifying the physical spaces wich were some of recommendations to reduce waiting times.

Background and Aim: Adverse events in hospitals are found to be a major problem of all health systems in the world. In fact, drug interaction side effects are now the fourth leading cause of death in the U.S. The aim of the current study was to identify the opinions of clinicians working in Shariati and Emam hospitals towards the use of computer applications for detecting drug-food interactions.

Materials and Methods: Ninety clinicians including physicians, pharmacists and nurses were selected randomly in the current descriptive- analytical study. The opinions of clinicians toward using computer application systems for detecting drug-food interactions were assessed by a questionnaire. The questionnaire's validity and repeatability was examined in a pilot study. Cronbach's alpha was 0.85 which indicated an acceptable level of repeatability of the questionnaire. The questionnaire was distributed among the academic staffs in order to determine its validity.

Results: 95.4% of clinicians had positive attitudes towards the requirement of computer application to detect drug-food interactions. Around 94% of them showed their willingness towards using the computer application systems. Therefore, use of computer application seems to be necessary in health system.

Conclusions: The collection and analysis of data encourages further investments in computerized system to prevent drug-food interaction. Such built-in warning systems in hospitals alert doctors to drug-food interaction and improvement in patient care. Screening each patient's medication plan for drug-food interactions can reduce medical error and improve the quality of health care

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.

Background and Aim: Randomized controlled clinical trial is the most valid type of epidemiological studies for the treatment of diseases. The aim of the present article is to determine the subject area, type of intervention, and blinding methods used in this type of study design.

Materials and Methods: This is a cross-sectional descriptive study in which all the articles based on randomized controlled clinical trial were studied. The articles were all affiliated to Tehran University of Medical Sciences(TUMS) and indexed in PubMed by the end of the year 2010.

Results: Among the subject areas, most randomized controlled clinical trials(44 cases or 14%) were conducted in the field of Obstetrics and Gynecology. In terms of intervention type, the majority of the studied trials(214 cases or 68.2%) used drug intervention. And regarding the type of blinding, double-blinding was employed more than other blinding techniques(152 cases or 48.4%). On the whole, 125 cases(39.8%) of randomized controlled clinical trials were conducted through drug intervention simultaneous with double-blinding technique.

Conclusion: In different subject areas, the application of blinding techniques and type of intervention are somewhat related to research methodology and medical ethics. It seems that intervention type depends on subject area, and blinding technique is determined by the selected type of intervention.

Background and Aim: Decision support systems(DSSs) refer to one of the types of information technology applications that can help clinicians to make right and timely decisions about patients. The aim of this study is to learn more about DSSs and their applications and effects on health care.

Materials and Methods: In this systematic review, articles which were published between 2000 and 2012, which were available as full texts through databases and search engines -- such as PubMED, EBSCO host research, Google scholar and Yahoo -- and which were also of clinical-trial type were examined besides, certain books in this area were used as primary sources.

Conclusion : The findings show that DSSs were applied in five areas in health care, which had a significant effect on improving the process of care and the performance of providers. These areas are as follows: disease progress management(15.15%), care and treatment(27.27%), medication(27.27%), evaluation(27.27%), and preventation(12.12%). In general, improvement can be seen in three areas: quality of care and patient safety, cost effectiveness, and provider’s level of knowledge.

Background and Aim: Clinical laboratories, due to their succeptibility to potential risks, are priorities in all activities concerning safety issues in hospitals.
Total Quality Management (TQM) is a model considered by WHO for clinical laboratories safety development. This study aimed to assess how safety standards were followed at the clinical laboratories of hospitals affiliated with Tehran University of Medical Sciences (TUMS) based on TQM safety regulations.

Materials and Methods: This descriptive study was conducted on a research population including TUMS hospitals clinical laboratories in 2012. For data collection, census was applied and sampling was not considered. The data gathering instrument was a checklist measuring seven safety components based on TQM. The validity of the instrument was determined through content validation, and Cronbach alpha was calculated to be 0.82. For the analysis of the results, descriptive statistics including frequency percentage of scores was employed.

Results: The safety of research population turned out to be suitable in terms of four factors: designing, existence of general safety items, conducting standard safety activities, and safe disposal of laboratory wastes. Besides, implementation of safety programs and increase in employees’ knowledge to cope with accidents were relatively acceptable. The emergency evacuation program, however, was estimated as poor.

Conclusion: The studied laboratories enjoy relatively safe conditions, but imperfect implementation of safety protocols can endanger safety conditions. Therefore, it is necessary to take the required correcting measures to ensure full safety in clinical labs.

 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: 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: Clinical governance is the application of mechanisms at the right time and place to do tasks for patients properly and obtain maximum clinical results. The implementation of clinical governance definitely requires the skills and inclinations of those working in healthcare sector. The main objective of this study is to identify the relationship between human resource management (HRM) on the one hand and the implementation of clinical governance and the optimal establishment of its framework on the other hand through offering strategies for effective human resource management.

Materials and Methods: This is a descriptive analytical study conducted in a cross-sectional way in 2012. The sampling method was a two-step cluster sampling. Shariati, Imam Khomeini, and Hashemi Nejad were randomly selected from among the hospitals of Tehran University of Medical Sciences (TUMS). The data collection instrument was a researcher-made questionnaire and a checklist. In each hospital, 30 questionnaires were randomly distributed. The gathered data were analyzed by SPSS.

Results: The minimum and maximum scores of clinical governance pertained to Imam Khomeini (594) and Hashemi Nejad (753) hospitals, respectively. Moreover, significant relationships were found between variables of training, recruitment and employment, salaries and benefits on the one hand and clinical governance on the other.

Conclusion : Considering the significant relationship between HRM and the implementation of clinical governance, investment in this aspct of clinical governance as the one that influences success in other aspects can be effective in the establishment of clinical governance.

 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: Every educational system, whether micro or macro, needs its training programs to be studied and educationally evaluated. This study aims to assess training and internship programs in hospitals based on surveying the students of Tehran University of Medical Sciences (TUMS).

 Materials and Methods: This is a cross-sectional study with survey descriptive design. The data collection tool was a questionnaire with 14 five-point Likert style items. The TUMS Educational Development Center (EDC) surveyed all 185 students of training and internship programs, using a questionnaire with the Cronbach’s alpha coefficient of 0.81 in 2011, in order to adjust the education with the society’s needs and to improve its quality.

 Results: The mean assessment scores of training and internship programs were 3.32%, 2.98%, 3.38%, and 3.29% for applied training, mental skills, communication skills, and practical skills courses, respectively.

 Conclusion: The students’ satisfaction rate regarding the quality of educational courses of training and internship programs was 50.2%. Educational authorities have made necessary attempts to implement these programs and use potential resources for realizing the objectives and achieving the educational quality however, they should make further attempts in this regard.

Background and Aim: To improve the implementation of clinical governance (CG) in Iran's hospitals, awareness of various aspects of its implementation and assessment is important. The aim of this study was to find out the obstacles and challenges of clinical governance implementation and assessment in Qazvin teaching hospitals. Materials and Methods: Semi-structured interviews with 17 senior managers, clinical staff and clinical governance experts were conducted in six hospitals of Qazvin University of Medical Sciences (QUMS). To analyze the collected data, framework analysis was used. Results: The challenges and obstacles of CG implementation in Qazvin teaching hospitals were explained using three themes of (1) challenges of CG implementation, (2) improvement in seven dimensions of CG, and (3) challenges of CG implementation assessment. Conclusion: The results of this study show that CG implementation needs to address three issues: improving clinical staff awareness about CG, changing organizational culture so as to make it more receptive to CG, and creating higher levels of cooperation among physicians, managers, patients, specialists, and professionals. The supportive role of top management in addressing the three issues and in providing resources and other infrastructures is obviously essent

Background and Aim: In medical centers, after obtaining visceral clinical samples in suitable containers under certain circumstances, they are sent to mycology laboratory. Since sometimes it is impossible to test specimens immediately, therefore, they should be kept in the refrigerator. Thus, possibility of keeping samples, the confidently time of samples keeping in a refrigerator and the appropriate guidelines for the maintenance of visceral samples for clinical centers have a particular importance for practical purposes and are the aim of this study.

Materials and Methods: At first, the specimen was examined by KOH direct microscopic examination for detection of fungal elements. After primary culture of visceral samples on the Sabouraud dextrose agar with chloramphenicol (SC) medium, the samples were sequentially placed in a refrigerator at temperature 2-8 ºc for 1, 2, 24 and 48 hs and each sample with the specific mentioned time culturing was performed on the Sabouraud dextrose agar (S) and SC media. Then the results of growth were recorded.

Results: From 100 samples, 79 samples had grown, 20 samples with lack of growth and in 1 sample reduced growth were observed.

Conclusion: After 48 hours of cold temperatures (2-8 ºc) visceral fungal clinical samples are able to grow in culture media. So samples which were not tested immediately, could be stored at temperatures 2-8 ºc in the refrigerator.

Background and Aim: The analysis of patients’ safety clinical indicators is considered as one of the safety improvement instruments. Therefore, the present study is aimed to analyze the indices of safety clinical services in selected hospitals of Tehran University of Medical Sciences (TUMS).

Materials and Methods: The present descriptive-analytical study was conducted in 11 TUMS hospitals in 2013. The study tool was the patient safety evaluation protocol of the World Health Organization (WHO). A checklist was completed following interviews, observations, and documentation reviews. The data were analyzed with descriptive and analytical tests, and SPSS software version 13.

Results: The average scores of the studied hospitals were 96.6, 85.6 and 66 for the required, basic and advanced indices, respectively. The figure was not acceptable in required standards, but it was acceptable in basic and advanced ones. In the studied hospitals, numbers 7, 2, 4, 11, and 9 enjoyed the highest amount of conformity with standard, and were placed in rank 2 according to the ranking protocol. Finally, there was no meaningful statistical difference among hospitals in their observance of standards.

Conclusion: Conformity with necessary standards was low in 6 studied hospitals, but in 5 hospitals, it was acceptable in basic and advanced standards. Hospitals need enhancement programs in statements of information management system, drugs management system, infection reduction system, and effective clinical system.

Background and Aim: Hospital complaining is an important dimension of clinical governance. This study aimed to determine the impact of clinical governance program on patients’ complaint in Shiraz public hospitals.

Materials and Methods: This applied study was conducted as descriptive-analytical in 2012 in Shiraz. The population studied was 10 public hospitals in Shiraz and the patients complaints were studied during 5 years. Data collected through Iranian Ministry of Health standard checklist of clinical governance. The data entered to SPSS version 21, and analyzed using descriptive statistics and analytical tests such as Chi-square.

Results: Registered complaints had increasing trend during the execution of the program  and were 1905. Moreover, 60.5% of the complaints have been made by family members. There was significant relationship between complaints registered with the hospital wards (P=0.000) and gender (P=0.000). Therefore, both genders and in all departments of the hospital complaints of poor quality and inappropriate behavior of the staffs was greater than other complaint.

Conclusion: The number of complaints has increased in recent years. It is proposed to reduce the number of complaints attention to improve  communication between physicians and patients, medical ethics, cut non-conventional financial relationaship between physicians and patients, and increased scientific and technical knowledge and skills.

Background and Aim: Early diagnosis is a tenet in oncology and enables early treatment with the expectation of improved outcome. The aim of this study was to determine the factors associated with personal characteristics and clinical signs in patients with breast cancer.
Materials and Methods: This research was a descriptive analytic that 
cross-sectionally assessed 232 patients with definite breast cancer diagnosis that referred to Razi hospital located in Rasht using a researcher designed questionnaire including demographic and clinical signs. Collected data (mammography, tumor size, pathological stage of tumor) were obtained from medical records of patients. Gathered data analysis was accomplished with SPSS V.19 and for description of data from average and standard deviation for inference statics fisher test with a 
P value of 0.05 were used.
Results: Mean age of subject was (49.80+10.27). 44 individuals (14%) had a precedent regular mammography before disease. Hundred and four (44.8%) in first appointment were referred to a general surgeon. Hundred and thirty six (58%) women were in stage III of the disease. Hundred and twenty nine (60%) patients had a tumor size more than 5 cm and 106 (46%) had a lymph node metastasis at the time of diagnosis. Patients referring with advanced stage of breast cancer had a low education (P=0.04) and income level (P=0.01).
Conclusions: Recognizing associated personal and clinical factors with early diagnosis can provide essential information for planning health education, screening and presenting appropriate solutions to overcome barriers to treatment and care in health system planning in this provinc