فهرست مطالب محمدرضا وفائی نسب

One of the biggest challenges of the emergency medical system is to respond to accidents with a large number of injured people. In Iran, despite the great progress made in pre-hospital emergency services, there are many problems and shortcomings. Therefore, the purpose of the present study was to determine the factors affecting the pre-hospital response to traffic accidents with a large number of casualties.

The present qualitative study was conducted using a semi-structured method with the participation of 31 officials and personnel of the pre-hospital emergency, Red Crescent and the police, as a purposeful sampling from June 2017 to September 2018 using the contractual content analysis method. Since the researchers was trying to explain the factors affecting the pre-hospital response in traffic accidents with a large number of casualties, the qualitative research method with the contractual content analysis approach was used. The first participant was selected using the goal-based method, and the other participants entered the qualitative interview process using the snowball sampling method. The main question of the interview was "Describe the factors influencing the response to the MCTI mass casualty traffic accidents in which you have been involved". Sampling ended when the participants did not add new data to the previous data and no new codes were created. The Elo and Kingas analysis method was used, which includes open coding, classification of codes, creation of the main class or within the theme. The collected data were analyzed using statistical tests.

In the present study, the researchers achieved information saturation with 31 participants (27 men and 4 women) who were at most 50 and at least 26 years old (average 35 years) and their work experience was at least 2 and at most 28 years (with an average of 13.2) year), the content of "pre-hospital response" consists of three layers: information management, evaluation, and incident scene management. This theme was extracted from the different experiences of the participants in responding to accidents with a large number of injured people, from the moment the accident was announced by the pre-hospital emergency dispatch center, the provision of relief and treatment services at the scene of the accident, the transfer of the injured to the hospital and their delivery to the trauma center.

Consolidation of relief organizations leads to their coordination at the scene of the accident and better services to the injured. Holding joint 6-month training courses for all relief organization employees provides the basis for more interaction, coordination and service delivery to the injured.

Despite many challenges, public-private partnership in hospitals is recognized as one of the most attractive investment platforms for the private sector. This study conducted to assess the challenges of private sector partnership with public hospitals using the public-private partnership model in public hospitals in Yazd.

The present qualitative research conducted in 2021. The viewpoints of 15 faculty members, directors, managers and operational experts on the participation of the private sector, those related to the transfer and contracts and the parties of the private sector are extracted through a semi-structured interview guide and analyzed using content analysis in three stages.

A total of 10 main themes including economic and policymaking problems, insufficient manpower readiness, lack of support authority, weak partnership laws, lack of knowledge and experience of managers in partnership, lack of financial transparency, conflict of interest, poor coordination, lack of cultural readiness and trust-building and lack of plans and supervision in the field of partnership in 28 sub-themes extracted.

There are challenges related to policymaking issues and the resulting instability, incoordination of different units, unpreparedness of manpower and contract details in using different models of public-private partnership in hospitals, in which the use of the same procedures, transparency and the meeting requirements of the private sector are recommended for partnership and the formulation of laws and contracts free from any shortcomings and weaknesses that could lead to the loss of the public sector.

One of the most common causes of chronic back pain is spinal stenosis.This disorder is common in the elderly.Treatments for spinal stenosis include surgery, laser therapy, ozone therapy, physical therapy, and medication.Since no study has been done to compare laser therapy and ozone therapy, this study was performed to evaluate the effectiveness of intramuscular injection of ozone gas in paravertebral muscles compared to high-power laser in patients with lumbar spinal stenosis.

This study was a randomized clinical trial.Patients referred to the Physical Medicine and Rehabilitation Clinic with spinal canal stenosis were evaluated in three groups: laser therapy, ozone therapy, and drug & physical therapy.After treatment, a valid SSSQ questionnaire was used to collect and the outcome of treatment.After data collection, they were analyzed by spss25 software.

The results showed that the mean score of pain and neuroischemic symptoms, physical activity and patients' satisfaction with the intervention performed immediately after treatment (p = 0.04), 4 weeks after the intervention (p = 0.001) and 8 weeks after the intervention (p = 0.001) Was statistically significant.

The results of the present study showed that laser therapy and ozone therapy versus drug and physical therapy alone were effective in reducing pain and neuroischemic symptoms in patients as well as improving patients' physical activity but there was no significant difference between laser therapy and ozone therapy during the time the patients were examined.

Patient satisfaction with health care indicates the organizational performance of a hospital. The level of patient satisfaction depends on factors such as ability of the physician, observance of the patientchr('39')s rights, and quality of treatment. The aim of this study was to investigate the level of patient satisfaction with the provision of inpatient services in selected wards of some hospitals affiliated to Yazd  Shahid Sadoughi University of Medical Sciences in 2016.

The present study was a descriptive cross-sectional research. Shahid Sadoughi, Shahid Rahnemoun, Afshar, Ziaei Ardakan, and Fatemeh Al-Zahra Mehriz hospitals were selected to conduct the study. Inpatients were included in the statistical population. The total sample size with an error of 5% was estimated at 1056 people. A researcher-made questionnaire was applied to collect the study  data. Data analysis was performed using SPSS software version 21 and frequency, mean, median, and exponential distribution tables were used to describe the findings.

The initial population was estimated at 83531 people. In order to reduce the error, a higher sample size (1527 people) was considered. The highest number of patients was from Afshar Hospital (24.6%). The average level of patient satisfaction with the physician was 4.30, with the nursing services was 4.23, with the nursing assist services was 4.25, with the service staff was 4.45, and with the welfare facilities was 4.33. Patientschr('39') satisfaction with the service staff was higher than other dimensions. In total, 95.2% of patients were satisfied with the provided services.

The authorities are recommended to plan the necessary interventions in order to improve the quality of care provided by medical personnel and eliminate patients’ dissatisfaction with the help of hospital officials. To this end, the patient rights should be observed by all personnel.

Menopause can change the musculoskeletal system by reducing estrogen hormone levels. The aim of this study was to evaluate the effect of regular resistance training accompanied by vitamins D and calcium supplements during pre-menopausal period on muscle tissues of Wistar rats’ postmenopausal period.

In this experimental study, female Wistar rats were randomly divided into control, placebo, vitamins D, Calcium, excercise, vitamins D- Calcium, vitamins.D- excercise, Calcium - excercise, and vitamins.D‐ Calcium - excercise groups. Control and placebo groups were fed with a standard diet and sesame oil, respectively. The amount of calcium consumed was 35 mg / kg and the amount of vitamin D was 10000 IU during the two-month period, and in the resistance training groups, two months of training was performed with a ladder. Then ovariectomy was done and sample of the gastrocnemius muscle was taken and the diameter of muscle fiber, the number of muscle and adipocyte cell as well as the number of inflammatory cells were studied. The statistical analysis by means of one-way ANOVA and SPSS version 20 was performed.

Compared to the control group, the increase in the number of adipocyte cells were observed in the vitamin D, calcium-vitamin D, vitamin D-resistance exercise and placebo groups but it was not significantly different. Muscle fiber diameter significantly increased in all groups compared to the control group (P <0.001). The number of muscle cells increased significantly in the calcium-resistance exercise group (103± 9), vitamin D-resistance exercise (105 ±6.9) and calcium-vitamin D-resistance exercise (114 ± 3.16) compared to the control group, while, there was a significant increase in inflammatory cells only in the control and placebo groups (p≤0.05).

Regular resistance exercise accompanied with vitamin D and Calcium supplements in premenopausal period can improve muscle fiber diameter and muscle cell numbers; in addition, the process of decrease in the muscle strength and muscle inflammation during menopause will be delayed

Menopause is the natural termination of menstruation, which affects the quality, and important aspects of women life. The aim of this study was to investigate regular resistance training along with vitamins D and calcium intake in the pre-menopausal period on bone mineral density (BMD) in rats.

 In this experimental study, the rats were randomly divided into control groups, placebo, vitamin D, calcium, resistance training, vitamin D + calcium, vitamin D + resistance training, calcium + resistance training, vitamin D + calcium + resistance training. Control and placebo groups were fed with a standard diet and sesame oil, respectively. Ovariectomy was done after two months of resistance training (Ex), calcium (35 mg/kg) and vitamin D (10000 IU) administration. BMD and bone mineral content (BMC) were measured. Hematoxylin-eosin staining was performed to examine bone total diameter and osteoclast and osteocyte cell numbers. The statistical analysis was done by a one-way analysis of variance (SPSS 20).

There was an increasing trend in BMD lumbar of the Ex group (P<0.001) in comparison with the control group. The amount of bone mineral in the whole body in calcium and calcium + resistance groups was higher than the control group (P <0.05). BMC total in the vitamin D, calcium + resistance training, vitamin D + resistance training and calcium + vitamin D + resistance-training groups was lower than the other groups. Osteoclast cell numbers were decreased in Ex, Vit D+Ex (P<0.05), Ca+Vit D, Ca+Ex and Ex+Vit D+Ca groups (P<0.001) compared to the control group, also, osteocyte numbers were decreased in VitD, Ca+Vit D (P<0.05), Ex, Vit D+Ex, and Ex+Vit D+Ca groups (P<0.001).

Regular resistance exercise, vitamin D and calcium supplements in pre-menopausal period can improve BMD and BMC and delay the process of osteoporosis in postmenopausal period.

Research activities are the main sources of new information and knowledge used by  different organizations. Research is an attempt to find the best possible solutions for solving problems in different life aspects. Therefore, the present study aimed to identify the research barriers from the viewpoints of the staff of Shahid Sadoughi University of Medical Sciences in Yazd in 2018.

This quantitative, descriptive,  analytical, and cross-sectional study was carried out among the staff working in Deputy of Management Development and University Resources selected using the census method. A researcher-made questionnaire was administered to collect data, which addressed the individual, organizational, cultural, social, economic, and demographic barriers. The questionnaire's validity was confirmed by a panel of experts and its reliability was confirmed by Cronbach alpha of 87.2. Data were analyzed using SPSS software.

The participants' overall satisfaction of economic, social and cultural, organizational, and individual factors was less than the average (12.8%), more than the average (57%), moderate (21.9%), and moderate (40.7%), respectively.  A significant association was observed between history of research activities and economic factors as well as between organizational status and organizational and individual factors (participants = 0.05).

The university should provide the researchers with spiritual appreciation, seek to eliminate economic barriers for further research, allocate more resources for research, provide an easy access to facilities for conducting research, conduct research methodology training courses within the organization tailored to the existing administrative expertise, and review the processes of presenting projects and payments.

Emergency medical services are a crucial component in the treatment of critically ill patients. A common principle in pre-hospital emergency services is defined as a target “8 minutes or less response time of advanced life support for people in life-threatening events”. Therefore this research is aimed to evaluate on performance of pre-hospital emergency stations in Yazd, based on essential time for attending at patient's bedside.
The present study is analytic descriptive conducted cross-sectional. Method of collecting data based on census and its analyzing method had been qualitative. According to Likert, performance is considered excellent with action less than 8 minutes, good with action by 8 minutes, and weak higher than 8 minutes.
according to the results, the best average performance time (In 1392 among stations of Yazd) belong to 4th District station with 8.58 minutes and the weakest time to 6th District station with 12.01 minutes. The average of performance of Yazd emergency medical services at urban missions had been 9.84 minutes. Findings show that the highest average time activity recorded on winter that was 10.2 minutes and lowest average time activity was recorded on summer which was 9.47 minutes. Also results show even though the number of missions in the summer were higher than the winter, but the mortality rate were less in contrast.
By comparing the obtained information from the research results, the impact of mission duration on mortality rate reduction has turned out. Also according to the sensitivity of pre-hospital emergency, the necessity of attention to urban missions’ timeframe in Yazd emergency service is another conclusion that this is achieved by authorities supervisory and provision of requirements and adequate facilities.

Triage is a part of the organizational process in emergency departments that affects their functional outcome. Each emergency department has its own special strategic state that may require adjustments to its triage system for localizing the process. Therefore, sufficient documentation is required in this field and studying triage is necessary. The purpose of this study was drawing a scheme of the studies carried out regarding triage in emergency departments during 2013 and 2014. For this purpose, articles published in this field were searched in Pubmed internet gateway using triage, fast track, hospitals, health care, emergency, medical services and emergency service as keywords. Based on this search strategy, 119 articles were found and classified into 7 triage- related fields. Finally, distribution of the articles regarding place, subject, type and methodology of the study was evaluated using descriptive analysis.

Prenatal mortality rate is regarded as an important index of health in a community. In order to maintain and promote health of infants, as a vulnerable group, factors affecting prenatal mortality need to be identified and appropriate strategies should be designed. Therefore, the present study aimed to investigate the causes of prenatal mortality on the basis of babies’ record in hospitals of Yazd province. This descriptive study was conducted using the available data in the files. The study population entailed children who were born dead in 2012 in 15 medical centers in Yazd or who were born alive after 22 weeks of pregnancy, but died within 29 days after the birth. Causes of death were extracted from the files according to the related doctor’s opinion. A total of 390 perinatal deaths were registered in Yazd hospital. The perinatal mortality rate was reported 14 out of 1000 alive births. The most common causes of perinatal mortality belonged to respiratory distress syndrome (42.05 %), late delivery (22.7 %), as well as abruption (4.6%) in regard with fetus- recorded, mother-recorded, and placenta-recorded causes respectively. Emphasizing prenatal care, detecting and tracking high risk pregnancies as well as developing neonatal intensive care units might be taken into account as the most important factors in prevention of prenatal death.

The purpose of this study was to show the major challenges and opportunities related to Health Technology Assessment (HTA) that most countries have faced with when launching and developing an HTA system for making appropriate decisions in policy making. Review of studies: This was a review study in the field of HTA and health policy. All literature potentially relevant to this issue had been studied via library and the Internet search of data bases related to HTA to select and present materials extracted. The search was focused on English papers published in 1980-2014. The impact of HTA depends in large part on the quality and transparency of the assessment and decision-making processes، as well as institutional، organizational، political and cultural dynamics broader than the scopes of national health care systems. As many countries increasingly gear their health systems towards policies emphasizing measurement، accountability، transparency and evidence-based practices، the challenges of HTA should be addressed in order to achieve concurrent health care system goals، and support those services offering large value of money and impact on health care outcomes. The role of HTA offering extensive opportunities to support governments and other stakeholders in decision-making has grown substantially. Countries should، therefore، seek to capitalize on the strengths of established HTA systems، while pioneering solutions to address major challenges and strengthening the HTA enterprise.

Efficiency indicators are the most important ways to measure hospitals performance, but the individual application of these indicators can result in misleading hospital performance measurement. The application of simultaneous indicators can eliminate many problems in the case of hospital performance measurement; therefore, through using Pabon Lasso Model, the indicators at university- affiliated and university-nonaffiliated hospitals were assessed simultaneously. This cross-sectional study was conducted in 20 hospitals of Yazd Province during 1391. The sample consisted of 13 university-affiliated and 7 university-nonaffiliated hospitals. Data were prepared by the University treatment assistant and then three indicators including Bed Occupancy Rate (BOR), Bed Turnover (BTO) and Average Length of Stay (ALS) were simultaneously assessed through Pabon Lasso Model. Pabon Lasso Model includes 4 areas in which among 12 university- affiliated hospitals, 3 cases (25%) were in the first area, 2 cases (16%) in the second, 5 cases (33.3%) in the third and 3 cases (25%) in the fourth, and among 7 nonaffiliated ones, 3 cases (42.8%) were in the first area, 1 case (14.3%) in the second, 2 cases (28.6%) in the third and 1 case (14.3%) in the fourth. The country hospitals in comparison with those in Yazd, and university-based comparing to non-university-based hospitals were centrally placed in the third area of efficiency. In this regard, it is essential that contemplation in available methods considers resource allocation and proposing new ways for Yazd and non-university based hospitals.

In view of high expences in the hospitals especially governmental Hospitals and need for regulations in the financials aspect makes it necessary to evaluate the effect of every factors effective in health services marketing (Internal and external customers attitude) the management can plan and design according to the role and effects of these factors in regulation of the hospitals، departments and sections under their control.

This is a descriptive study to determine the role of management in relation to degree of aplication of each effective factors in health services marketing (Internal customers attitude) during this fall 1390 was carried out. In this study hospital administrators، heads of nursering services. Heads of financial department، educational suprevisors، heads of pharmacy، heads of laboratory، heads of radiology were studied. Data was collected by questionaire complemeted by managers and analysis carried out by spss and statistica software

According to this study following results were obtained: maximum frequency the role of management in relation to degree of aplication of service or product factor was evaluated within the limits of intermediate and was dependent to heads of laboratory. Price factor evaluated low and was dependent to heads of administrative and financial. place and time factor، intermediate and was dependent to heads of laboratory. Promotion factor، lowly and was dependent to heads of administrative and financial. people factor، high and was dependent to heads of radiology. Physical evidence factor، high and was dependent to hospital managers. process factor، high and was dependent to egucational superwisers. productivity and quality factor، intermediate and was dependent to heads of laboratory.

According to this study results maximum frequency the role of management in relation to degree of aplication of service or product factor and people، physical evidence، productivity and quality، process was dependent to metrons. Maximum frequency the role of management in relation to degree of aplication of Promotion factor was dependent to heads of radiology. Frequency the role of management in relation to degree of aplication of price factor was dependent to heads of farmacology. According to this study following results were obtained hospital managers believed to high and intermediate rol in relation to degree of aplication of effective factors in health services.

The prevalence of Stroke disease and increased health care costs are in urgent need of reconsideration in the case of the best and most affordable way for care. This study is to investigate the cost-effectiveness of home care compared to hospital care for stroke patients in Tehran city.

This study is an analytical cross-sectional one that data of 52 stroke patients of Dam home care Institution and 52 patients of Imam Khomeini and Rasoul Akram hospital obtained from the Balance Sheet and other data sources, by using the SF36 questionnaire, the patient recovery rate was measured. For data analysis and T-test, SPSS software was used and p < 0.05 was evaluated.

The lowest health care costs were related to the age group lower than 39 years and effectiveness maximum was related to the same group with a mean of 0.58. The lowest average hospital costs were related to the age group 40 - 59 years and effectiveness maximum was related to groups lower than 39 years.

System of home care for stroke patients suitable alternative to hospitalization of patients in hospitals and this problem is due to a shortage of beds in Iran hospitals are more important and should be considered by policy makers.

Methadone maintenance therapy is a well-known approach to the treatment of drug use disorders and harm reduction. But the main challenge is retention rate in MMT Through simple random sampling, 155 addicts aged between 18-60 years who referred to drug addiction center of university and underwent MMT were followed for at least one year and up to two and half years. Of the total, 3.9% female, 62% married, 37.4% workers and 27.1% were jobless. 80% had education level of less than diploma, 43.2% abused marijuana, 54.2% abused alcohol and 49.7% were living in rented houses. 60% referred to this center because of economical problems, 15.5% because of legal issues and 67.7% because of family pressure. 31.6% were opium and opium resin addicts, 60% were heroin addicts, 8.4% were crack addicts and 21.9% were IV abusers. 76.8% had at least one high risk behavior. Average dose of methadone was 86.5+35 mg/day. Mean survival time was 80 weeks. Relapse rate was 3.3% in the first month, 13.9% in three months, 23.2% in six months, 31.7% in first year and 41. 7% was a total relapse rate. Survival rate had a direct significant statistical relationship with the age, type of drug and method of use. According to the results of the present study that indicate a survival rate of 68.2% in a year and 58.3% after a year and also considering the results of other studies, we can conclude that MMP could be an effective method in the treatment of opiate drug disorders.