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Nadali F, Ferdowsi Sh, Karimzadeh P, Chahardouli B, Einollahi N, Mousavi A, Bahar B, Dargahi H, Toogeh Ghr, Alimoghaddam K, Ghavamzadeh A, Ghaffari Sh,
Volume 68, Issue 4 (6 2010)
Volume 68, Issue 4 (6 2010)
Abstract
Background: JAK2 is a nonreceptor tyrosine kinase that plays a major role in myeloid disorders. This mutation is characterized by a G to T transverse at nucleotide 1849 in exon 12 of the JAK2 gene, located on the chromosome 9p, leading to a substitution of valine to phenylalanine at amino acid position 617 in the JAK2 protein. In this study we compared the amplification refractory mutation (ARMS) assay and allele- specific (AS- PCR) to evaluate JAK2V617F mutation patients with non-CML myeloproliferative neoplasms (MPNS). Methods: In this experimental study we evaluated JAK2 mutation in 58 patients with a known or suspected diagnosis of a myeloproliferative neoplasm by simple randomized sampling. The mutation was detected by ARMS-PCR and AS-PCR in patients. In order to verify the methods, amplified products from some patients were sequenced. Results: The JAK2 V617F mutation was detected in 86.6%(26/30) of patients with polycythemia vera and 61.5%(8/13) of patients with idiopathic myelofibrosis by ARMS-PCR and AS-PCR. 46.6%(7.15) of essential thrombocythemia patients were positive using ARMS- PCR method while 53%(8.15) of then were positive when AS- PCR were used. The mutation was confirmed by sequencing. Conclusions: The incidence of JAK2 mutation using above PCR methods is similar to previous studies. The different results may depend on the molecular technique used
Gaeini Aa, Khaledi N, Fayazmilani R, Ravasi A, Sedghroohi G, Arabkari V,
Volume 71, Issue 1 (4 2013)
Volume 71, Issue 1 (4 2013)
Abstract
Background: Alpha-actinins are located in the skeletal muscle Z-line and form actin–actin cross-links. It belongs to a highly conserved family of actin-binding proteins- the spectrin superfamily, which also contains the spectrins and dystrophin. Mammalian skeletal muscle has two isoforms: alpha-actinins-2 and alpha-actinins-3. However, the response of alpha-actinins to exercise training is little understood. This study examined the effects of 8 weeks of resistance training on muscle mass, ACTN3 (alpha-actinins-3) gene expression levels and fiber type composition in the flexor hallucis longus (FHL) muscle.
Methods: Forty five female Sprague-Dawley rats (Initial body mass: 169.25±9gr age: 3 month) were obtained and assigned to a control (C n=18) or exercise training (T n=22) and pilot (P n=5) groups. The resistance training consisted of climbing a ladder carry-ing a load suspended from the tail and the weight increased progressively. Real-time PCR and Immunohistochemistry techniques were used to measure gene expression leve-ls and myosin heavy chain (MyHC) composition, respectively.
Results: Following 8 weeks of training, we observed significant increase in absolute muscle mass in FHL (P=0.01). Results showed that no significant difference was found in ACTN3 gene expression levels between training and control groups (P=0.852 respecti-vely). Also, Pearson coefficient didn't indicated any significant relationships in gene expression and Fiber type IIX in response to resistance training in FHL (r=0.12).
Conclusion: However, resistance training effects on sarcomeric proteins development, these results showed no effect of resistance training on alpha-actinins-3 levels. Althou-gh alpha-actinins-3 has an important function to produce and progress of force in sarco-mere, but didn't changed significantly in response to resistance training.
Ali Mohammad Mosadeghrad , Fatemeh Khalaj ,
Volume 74, Issue 5 (August 2016)
Volume 74, Issue 5 (August 2016)
Abstract
Background: Operation theatre in a hospital requires considerable human and physical resources to deliver surgery services on an agreed schedule. However, operation theatres are sometimes underutilized due to avoidable last minute cancellations of operations. Cancellation of operations on the day of intended surgery results in operation theatre planning difficulties, hospital inefficiency and resource wastage. In addition, it causes stress for patients and their relatives and results in unnecessary hospital staying. Cancellation of planned operations could be avoided by applying appropriate management strategies and techniques. Quality management as an organizational strategy helps enhance hospital departments’ productivity.
Methods: This study aimed to reduce cancelled surgeries in Shahid Rajaei Hospital in Tehran using a quality management model. A participatory action research was used for the intervention between April 2013 and March 2014. Information on operations cancelled on the day of surgery obtained each day from the operating theatre list. Using a checklist, the reasons for operations cancellation were identified, investigated and an action plan was developed for its reduction. The plan was implemented using the action research cycle.
Results: The number of surgeries increased by 4.06 percent and operations cancellation was reduced by 32.4 percent using the quality management strategy. Surgeon and anesthetist related factors, over-running of previous surgery, changes in patient clinical status and lack of intensive care unit beds were the main reasons for cancelling surgeries. Standardization of processes, proper planning and using anesthetics clinic helped reduce the operations cancellation.
Conclusion: Last minute surgeries cancellation is potentially avoidable. Implementing an appropriate quality management model helps enhance hospital departments’ productivity and reduce surgical cancellation.
Soghra Khazardoost , Fahimeh Ghotbizadeh , Shiva Golnavaz , Masoumeh Shafaat ,
Volume 75, Issue 3 (June 2017)
Volume 75, Issue 3 (June 2017)
Abstract
Background: Lochia is the slight vaginal bleeding between 24 hour to 12 week after delivery. There isn't any standard definition for difference between normal and abnormal lochia in post-partum period. The aim of this study was to determine the relationship between ultrasonic findings of the postpartum uterus after normal vaginal delivery with the duration of lochia discharge.
Methods: In this cross-sectional study was done in Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, from 2014 to 2015. In this study 160 women with non-complicated vaginal delivery were entered. Inclusion criteria were: Term pregnancy with gestational age > 37, singleton fetus with cephalic presentation. Exclusion criteria were pre-term pregnancies, previous Cesarean section or other uterine surgeries and twin fetuses. Transvaginal ultrasound was done in first 48 hours after delivery, endometrial thickness echogenicity and uterine size was evaluated. Maternal age, parity, duration of labor and neonatal weight were evaluated. Then the mothers were followed for 6 weeks. The quality and the quantity of lochia discharge were asked by the phone.
Results: Lochial discharge last more than 6 weeks in 96 out of 160 (60%). One had less than 4 weeks. The uterus length, thickness, height and endometrial length did not show any relationship with the duration of lochial discharge, but endometrial strip thickness significantly correlated with the duration of lochial discharge period (P=0.04). None of clinical variables like the number of gravidity, parity, live birth or child birth weight, were correlated to the duration of lochia discharge period, but the labor time was correlated to the duration of lochia discharge period (P=0.04). Although both endometrial thickness and labor time in univariate analysis were correlated to the lochia duration time but this was true just for endometrial thickness in multivariate analysis.
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Conclusion: The endometrial thickness in first 48 hours after normal vaginal delivery could predict the duration of lochia discharge, there wasn’t any correlation between lochia discharge period and other ultrasound parameters. |
Ali Mohammad Mosadeghrad , Ensieh Ashrafi ,
Volume 75, Issue 3 (June 2017)
Volume 75, Issue 3 (June 2017)
Abstract
Background: Patient satisfaction is an important indicator of healthcare quality and effectiveness. Quality management as an organizational strategy enhances the quality of hospital services through continuously improving hospital structures and processes. This study aimed to examine the impact of quality management on patient satisfaction.
Methods: A participatory action research was conducted in respiratory intensive care unit, at Labafinejad hospital, Tehran, Iran, in 2013. A quality improvement team was established. Operational processes were improved using a quality management model. The quality improvement team standardized processes, identified quality goals for the processes and improved them until achieved quality goals. Patients’ satisfaction data was collected before and after the intervention using a valid and reliable questionnaire.
Results: Patients’ satisfaction was 75 percent at the beginning of the study. Patients were mostly dissatisfied with the nutrition services, amenities, lack of attention to their personal needs and lack of involving them in their treatment processes. An action plan was developed for improving patient satisfaction. After the quality management intervention, patient satisfaction reached to 81 percent at the end of this study. The quality management model improved the quality of services by 54.5 percent and consequently increased patient satisfaction by 7.2 percent. Almost half of the patients at the beginning of this study were definitely willing to recommend the hospital to their friends and relatives. This figure increased to 76 percent. The rest of patients stated that they may recommend the hospital to others.
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Conclusion: Implementing an appropriate quality management model appropriately in a supportive environment helps improve the quality of services and enhance patient satisfaction and loyalty. |
Ali Mohammad Mosadeghrad , Ali Akbari Sari , Taraneh Yousefinezhadi ,
Volume 75, Issue 4 (July 2017)
Volume 75, Issue 4 (July 2017)
Abstract
Background: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results (outputs/ outcome) by an independent professional accreditation body using pre-established optimum standards. Hospital accreditation has an important role in improving the quality, safety, effectiveness and efficacy of health care services. The effectiveness of an accreditation system depends on the quality and conformity of its methods, standards and surveyors. This study aimed to evaluate the hospital accreditation method from the perspective of Iranian hospital managers.
Methods: This descriptive, applied and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire. The study population consisted of 914 hospital managers. Overall 547 hospital managers were surveyed through stratified random sampling. SPSS software was used for data analysis.
Methods: This descriptive, applied and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire. The study population consisted of 914 hospital managers. Overall 547 hospital managers were surveyed through stratified random sampling. SPSS software was used for data analysis.
| Results: Almost 71.7 percent of hospitals achieved grade one and above in the first round of national accreditation survey. The mean score of managers’ satisfaction of hospital accreditation method was 3.21±0.63 out of 5 (Average). About 38 percent of hospital managers were satisfied with the hospital accreditation method. Most complaints were related to lack of reliability among surveyors and their low knowledge, skills and experience. Hospital managers were satisfied with surveyors’ attitude and adequacy of the number of survey days. Hospital managers mostly believed that accreditation is better to be done by Ministry of Health, compulsory, and every two years. About 95 percent of hospital managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey. Conclusion: Hospital managers were moderately satisfied with the national accreditation system. Developing job description and person specification for accreditation surveyors and recruiting them accordingly, and providing professional education and training for them help improve the effectiveness of Iranian hospital accreditation method. The method of hospital accreditation in Iran has to be changed. Self-assessment, unannounced surveys, review of hospital key performance indicators and patient satisfaction surveys should be added to the current scheduled on-site surveys to enhance the credibility of the accreditation result. |
Ali Mohammad Mosadeghrad , Mahnaz Afshari ,
Volume 75, Issue 10 (January 2018)
Volume 75, Issue 10 (January 2018)
Abstract
Background: Hospitals are dealing with unlimited demands and limited resources. Hospital managers should use appropriate strategies to improve quality of services, enhance patients’ satisfaction and increase financial resources. This study aimed to examine the impact of quality management.
Methods: A participatory action research was used for the intervention on income of operating theatre in Vali-e-Asr Hospital in Tehran University of Medical Sciences, between March and September 2014. A quality improvement team was established and improved operational processes of the operating theatre department of the hospital using Mosadeghrad’s ten-step quality management model. The quality improvement team standardized processes, identified goals for the processes and improved them until achieved the goals. Accordingly, an action plan was developed and implemented for increasing the income of the operating theatre department. Income data of the operating theatre department were obtained for a 6-month period in 2014, and were compared with a control 6-month period in 2013.
Results: Implementing quality management increased the number of surgeries by 14.96 percent, decreased cancelled surgeries by 14.6 percent and reduced bill deductions imposed by health insurance companies by 44.9 percent. As a result, the operation theatre department income has increased by 68.8 percent (P=0.028). Some of solutions used for increasing the income were as standardizing and improving working processes, removing unnecessary activities, empowering staff; increasing department’s working hours, on time visit of patients by doctors and surgeons, reducing surgery cancellations, increasing number of patients, reducing deductions applied by the health insurance companies and training staff and patients.
Conclusion: Implementing an appropriate quality management model appropriately helps improve quality of services and enhance hospital departments’ income.
Methods: A participatory action research was used for the intervention on income of operating theatre in Vali-e-Asr Hospital in Tehran University of Medical Sciences, between March and September 2014. A quality improvement team was established and improved operational processes of the operating theatre department of the hospital using Mosadeghrad’s ten-step quality management model. The quality improvement team standardized processes, identified goals for the processes and improved them until achieved the goals. Accordingly, an action plan was developed and implemented for increasing the income of the operating theatre department. Income data of the operating theatre department were obtained for a 6-month period in 2014, and were compared with a control 6-month period in 2013.
Results: Implementing quality management increased the number of surgeries by 14.96 percent, decreased cancelled surgeries by 14.6 percent and reduced bill deductions imposed by health insurance companies by 44.9 percent. As a result, the operation theatre department income has increased by 68.8 percent (P=0.028). Some of solutions used for increasing the income were as standardizing and improving working processes, removing unnecessary activities, empowering staff; increasing department’s working hours, on time visit of patients by doctors and surgeons, reducing surgery cancellations, increasing number of patients, reducing deductions applied by the health insurance companies and training staff and patients.
Conclusion: Implementing an appropriate quality management model appropriately helps improve quality of services and enhance hospital departments’ income.
Ali Mohammad Mosadeghrad , Negar Mirzaee , Mahnaz Afshari , Alireza Darrudi ,
Volume 76, Issue 4 (July 2018)
Volume 76, Issue 4 (July 2018)
Abstract
Background: Tariff setting in healthcare is an important control knob affecting the quality, access and cost of services. As part of Iran Health Transformation Plan (HTP) in 2014, the relative value of health care and services was increased to motivate healthcare providers to deliver high quality services. This study aimed to examine the impact of HTP on health services tariffs.
Methods: This descriptive and cross-sectional study used the data from California Tariff Book (2013 edition) and the new relative value book (2016 edition). The weighted average of the relative value of the anesthetic and surgical services in both books was calculated and compared.
Results: The California book and the new relative value book had 5281 and 3448 service codes respectively in 13 major medical specialties (34.7 percent reduction of service codes in the new tariff book). Overall, 64985.9 K and 125133.6 K were considered in the California book and the new relative value book (92.6% growth). The California book and the new relative value book considered 25,976 K and 22,307 K for anesthesia services, respectively in those 13 medical specialties (14.1% reduction). The HTP has increased the relative value of healthcare services tariff by 1.9 times in average.
Conclusion: The HTP has doubled the tariff of healthcare services. A rise in the relative value of healthcare services has incurred financial burden on Iranian public health insurance companies and made it difficult to finance health system of the country. A sustainable health financing system should be developed as well a change should be applied in provider payment system to control the cost and increase the health system efficiency.
Methods: This descriptive and cross-sectional study used the data from California Tariff Book (2013 edition) and the new relative value book (2016 edition). The weighted average of the relative value of the anesthetic and surgical services in both books was calculated and compared.
Results: The California book and the new relative value book had 5281 and 3448 service codes respectively in 13 major medical specialties (34.7 percent reduction of service codes in the new tariff book). Overall, 64985.9 K and 125133.6 K were considered in the California book and the new relative value book (92.6% growth). The California book and the new relative value book considered 25,976 K and 22,307 K for anesthesia services, respectively in those 13 medical specialties (14.1% reduction). The HTP has increased the relative value of healthcare services tariff by 1.9 times in average.
Conclusion: The HTP has doubled the tariff of healthcare services. A rise in the relative value of healthcare services has incurred financial burden on Iranian public health insurance companies and made it difficult to finance health system of the country. A sustainable health financing system should be developed as well a change should be applied in provider payment system to control the cost and increase the health system efficiency.
Ali Mohammad Mosadeghrad , Ali Akbari-Sari , Taraneh Yousefinezhadi ,
Volume 76, Issue 5 (August 2018)
Volume 76, Issue 5 (August 2018)
Abstract
Background: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. This study aimed to evaluate the hospital accreditation system.
Methods: This descriptive and cross-sectional study was carried out between November 2015 and February 2016 using a questionnaire covering accreditation standards, methods, surveyors, implementation and effects. The study population consisted of 161 hospital managers in Tehran province, Iran. Overall 87 hospital managers were surveyed through stratified random sampling.
Results: The mean score of managers’ satisfaction of hospital accreditation system was 2.93 out of 5 score. About 16 percent of managers were satisfied with the hospital accreditation system. Hospital managers were most satisfied with accreditation effects (3.14) and least satisfied with accreditation standards (2.54). Hospital managers were satisfied with surveyors’ attitude, number of survey days and the number of surveyors in the accreditation team. They were least satisfied with the lack of consistency among surveyors, lack of transparency of standards, too many standards and low competency of surveyors. Hospital managers mostly believed that accreditation should be done by Ministry of Health, compulsory, and every two years. About 97 percent of managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey.
Conclusion: Accreditation was moderately successful in Tehran hospitals. Accreditation had the most effect on improving patient safety and meeting patients' rights and least effect on improving employees' job satisfaction and involving doctors in quality improvement. Strengthening Iran hospital accreditation system, training managers and employees on implementing standards, and providing necessary resources make it possible to achieve accreditation goals.
Methods: This descriptive and cross-sectional study was carried out between November 2015 and February 2016 using a questionnaire covering accreditation standards, methods, surveyors, implementation and effects. The study population consisted of 161 hospital managers in Tehran province, Iran. Overall 87 hospital managers were surveyed through stratified random sampling.
Results: The mean score of managers’ satisfaction of hospital accreditation system was 2.93 out of 5 score. About 16 percent of managers were satisfied with the hospital accreditation system. Hospital managers were most satisfied with accreditation effects (3.14) and least satisfied with accreditation standards (2.54). Hospital managers were satisfied with surveyors’ attitude, number of survey days and the number of surveyors in the accreditation team. They were least satisfied with the lack of consistency among surveyors, lack of transparency of standards, too many standards and low competency of surveyors. Hospital managers mostly believed that accreditation should be done by Ministry of Health, compulsory, and every two years. About 97 percent of managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey.
Conclusion: Accreditation was moderately successful in Tehran hospitals. Accreditation had the most effect on improving patient safety and meeting patients' rights and least effect on improving employees' job satisfaction and involving doctors in quality improvement. Strengthening Iran hospital accreditation system, training managers and employees on implementing standards, and providing necessary resources make it possible to achieve accreditation goals.
Ali Mohammad Mosadeghrad, Abolghasem Pourreza, Neda Akbarpour,
Volume 76, Issue 10 (January 2019)
Volume 76, Issue 10 (January 2019)
Abstract
Background: The prevalence of autism spectrum disorder (ASD) as a child neurodevelopmental disorder has increased significantly during the past 3 decades worldwide and in Iran. This chronic disease does not cause premature death and there is no definitive treatment. Thus, the cost of ASD is extremely heavy and overwhelming. The purpose of this study is to calculate the economic burden of ASD in Iran.
Methods: A cross-sectional descriptive-analytic study was conducted to calculate all-important ASD costs. Two hundred and ninety autism patients in Tehran participated in this study in 2017 with the support of Tehran University of Medical Sciences (TUMS). A valid and reliable questionnaire was used to estimate direct medical costs, direct non-medical costs and indirect costs.
Results: The annual economic burden of ASD is estimated to be 223,561,841 Rials ($6,883 2014 USD) per patient in Tehran, Iran in 2017. Approximately 32%, 52% and 16% of the total cost were direct medical costs, direct non-medical costs, and indirect costs. The average ASD direct cost was $5,765 of which 38% was direct medical costs and 62% was direct non-medical costs. The average annual ASD direct medical cost was $2,215 per patient of which 70%, 16% and 7% were related to rehabilitation, medicine and doctor visit costs. The average annual ASD direct non-medical cost was $3,550 per patient of which 35% was the cost of parents’ immigration to Tehran to receive health care services. The average annual ASD indirect cost for productivity loss from unemployment or reduced work productivity was estimated at $1,118. The largest cost component was parents’ productivity loss due to caregiving (70%).
Conclusion: Autism imposes substantial direct and indirect economic effects on patients and their families. Hence, health policy makers must take the most effective measures to make best use of scarce societal resources, to reduce the cost of the disease for patients and their families and subsequently, reduce its psychosocial burden.
Methods: A cross-sectional descriptive-analytic study was conducted to calculate all-important ASD costs. Two hundred and ninety autism patients in Tehran participated in this study in 2017 with the support of Tehran University of Medical Sciences (TUMS). A valid and reliable questionnaire was used to estimate direct medical costs, direct non-medical costs and indirect costs.
Results: The annual economic burden of ASD is estimated to be 223,561,841 Rials ($6,883 2014 USD) per patient in Tehran, Iran in 2017. Approximately 32%, 52% and 16% of the total cost were direct medical costs, direct non-medical costs, and indirect costs. The average ASD direct cost was $5,765 of which 38% was direct medical costs and 62% was direct non-medical costs. The average annual ASD direct medical cost was $2,215 per patient of which 70%, 16% and 7% were related to rehabilitation, medicine and doctor visit costs. The average annual ASD direct non-medical cost was $3,550 per patient of which 35% was the cost of parents’ immigration to Tehran to receive health care services. The average annual ASD indirect cost for productivity loss from unemployment or reduced work productivity was estimated at $1,118. The largest cost component was parents’ productivity loss due to caregiving (70%).
Conclusion: Autism imposes substantial direct and indirect economic effects on patients and their families. Hence, health policy makers must take the most effective measures to make best use of scarce societal resources, to reduce the cost of the disease for patients and their families and subsequently, reduce its psychosocial burden.
Ali Mohammad Mosadeghrad , Ali Akbari Sari , Taraneh Yousefinezhadi,
Volume 76, Issue 12 (March 2019)
Volume 76, Issue 12 (March 2019)
Abstract
Background: Hospital accreditation is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. Accreditation has an important role in improving the quality, safety, effectiveness and efficiency of hospital services. This study aimed to examine the effects of hospital accreditation program from hospitals managers’ perspective.
Methods: This descriptive and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire designed to examine accreditation effects on hospital performance, hospital employees, patients, and the society. The study population consisted of 914 hospital managers in Iran. Overall, 547 hospital managers were surveyed through stratified random sampling.
Results: About 71% of hospitals achieved grade one and above accreditation status. The mean score of accreditation positive effects in hospitals was 3.16±0.66 out of 5 (Average). Almost 38% of managers were satisfied with the accreditation results in their hospitals. Hospital accreditation program was successful in improving patient and staff safety, reducing medical errors and enhancing staff competencies. Its success in improving communication, promoting organizational culture, continuous quality improvement, resource utilization, and reducing nosocomial infections and hospital mortality rates was moderate. Accreditation was less successful in improving staff satisfaction, getting physicians involved in process improvement, practicing evidence based medicine, attracting patients and increasing hospital income. A statistically significant correlation was found between hospital size and accreditation results (P=0.038, r=-0.090). There was no correlation between using quality management models and getting better accreditation results (P=0.085). However, there was correlation between using accreditation consultants and positive accreditation results (P=0.045, r=-0.087). Utilizing hospital resources, organizational learning, continuous quality improvement and effective communication had the most effect on accreditation success.
Conclusion: The accreditation program had a moderate effect on hospital performance. It is costly to implement accreditation standards in hospitals. Hence, changes should be made to the accreditation system including accreditation standards and methods in order to have more positive effects on the staff and hospitals’ performance.
Methods: This descriptive and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire designed to examine accreditation effects on hospital performance, hospital employees, patients, and the society. The study population consisted of 914 hospital managers in Iran. Overall, 547 hospital managers were surveyed through stratified random sampling.
Results: About 71% of hospitals achieved grade one and above accreditation status. The mean score of accreditation positive effects in hospitals was 3.16±0.66 out of 5 (Average). Almost 38% of managers were satisfied with the accreditation results in their hospitals. Hospital accreditation program was successful in improving patient and staff safety, reducing medical errors and enhancing staff competencies. Its success in improving communication, promoting organizational culture, continuous quality improvement, resource utilization, and reducing nosocomial infections and hospital mortality rates was moderate. Accreditation was less successful in improving staff satisfaction, getting physicians involved in process improvement, practicing evidence based medicine, attracting patients and increasing hospital income. A statistically significant correlation was found between hospital size and accreditation results (P=0.038, r=-0.090). There was no correlation between using quality management models and getting better accreditation results (P=0.085). However, there was correlation between using accreditation consultants and positive accreditation results (P=0.045, r=-0.087). Utilizing hospital resources, organizational learning, continuous quality improvement and effective communication had the most effect on accreditation success.
Conclusion: The accreditation program had a moderate effect on hospital performance. It is costly to implement accreditation standards in hospitals. Hence, changes should be made to the accreditation system including accreditation standards and methods in order to have more positive effects on the staff and hospitals’ performance.
Zahra Imanian, Ali Mohammad Mosadeghrad, Mojtaba Amiri , Mohsen Ghadami , Robert McShery,
Volume 77, Issue 1 (April 2019)
Volume 77, Issue 1 (April 2019)
Abstract
Background: Hospital accreditation is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. Hospital accreditation has an important role in improving quality, safety, effectiveness and efficiency of hospital services. A generic questionnaire is usually used to accredit all hospitals. However, specific instruments should be used for evaluation and accreditation of specialized hospitals considering their unique nature and specific requirements. Thus, this study aimed to develop an accreditation model for children hospitals.
Methods: A mixed method approach was used for such a descriptive and cross-sectional study. First, using a comparative study, accreditation standards and measurement criteria of children friendly hospitals were extracted from 10 well-known hospital evaluation and accreditation models and initiatives. Second, complementary interviews with 57 hospitals senior, middle and front line managers and pediatrics doctors and nurses were conducted to identify more children friendly hospital accreditation standards and measurement criteria. Third, children friendly hospital accreditation standards and criteria were modified considering the Iranian context. Finally, five pediatrics doctors reviewed, modified, finalized and confirmed accreditation standards and criteria.
Results: The Iranian framework for accreditation of children-friendly hospitals was consisted of ten standards covering management and leadership, planning and policy making, education, patient management, employee management, resource management, process management, patients’, employees’ and organization results and 132 measuring criteria. Such a systemic framework covers pediatrics hospitals’ structures, processes, outputs and outcomes. A children friendly hospital achieves better results for employees and patients through strong management and leadership, proper planning and policy making, continuous education and training staff and patients and effective management of employees, patients, resources and processes.
Conclusion: The proposed children-friendly hospitals accreditation model can be used for evaluation and accreditation of children hospitals and provide a clear picture of the performance of these hospitals.
Methods: A mixed method approach was used for such a descriptive and cross-sectional study. First, using a comparative study, accreditation standards and measurement criteria of children friendly hospitals were extracted from 10 well-known hospital evaluation and accreditation models and initiatives. Second, complementary interviews with 57 hospitals senior, middle and front line managers and pediatrics doctors and nurses were conducted to identify more children friendly hospital accreditation standards and measurement criteria. Third, children friendly hospital accreditation standards and criteria were modified considering the Iranian context. Finally, five pediatrics doctors reviewed, modified, finalized and confirmed accreditation standards and criteria.
Results: The Iranian framework for accreditation of children-friendly hospitals was consisted of ten standards covering management and leadership, planning and policy making, education, patient management, employee management, resource management, process management, patients’, employees’ and organization results and 132 measuring criteria. Such a systemic framework covers pediatrics hospitals’ structures, processes, outputs and outcomes. A children friendly hospital achieves better results for employees and patients through strong management and leadership, proper planning and policy making, continuous education and training staff and patients and effective management of employees, patients, resources and processes.
Conclusion: The proposed children-friendly hospitals accreditation model can be used for evaluation and accreditation of children hospitals and provide a clear picture of the performance of these hospitals.
Rostam Zalvand, Mehdi Yaseri, Ali Mohammad Mosadeghrad , Maryam Tajvar,
Volume 77, Issue 2 (May 2019)
Volume 77, Issue 2 (May 2019)
Abstract
Background: Identifying determinants of maternal mortality is essential in developing appropriate health policies for reduction of maternal death. This study aimed to determine the determinants of maternal mortality in Iran during 1990- 2015 and also to identify the trends of these determinants during the same period.
Methods: This is a quantitative longitudinal study that has been conducted at the Tehran University of Medical Science, Iran, from March to December 2018. Initially, a long list of determinants (n=32) were identified through a comprehensive systematic reviews. Variables with more than 25% missing data were omitted and the missing values for remaining variables were estimated through statistical methods. The data for the identified variables were gathered through internal sources including Iran’s Ministry of Health and international sources including the websites of World Bank, World Health Organization and United Nations. Finally, 12 indicators as determinants of death were constructed after data processing and data management and their associations with maternal mortality rate in Iran were examined through regression analysis.
Results: Maternal mortality rate has been reduced by 80% during 1990- 2015 in Iran. Improvement of indicators including employment status, total health expenditure share (as a percent of GDP), vaccination coverage, urbanization, access to health and welfare facilities, GDP per capita and political performance played a significant role in reduction of maternal deaths according to the multivariate analyses. A reduction in out of pocket payment and total fertility rate also showed a significant association with lower maternal mortality. However neither education level in the country nor life expectancy at birth showed an important role in the maternal mortality rate.
Conclusion: Maternal mortality rate was reduced significantly in Iran during the last quarter of the century. Maternal death is not only affected by health and biological factors of mothers, but also, by macro-economic, social and welfare factors. A high political performance of the countries also is a grantor of better health of mothers and the community in general.
Methods: This is a quantitative longitudinal study that has been conducted at the Tehran University of Medical Science, Iran, from March to December 2018. Initially, a long list of determinants (n=32) were identified through a comprehensive systematic reviews. Variables with more than 25% missing data were omitted and the missing values for remaining variables were estimated through statistical methods. The data for the identified variables were gathered through internal sources including Iran’s Ministry of Health and international sources including the websites of World Bank, World Health Organization and United Nations. Finally, 12 indicators as determinants of death were constructed after data processing and data management and their associations with maternal mortality rate in Iran were examined through regression analysis.
Results: Maternal mortality rate has been reduced by 80% during 1990- 2015 in Iran. Improvement of indicators including employment status, total health expenditure share (as a percent of GDP), vaccination coverage, urbanization, access to health and welfare facilities, GDP per capita and political performance played a significant role in reduction of maternal deaths according to the multivariate analyses. A reduction in out of pocket payment and total fertility rate also showed a significant association with lower maternal mortality. However neither education level in the country nor life expectancy at birth showed an important role in the maternal mortality rate.
Conclusion: Maternal mortality rate was reduced significantly in Iran during the last quarter of the century. Maternal death is not only affected by health and biological factors of mothers, but also, by macro-economic, social and welfare factors. A high political performance of the countries also is a grantor of better health of mothers and the community in general.
Alimohammad Mosadeghrad,
Volume 77, Issue 3 (June 2019)
Volume 77, Issue 3 (June 2019)
Abstract
Mehrdad Mohammadi, Jamshid Faghri,
Volume 77, Issue 4 (July 2019)
Volume 77, Issue 4 (July 2019)
Abstract
Background: Staphylococcus aureus is a common pathogen in human that can be the cause of a wide range of infectious diseases including bacteremia, pneumonia, cellulitis, and osteomyelitis and skin and soft tissue infections. The coagulase enzyme is one of the most important virulence factors of this bacterium. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) Coa pattern is one of the molecular base typing methods. Molecular typing plays an important role in epidemiological studies of nosocomial infection, such as methicillin-resistant Staphylococcus aureus (MRSA) infection. The PCR-RFLP Coa gene technique provides a useful preliminary method to monitor variations in MRSA populations. We were done Coa-RFLP typing according to the method of Hookey et al., with some modifications.
Methods: In this cross-sectional study, one-hundred fifty isolates of S. aureus from urine and blood samples of patients that collected from educational hospitals of Imam Hossein and Al Zahra Isfahan University of Medical Sciences, Iran, from February 2018 to October 2018 were analyzed. After bacterial confirmation of isolates by Coa gene in polymerase chain reaction (PCR) technique, to perform coagulase gene typing, the repeated units encoding hypervariable regions of the coagulase gene of S. aureus were amplified by PCR. This was followed by AluI restriction enzyme digestion and analysis of restriction fragment length polymorphism (RFLP) patterns.
Results: Of 150 samples, 45 isolated of S. aureus were confirmed by biochemical methods. Of previous positive samples, 36 (80%) isolates carried Coa gene. Two different genotypes of Coa gene were obtained that include bp680 fragment in 20 specimens and bp750 fragment in 16 specimens. After enzymatic digestion by AluI restriction enzyme for RFLP, four different restriction patterns were obtained that including, the 280+400 pattern in 16 specimens (44.4%), 280+470 pattern in 7 specimens (19.4%), 340+340 pattern in 6 specimens (16.6%) and 750 patterns without digestion were in 7 specimens (19.6%).
Conclusion: Using the present experiments, it was determined that the PCR-RFLP pattern, 280+400, was the dominant pattern in the Staphylococcus aureus samples isolated in Isfahan.
Methods: In this cross-sectional study, one-hundred fifty isolates of S. aureus from urine and blood samples of patients that collected from educational hospitals of Imam Hossein and Al Zahra Isfahan University of Medical Sciences, Iran, from February 2018 to October 2018 were analyzed. After bacterial confirmation of isolates by Coa gene in polymerase chain reaction (PCR) technique, to perform coagulase gene typing, the repeated units encoding hypervariable regions of the coagulase gene of S. aureus were amplified by PCR. This was followed by AluI restriction enzyme digestion and analysis of restriction fragment length polymorphism (RFLP) patterns.
Results: Of 150 samples, 45 isolated of S. aureus were confirmed by biochemical methods. Of previous positive samples, 36 (80%) isolates carried Coa gene. Two different genotypes of Coa gene were obtained that include bp680 fragment in 20 specimens and bp750 fragment in 16 specimens. After enzymatic digestion by AluI restriction enzyme for RFLP, four different restriction patterns were obtained that including, the 280+400 pattern in 16 specimens (44.4%), 280+470 pattern in 7 specimens (19.4%), 340+340 pattern in 6 specimens (16.6%) and 750 patterns without digestion were in 7 specimens (19.6%).
Conclusion: Using the present experiments, it was determined that the PCR-RFLP pattern, 280+400, was the dominant pattern in the Staphylococcus aureus samples isolated in Isfahan.
Ali Mohammad Mosadeghrad, Leili Eslambolchi,
Volume 77, Issue 4 (July 2019)
Volume 77, Issue 4 (July 2019)
Abstract
Ali Mohammad Mosadeghrad , Parvaneh Isfahani ,
Volume 77, Issue 6 (September 2019)
Volume 77, Issue 6 (September 2019)
Abstract
Background: Unnecessary patient admission to a hospital refers to the hospitalization of a patient without clinical indications and criteria. Various factors related to the patient (e.g., age, disease severity, payment method, and admission route and time), the physician and the hospital and its facilities and diagnostic technologies affect a patient unnecessary admission in a hospital. Unnecessary patient hospitalization increases nosocomial infections, morbidity and mortality, and decreases patient satisfaction and hospital productivity. This study aimed to measure unnecessary patient admissions in hospitals in Iran.
Methods: This study was conducted using a systematic review and meta-analysis at Tehran University of Medical Science in August 2019. Seven electronic databases were searched and evaluated for original research papers published between March 2006 and 2018 on patients’ unnecessary admission to a hospital. Finally, 12 articles were selected and analyzed using comprehensive meta-analysis software.
Results: All studies used the appropriateness evaluation protocol (AEP) for assessing patients’ unnecessary hospitalization in the hospitals. Overall, 2.7% of hospital admissions were rated as inappropriate and unnecessary (CI 95%: 1.5-4.9%). The highest unnecessary patients’ admissions were 11.8% in a teaching hospital in Meshginshahr city in 2016, (CI 95%: 8.8%-15.8%) and the lowest unnecessary patients’ admissions was 0.3% in a teaching hospital in Yasuj city in 2016 (CI 95%: 0%-3.6%). Unnecessary patient admission in public hospitals was higher than private hospitals. A significant statistical correlation was observed between unnecessary patient admission, and sample size (P<0.05).
Conclusion: The rate of unnecessary hospital admission in Iran is low. However, hospital resources are wasted due to unnecessary admissions. Expanding the primary health care network, reducing hospital beds, introducing an effective and efficient patient referral system, using a fixed provider payment method, and promoting residential and social services care at macro level, and establishing utilization management committee, using the appropriateness evaluation protocol, establishing short-stay units, and implementing quality management strategies at the hospital level are useful strategies for reducing avoidable hospital admissions.
Methods: This study was conducted using a systematic review and meta-analysis at Tehran University of Medical Science in August 2019. Seven electronic databases were searched and evaluated for original research papers published between March 2006 and 2018 on patients’ unnecessary admission to a hospital. Finally, 12 articles were selected and analyzed using comprehensive meta-analysis software.
Results: All studies used the appropriateness evaluation protocol (AEP) for assessing patients’ unnecessary hospitalization in the hospitals. Overall, 2.7% of hospital admissions were rated as inappropriate and unnecessary (CI 95%: 1.5-4.9%). The highest unnecessary patients’ admissions were 11.8% in a teaching hospital in Meshginshahr city in 2016, (CI 95%: 8.8%-15.8%) and the lowest unnecessary patients’ admissions was 0.3% in a teaching hospital in Yasuj city in 2016 (CI 95%: 0%-3.6%). Unnecessary patient admission in public hospitals was higher than private hospitals. A significant statistical correlation was observed between unnecessary patient admission, and sample size (P<0.05).
Conclusion: The rate of unnecessary hospital admission in Iran is low. However, hospital resources are wasted due to unnecessary admissions. Expanding the primary health care network, reducing hospital beds, introducing an effective and efficient patient referral system, using a fixed provider payment method, and promoting residential and social services care at macro level, and establishing utilization management committee, using the appropriateness evaluation protocol, establishing short-stay units, and implementing quality management strategies at the hospital level are useful strategies for reducing avoidable hospital admissions.
Ali Mohammad Mosadeghrad,
Volume 77, Issue 8 (November 2019)
Volume 77, Issue 8 (November 2019)
Abstract
Full Text in Persian
Ali Mohammad Mosadeghrad,
Volume 77, Issue 12 (March 2020)
Volume 77, Issue 12 (March 2020)
Abstract
Full Text in Persian.
Ali Mohammad Mosadeghrad , Parvaneh Isfahani, Taraneh Yousefinezhadi,
Volume 78, Issue 4 (July 2020)
Volume 78, Issue 4 (July 2020)
Abstract
Background: Medical errors are those errors or mistakes committed by healthcare professionals due to errors of omission, errors in planning, and errors of execution of a planned healthcare action whether or not it is harmful to the patient. Medical error in hospitals increases morbidity and mortality and decreases patient satisfaction and hospital productivity. This study aimed to determine the prevalence of medical errors in Iranian hospitals.
Methods: This study was conducted using systematic review and meta-analysis approaches. All articles written in English and Persian on the prevalence of medical errors in Iranian hospitals up to March 2019 were searched in Web of Science, PubMed, Elsevier, Scopus, Magiran, IranMedex and Scientific Information Database (SID) databases, and Google and Google Scholar search engines. In addition, reference lists of the retrieved papers were hand-searched. A total of 9 studies matching the inclusion criteria were identified, reviewed, and analyzed using comprehensive meta-analysis software.
Methods: This study was conducted using systematic review and meta-analysis approaches. All articles written in English and Persian on the prevalence of medical errors in Iranian hospitals up to March 2019 were searched in Web of Science, PubMed, Elsevier, Scopus, Magiran, IranMedex and Scientific Information Database (SID) databases, and Google and Google Scholar search engines. In addition, reference lists of the retrieved papers were hand-searched. A total of 9 studies matching the inclusion criteria were identified, reviewed, and analyzed using comprehensive meta-analysis software.
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Results: The prevalence of medical errors was reported in 9 studies and prevalence rate ranged from 0.06% to 42%. Most studies used reporting forms completed by hospital employees for determining the prevalence of medical errors (67%). Only three studies collected data by reviewing patients’ medical records. Accordingly, the overall prevalence of medical error in Iran's hospitals based on the nine published articles was 0.01% (95% Cl 0%-0.01%) during 2008 to 2017. The highest medical error was recorded in a hospital in Shiraz, 2.1% (95% Cl: 1.4%-2.7%) in 2012. A significant statistical correlation was observed between medical errors and sample size (P<0.05).
Conclusion: The prevalence rate of medical error in Iran is low. It is strongly recommended to use more advanced and valid methods such as occurrence reporting, screening, and the global trigger tool for examining medical errors in Iranian hospitals. Proving adequate education and training to patients and employees, simplifying and standardizing hospital processes, enhancing hospital information systems, improving communication, promoting a safety culture, improving employees’ welfare and satisfaction, and implementing quality management strategies are useful for reducing medical errors. |
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