International Journal of Hospital Research
Volume:8 Issue: 1, Winter and Spring 2019

Risk-adjusted Bernoulli control chart is one of the main tools for monitoring multistage healthcare processes to achieve higher performance and effectiveness in healthcare settings. Using parameter estimates can lead to significantly deteriorate chart performance. However, so far, the effect of estimation error on this chart in which healthcare services delivery is considered as Bernoulli response variable has not been surveyed. We examined the effect of estimation error on the in- and out-control performance of Bernoulli Group Exponentially Weighted Moving Average (GEWMA) risk-adjusted chart for multistage healthcare processes. In this paper, the effect of estimation error is indicated by run length properties using repeated sampling of the data under different scenarios in both in- and out-of-control situations. In this regard, three methods of increasing sample size, adjusting control limit, and applying Dynamic Probability Control Limits (DPCL) are proposed to diminish the effect of estimation error on the proposed chart. Also, DPCL are applied in both zero- and steady-states. Simulation results showed that estimation error can have a substantial effect on Bernoulli GEWMA risk-adjusted chart performance. Also, results show that the effect of estimation error can be serious, especially if small samples are applied. Using our simulation, control limit can be adjusted in a given sample size to reduce the effect of parameter estimation for medical situations in which there is not enough sampling data. Applying the DPCL has the superior performance than the other proposed methods to reduce the estimation error especially in steady state. Moreover, a comprehensive analysis on results allows us to provide suitable sample size recommendations in constructing these charts to reach a desired hospital performance.

 The purpose of this study was to develop a structural model of psychological well-being based on optimism, resilience and positive thinking through mediation of emotional regulation.  The research method was descriptive-correlational. The population under study was a graduate students of the Faculty of Humanities and Social Sciences of Islamic Azad University, Science and Research Branch of Tehran. 358 of them were selected by stratified random sampling, proportional to the number of undergraduate and postgraduate students. Participated in the research. Data analysis was performed using Pearson correlation coefficient and Structural Equation Modeling with Emo software. The results showed that the effect of optimism on emotional regulation and psychological well-being was positive and significant. All questions has factor loadings above 0.3 and are significant, while the p-value was less than 0.05. The effect of resilience on emotional regulation and psychological well-being is positive and significant. The positive effect of thinking on emotional regulation and psychological well-being is positive and significant. The effect of emotional regulation on psychological well-being is positive and significant. Optimism through emotional regulation has a positive and significant indirect effect on psychological well-being. Exposure through emotional regulation has a positive and significant indirect effect on psychological well-being. Positive thinking through emotional regulation has a positive and significant indirect effect on psychological well-being.  It can be concluded that variables of optimism, resilience, positive thinking and emotional regulation can predict psychological well-being and the tested model has a suitable fit.

Nowadays, using umbilical cord blood (UCB) as a rich source of hematopoietic stem cells has been an important issue for both researchers and physicians in many parts of the world. According to the benefits of using cord blood in curing disorders, awareness of parents about cord blood utility and cord blood banking is important. The aim of the study was to evaluate the knowledge and willingness of Iranian pregnant women and also the information level of doctors about cord blood banking.
This is a survey that conducted among at least 28 weeks 824 pregnant women and 152 Obstetric-Gynecologists (OB-GYNs) in private hospitals of 24 provinces of Iran to evaluate the knowledge using a questionnaire.
Our finding indicated that 38.7% of participants were aware of cord blood banking and less than 50% of doctors had complete information about cord blood usage. The mother’s attitude is related to their doctor’s recommendation. The results show that the level of education, employment status, and occupation, income has an impact on the parent’s attitude for cord blood banking.
The level of knowledge among the pregnant women about cord blood usage is low totally. Even the doctors had not complete awareness about cord blood banking. Hence the most of the women tend to get advice from their physician; we should try to introduce Royan cord blood bank and the advantages of cord blood stem cells via holding congresses and medical gathering.

The production of science and research has always been one of the indicators of scientific progress that advances social, economic, social, cultural, and so on. The purpose of this study was to investigate the structural relationships between the performance variables of graduate students' performance with the performance of faculty members with the role of intermediate motivation for academic achievement and self-efficacy of students.
The design of this research was relational. The statistical population of the study was all postgraduate students of the University of Tehran during the academic year of 1969-98. A total of 648 people were selected through stratified sampling. The research tools were questionnaire of student evaluation of teachers' educational performance, Educational Achievement Motivation Questionnaire, Commodity Inventory Questionnaire and Research Performance Questionnaire. The data was compiled using two spss and lisrel software.
The mean and standard deviation of students' research performance from 24 points were 4.77 ± 2.61. The structural effect of academic achievement motivation on self-efficacy and research performance was significant. The effect of teacher training performance on students' research performance was significant. The value of 0.17 of variance of research performance by model variables, 0.31 of self-efficacy variable was explained by the variable of motivation of academic achievement and teaching performance of faculty members, and 0.57 of the motivation variable of academic achievement was explained by the teacher's educational performance variable. The effect of educational performance of faculty members on the motivation of academic achievement and self-efficacy was significant on student's research performance.
It can be concluded that the performance of teaching faculty is one of the important variables on other important educational structures of the students.

Background and objective : Milk as a complete food source comes from a variety of sources, including cattle, goats, sheep and buffalo, for human consumption. Knowledge of fungal diversity in the environment is poor compared with bacterial biodiversity. The main objective of this study is to identify the raw milk in healthy conditions.  
 In this study, milk samples collected from 14 industrial dairy farms in Alborz and Tehran Provinces were examined. 262 milk tank samples were cultured and then DNA of filamentous fungi were extracted and amplified rDNA16s -ITS-1.ITS-4 region was identified using sequencing test.
 This review was conducted from February 2017 to January 2018. 11.8% cases were identified with filamentous fungi including the following genera and species. Results demonstrated that the key point is that mycotoxin M1 is reduced in the pasteurization process, and its risk is also reduced but not removed; thus, new techniques and better technology are needed to overcome this problem.
 The microbial milk contamination source comes from herd hygiene and health status, mastitis prevalence, production environment, and milking parlor and milk conserving practices in dairy farm. Moreover, these facts are implicated in milk quality and milk spoilage and unsafe dairy products. The milk production system and the dairy plant operations keep track in pasteurized milk and fresh dairy products reviewing the traceability in field situational diagnosis report.

Medical tourism is of great importance to the economy and society. Due to its high capacity to create foreign exchange earnings, job creation, high competitive advantage through the export of health services and helping a country to engage constructively with the region, the international system and gain strategic position. Iran has the potential to become one of the leading countries in the field of medical tourism. The main purpose of the research is to propose the procedure for developing the health tourism.
Data needed for conceptualization of policy were collected from interviews with 9 experts and experts in related organizations. Based on the conceptualization results, a four-layer model was developed based on four main questions of the research, whose core is policy objectives. Then, the features of the policy and its tools are identified, and then the involved entities and the main actors are involved in the design, explanation, development and implementation of policies.
Results showed that economic drive and medical tourism experience is one the major factors that have driven them to be actively promoting medical tourism industries. Each policy needs were forecasted and targets were defined in the process of formulating the health policies. The policies were then implemented accordingly.
 
The four-layer model, according to interviews, could lead to the development of policy-making in medical tourism in the country. On the basis of this, at the end of the application, proposals are presented based on each dimension.

The Department of Medical Services has a long-standing goal to improve the quality and operation of clinical management by efficient use of materials. The present undertaking structures and aspects of the continuing critical evaluation of current support operations in the Medical service department (MSD) -constraint semi-governmental emergency centers, including the re-appropriation and eventual management of temporary workers and services. The key test is to see how maintenance activities can be managed even more easily and conducted more cleverly. In this paper, a mechanism was developed to answer these questions: only with correcting the processes and at the lowest cost possible, how can we improve the maintenance operations?

For this purpose, current procedures and circumstances in 2 general hospitals in Mazandaran province in Iran are studied and data were gathered via questionnaire, interviews, and observation from 66 people including managers, supervisors, and employees. 56 questions were posed about 5 factors affecting maintenance management and their reliability was confirmed through the Cronbach's alpha method. To analyze these questions, a wide range of statistical techniques such as Spearman's rank correlation coefficient, Chi-squared test, Cramer’s V and Factor Analysis were used by SPSS software. Then for a more accurate survey, tools like Critical Success Factors, Key Performance Indicator, the theory of constraints & the Current Reality Tree are utilized.

Results have shown that effective factors in the improvement of maintenance management can be divided into 4 important principles called continuous learning, clarity in policies and procedures, encouraging innovation and balancing the number of maintenance employees with the work volume.

These four principles can form a useful framework with the lowest cost to improve the current maintenance management procedure in the hospitals which are under review in this paper’s case study.

Different occupational environments have serious effects on health and life quality. Paying attention to nurses’ abilities and beliefs in work situation is important not only of keeping them healthy but also as people who are responsible for health of other society members. This study was performed to compare the religious belief, quality of life and resilience in nurses of special care units and general care units, and also how religious beliefs and quality of life can predict nurses' resilience. This descriptive-cross sectional study was performed on 288 nurses working in special care units and general care units in all hospitals (public and private) in 2015 in Urmia city by systematic random sampling. Data collection tools were: 1- Quality of Life Scale (WHOQOL-BREF), 2- Systems of Belief Inventory (SBI-15-R), and 3- Caregiver Burden Inventory (Resilience).   Data were analyzed using SPSS version 21 Software. Mean scores of quality of life, resilience, and religious belief showed no significant differences between nurses in two units.  Results also showed that quality of life can predict nurses’ resilience. According to results, the effect of religious beliefs on nurses' resilience (3.903) at 0.001 is negative and not significant, but the effect of quality of life on vibration (0.485) at 0.001 is positive and significant. This study concluded that the better nurses’ quality of life leads to increasing their resiliency. The findings showed significant effectiveness of spiritual- religious interventions on increasing the resilience of family members of patients.

Ventilator-associated pneumonia is defined as inflammation of the lung parenchyma due to infectious agent activity 48 hours after the start of mechanical ventilation in patients who have tracheal intubation and did not have pneumonia at the time of intervention. Due to the lack of local information available, the high mortality rate and the results of this study can help improve child care standards under mechanical ventilation in NICU. The aim of this study was to investigate the incidence of ventilator-associated pneumonia and its related risk factors in patients admitted to neonatal intensive care unit (NICU)  in  Ardabil city hospital.

This descriptive cross- sectional study was performed on 100 neonates admitted to NICU of Bu-Ali hospital in Ardabil city in 2018. For each neonates, necessary information were collected by a checklist including incidence of ventilator-associated pneumonia and related risk factors. Collected data were analyzed by statistical methods in SPSS version 19.

In this study, 100 neonates admitted to NICU of Ardabil city hospital, 61% of them were boys and the rest were girls. Out of all neonates, 48% had ventilator-associated pneumonia. There was a significant relationship between duration of mechanical ventilation time and the incidence of ventilator-

The main purpose of this research was to find a proper Poly Vinyl Chloride (PVC) stabilizer system for medical purpose. It was sterilized by ethylene oxide gas, constant ratio of metallic soap stabilizers (calcium-zinc stearate) as well as stabilizers based on organotin (octyle sn-mercaptide, which is commercially known as 17mok901) and soybean oil were studied.
PVC S-6058 with value=60 from Iran Petrochemical Commercial Company, di-2 ethyl hexil phethalate plasticizer from Iran Azarshimi Company, epoxide soya bean oil (from South Africa’s MBT Company), calcium-zinc stearate (from India’s Shital Company), octyl tin mercaptide, commercially known as 17® MOK 901, (from India’s Shital Company) and BHT (2,6-di-tert-butyl-4-methyl phenol) anti-oxidant (commercially known as Lanxess from Germany’s Volkanux Company) were provided and utilized during the research. PVC mixtures prepared by the aforementioned stabilizers were tested under mechanical testing, thermal gravimetric analysis (weight measurement under heating) (TGA) and Fourier transform infra-red (FTIR) (determination of functional groups in the stabilized PVC) before and after sterilization by ethylene oxide gas.
Assessment of blood compatibility of samples was done by Hemolysis test, according to ISO 10993 standard part 4. Results of the tensile test demonstrated that calcium-zinc stearate was the best PVC stabilizer. In order to improve its tensile properties, with 2.67 strain rate, sterilization improved its mechanical properties while preserving strength.
The results from Fourier transform infra-red (FTIR) on chemical structures of samples suggested that sterilization by ethylene oxide gas had no negative effect on the structure of the stabilized PVC. Furthermore, the mixture made from PVC had stabilized on organotin and was of higher thermal stability as well as had better blood-compatibility properties with respect to other stabilizers. This confirms acceptable efficiency of stabilizers utilized for hygienic and medical purposes.

One of the most important factor of developing countries is the quality of services in health and hygiene. In this paper previous study on factors affecting the quality of health services show that prioritization of all factors has not been done. Therefore, in this paper, it is attempted to identify and rank the factors affecting the quality of health services., our purpose is to rank final factor for strengthening factor and increasing the quality of healthcare services according to experts from Imam Reza hospital by using COPRAS RUGH.
This research is launched to identify an evaluation of criteria. The case of study is considered Imam Reza hospital and the questionnaire paper distributed between 400 patients. The identified criteria are timeliness, capitalization, feasibility, and infrastructure.
Based on the obtained final rating, it is detected that the standard of healthcare services presented in a hospital is a factor that can be expanded than others. Considering the newly established Imam Reza hospital in Qom province, the presentation of healthcare services requires an evaluation and repetitious inquiry until this hospital enables to present high-quality healthcare services.
In fact, the ranking of factors above is important in management decisions and could be conducive to the concentration of managers on expressed factors. After calculating the final value of each factor from positive and negative criteria, the ultimate value of each option will be calculated and standard and skill factors evaluated first and second factors respectively.

The current research was conducted to develop a mindfulness skill educational package specific for children with oppositional defiant disorder (ODD) and examining its effectiveness on the child, parent, teacher, and peers interactions.
This research has used a mixed type method. In the conducted qualitative stage, the grounded theory method was used. To analyze the data, thematic analysis was used and the educational package was developed and validated. In the quantitative section of the research, the quasi-experimental design of heterogeneous groups was used. A total of 40 subjects were selected by convenient sampling method and they were assigned into two experimental and control groups. The instruments used in the current research included Pianetta Parent-Child Interaction Questionnaire, Student and Teacher Communication Questionnaire.
Based on the implementation of the follow-up test, the collected data were analyzed using repeated measures test ANOVA. The results of this research suggested that the effect of mindfulness education on the variables of conflict and interaction with peers was significant. In the post-test, the scores had improved, but this effect was not maintained in the follow-up test. However, in other variables (closeness, dependency, and interaction with the teacher), the effect of mindfulness education was not significant.
The components of the mindfulness educational package (specific for ODD children) were identified using library studies and through interviewing with child psychology specialists. The review of theoretical and research showed that the role of teachers in the interaction of students and teachers is more prominent than the role of students in this interaction. Therefore, teacher's behaviors are more important in improving child and teacher interaction and should be the focus of interventions.