فاطمه دباغی

Value-based care is the creation and operation of a treatment system in which the importance of care results is prioritized over the cost of access for patients. The present study was conducted with the aim of determining value-based care and its measurement indicators in cancer patients between 2000 and 2023.

The method of the present study is a review with a systematic approach, in which all full-text Persian articles were searched with the keywords value-based care, cancer care, value and cancer in SID Magiran, Google Scholar databases, during the years 2000 to 2023. In addition, all full-text English articles with the keywords value-based care, cancer care, value, and cancer, which in their title exactly examined the results of value-based care in the medical system, are in Pub Med, Scopus, and Web databases. of Science was searched during the years 2000 to 2023. In order to collect data, the "Data Extraction Form" was used, which was designed based on the purpose of the current research. 23 articles out of 5643 articles were studied.

Among the 23 reviewed studies, 16 studies (69.56%) were quantitative, 5 studies (21.73%) were qualitative, and 2 studies (8.69%) were mixed. The articles were done in different countries of the world. The results showed value-oriented care causes patient-center (better doctor-patient communication, improvement of joint decision-making between the patient and the treatment team, increase of patient trust and satisfaction, improvement of the patient's quality of life), organization (implementation of guidelines and standards, cost reduction, waiting time reduction), the performance of the patient care information system (information collection and timely reporting), patient-reported outcomes (improvement of quality of care, better treatment results, increased life expectancy) in cancer patients.

Value-based care includes patient-center, organization, patient care information system performance, and patient-reported outcomes that are effective in cancer care. Therefore, it is suggested to provide the above method by medical organizations.

Considering that many risk factors of non-communicable diseases are rooted in people's lifestyles, the role and importance of society's participation in preventing and controlling these diseases is more evident than before. The present study was conducted to design and determine the validity and reliability of a questionnaire on ways to attract community participation in preventing and managing non-communicable diseases.

This descriptive-applied study was conducted in 2022. The initial questionnaire was prepared based on the data from a combined research consisting of comparative study stages, interviews with experts and Delphi. Content validity was measured using a panel of 15 experts, the content validity ratio (CVR), and the content validity index (CVI). The test-retest method was utilized to determine the reliability of the questionnaire in a sample of 30 people. Data analysis was done using SPSS 20 software.

The final questionnaire with 52 items to attract people's participation in preventing non-communicable diseases was confirmed with a total content validity index score of 0.98 and a content validity ratio of 0.84. The results of Spearman's correlation coefficients for the seven questionnaire dimensions showed the acceptable reliability of the questionnaire components.

Since the designed questionnaire obtained acceptable validity and reliability, it can be used confidently to determine community participation requirements in preventing non-communicable diseases.

Aging population and diseases in old age will increase the need for outpatient and inpatient services and consequently increase the costs of the health system. Studies on health needs and quality of life in the elderly in different countries of the world However, in the field of integrated care for the elderly, with a qualitative approach and considering the experiences of the health care care team, there is a need. Since the care programs in the country do not meet the challenge of providing services the elderly, The researcher decided to conduct a study with the aim of understanding integrated care for the elderly in health care centers with a qualitative method.

This study was conducted using a qualitative design and content analysis approach to explore integrated care experiences for the elderly in nursing health centers. The participants in the present study include 35 people. It consists of 15 physicians, of which 2 are health workers and 13 are family physicians. There are 10 male and 5 female physicians. The age range of physicians in this study was between 30 and 53 years and the average was 42. Fifteen elderly caregivers were health professionals, one was a health services manager, and one was a senior geriatrician. The inclusion criteria in this study were health care providers with the age range of participants between 33 to 51 years and the average was 42 years. The method of data collection was semi-structured interview and the method of content analysis was analysis. 

From the findings of this study, 241 primary codes were extracted and 141 codes emerged by matching similar codes. The codes were analyzed and categorized based on features, which resulted in the emergence of 86 codes and were placed in 14 subcategories. The extracted codes and statements of the participants were divided into 5 main categories. Concerns expressed by the elderly and caregivers, including physicians and health care providers, include: the complexities and concerns of the elderly, the lack of health services in the centers, the lack of health services in the centers, cultural services and the culture of healthy aging in the centers, support The welfare economy was for the elderly to benefit from the services.

In general, it can be concluded that according to the results of this study on the process of integrated care for the elderly, the main success of this care and the provision of services by caregivers in health care centers based on structural, executive, resource reform Human and financial are the center and families of the elderly. In the past, the focus was on the elderly only in some health services in health care centers and less attention was paid to services, welfare and home care services in old age. In Iran, according to the results of this study, providing more developed services but still challenges There is a lot in terms of specialized organizational structure and resources and how to provide services.

The tool used to collect data should have validity in the first stage and reliability in the second stage. The aim of this study was to design a tool for program management of middle-aged people in health centers in 2019.

This study was a descriptive-applied research. The research tool was a researcher-made questionnaire from a comparative study and interview. The validity of tool was examined by surveying 14 experts in the field of health services management, health education, general practitioner and nursing using Lawshi method. The reliability of the questionnaire was determined by selecting 30 experts in middle-aged people program and using the test-retest method with time interval of two weeks. For data analysis, the SPSS software version 20 was used.

In the validity stage, based on the opinions of 14 experts, out of 87 questions, 1 question with a content validity ratio of 0.45 and a content validity index of 0.73 was removed from the questionnaire questions and the rest of the questions were approved in terms of content. Cronbachchr('39')s alpha coefficient was obtained in two stages (the first stage was 0.85 and the second stage was 0.95) and the correlation coefficient was 0.99 for the whole questionnaire.

The results of the present study showed that the component of public participation and the component of executive management had the highest and lowest correlation in the management of health services for middle-aged people, so policymakers and health care planners can use it to improve the quality of health services for middle-aged people.

"Health Assistant Plan" is one of the health system designs whose effectiveness has been less considered.The aim of this study is to determine the correlation between social accountability and quality of service delivery in "Health Assistant Plan" of Imam Hossein Medical Education Center, Tehran.

In this descriptive-correlational study, 384 patients referred to Imam Hossein Medical Education Center of Tehran participated by convenience sampling method. Data were collected using “Health Assistant Plan Evaluation Questionnaire” which developed in this study. Validity of the questionnaire was confirmed by content, face and construct validity through factor analysis. The reliability of the questionnaire was confirmed by internal consistency and Cronbach alpha. Data was analyzed by SPSS. 16.

There was a significant and positive correlation between social accountability and the quality of service delivery (r = 0.562, P = 0.001). The mean scores for the dimensions of human of dignity, autonomy, quality of facilities, access to support, communication clarity and behavioral aspects were less than average. The mean scores dimensions of privacy and confidentiality, the choice of therapist, equipment and physical facilities, environmental health, access and care were more than average.

There was a correlation between social accountability and the quality of services delivery at Imam Hossein Hospital. It is suggested that health planners and health officials consider the two main principles of social accountability and quality of service delivery.

Meeting the increasing demand and satisfaction of patients from hospital services is considered the most important factor in the survival of health care institutions. The aim of this study was to identify the most effective reasons for patients to select health centers based on seven factors of marketing mix (7p) in Iranian hospitals.
The present research is a escriptive-analytical study implemented in a cross-sectional approach in 2016. To collect data, Soltani et al.'s questionnaire, which was validated by qualified people and its reliability was assessed using Cronbach's alpha coefficient (85%), was used. The statistical population of this study covered admited and discharged patients at educational hospitals affiliated to Iran's medical universities, selected out of five counties of north, south, east, west, and center of Iran and randomly selected from two hospitals in each region. Using a sample size formula, a ratio of N = 400 was determined. The obtained data was analyzed using Kruskal Wallis test in SPSS version 19.
Findings: Among the seven dimensions of marketing in the selection of health centers, the highest index of prices (60.2) and the lowest of advertising (17.7) was the most significant. The type of insurance in the price index and the recommendation of the doctor in the index of advertising ranked first. The findings indicated that there was a significant positive correlation between the factors affecting patient's preferences in choosing a hospital (r=0.278, p=0.00).
Discussion & The results showed that the most important factor in patient's interests was the low costs of the hospital as well as hospitals’ acceptance of all types of insurance, so that the patients’ payment charge might be reduced and some services provided to them free of charge.

Endodontically treated teeth with extensive loss of coronal structure can be restored with various post systems. Choosing a right type of post will affect the life of the final restoration. The aim of study was to investigate the fracture resistance of endodontically-treated teeth restored using a suggestive and three conventional post systems. Subjects and Forty extracted and endodontically treated premolars were decoronated 1 mm coronal to CEJ. the teeth were randomly divided into four restorative groups: Group 1، cast post and core; 2، fiber post and composite core; 3، suggestive stainless steel post and composite core; 4، titanium post and composite core. In all groups، posts were cemented with a resin cement (Panavia F). Each root was embedded in an acrylic resin block and loaded vertically in a universal testing machine at a crosshead speed of 0. 5 mm/minute until fracture. The data were recorded and analyzed using one-way ANOVA and Tukey tests. The teeth restored with cast post and core demonstrated fracture resistance (162 N) significantly higher than other groups (P<0. 001). The fracture resistance in fiber glass post group (133 N) was significantly higher than that in stainless steel and titanium post groups (P<0. 001). The difference of fracture resistance between stainless steel post group (102 N) and titanium post group (90 N) was not significant (P=0. 28). The results of study indicated that endodontically treated premolars restored with cast or fiber glass post systems are more resistant to fracture compared to stainless steel and titanium posts.

Background and There are many studies about nursing clinical settings and their problems but the teaching style of teachers on the bedside has not been studied as a whole. Therefore this study was conducted to assess describe and interpret nursing trainers’ perceptions of the teaching style in clinical settings. Methods and Materials: The grounded theory approach was used to conduct this study. Fifteen nursing teachers were interviewed individually in 2006-2007. The interview protocols were tape-recorded and later transcribed verbatim. The tranh1ions were analyzed using Strauss and Corbin's method. Three major themes and 12 sub-themes emerged from the study data which portray the clinical teaching styles of the nursing teachers. The main themes are multiple styles in teaching nature of clinical teaching control and adaptation in the educational atmosphere and multiplicity in teaching style. Individualized styles were observable across teachers but they varied across situations type of skills (content) educational environment and facilities levels of the learners and the control and accommodation of teachers with the teaching atmosphere. Although teaching style is a complex phenomenon but this study has helped emerge some of the rules and principles of clinical training of nurses.

Learning style as a whole is less regarded in nursing education. This study was conducted to explore, describe, and illustrate student's perceptions and experiences of learning style. The multiplicity feature of student's learning style in theoretical courses is presented in this article. In this qualitative study, 16 bachelor and master students in different academic semesters were selected through purposeful sampling and interviewed using deep and semi-structured interviews. All interviews were tape-recorded, transcribed and then analyzed using constant comparison based on Strauss and Corbin's method. Student's learning style in theoretical courses as the main theme comprised 8 sub-themes including learning through question and answer learning through example, story, and objective instances (visualizing or exemplifying intellectually) observational or visual learning learning through organizing the content learning through practice and homework learning through active participation and cooperation learning through making to think and get motivated and, learning through listening and note-taking. Students make use of different learning styles or a combination of them based on the type of content, environment, and educational situation. Student's learning style is highly influenced by instructors teaching style who are more focused on their teaching style and completing their course syllabus. Nursing instructors, students, and curriculum planners could use the introduced styles in this study in order to modify and promote the quality of nursing education.

Although family caregiving is the essential part in health care systems, but there is not any qualitative research in Iran about nature of family caregiving process in frail elderly at home. The present study is a part of study about family caregiving process and its aim has been determining of facilitator and barrier factors of this process. In this grounded theory study according to Strauss and Corbin's approach(1998), 14 family caregivers participated and data was gathered by in-depth semi-structured interview and observation in the field and movies. All of interviews were transcribed and were analyzed through open, axial and selective coding. Triangulation of the data gathering from different methods, prolonged engagement with caregivers, member check by participants and experts, was used to increase rigor of the study. "Searching a balance point" is the family care giving process and core variable in this study. Caregivers experienced facilitator and barriers factors in 6 sub-groups that affect the caregiving process. Modifying facilitator and barriers factors by improvement of other family members participation and assistance, caregiver support, improvement of caregiving knowledge, providing facilities and establishing appropriate health care and wellbeing policies not only for caregiver but also for care recipient would be effective in managing of the process by caregivers.

There is worldwide growth in the elderly population. Family care of elderly is key to long term care system and main duty of women at home. Qualitative study about facilitating and hindering factor of family care giving process provide clarified viewpoint on female caregivers need to plan and make effective supportive health policy.Methods & Materials: The present study was conducted by grounded theory. A purposive sample of 12 family caregiver participated in this study and data was gathered by deeply semi-structured interview and observation in the field. All of them were transcribed word by word and were analyzed through open, axial and selective coding according to Strauss and Corbin's approach (1998). Triangulation of the data gathering from different methods, prolonged engagement with caregivers, member check by participants and experts, was used to increase rigor of the study. Female caregivers experience facilitator and hindering factors that affect the care giving process. These factors were categorized in 3 main classes of personal, familial and external factors and 9 subcategories of caregiver's knowledge on elderly care, personal characters of caregiver and care recipient, care giving burden, background of interpersonal relationship between caregiver and care recipient, familial supportive network, family member participation, formal supportive system, context of family care giving at home, and community based health care systems for elder people. Naturally, intervening factors in care giving process can confront caregivers with relief or difficulty Based on caregivers experiences, modifying facilitator and hindering factors by more family participation, psychosocial support, care giving education, improvement of care giving context and establishing appropriate age friendly health care systems would be effective in managing of the process by female caregivers, and could be helpful for them to be success in this manner.

Educational systems need to have committed, concerned and enthusiastic teachers in order to reach their high aims which is educating human beings. Committed teachers feel responsibility and do their duties in the best possible way and the result would contribute to the efficacy, effectiveness and productivity of educational system. This article is a part of a larger study which aimed to explore the experiences and perspectives of nursing & midwifery faculty members about organizational commitment. A qualitative approach using grounded theory was adopted. Data was collected through semi-structured interviews, from a purposive sample of 34 nursing and midwifery faculty members who were subjected to question and constant comparative analysis. Analysis uncovered a number of themes. Five themes of a committed faculty emerged, including doing the tasks and responsibilities, passion for the work, going to extra mileage, efficacy, and understanding the student. This re-conceptualization of organizational commitment and additional research in this area can assist educational managers to better understand and successfully manage their faculties. New knowledge from this and future studies can contribute and promote faculties’ organizational commitment.

The 21st century is the era of continuous changes in the way modern medical and scientific world functions, thus the need for adaptation in complex systems becomes paramount. In such a dynamic society optimum standard of survival may depend on the ability of individuals and groups to investigate multiple alternatives or choices and finally make wise decisions. Therefore, the need for critical thinking skills is an absolute vitality for today’s health science professionals. Education is the most powerful tool in developing learning skills and the main aim of every educational institution is to assist students and trainees to achieve such end. Besides professional competency, the main aim of medical sciences education is to develop students’ ability in decision making ability and problem solving, and leading them to become efficient critical thinkers. Critical thinking skills are vital in coping with the unprecedented rapid changes occurring in health care field. In order to cope with the complexity of today’s medical issues, nurses and physicians need to equip themselves to critical thinking ability so that they can offer the most effective services and treatments for their patients and clients. It seems that there is challenge in training capable and skilful graduates in Iran medical education system. Hence, essential actions are needed to uplift the standard of medical education in this country. To this end, urgent priority should be given both to development and improvement of critical thinking skills of students and trainees of health field. First, based on authors’ experiences, some of the barriers for critical thinking skills nursing of students is reviewed. Then, based on literature review and panel of experts’ viewpoints a suggested solution in a graphical format, is suggested. Planning for an urgent action is also suggested to improve critical thinking skills of students and trainees in health field which seemingly is a challenge in iran nursing education system.

Powerlessness has become endemic among most nurses in their work settings. It may be the result of inappropriate distribution of power in hospitals, allocating power to only a few at the top of hospital hierarchy imposing it. Determining the relationship between nurse's perception of their head nurse's empowering behaviors and their own work empowerment, a correlational study with contribution of 132 licensed nurses was carried on, in which nurses perceptions were measured by two self-report questionnaires. The results indicated that nurses obtained a moderate score in Leader Empowering Behavior (LEB). scale (=3.78 1.71) and also in Conditions of Work Effectiveness Questionnaires (C.W.E.Q) (=15.15 4.2). Also a relatively strong statistically significant relation between the two major variables of the study was identified (rs=0.518, p<0.0001). So, it can be revealed that organizational managers have important roles in increasing work effectiveness through facilitating employee's access to empowerment structures at work settings. Broader surveys on empowerment in nursing and other health care professions are suggested.

According to the reports of world health organization (WHO), 80 percent of human diseases are due to contaminated water either for drinking or sanitation. International water sanitation program says that 50 percent of people across the world have no access to healthy water and 75 percent of the third world population do not have water for sanitation. The present semi experimental study aims at determining factors relevant to the chlorination in the families under the coverage of health houses of Sistan and Baluchestan province. Research sample was composed of 2100 households which were under the coverage of health houses of the province. They were investigated in two groups (case and control) on the basis of stratified and random sampling. The findings indicated that 37.5. Percent of households who used 1% chlorine for chlorination, had a comprehensive knowledge about it and of which 23.5 percent belonged to the control group. The results of logestic regression indicated that those who had good or moderate knowledge, used 1% chlorine for chlorination more than the group with poor knowledge. Finding also showed that 98.8 percent in case group and 93.7 percent in the other one had a positive approach to chlorination. Furthermore, a significant correlation was established between approaches and performances of both groups (P<0.05). Meaningful relationships existed between the level of knowledge and approaches, household and ethnicity, the performances and the size of the households (P< 0.05). Reasons for not doing chlorination were awful taste and smell (37.65%), no access to chlorine (26.64%) and time limitation to do so (18.23%), meanwhile, those who were doing chlorination mentioned that prevention of diseases (68.88%), considering sanitary principles (16.06%) and a combination of these two (12.06%) are our reasons for doing this task. To conclude, regarding the results of this study training programs should be considered to enhance awareness about the importance of chlorination and the usage method, in order to prevent undesirable physical damages due to contaminated water.

Medical equipment play an important role in the diagnosis, treatment and education of medical affairs. Each year a noteworthy volume of medical sets and equipments in hospitals become obsolete due to technical defects and lose their efficiency in a way that major parts of hospitals’ expenses are allocated for the supply, service and repair of this equipment. The outcome of such expenses are, finally, a gigantic scientific and economic losses that are imposed on the State’s health care and medical treatment. Present research is a cross sectional study for investigation of maintenance, service and care expenses of medical equipment of hospitals affiliated to Iran University of Medical Sciences. For this purpose, 284 cases of classified sampling regarding equipment and sets of affiliated hospitals with more than 5-year operational history were investigated. The means for preparing and compiling relevant data and information constituted an inquiry form which was distributed and completed by person in charge of inquiry and was used for analysis of the obtained information from descriptive and deductive statistics, as well as one-way variant analysis and Spirman coordinating coefficient. The results of the research showed that almost 60% of medical equipment of these hospitals had not at all been controlled or evaluated by the personnel of medical units and at none of the investigated hospitals there existed an engineering maintenance medical unit. In this research work the up-keep and maintenance of medical equipment relates to supply, repair and technical training of the sets and, on the whole, medical equipment of the studied hospitals had fairly a proper standard as follows: Repair service and maintenance: 29.6%, Supply of equipment: 26.1%, Educational and training aspects: 14.1 %. The variant analysis, too, showed that the average achieved points of the situation in which supply, repair and training of medical equipment were performed does not differ so much statistically when looked at it from international standards point of view. Almost 24% of the total amount of the hospitals’ budget are allocated for incurred expenses of supply, repair and technical training of medical equipment. On the average, the situation in which medical equipment of studied hospitals caused extra costs showed 74.6 % improper balance. Proportionate relation between supply and cost (r=0.35 and p<0.005) and between repair and cost (r = 0.15 and p<0.001) and between technical training and costs of medical equipment (p<0.000 and r=0.35), too, showed that there existed a meaningful relation between them. The overall outcome and result of this research work testifies to the fact that there exist lack of a proper planning system for the supply, repair, maintenance, technical training and the incurred costs of available medical equipment at Iran University of Medical Sciences and Health Services.

Pregnant women with high level of anxiety are likely to give birth to babies who are irritable, restless, have sleep disorders and low birth weight. To determine the relation of psychosocial status of women during pregnancy and pregnancy outcomes. Design : This was a comparative study. Data were collected using a questionnaire. Samples : 360 subject nuliparas to multiparas 4, were selected through consequative sampling, 180 in each group (appropriate and inappropriate psycholocial status). There was a relation between psychosocial status of mothers and LBW (p=0.005), IUGR (p=0.028) and preterm labor (p=0.000). Emotional support by family and health care providers should be targeted at women with poor psychosocial status during pregnancy in order to decrease their emotional distress and to enhance their self- esteen and self- confidence.

International travelers are one of those groups who are in danger of affecting with AIDS. They should be informed about it's risk factors. It is not important where the travelers intend to go, but it is important that they have information about ways of transmission and prevention of AIDS. To determine knowledge of non pilgrims international travelers about the ways of transmissions and prevention of AIDS. Design : This was a cross- sectional study. Data were collected through questionnaire. Samples : 200 non pilgrims travelers were selected randomly. The findings indicated that the knowledge of non pilgrims travelers about ways of transmissions and prevention of AIDS was in middle range. Research findings showed that the knowledge of travelers intending to go abroad are not enough about transmission and prevention of AIDS. In order to protect their health their knowledge should be increased through education.