فهرست مطالب عرفان خوارزمی

The advantages of telemedicine for the elderly are well known, but there are scattered studies on how to better prepare, implement, and evaluate it for older people in the world. It seems necessary to conduct a study to identify the managerial requirements for providing telemedicine to older people. Therefore, the present study aims to review the managerial requirements for providing telemedicine services to the elderly.

This review study was conducted based on the 5-step approach of Arksey & O’Malley. Related studies were identified by searching in three databases of Scopus, Web of Science, and PubMed as well as searching for gray literature in Google Scholar. This search was limited to articles published from 2010 to 2022. Inclusion criteria were the study of the managerial requirements of telemedicine in three stages of preparation, implementation and evaluation, publishing from 2010 to 2022, written in English or Persian language or having English abstracts with sufficient evidence for extraction, and availability of full texts. There were no restrictions regarding the country of study. The studies with no access to their full texts were excluded. 

In total, 209 primary concepts, 55 unique concepts, 21 primary themes and 7 main themes regarding the preparation, implementation and evaluation stages were extracted. Out of 38 reviewed studies, 34 were related to the preparation stage, 32 related to the implementation stage, and 13 related to the evaluation stage. The need for organizing resources and manpower in the preparation stage, the need for monitoring, preservation and maintenance in the implementation stage, and the need for evaluation of long-term outcome and scalability of technology in the evaluation stage had the highest level of importance compared to other requirements.

The number of studies on managerial requirements of telemedicine in the implementation and evaluation stages is lower than the studies on the requirements in the preparation stage. It is necessary to identify these requirements in all stages. This study provides valuable information about managerial requirements for providing telemedicine services to the elderly, which can help managers and policy makers in the health system in promoting the quality and accessibility of telemedicine services for older adults.

Estimation of cost functions is an appropriate tool for optimal resource allocation in hospitals. The present study aimed at estimating cost function for hospitals affiliated to Shiraz University of Medical Sciences.                              

 In the current cross-sectional study, inputs, costs and resources data for 28 hospitals were gathered from hospital statistics and information system. Required data were collected monthly for two years (2015-2016). Then, The Cobb-Douglas cost function was estimated using panel data analysis. STATA 14 was used for data analysis.

Estimates showed that hospitalschr('39') cost elasticity concerning the inpatient and outpatient admission were 0.555 and 0.058 for large hospitals, and 0.769 and 0.099 for small hospitals (P<0.01). Among hospitals inputs, the cost of a physician with coefficient 0.175 in large hospitals and 0.481 in small hospitals (P<0.01) was most cost driver. In studied hospitals, average cost (36,406,480 Rial) was higher than marginal cost (26,548,020). Moreover, scale economies index were in small, large, and all hospitals were 0.868, 0.613 and 0.729, respectively. The number of active bed, length of stay and teaching activity had a positive effect on hospitals cost (P<0.01).

According to the findings, to control costs, the hospital should manage most cost drivers, such as physicians and pharmaceutical costs. Moreover, According to the average and final cost and scale economies index, hospitals should expand their service provisions with current inputs and resources in order to reach the optimum point of output.

The primary aim of the financial reporting system is to provide qualified information. The aim of this study was to investigate the relationship between managers’ attitudes toward the quality of financial reports presented in Hormozgan University of Medical Sciences in 2018.

This was a descriptive-analytical study. The statistical population of this study comprised 50 senior and middle managers of Bandar Abbas University of Medical Sciences who were selected by census in 2018. Data were analyzed using a standard questionnaire containing 29 statementsby SPSS 21 using descriptive statistics, T-test, and ANOVA.

The results showed that there is a significant relationship between the average dimensions, the relevance of financial information, the accuracy of presenting information and understandability of information with gender in managers toward the quality of provided financial reports. Also, significant relationship exists between the comprehensibility of financial information with marital status, the accuracy and comprehensibility of information with age group, the relevance,accuracy and comprehensibility of financial information, with the managers' level of education, the comprehensibility of information with managers' work experience, the accuracy and relevance of financial information with the type of managers' employment.

The results of data analysis showed that the highest mean was related to the "relevance of financial information". As stated, information is relevant to help users anticipate past, present, and future events or be able to confirm or adjust their past expectations. Since most of the problems of today's organizations are economic problems, it is necessary to overcome these problems and solve them, to predict the present situation with the help of past and present information. Therefore, the highest average is assigned to this dimension.

Low physical activity during the past decades has increased incidence of diabetes and hypertension in human societies. The aim of this study was determination of the impact of education based on Trans-Theoretical Model on promotion of physical activity among children of patients with hypertension and diabetes.
According to the type of the study, objectives and research hypotheses 179 children's of patients with hypertension and diabetes (under coverage of rural health centers in Firuzabad) were selected for this interventional clinical trial research using multistage sampling method. After educational need analysis, case group was trained within three two-hour sessions using different practices. To achieve objectives and assess the intervention effects, a questionnaire, that its validity and reliability were already verified, was completed before and after 6 months of training courses. Data were analyzed by descriptive statistics, t-test, Chi-square, correlation and Mam-whitney tests using SPSS18 software.
Mean age of the individuals was 41.43±17.57 in control group and 41.65±15.85 in case group. Marital status was significantly different in two groups. On decisional-balance and before the intervention, no significant differences were observed in physical activity between case and control groups who were in the process of precontemplation and contemplation. However, in contemplation, action and maintenance stages there were significant differences between two groups after the intervention. After the intervention, there were significant differences in average scores of cognitive-behavioral process and self-efficacy between two groups in contemplation, action and maintenance stages; the average scores in cases being higher than the controls (p The intervention program based on Trans Theoritical Model caused progress and promotion in physical activity of patients’ children. It is recommended to implement practical program at the community level for all of the children.

Shift work as a social phenomenon is one of the effective factors on operation of health workers which can have significant impacts on their health. Hence, the current study was conducted to determine the effect of shift working on health problems and the risk factors causing these disorders among nurses.
This cross-sectional study was carried out on 189 nurses selected randomly from Shahid Namazi and Shahid Faghihi hospitals. The data collection tool was the "Survey of Shift Worker" standard questionnaire. Data were then analyzed by SPSS 16 software using Pearson coefficient of correlation test.
The results showed that the highest prevalence of problems caused by shift work was related to individual, family, and social life disorders. Moreover, the compulsory selection of shift work system has reduced job satisfaction (p = 0.001).
Based on the findings, shift working could be associated with physical complications such as cardiovascular diseases and disturbances in circadian rhythm, as well as mental disorders in nurses. Therefore, it is necessary for nursing authorities to plan shifts more precisely regarding factors such as employee's age and job experience.

With regard to novel plans in the health sector، including “Health Sector Evolution” and changes of hospitals’ issues، change and innovation skills are considered essential for hospital administrators. This study aimed to determine the relationship between management style and change and innovation skills of administrators in Teaching Hospitals of Shiraz University of Medical Sciences in 2009. This was a cross-sectional and descriptive-analytical survey. Study samples were 9 managers and 135 headquarter staff of hospitals affiliated to Shiraz University of Medical Sciences. Data were collected using the management style questionnaire of Rensis Likert and questionnaire of change and innovation skills. Data were analyzed through SPSS16 and using descriptive statistics (frequency، percentage and mean) and analytical statistics (t-test and ANOVA. ( Most hospital administrators of Shiraz University of Medical Sciences had consultative management style. The majority of headquarter staff were in the age group of 20-40 years. There was a significant relationship between change and innovation skills of hospital administrators and their management styles (P<0. 001). It seems that in order to implement the change and innovation plans in hospitals، implementing a successful participatory management style is very effective، because with honest participation، the organizational goals will be more achievable.

medication errors، patient safety risk factors that attempt to identify and track which has been discussed in recent years. This study aims to identify، assess، prioritize and process analysis to medication administration errors in hospitals Peymanieh using Failure Mode and Effect Analysis error as risk management techniques and was designed to enhance patient safety.

This study is a descriptive study which combines quantitative - qualitative methodology Modes and Effects error with FMEA (Failure Mode and Effect Analysis) Peymanieh at the hospital in 2012، has analyzed. To collect data from a worksheet and standard error modes analysis technique and its effects and sampling was purposeful. In this method، each of errors based on the severity of the error occurrence rate of error and the probability of error detection was given a score between 1 and 10، which is obtained by multiplying the score RPN.

method FMEA، 81 cases of potential error in 11 selected areas of medication administration process to identify and evaluate and score each of RPN was calculated. The overall mean score eleven RPN scope of the drug was found to give the lowest score of nearly 190 references related to service personnel receive the highest score in drug-drug card for drugs belonged to the sphere of writing. For analysis data use of Excell 2010 software and data calculating and rating based on RPN= S. O. D formula.

Considering the high rate of medical error، it seems that the field of study and understanding of working conditions and adjusted to reduce errors and provide. In general، techniques such as FMEA and a proactive approach must be based on teamwork، increase accuracy and attention to their employees'' career potential weaknesses and trying to eliminate them.

Healthcare authorities, in all around the world, are faced with resources limitations and limitless needs of citizens. Therefore, optimal resources allocation, particularly in the health sector and emergency system, seems to be of great importance. The present study aimed to determine the optimality rate of patient's distribution to hospitals by emergency stations based on the transportation model. In the current descriptive-analytical, cross-sectional study, three required data including the number of patients transferred from the emergency stations to the state hospitals, the average distance between the incident place and the state hospitals and the number of beds in the emergency departments were determined. Then, the transportation model was created based on the above data. Afterwards, the model was put in the LINGO software and the optimal results were obtained. The data provided by the Central Emergency Unit showed that from Sep. 2009 to March 2010, the number of transferred patients had been 4233 to Namazi, 1087 to Faghihi, 1999 to Beheshti, and 14 to Ali-e-Asghar hospitals. After modeling by putting the model in the LINGO software, the number of patients’ allocation were determined 584 for Namazi, 1529 for Faghihi, 3600 for Beheshti, and 1620 for Ali-e-Asghar hospitals. According to the obtained results, the majority of patients should be transferred to Beheshti and Ali-e-Asghar hospitals. Therefore, it is required that the mentioned hospitals be improved regarding their human resources and medical equipment.

Motivation is one of the effective factors in increasing employees’ efficiency in an organization. One of the most common theories for assessment of motivation is Maslow's hierarchy of needs whose results can be used to increase organizational efficiency. This study aimed to determine the effects of motivational factors based on Maslow's hierarchy on increase of efficiency from the viewpoints of the staff of Shiraz University of Medical Sciences in 2014.
This descriptive, cross-sectional study was conducted on 100 staff working at the central building of Shiraz University of Medical Sciences selected through stratified sampling and simple random sampling methods. The study data were collected using a questionnaire including the effective factors in increasing efficiency based on Maslow's hierarchy. The collected data were entered into the SPSS statistical software (v. 18.0) and analyzed using descriptive statistics, T-Test, and ANOVA.
The results showed that the highest and lowest mean scores were related to need for self-actualization and need for prestige, respectively. Besides, no significant association was found between the effect of Maslow’s hierarchy of needs on increase of efficiency and demographic characteristics (P>0.05).
According to the results, need for self-actualization followed by need for belonging, need for security, physiological needs, and need for prestige were priorities of effect on efficiency. Therefore, organizations’ managers and authorities are recommended to apply appropriate motivational factors based on these priorities and needs.

Managers can provide manpower motivations activity contexts and real efficiency through identifying and anticipating according to organizational goals. Since, today’s working motivations have not been realized in hospitals, this study aimed at determining and comparing the importance of hygiene-motivational factors in both Kosar and Faghihi hospitals in Shiraz. In this cross-sectional survey, study populations included all staffs of Kosar and Faghihi hospitals in Shiraz. One hundred fifty selected by stratified randomly sampling participated in the study.The study questionnaire was designed based on Herzberg theory. Questionnaire validity proved by available experts and Cronbach alpha calculated 0.95. Statistical analysis was done using SPSS software and independent t-test. The most important hygiene factors were "job security" and "supervision" and the most significant motivational factors were "success" and "appreciation". Hygiene factors are more important than motivational ones in both hospitals. Hygiene and motivational factors had more mean score in Kosar hospital compare to Faghihi hospital. In the Kosar charity hospital hygiene-motivational factors were significant more than faghihi governmental hospital from the staff viewpoints. Hence, the directors of the hospitals should organize appropriate incentive actions owing to differences in terms of ownership toward quality improvement and efficiency of hospitals.

One of the latest methods for analysis of structural complexity is, Design Structure Matrix which has been used and has been given, lots of attention in academic and scientific centers in recent years. This project was undertaken in order to reveal the structural complexity of Frirooz Abad (Fars Province) Healthcare network. This analytical research has descriptive and realistic dimensions. At first, by studying the functions of present network and organization, the current structure was extracted. Then the direct and indirect dependencies of each sector and units were analyzed. The results of these dependencies in house of quality proof were used in Quality Function Deployment Techniques to generate the current system which is an amalgamation of the two methods mentioned above. Based on our findings, we can give all the responsibilities of the network campaign (Setade Shabake) to the central healthcare system (Markaz Behdasht) and remove it from that system. The mixture of the two mentioned techniques can change the organizational structure of central healthcare system which is dependent on productivity and change it in to a division or a branch. And at the same time, hospital mechanical bureaucracy can change into a professional bureaucracy. However, the organizational structure of emergency centers won’t go through any dramatic changes. Finally, the structure of healthcare network will be of a hybrid one. Combination of the mentioned techniques by modifying the organizational structure without any changes to network functions will lead to a flexible structure that can answer the demands of those who benefit from it.

Abstract Hospital Emergency ward plays a pivotal role in hospital and health care system regarding necessity of immediate،qualicative and effective performance due to numerous and complicated processes happens in the emergency ward. QFD is one of the most effective methods used for designing and improving the quality in order to fulfill customers'' expectations and improve their satisfaction from provided service. This study is aimed to investigate following subjects: 1)identifying the customers'' expectations (n=80) and service`s components (n=15) through interviews، 2) defining the relationship between patients'' expectations and the service`s components، and also relationship between the service`s component themselves 3) designing the service quality model based on the house of quality diagram” After identifying 13 components of customers'' expectations and 20 components of service، 9 components of service were prioritized as parts of service quality model in 3 levels: 1) Physician''s office physical environment 2) Improving Nursing performance`s and hospital hotel`s service facilities، equipping inpatient` room، physician`s room and triage space 3) Improving guide systems، providing adequate welfare for the patients'' families، and facilitating the waiting room. The current quality model designed in this study can be a general guide to improve the quality of services provided by the emergency ward. However، using this model has its limitations such as being complex and time-consuming.

Waiting time affects medical services quality and patients'' satisfaction. Quality Function Deployment (QFD) method is the most effective instruments for improving quality; and is used to assess customers'' needs and increase their satisfaction. We used the QFD method to identify strategies to reduce waiting times in the emergency department of faghihi hospital in Shiraz، 2012. The major steps of the study included determining the mean of the clients'' waiting time، identifying the customers'' needs and expectations through interviews (n=80)، identifying the service elements through interviews (n=15)، determining relationship between the patients'' expectations and the service elements، determining relationship between the service elements based on the house of quality analysis through QFD Designer software، designing the service quality model، and presenting strategies. The mean waiting time of the clients of the emergency department through 20 processes was 335±98 minutes. Through identifying 13 customers'' needs and expectations and 20 service elements، nine service elements were prioritized as the components of service quality model in three levels including: 1) physical space of physician''s room; 2) improvement of nursing services، hoteling facilities، inpatient room، and triage space; and 3) improvement of guide systems، providing welfare facilities for patients'' companions، and improving waiting room. Considering patients'' expectations، the quality model designed in the present study can be used as a comprehensive guide to improve quality of services provided by the emergency department. However، complexity of the model and time-consuming procedures are among the limitations of using the QFD method.

Objective (s): To determine economics cost of diabetes in type II diabetic patients under the cover of Naderkazemi clinic in Shiraz in the first half of 2008. this study is an applicable one and the way of study is descriptive-analytic.the study society includes type II diabetic patients that referred to Naderkazemi clinic and made file. in this study among the 4900 files related to type II diabetic patient, at first, in the pilot study,30 files chosen by the way of systematic sampling and examined. standard deviation these files was ±/38.that in respect to received standard deviation,220 files were chosen as samples that eventually with the help of statistics advisor,288 file were chosen as samples and were studied in a systematic way. the needed information in this study were gathered from observing the existing information in patient´s files, interviewing with personnel and manager and also from existing information and ducuments in provision, accounting and personnel departments. results were classified as charts and graphs and were expressed descriptively. in this study, total economic costs of type II diabetes calculated 37942315040 Rials (4079818.8 $), that medical direct costs and indirect costs share was 3994348680(429499.9 $) and 33947966360(3650319 $) Rials, respectively. Medical direct and indirect costs of diabetes in a type II diabetic patient in first half of 1387 was 815173/2(87.65 $) and 6928156/4(744.96 $) Rials respectively, and altogether was 7743329/6 Rials (832.61 $). Economic cost of type II diabetes is very high and complications of this disease can important influence on patient and their family. Be cause of restricting resources of medical-health in society, diabetes is one of medical-health priority in our country and should have large actions to reducing costs and complications of this disease.

The inefficiency of financing health care in developing countries made led in many health policy-makers to consider alternate means of service provisions. Outsourcing public financed health services in private sector organization is one of the interventions. Advocates claim that the contracting out of health care services will improve the service delivery performances through stimulating competition among providers and also by creating economic incentives to improve performance through linking payment to provider performance.

The purpose of this cross sectional study was to provide decision matrix to guide decision-makers whether outsource hospital services or not. Tow kind of questionnaire were developed and used.

Findings showed that the most propensities of outsource is in nutrition services (87%), and the least is in nursing services (43.4%) based on administrators’ attitude. Shaping of decision matrix showed propensity to outsourcing of nursing, radiology, laboratory services are high while nutrition services is been low.

Finding showed some differences between results of decision matrix and administrators’ propensity to outsourcing in radiology and laboratory services. Lack of attention in characteristics of the hospital services might be one of the reasons. Cost saving is the main reason for outsourcing the services while administrators should consider as an effect and side effect of outsourcings.

To increase the productivity of the organization, several conditions are needed human resource is the most important one. That is why staffs incentive needs, are the most important factor and it happened by increasing their level of their morality and the job satisfaction. To achieve these, their needs in work environment must be identified and satisfied. The aim of this research is to study incentive needs for nursing staffs in selected teaching hospitals of universities of medical sciences according Maslow's needs hierarchy. This research is a descriptive cross-sectional study. The statistical population are Namazi, Shahid Faghihi, Shahid Chamran, Hafez, and Khalili hospitals. Some 141 nurses have been involved in study selected by stratified random sampling. The needed information have been collected by questioners and analyzed using SPSS software calculation. Data showed that all fifth levels of Maslow's needs had a high level of incentive needs and evaluating and comparing the average incentive needs, and the respect need has the maximum score. Also, it showed there are a significant meaningful relation between physiological needs and age and sex, receptiveness and job situation variables, job experience and age, the respect needs and job experience and age factors. However there is no significant relation between security needs and self- dehiscence. according to the achieved data, the fifth level incentive needs for nursing staff in Namazi, Faghihi, Chamram, Hafez,and khalili hospitals are listed as below: 1.Need to respect, 2.Physiologic needs, 3.Needs to kindness and love, 4Need to security, 5.Need to self- dehiscence.