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The balanced scorecard (BSC) provides useful and relevant information about the factors affecting the internal and external performance of the organization and it is the most suitable framework for evaluating the performance of healthcare organizations. One of the key principles in using the BSC is to identify the appropriate views of each organization with regard to its main mission so that it can achieve the best results to achieve its goals and strategy. The present study is aimed to identify the views and related goals in the BSC model suitable for health care centers using the fuzzy Delphi technique.

The present study was a qualitative and applied research. The statistical population of the research included 15 experts in the field of health and treatment who were selected by purposive sampling. First, through literature review, and then with the help of a researcher-made questionnaire with the consensus of experts using the Delphi technique in two rounds, the views of the BSC and the related goals were determined according to the health care centers.

In this research, the perspective of patients and society with three goals, financial status and performance with two goals, growth and development with four goals, internal organizational processes with four goals, and social responsibility as a new perspective with two goals to evaluate the performance of health care centers replaced the traditional perspectives of BSC.

The use of 4 points of view appropriate to health care centers in the BSC and the addition of a new point of view under the title of social responsibility to evaluate the performance of health care centers will increase productivity and ultimately increase the satisfaction of patients and society.

 Health professional workers, including nurses, need continuous in-service training due to the rapid growth of the health industry, competition, diverse and numerous needs of customers. High-quality and effective courses guarantee the competency of staff and efficiency and productivity of organizations. The aim of this study is reviewing the effectiveness of in-service training courses for nurse according Kirkpatrick model.

 This is a review of existing literature based on a systematic search, focusing on published studies on the effectiveness of in-service training for nurses in Iran in the period of 2009-2022. Scopus, PubMed, google scholar and Google search engines, Iranian Research Institute for Information Science and Technology, Magiran databases, Scientific Information Database were searched. Data analysis was performed with a qualitative approach and content analysis method.

 45 articles in the initial search and 3 articles in manual review of references were identified. After initial assessment 11 articles include in final analysis. Based on the findings, in-service training in general have been relatively effective. This effectiveness is mostly focused on the first and second level, i. e. reaction and learning, and it has not been very successful in terms of improving skills and performance.

 policymakers and managers in the field of human resources should revise the current approach in employee training, take measures at all levels to improve the process, content, methods of training and evaluation, as well as incentive strategies for participation in courses with a special focus on improving their effectiveness.

Human health is a fundamental right and a valuable asset for all members of a society at any level and social class. The existence of a strong and stable health system in a country displays the all-round stability of that society. The three main characteristics for evaluating the performance of the health system include the health status of the community, citizens' satisfaction with the services provided by the health sector, and protection against financial risks. Therefore, the aim of the current research was to design an efficient model for cost management of non-surgical cancer treatment in Iran.

This was a descriptive-analytical study with a survey method conducted in 2018. The method of data collection was a library (through examining hospital records) and the tool used was a questionnaire. For this purpose, an available sample consisting of 50 elites from the fields of health service management and health economics was selected and were asked to answer the designed questionnaire. The data collected by means of the main statistics used in the Delphi technique were the central measurements (mean, median and mean) and dispersion index, standard deviation and interquartile range.

The amount of extracted variances was 0.529 after management of visit costs, 0.518 after management of diagnosis costs, 0.494 after management of hospitalization costs, 0.496 after management of chemotherapy costs, and 0.501 after management of radiation therapy costs. These results indicated that the amount of extracted variances was higher than 0.5; moreover, all the AVE values of the model dimensions were lower than the combined reliability, as a result the, condition of convergent validity was established.

The results of the present study indicated that the costs of non-surgical cancer treatment could be classified into 5 main indicators, including the cost of visits, diagnosis, hospitalization, radiation therapy and chemotherapy.

Measuring the cost of treatment is one of the daily concerns of the developed world, which play a fundamental role in the design and evaluation of health systems. The present study was conducted with the aim of development and psychometrics of "Treatment Cost Management Scale" for children with cancer.

The current research is of a methodological type. In the qualitative part, a wide review of the literature related to the research subject, including library documents and scientific articles from 2003 to 2021, was conducted and by analyzing them in the form of a data extraction form, "Treatment Cost Management Scale" was developed. In the quantitative part, the content validity ratio and the content validity index of the scale were conducted by asking the opinions of 15 people from the medical staff of Shafizadeh Children's Hospital in Babol city with the snowball method. Construct validity was investigated by exploratory factor analysis, convergent validity and divergent validity by distributing the designed scale among 250 available medical staff of Shafizadeh Children's Hospital. Composite reliability and internal consistency reliability were calculated by calculating Cronbach's alpha coefficient. The data were analyzed in SPSS. 22 and Amos. 24.

In the qualitative part, "Treatment Cost Management Scale" was developed with 24 items. The values of the content validity ratio for all items were 0.49 and the content validity index was 0.80. Exploratory factor analysis showed the construct validity of 6 subscales. Divergent validity was equal to 0.58 and composite reliability was equal to 0.89 and reliability by internal consistency method was obtained by calculating Cronbach's alpha coefficient equal to 0.88.

"Treatment Cost Management Scale" is valid and reliable with 24 items and 6 subscales. It is suggested to use the designed scale in researches related to health and treatment services to manage the costs of children with cancer.

Parallel to the progress of services, organizational complexity levels in health care centers (HCCs) have increased. The influential factors in this regard include the variety of services, the non-uniformity of the centers’ management conditions, and the rising expectations from the health system. Therefore, considering many factors influenced and effective, improvement of health services requires development of a systematic approach to evaluate their efficiency and management system. The aim of this study was to develop a balanced scorecard (BSC) model suitable for HCCs using a hybrid approach that combines the Fuzzy Delphi and DNAP techniques. 

This research was a combined qualitative-quantitative study that was conducted with the aim of developing a BSC model suitable for HCCs. The statistical population consisted of 15 experts in health and medicine, who were selected based on the targeted snowball sampling. A researcher-made questionnaire and a 20×20 matrix questionnaire were used to collect the data. The questionnaire validity was calculated based on the experts’ opinions and the reliability was calculated using Cronbach’s alpha and consistency rate. The data was analyzed using Excel and MATLAB, and DNAP technique was used to determine the cause-and-effect relationship and the influence levels of the objectives. 

According to the results of the Fuzzy Delphi technique in the panel of experts, 5 viewpoints with 20 objectives of the BSC suitable for HCCs were identified and replaced the traditional viewpoints of the BSC. In addition, these results showed that the views of growth and development, intra-organizational processes, and social responsibility are considered as the influential factors due to the positive D-R values, while the views of patients and society, financial status, and performance are considered as the factors that are effective due to the negative D-R values.

The results of this study indicated that those points of view that are consistent with the goals of the HCCs should be used in the BSC in order to evaluate their performance. Also, prioritizing and determining the cause-and-effect relationship and considering the contribution of each point of view for achieving the goals of the HCCs can increase the performance.

Due to the level of complexity of healthcare organizations, many factors play a role in improving health services. Therefore, it is necessary to develop a systematic approach to evaluate their efficiency and management system.  Balanced scorecard can play a role in this field as an evaluation system by examining the cause-and-effect relationship of goals and drawing a strategy map.  Therefore, the purpose of this research was to develop a strategy map for healthcare centers with a balanced scorecard approach.

This was a qualitative and applied research conducted using mixed methods in 2019. The statistical population of the research included all health experts from medical sciences universities across the country, 15 of whom were selected based on a targeted snowball sampling. First, through the review of texts and articles related to the literature on the subject with a general search in foreign and domestic electronic databases, a list of balanced scorecard views and the goals related to health and treatment centers of comprehensive health service centers was identified. After that, through a researcher-made questionnaire, by asking experts their opinions using fuzzy Delphi method in 2 steps, the views and goals related to comprehensive health service centers were identified. Then, through the relationships of improved network analysis process technique based on DEMETEL, in 4 steps by Excel 2016 and Matlab 2014 software, the relationships between them were examined. Finally, the effect of goals and views on each other was determined, and a strategy map was drawn.

In this research, social responsibility, as a new perspective and the attitudes of patients and society, financial status and performance improvement, growth and development, and internal processes, replaced the main perspectives of the balanced scorecard, and social responsibility was designated as a new perspective. By examining the relationship between them, the perspectives of growth and development, intra-organizational processes, social responsibility, and other views were found to be effective.

Considering the complexity of the activities regarding comprehensive health service centers, replacing the views appropriate to the comprehensive health service centers with the main views provided by Kaplan and Norton (2004) can obtain the best results regarding the goals and strategy. Based on the cause-effect relationship of views, strengthening views and effective goals creates value for effective goals. Investing on influential views and goals will empower and promote the development of balance between income and expense, and the optimal use of resources will improve the views of society and patients and the quality of services, which is the main goal of comprehensive health service centers.

Human immunodeficiency virus/Acquired immune deficiency syndrome (HIV/AIDS) is an emerging disease that has a close relationship with high-risk behaviors and affected different age groups, gender, race, culture, and social and economic classes. The aim of the present study was to investigate the mediating role of demographic variables in the relationship between high-risk behaviors and HIV/AIDS.

This descriptive study was conducted using the census method on 3838 people referred to behavioral disease counseling centers of Shiraz University of Medical Sciences in 2020. The data collection tool was the national software for registering behavioral diseases consultation, including demographic variables and high-risk behaviors in two groups of HIV/AIDS identified as positive and negative. Structural equation modeling was used to analyze the data.

According to the final model, demographic variables explain 13.46% of disease cases, but high-risk behaviors explain 44.40% of disease cases. Therefore, the explanatory power of demographic variables in contracting the disease is lower than high-risk behaviors, so demographic variables do not play a mediating role. The relationship between demographic variables and high-risk behaviors and HIV/AIDS was statistically significant (p<0.001).

According to the findings, demographic variables do not play a mediating role, and considering the significant relationship between demographic variables and high-risk behaviors and AIDS, demographic variables play a confounding role. Therefore, continuous educational programs in the field of prevention and control of high-risk behaviors will be very helpful in reducing the incidence of AIDS. 

This study evaluates the ability of different quantitative mapping (QM) methods as a bias correction technique for ERA5 reanalysis precipitation data. Climate type and geographical location can affect the performance of the bias correction method due to differences in precipitation characteristics. For this purpose, ERA5 reanalysis precipitation data for the years 1989-2019 for 10 selected synoptic stations in climates with different topographic characteristics were received daily from the European Centre for Medium-Range Weather Forecasts (ECMWF) website. Bias correction of these data was performed using 5 quantitative mapping methods based on observational data in R software environment. Two-part evaluation and Taylor diagram were used to compare the performance of different methods. The results showed that the performance of the quantification mapping method depends on the performance functions, set of parameters and climatic conditions. In general, non-parametric methods of multiple mapping have better performance than parametric methods, so that the best performance is related to QUANT and RQUANT methods, among which DIST method has the weakest performance.

The Integrated Health System (SIB) is the latest electronic health record system in Iran, officially began in Iran in March 2016, with the goal of integrating health information and providing health services. This study aimed to design a model for establishment of the electronic health record in family physician program of Guilan university of medical sciences.

The research method was mixed method. Fifteen organizational and academic experts in the fields of family physician program and information technology were interviewed through purposive sampling using qualitative content analysis with conventional approach. Having identified the important components and respective dimensions in the initial conceptual model, the primary questionnaire was developed and submitted to the experts for their approval. Then, the final Likert-scale researcher-made questionnaire was extracted. Its content validity index was calculated by the experts and the reliability of the questionnaire was assessed through Cronbach’s alpha. The questionnaire was sent to 453 members of the healthcare team for being completed. Through analysing data by SPSS and LISREL, the final model was extracted using the specialized statistical techniques of exploratory and confirmatory factor analyses.

The model was presented with eight factors of attitudinal and behavioural, supervision and managerial, individual factors of users, interactions and teamwork, organizational, technical, systemic and job stability which can explain over 63 percent of the variance of the variables of electronic health record-based family physician program. The highest and lowest impacts on the proposed model came from the managerial and supervisory (0.85) and the job stability components, respectively (0.45).

Establishing an electronic health record in the family physician program with the aim of providing good quality services and lower costs, is influenced by various factors that by strengthening the positive aspects and removing barriers in the identified factors, it is possible to institutionalize and use it more practically in order to solve health problems.

Health & Well-being is one of the most important fundamental human requirements and the main indicators of development and social welfare. However, with rising health costs and unlimited needs and dwindling health system resources, it is necessary to rethink new remedial behavior. Paraclinical services are an important and costly part of health services, it appears crucial to understand the elements that influence them.

This is a qualitative study that has been designed & performed from 23rd September 2019 to 23rd September 2021 through face-to-face interviews with selected experts. The project has been approved by the institutional review board of Islamic Azad University, Semnan branch through ethical registration codes as IR.IAU.SEMNAN.REC.1399.014. The first stage was to identify the dimensions and components affecting paraclinic services offered at Iran Social Security Organization (SSO) clinics & hospitals. A semi-structured questionnaire was prepared. The interview has been arranged with SSO managers, experts and officials and finally analyzed through the thematic analysis method.

Doing qualitative research and conducting thematic analysis, paraclinical services were classified into three categories: input, process, and outcome. The inputs  category had 5 organizing themes including paraclinical structure, human resource empowerment, cost management, social responsibility and service purchasing. The processes consisted of four themes: organizing the acceptance and delivery of services, monitoring and evaluating implementation, interdisciplinary coordination, applying innovation, and creativity in service delivery. Finally, outputs included three themes: organizing disease prevention and health promotion, gaining a competitive advantage, and reducing health costs.

According to the study's findings, to purchase or rationally use paraclinical services, it is necessary to know the dimensions and components that affect them. Managers of the social security organization are urged to lay a greater focus on employee empowerment, the employment of innovative approaches, and interdepartmental collaboration to enhance paraclinical service supply. Additionally, they may better fulfill their social duties and enhance their workers' health services by monitoring and evaluating executive actions.

Citrus Lemon is one of the medicinal herbs that is cultivated mainly because of its alkaloids, nutritional properties and antioxidants. Lemon peel extract is rich in tocopherol, phenol, flavonoids and vitamin C, and has an antioxidant activity. The purpose of current study was to investigate the effect of solvent, microwave and ultrasound extraction on the antioxidant properties of sour lemon extract. The effects of different methods extraction such as soaking, microwave and ultrasound carried out using water: ethanol solvent (30:70) on amount extraction of tocopherol and phenolic compounds and antioxidant activity, and the study of colorless process of β-carotene-linoleic and the amount of vitamin C in extract of lemon peel to obtain the best extraction efficiency for proper use of the extract. And the antioxidant activity and the inhibitory effect of the linoleic acid oxidation of the extract were compared with synthetic antioxidant BHT. The results showed that the phenolic compounds (480 mg gallic acid/gram), tocopherol (145 mg/ml) and ascorbic acid (85 mg/100 g) in the ultrasonic extraction method had the highest content. Also, the percentage of free radical scavenging DPPH (91%) and the colorless process of β-carotene-linoleic (58%) in the extract extracted by ultrasound showed the highest percentage of inhibition, however, they had a lower percentage of inhibition compared to BHT. According to the results of this study, using an ultrasound method, an extract can be obtained that does not significantly differ with the antioxidant BHT level in terms of antioxidant activity.

HIV infection has spread over the last 30 years and is undoubtedly the major public health challenge in worldwide. The aim of this study was to determine the epidemiological status of HIV/AIDS infected under the Covered of the Behavioral Diseases Counseling Center of Shiraz University of Medical Sciences during 1994 to 2020.

In this descriptive study, 3710 people living with HIV/AIDS in Fars province, covered by the Behavioral Diseases Counseling Center of Shiraz University of Medical Sciences, were selected as a sample by census method. The source of data collection was the national behavioral disease counseling software. Data analyzed by Fisher test, Chi square test and ANOVA test using SPSS19 statistic software.

78.32% of the infected were men. The mean and standard deviation age of infected was 44.61± 10.36 and the highest age group was 35-44 years old, 1488 people (40.1%). In terms of marital status, 1338 single people (36.06%) were the most and dead spouses were 229 (6.48%) were the lowest. The highest route of transmission injected drug abuse 2383 cases (64.2%) and the lowest was 71 cases (1.9%) from mother to child. Compared to the first and last high-risk behaviors, Heterosexual contact increased from 41.50 to 43.82% and only 5.37% used condoms continuously.

According to the findings, the transmission of the disease sexual contact is increasing. Therefore, designing and formulating effective control programs in the field of sexual behaviors is felt more than before.

Electronic health record is electronic data of “entire life of a person” registered by healthcare providers and shared in different health centers. The electronic health record has been announced to all medical universities of the country since March 2016 by launching the Integrated Health System (SIB). This study explains the barriers and shortcomings of the family physician program based on electronic health records in Guilan University of Medical Sciences. 

this qualitative content analysis study  with a  purposefull sampling  was conducted until data saturation time; Experiences and viewpoint of 15 assistants of health networks, Authorities of Health networks development, family physicians and expert of information security of University were collected through individual interview and notes in 2019-2020. Data were entered into MAXQDA software and the process of analysis (repeated reading and coding) was performed.

Findings were extracted in the form of five main categories including constraints: Structure and manpower, insufficient skills of planners and service providers, internal and external coordination, web-based system and related equipment, budgets with several subcategories.

In order to improve the quality of the implementation of the family physician program, which aims to provide health care to the covered population, the use of electronic health records can be institutionalized with the objectives of the family physician program by eliminating the identified shortcomings.

Intakes are the most significant hydraulic structures, which are also used as inlet structures in outlets to supply water for hydro-electric power, irrigation, and drinking. A major problem for vertical circular spillways is that vortexes are formed on their inlet with several negative effects: reducing discharge coefficient, excessive head formation on spillway inlet, structure vibration, increasing of cavitation formation probability, suction of floating bodies into conduit, excessive oscillations on flow surface, unsteady flow formation, and increasing energy losses are the major consequences. Vortex flows result from flow direction variation, viscosity and surface tension. The flow type causes negative effects in operation of structures such as vertical circular spillway (Kabiri Samani and Borghei, 2001).Taştan and Yildirim (2010) indicated that critical submerged depth for intake in canal with uniform flow equals radius of spherical sink surface, which was finally named critical spherical sink surface. Rankine (1858) represented a model of vortex, namely Rankine compound vortex. In this model, it is assumed fluid particles, which are in the vicinity of vortex center, are solid bodies with high viscosity and rotational motion around their axes (Forced Vortex). The area is located inside nonviscous zone at a distance from vortex center. This research investigates geometric and hydraulic properties of critical sink surface by simulating flow in the environs of vertical intake inlet.