edris kakemam

The growing trend of useless care might lead to negative consequences for patients, staff, and the organization. The employees who care for patients in their last stages of life for a long time might not tend to pay enough attention to the patients' pain. As a result, the quality of care services might be negatively affected. This study aimed to compare the perceptions of operating room technicians and nurses regarding futile care in the selected hospitals in Hamadan province, Iran from October to December.

Using available sampling method, the present descriptive cross-sectional study was performed on 200 health care workers (114 nurses and 86 operating room technicians). Data collection tools included a two-part demographic information questionnaire and the perception of futile care designed based on the Corley’s Moral Distress Questionnaire. The questionnaires were distributed in person and electronically. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software version 26. We used frequency, mean, and standard deviation for descriptive statistics and independent t-test and analysis of variance (ANOVA) for analytical statistics.

The mean score of nurses' perceptions regarding futile care was significantly higher (16.53±6.18) than that of operating room technicians. While the nurses' perceptions of futile care in both dimensions of intensity (66.71±13.72) and repetition (60.03 13 13.72) were at a high level, the perceptions operating room technicians in both dimensions of intensity (50.19±18.90) and repetition (52.43±18.8) were at an average level.

Nurses seem to have a relatively better understanding of futile care compared to operating room technicians. This is probably due to frequent contacts with patients overlooking death, as well as direct contacts with their family and relatives. In this regard, it is essential to develop guidelines in Iran delimiting the standards for the staff’s provision of futile care.

Obligation from physicians in the form of an oath dates back to the oath of Hippocrates and ancient Greece. These oaths have long been popular with changes in localization with respect to different cultures. In the Islamic period, not only the Hippocratic Oath was localized, but also other valuable effects were compiled in the form of advice letters; for instance, to create a sense of responsibility in physicians. Today in Iran, obtaining oaths from physicians is performed in the form of a graduation ceremony for medical students, and no attention is paid to its jurisprudential issues. This study was conducted with the aim of pathology of the jurisprudential dimensions of physicians’ oaths in Iran.

The present study was conducted with a qualitative exploratory approach in 2021 at the Tabriz University of Medical Sciences. Four sessions of focus group discussion with the presence of twelve experts in the fields of medical ethics, philosophy, law and theology were performed to collect data. Six-step thematic analysis method of Brown and Clark (2006) was used for data analysis.

The findings showed that physicians’ oaths in Iran was purely moral and that granting jurisprudential and religious status, such as the obligation of atonement in violation of the oath, may have negative consequences. Furthermore, it does not legally create any right for patients than to physicians.

Modifying the provisions and the manner of performing the oath ceremony and obtaining it in the three stages including entering education, during education and graduation, is one of the important suggestions of the present study.

The implementation of WHO safe surgery checklist (SSC) was proposed by the Ministry of Health and Medical Education in the operation rooms of Iranian hospitals in 2011, but was canceled after several years due to some challenges in implementation.

This study aimed to investigate the barriers and facilitators of the effective implementation of the SSC.

This cross-sectional study was performed in public hospitals of Tabriz city in 2019. The study population consisted of operation room working staff, and the purposive sampling was used. The research tool was a researcher-made questionnaire designed through literature review and included three parts of demographic variables, barriers, and facilitating factors. Data were analyzed with SPSS-22.

The mean of barriers to implementation of the SSC was 3.03 out of 5. The most important barrier to implementing the checklist was the weakness in team working (3.18), while checklist barriers were the least important (2.98). The mean score of facilitating factors was 3.46. Among the facilitators, the highest score was for team working facilitators with a score of 3.47 and the lowest score was for the facilitators associated with the checklist with a score of 3.37.

This is one of the first studies that explored the barriers and facilitators of SSC implementation in Iranian hospitals. We identified weak team working as the most important barrier to implementing the checklist. These results help policymakers and hospital managers to implement the checklist more effectively.

Providing quality services in different organizations depends on understandingthe needs and problems of human resources and responding to them appropriately. Thisstudy aimed to design and validate a questionnaire to assess the internal marketing status ofhealth care centers in Persian. After collecting the related articles and interviewing the experts, we designed theinitial questionnaire consisting of 35 questions in 8 different dimensions. For the validity ofthe instrument, face validity and content validity were used. For checking the reliability, theinternal consistency (Cronbach’s Alpha) and test-retest (Intraclass Correlation Coefficient)methods were used. All statistical analyses were performed using SPSS-v24 software. Using a panel of 15 experts to evaluate the content validity of the instrument, wefound that the optimal value of content validity ratio (CVR) and content validity index (CVI)were 0.49 and 0.79, respectively. Finally, 30 questions in the form of 7 dimensions were kept.Also, the reliability of the instrument was confirmed with Alpha=0.88 and ICC=0.85. This study provided a suitable and reliable instrument in Persian to investigatethe internal marketing status of health care centers that can be used by researchers.

Health services management is one of the important fields in health system. Assessing the abilities of graduates in this field will help to identify educational needs. Therefore, the purpose of this study was to evaluate the competency of bachelor graduateswho have employed in the health system units.

This cross-sectional study was conducted on 51 graduates, 41 junior employee and 28 senior employees of health-related organizations in East Azerbaijan Province and from the perspective of all three groups. The 360-degree method was employed using a researcher-made validity and reliability questionnaire with a 5-point Likert scale. Data analysis was performed using descriptive statistics and paired t-test.

Graduates in the field of ethics from a superior perspective (4.01 ±0.76), Customer orientation from the perspective of graduates (4.13 ± 0.76), Problem solving from the perspective of a colleague (3.94 ± 0.89), Service delivery management (3.93 ± 0.91) and change management from the perspective of a graduate (3.90 ± 0.85) And in the field of financial management (3.32 ± 1.14), human resource management (3.74 ± 0.81) and knowledge management from a superior perspective (3.46 ± 1.01) had less ability. The largest gap was identified in the field of financial management from the perspective of all three groups, but from the perspective of the graduates themselves, there was a greater gap in the field of information and communication management (3.89. 0.84).

This study showed that graduates in financial management and information and communication management need to be promoted. Therefore, reviewing the educational curriculum, using new teaching methods and holding supplementary training courses in these fields can help to improve graduates' abilities.

Patient safety culture has been identified as one of the important factors in reducing hospital adverse events and improving patient safety. The present study was conducted to investigate the relationship between patient safety culture and adverse events among nurses of selected teaching hospitals in Tehran.

This cross-sectional study was performed in 2019 on 260 nurses in 7 hospitals affiliated to Tehran University of Medical Sciences. Data was collected using the patient safety culture questionnaire and the frequency of adverse events. Multiple logistic regression was used to investigate the relationship between patient safety culture and adverse events in SPSS 22.

Among the dimensions of patient safety culture, the highest mean score was related to the dimension of "organizational learning" and the lowest score was in the area of "information exchange and transmission". Between 35.4% and 51.9% of nurses estimated that they had experienced one of six adverse events in the past year. Logistic regression results indicated that dimensions of management support for patient safety, general understanding of patient safety culture, teamwork within organizational units, communication and feedback about errors, staffing issues and information exchange and transmission were significant predictors for adverse events (P<0/05).

The results of the present study confirmed the hypothesis that improving the patient safety culture leads to decrease in the incidence of adverse events among nurses, therefore promoting the safety culture in hospitals of country should be considered as one of the main priorities of management programs.

The World Health Organization has identified health literacy (HL) as one of the most important determinants of people’s health. Therefore, this research aimed to investigate the status of HL and its predictors.

This research was a cross-sectional study that was performed on 600 adults in Bijar County, Iran. Cluster sampling was used to select the samples. Data were collected using the questionnaire of HL for Iranian adults. Data were analyzed using one-way analysis of variance, Student’s t-test, and multiple linear regression in SPSS 21.

The mean score of HL was 3.6 out of 5; 69% and 29% of the samples had a moderate- to-high health status, respectively. Among the dimensions of HL, the highest and the lowest means were perception (3.94) and evaluation (3.21), respectively. Based on the multiple regression results, the variables (gender – B = −0.142, confidence interval [CI]: −0.409 to −0.011, P = 0.39; education level – B = 0.391, CI: 0.149–0.287, P = 0.00; and income level – B = 0.203, CI: 0.00–0.00, P = 0.01) were significantly positively associated with HL.

The results of this study can be applied to educational interventions through media and radio-television to increase public awareness. Education is also strongly recommended in terms of demographic variables and characteristics to promote HL in the society.

Patient safety culture is an important factor in reducing hospital's adverse event and improving patient safety. The aim of this study was to evaluate the relationship between patient safety culture and adverse events in hospitals of Hamadan city.

The present study was a descriptive-analytical study which was performed in hospitals of Hamadan in 2018. The study population consisted of nurses working in hospitals. The patient safety culture questionnaire and adverse event checklist were used for data collection. Questionnaires were completed by 650 nurses. Multiple logistic regression was used to examine the relationship between the variables.

The highest mean score of patient safety culture was related to the dimension of organizational learning, and the lowest score was for exchange and transfer of information. 35.4 percent of nurses said they had seen at least one patient fall in the past year (the least adverse event). Moreover, 51.9 percent of nurses stated that at least one pressure ulcer, or a complaint by a patient or his/her family had happened at their workplace in the past year (the most adverse event). Finally, the mean score of the patient safety culture had a significant relationship with the incidence of adverse events.

This study confirms the patient safety culture as a predictor of adverse events. Hence, health officials and hospital administrators should provide prerequisites for promoting patient safety culture and reducing adverse events through different strategies, such as encouraging erse events reporting as well as holding nurse training courses.

Surgery is one of the most widely used health care that High levels of morbidity and mortality is attribute to this care, while half of these outcomes are preventable. The purpose of the present study was to evaluate the effect of surgical safety checklist on morbidity and mortality in operated patients.

The present descriptive-analytical and prospective study was performed in three general steps with before-after method at a public hospital in Tehran. 1604 patients among the operated patients were randomly selected in the control and intervention groups before and after the intervention and their data were extracted based on WHO standardized surgical safety checklist. Statistical analysis was performed using descriptive tests (mean, percentage) and analytical tests (chi-square, paired t-test) by Stata software.

The validity of the study instrument was determined by face validity and its reliability was determined by Cronbach's alpha. According to the results, there was no significant difference before and after the implementation of surgical safety checklist in morbidity and mortality of operated patients (P˃0.05).

The effectiveness of an instrument depends on a set of conditions and using method and the attitude of the staff towards it is very determinative, Therefore, it seems that completing the surgical safety checklist merely as one of the stages of the surgical process cannot improve the situation and reduce the morbidity and mortality of the operated patients.

Sufficient length of consultations is of utmost importance for improving the quality of care and establishing a good physician-patient relationship. Multiple factors affecting outpatient consultation length were investigated among Sheikh Al-Raisi specialists. Sheikh Al-Raisi is a general medical institute in Tabriz, in 2018.

This study was a cross-sectional and performed at a specialty clinic in Tabriz. In order to select the samples, random sampling was used. The consultations of 400 patients with 18 specialists were analyzed. Length of Consultation and demographics of patients and physicians were collected in the year 2018. Checklists were used to collect the data and a multiple regression analysis was applied to investigate the association of the variables with consultation length.

The mean and standard deviation consultation time was 6.9 and 2.6 min. In the multivariate model, the consultation time was longer for female patients. Lengthy consultation time was recorded in patients with bachelor's degrees or higher levels of education. The consultation time was longer in patients with gynecology problems (mean = 9.1) compared to those with other problems. In addition, older and female physicians provided longer consultation.

Clinical consultation time in specialists’ practice is estimated as short and is associated with the characteristics of the patients and the doctors and the types of their specialty. The results can be applied to make specialty consultation more effective, which can ultimately result in the delivery of the most optimum consultation period for each and every patient.

Iranian public hospitals have been excessively changing during the healthcare reform since 2014. This study aimed to examine the technical efficiency of public hospitals during before and after the implementation of Health Sector Evolution Plan (HSEP) and to determine whether, and how, efficiency is affected by various factors.

Forty-two public hospitals were selected in Tehran, Iran, from 2012 to 2016. Data envelopment analysis was employed to estimate the technical and scale efficiency sample hospitals. Tobit regression was used to relate the technical efficiency scores to seven explanatory variables in 2016, the last year.

Overall, 24 (57.1%), 26 (61.9%), 26 (61.9%), 24 (57.1%) and 21 (50%) of the 42 sample hospitals ran inefficiently in 2012 to 2016, with average technical efficiency of 0.859, 0.836, 0.845, 0.905 and 0.934, respectively. The average pure technical efficiency in sample hospitals increased from 0.860 in 2010 (before the HSEP) to 0.944 in 2012 (after the HSEP). Tobit regression showed that average length of stay had a negative impact on technical efficiency of hospitals. In addition, bed occupancy rate, ratio of beds to nurses and ratio of nurses to physicians assumed a positive sign with technical efficiency.

Despite government support, public hospitals operated relatively inefficien. Managers can enhance technical efficiency by increasing bed occupancy rate through shortening the average length of stay, proportioning the number of doctors, nurses, and beds along with service quality assurance.

To respond to the growing expectations of the public and to meet the needs of the society, health systems have always tried to improve their performance. This study investigated the changes in the performance and quality of emergency department (ED) after implementation of the health transformation plan (HTP) in Iran.

This was a before–after study that was conducted in Tehran’s Lolagar General Hospital in 2016. The data related to the performance indices and patients’ satisfaction indices were collected in the two periods of 6 months before and 6 months after the implementation of the HTP. The data were gathered by a checklist designed by the researchers.

Among performance indices, the maximum positive change was related to the failure in cardiopulmonary resuscitation, which had a reduction of 18.27%. Discharge against medical advice had a reduction of 1.11%, which is considered to be significant. Among the factors related to patients’ satisfaction, the maximum changes belonged to the out‑of‑pocket payment, access to medicines, and giving information to the patients, which were 0.87%, 72%, and 61%, respectively.

HTP and its supporting packages have led to positive changes in the performance of the ED of the hospital. Therefore, based on the results of this study, the continuation of this plan is recommended.

Inefficient management of hospitals leads to the substantial waste of resources. Therefore, hospital efficiency has recently been a major concern among researchers. The present study aimed to evaluate the association of the management competency and technical efficiency in the general hospitals of Tehran, Iran.
This descriptive-analytical, cross-sectional study was conducted in 28 general hospitals in Tehran, Iran in 2015. In the first step, a survey was performed among 224 managers at different levels in the hospitals using a researcher-made management competency self-assessment questionnaire. In the second step, technical efficiency in the selected hospitals was measured by the Data Envelopment Analysis (DEA). Data analysis was performed using SPSS, Enterprise Management Software (EMS), and Deap1, 2.
The average of competency was relatively high among the hospitals managers. However, more than half of the hospital performances were observed to be inefficient. Moreover, the results indicated that the competency of hospital managers was significantly correlated with their field of education, participation in training courses, and managerial experience. Also, a significant, direct association was observed between the competency of managers and technical efficiency in the studied hospitals.
According to the results, although the level of technical efficiency was favorable in the studied hospitals, the hospital managers with high competency should further develop and improve their performance and efficiency in these hospitals.

Public sector in Iran is responsible for providing whole primary health care and approximately 85% of the second and third level services. Following the previous programs, and in order to improve health system performance, Iranian Ministry of Health and Medical Education launched Health Sector Evolution Plan of Iran (HSEP) in 2014 aimed to reduce patients’ cost, improve quality, and provide equal access for all.
We examined the achievement of these objectives through reporting a case and comparing current and past situation. The data related to the case were collected by interview and surveying patient documents. Published articles were considered as a base to compare some indices before and after the plan.
Our case was a Ph.D. student who sought out health care for his wound treatment. Total treatment expenses were $ 195 and many medical supplies were used. Waiting time and visit length were calculated 345 minutes and 1 minute, respectively. Paying an amount of money equivalent to almost 57% of his salary and too long waiting time to receiving short visit are in contrast to the primary objectives of HSEP and show no improvement in these indices compared with prior to the plan.
With regard to increasing financial resources through HSEP (70%) compared with the same time before HSEP, it is necessary to manage these funds properly to achieve objectives more effective and efficient than the current ones.

Introduction. The aim of this systematic review and meta-analysis was to evaluate the efficacy-related events and adverse events of 2 different doses of everolimus in kidney transplant recipients.
Materials and Methods. The Cochrane, PubMed, and Google Scholar databases were searched for randomized controlled trials published by the end of 2015 on the use of everolimus in kidney transplant recipients at doses of 1.5 mg/d and 3 mg/d. Two independent reviewers assessed the studies for quality and eligibility and extracted the data. The relative risk (RR) and 95% confidence interval (CI) for treated efficacy-related events and adverse events were collected to calculate pooled measures.
Results. A total of 8 articles describing 7 randomized controlled trials (n = 2148 participants) were included in this study. The overall RR in adverse event outcomes was significantly in favor of the lower dose of everolimus (RR, 0.96; 0.95% CI, 0.93 to 0.99; P Conclusions. The result of this systematic review and meta-analysis showed that the overall outcomes of adverse events and graft loss were better with everolimus, 1.5 mg/d, than with everolimus, 3 mg/d, when combined with other kidney transplantation medications.

High organizational justice and its factors are associated with reduced turnover intention. Therefore, in this study, we aimed to examine the relationship between organizational justice and turnover intention among hospital nurses.
This descriptive, analytical study was conducted on 135 nurses working in Labafi Nejad Hospital in Tehran, Iran, 2015. The data were collected using Beugre's (1998) questionnaire of organizational justice questionnaire. To analyze the data, Pearson’s correlation and ANOVA tests were performed using SPSS, version 20.
Mean organizational justice and turnover intention scores were 68.85±7.67 and 47.8±12.47, respectively. Among the different types of organizational justice, the highest mean score was pertinent to interactional justice (75.24±16.68). A significant inverse correlation was observed between turnover intention and organizational justice (r=-0.36), interactional justice (r=-0.38), and procedural justice (r=-0.36), while no association was noted between turnover intention and systemic and distributive types of justice. Furthermore, there was no link between demographic variables, organizational justice, and turnover intention.
Considering the prominent role of organizational justice in personnel’s intention to leave their job, and given high costs of recruiting and training new staff, managers should pay especial attention to promoting justice and employees’ satisfaction and enhancing stability in their organizations by reinforcing positive attitudes in the employees.

Scientific and technological developments have promoted the status of organizational learning as a reasonable way to deal with the present changing circumstances. The development of organizational learning improves the performance of employees, and makes them feel satisfied. The aim of this study is to investigate the relationship between job satisfaction and organizational learning capabilities among the employees of Tehran hospitals.
Materials and Methods This descriptive, analytical study was conducted among 290 employees in 2014 in Tehran hospitals. For data collection, a three-part questionnaire (including demographic characteristics, Gomez`s Organizational Learning Capability Questionnaire and Minnesota Job Satisfaction Questionnaire) was given to 290 employees. Data were analyzed using the SPSS-20 software with Spearman test.
Mean scores of organizational learning capability and job satisfaction were (3.03± 0.61) and (2.8± 0.61), respectively. Among the dimensions of organizational learning capability, the highest score pertained to systematic perspective (3.29± 0.78); regarding job satisfaction, the highest score was related to organizational climate (3.23± 0.1). The results showed that there was a significant correlation between the dimensions of organizational learning capability and job satisfaction. Also, a significant correlation was observed between organizational learning capabilities and job satisfaction.
Organizational learning improves the performance of employees and is positively correlated with their satisfaction. Also, employee satisfaction is one of the factors affecting their performance. Therefore, managers can make employees satisfied and develop their organization through improving organizational learning.

Objective (s): Medical tourism is quickly emerging as a symbol of global trade in health care. The aim of the study was to assess Qazvin’s hospitals preparedness in attracting medical tourists based on JCI patient-oriented standards. A descriptive study was conducted in seven hospitals of Qazvin in 2012. The patient-oriented checklist of JCI standards was used to collect data. The results showed that among 7 standards, maximum score was belonged to Anesthesia and Surgical Care (77.5%) and minimum score was belonged to Patient and Family Education standard (52.5%). Finally, The Rahimian hospital acquired maximum score (85.4%) and the Kosar hospital acquired minimum score (5). The hospitals in Qazvin showed a relative preparedness in medical tourists. Standards in private hospitals were more acceptable than state teaching hospitals.

The importance of safety in hospitals can be studied from different angles since hospital is a critical environment for incidents. Assessment of occupational accidents in hospitals can prevent their recurrence and maintain human and financial resources. This study aimed to investigate the occupational accidents among staff in a hospital. This cross-sectional descriptive-analytical study was carried out in a hospital in Tehran University of Medical Sciences. Two hundred and thirty staff from various wards of the hospital were recruited by stratified random sampling. Data collection was performed using a researchermade questionnaire. Data were analyzed by the SPSS-20 software with descriptive statistics, Mann-Whitney and Kruskal-Wallis tests. The study results revealed that among staff, most of the occupational accidents was related to skin contact with blood or other body fluids and least of them belonged to toxicity with solvents. The results showed significant differences regarding occupational accidents between different groups of gender, years of work experience, organizational position, shift type, and age. Since most of the occupational accidents happened at least one time among hospital staff, paying attention to prevention of it is necessary. Due to the complex nature of hospitals, management and prevention of occupational accidents require all personnel’s willpower and involvement, and hospital management reform.