mahmood nekoei-moghadam

 Hospitals are the front line of dealing with Incidents. Chemical, biological, radiological, and nuclear (CBRN) incidents are alarming for governments' healthcare providers and the public. Therefore, they must make the necessary preparations to deal with these incidents.

 This study aimed to evaluate the preparedness of hospitals against chemical, biological, radiological, and nuclear incidents and the related influential factors.

 The present study was a cross-sectional survey in northwest Iran, 2020-2022. The statistical population was the hospitals of West Azerbaijan province. The inclusion criteria were that hospitals must be university or therapeutic affiliated with the West Azerbaijan University of Medical Sciences, and at least one year had to be passed since the hospital’s operation. Also, the exclusion criteria were that the hospitals were on the verge of closing or changing their use. In this way, 26 hospitals in West Azerbaijan were studied. The "Canadian Center for Emergency Preparedness" evaluation checklist research tool was used to determine the level of preparedness of the studied hospitals in CBRN incidents. The data was collected for 5 months, from January to May 2021. Cronbach's alpha score for this checklist was 0.94. Descriptive and analytical statistics indicators were used for data analysis using SPSS 20 software.

 The study showed that the hospitals lacked the preparation, capacities, and abilities to deal with CBRN incidents. In the single-variable mode, in the chemical dimension, the number of morgues of the deceased (P = 0.006); in the biological aspect, per capita educational factors in the biological domain (P = 0.03), the number of facility personnel (P = 0.04), the number of infectious disease specialists (P = 0.02), the number of equipment with optimal laboratory capabilities (P = 0.04), and the number of morgues of the deceased (P = 0.006); in the radiological and nuclear dimensions per capita of nuclear education (P = 0.01) and dosimeter (P = 0.03), and the general dimension the CBRN training per capita (P = 0.004), the number of personnel (P = 0.015), and laboratory equipment (P = 0.006) had a significant relationship with the preparedness of hospitals against CBRN incidents (P < 0.05).

 Overall, this study's results showed that hospitals' preparedness against CBRN incidents was unsatisfactory, and appropriate policies needed to be adopted to improve it.

One of the aspects to consider in the health system is to focus on the core competencies of specialists in this field, which allows them to create significant differentiation from competitors by investing in their strengths. The purpose of this research is to design the model of core competencies of health system specialists in a hybrid method.

The present research was conducted using a meta-combination method in several stages in the health system. After identifying the concepts and codes of core competence components and evaluating its validity and reliability, the initial conceptual model of the research was designed. From the 53 retrieved studies, 7 studies related to the purpose of the study were included for meta-combining. At the level of analysis and presentation of the model, Sandelovski and Barso (2006) meta combination method was used.

The findings showed that the research model includes 9 components including participation and teamwork, health quality promotion, personal development, use of health information technology, system thinking skills, professional performance of responsibilities, evidence-based research and practice, profession E-ism was the observance of moral and legal procedures. The identified factors were approved by experts.

In order to focus on the core competencies in the health system, it is necessary to pay attention to the components of the core competencies of specialists and to institutionalize them in all parts of the health system.

Evaluate the patient's safety status in Iranian hospitals using the Patient safety friendly hospital initiative (PSFHI) assessment tool provided by the World Health Organization. PSFHI assessment tool of 140 patient safety standards, they are classified as mandatory (20 standards), basic (90 standards) and advanced (30 standards). Mandatory standards are necessary criteria that hospitals must meet to register for PSFHI. The first stage of the patient safety program in Iran is to achieve the implementation of the mandatory standards to enter the patient safety friendly hospital program. We aimed to evaluate the patient's safety status in Iranian hospitals in terms of implementing mandatory patient safety standards.

In this systematic review, articles were searched between 2001 and 2021 in Web of Science, PubMed, Scopus Google Scholar, and Iranian SID and Magiran databases. Keywords including patient safety, quality assessment, standards, patient safety friendly hospital, Iran were performed. These articles were evaluated independently by two researchers and the contradictions were discussed with the third author.

Finally, 7 eligible studies were included in the study. The highest score (75%) was related to the fourth domain of safe environment and the lowest score with (47%) was related to the second domain of engaging and interacting with the patient and the community. The overall average of compliance with standards in all four areas was 70%.

Institutionalizing a patient safety culture, paying more attention to creating a culture to identify patients, educating staff and patients, and removing legal barriers, Increases the observance of mandatory patient safety standards in the Iran.

The implementation of the performance-based payment scheme sparked a hope that the changes in the payment of financial rewards to employees in a fair manner and based on their performance can increase employees’ motivation and job satisfaction. Accordingly, this study investigated the consequences of performance-based payments and regulatory schemes from the perspective of health managers in selected educational and medical centers in Isfahan. This qualitative study was conducted using a phenomenological approach. The data in this study were collected through in-depth interviews with eleven experts working in the management divisions of hospitals and central offices as well as the staff and faculty members of Isfahan University of Medical Sciences. The respondents were selected using purposive sampling. The collected data were analyzed using the content analysis method. The consequences of performance-based payments were explained by one main theme (the consequences of implementing the performance-based payment plan in the health system) and four subthemes. Besides, one main theme (the general national and professional factors of the health system affecting the regulatory schemes) and five subthemes accounted for regulatory schemes. Payment regulatory schemes should be formulated effectively to address the problems associated with the current payment system so that the establishment of a performance-based payment system can serve as a mechanism to achieve this goal and a basis for reforming the existing payment systems.

The infinite and increasing need for health service providers along with limited health sources has led to an increase in health costs and, consequently, the transfer of government resources from other social services to the health sector. One of the hospital services that has increased the costs in hospitals is total knee arthroplasty. Knee joint is one of the important joints of the body that is affected by various inflammatory and erosive diseases, which ultimately causes destruction of the articular cartilage and loss of proper joint function. Today, we are faced with an increasing demand for total knee arthroplasty. Knowledge of the distribution and extent of TKA provides the basis for health managers to design and implement interventions to reduce TKA surgery.

This study is a cross-sectional study. 14329 records of total knee arthroplasty patients in Iran were selected by census method in 2019-2021. The data collection tool in this study was a standard checklist. Data were analyzed by SPSS version 24 software using descriptive statistics.

The mean age of the patients was 66.1 years. 81.31% of the patients were female. 87.4% of them lived in cities, 31.5% had supplementary insurance, and most of the patients (51.9%) had undergone total knee arthroplasty in private hospitals. Discussion and

The pattern of total knee arthroplasty in our country is similar to that of other countries; most surgeries are performed in private hospitals, which may generate induced demand. TKA is more prevalent in the urban population, and most people who have had surgery do not have supplementary insurance coverage, and the northern provinces have the highest TKA;  thus, the attention of researchers and policy makers to the field of health in identifying and preventing the factors leading to knee replacement will make the demands for total knee arthroplasty reasonable.

Branding is one of the most important needs of any organization to survive and improve the quality of provided products and services.Today, branding is also being increasingly used by health organizations and has become one of the important elements for improving the quality of services provided by hospitals as the main body of health services. In the present study, the factors affecting the customer-based brand equity were investigated in selected hospitals.

This is a descriptive-analytical and cross-sectional study. Using stratified random sampling method, 350 patients were selected from private hospitals in Tehran and Kerman in 2020. Data were collected through a questionnaire and the Stata software V.14 was used for data analysis.

The average customer-based brand equity was higher in women, those with a degree lower than diploma, and in surgical treatment group. Different dimensions of hospital brand value including perceived quality (average), patient loyalty (average), brand image (good) and service brand value (very good) were evaluated and average customer-based brand equity received 76.38 points out of 100 and was at a high level.

Hospital brand value has an important effect on hospital marketing. Hospitals can take steps to attract and retain patients and can create a competitive advantage over others. The results showed the positive effect of perceived quality, patient loyalty, brand image and service brand value on customer-based brand equity.

Hospitals are a significant part of the health system, so their performance is always measured based on some factors such as patient satisfaction and their safety level.

The present study was aimed to examine the relationship between patient safety culture with patient satisfaction and hospital performance.

This descriptive–analytical, cross‑sectional study was performed on 240 patients, 240 staff and 20 hospital managers in Shafa hospital of Kerman, Iran, in 2020. To collect data, the patient safety culture, the patient satisfaction, and the hospital performance questionnaires were used. The data were analyzed by SPSS and PLS software; to measure the research model, structural equation models and confirmatory factor analysis were used.

The variable “patient satisfaction” and its components had a high mean, with the component “the treating physician” having the highest mean. The variables “patient safety culture and hospital performance” had a medium mean. There was a significant positive relationship between patient safety culture–hospital performance, patient safety culture–patient satisfaction, and patient satisfaction–hospital performance.

The patient satisfaction level was appropriate in the studied center, and a positive and significant relationship was found between patient safety culture and patient satisfaction and hospital performance.

Uncertainty and sudden occurrence of disasters require special attention and nurses, as the largest human resource, have a critical role in maintaining and promoting the health. The use of telenursing care during disaster is an applicable way to provide care. The aim of this was to prioritizing telenursing care in disasters from the view of nurses.

This descriptive-analytical study was part of a larger mixed methods on prioritizing telenursing care in disasters from the view of nurses. Samples were selected using census. The data were analyzed using SPSS software.

The prioritizing extracted care included:(1) Management of trauma, (2) Technical skills, (3) Care and decision-making in stressful situations (triage), (4) Management of patients with special needs, (5) Life-saving intervention, and (6) Psychological and emotional supports.

According to the shortage of specialized nurses in disastrous areas, a telenursing program will provide a new window and provide help to victims of disasters.

Context: 

Social networks can perform a peculiar role in people'scommunication in the case of crisis and disaster. These media are interactive, digital, or mobile-based tools. Accordingly, the present study aimed to assess the role of social media in earthquakes.

Evidence Acquisition:

In this current systematic review, a query was conducted on such databases as Embase, Web of Science, Scopus, and Cochrane for articles in English language, based on the required criteria from 2000 to 2019 regarding the role of social media in disaster. As a result, 13,924 studies were retrieved, among which 3,963 were deleted due to duplication. Finally, among 244 selected articles, 19 full-text articles were analyzed.

In the present research, 19 studies were thoroughly reviewed. The findings were assigned to four main categories (identification, notification, requests, as well as storage and retrieval of information) with 12 sub-topics. Most of the main topics and subsets were as follows: medical and food needs, information about the accident, as well as medical and relief services, efforts to save lives, the amount of damage, problems and limitations, post-crisis measures, such as keeping calm, reducing anxiety, avoiding high-risk areas, asking for financial assistance, as well as using the information to provide relief and map the affected areas and evacuation centers.

Considering the behavior of people in different geographical locations in the earthquake crisis, it seems that the case studyof how to use social media in disaster management carries profound implications for modeling and localizing the cases in related disaster management institutions of many different countries, such as Iran.

Unusual impacts of disasters on normal living conditions pose challenges to the health system. Nurses who take care of disaster victims may face situations that make decision‑making difficult; hereon, the use of new technologies can be a useful solution. The study aimed to identify the telenursing care during incidents and disasters.

The study was conducted at a medical science university in Iran from 2018 to 2019. This was a semi‑structured interview‑based qualitative study using content analysis. Eighteen nurses, nursing teachers, and emergency medical technicians were included in the study. Data analysis was performed using inductive content analysis and coding with MAXQDA (2010) software. The Lincoln and Guba (1985) trustworthiness criteria were used for the reliability and validity of the data.

Telenursing in critical and supportive care was the main theme identified from data analysis. This theme included six main categories: (1) management of trauma, (2) technical skills, (3) care and decision‑making in stressful situations, (4) management of patients with special needs, (5) life‑saving intervention, and (6) psychological and emotional supports.

Telenursing in disasters is the turning point of the care management of victims. In order to achieve this goal, nurses should acquire the relevant knowledge, skills, and abilities.

Natural and man-made disasters have significant effects on the physical, psychological, and emotional health of society. Nurses play an essential role in disaster management. Therefore, nurses should have specific core competencies to provide care for affected people during disaster situations. This study aimed to assess hospital nurses’ disaster competencies in such situations. This cross-sectional, descriptive study was conducted using a self-report questionnaire that included 50 questions on NCDS (Nurse Competence Disaster Scale) in four domains. The questionnaires were distributed among 142 nurses working in three teaching hospitals in Kerman, Iran, in 2018. The average percentage scores of nurses on their responses to questions in the domains of management, ethical aspects, personal aspects, and technical aspects of disaster competencies were 39.76%, 19.53%, 32.02%, and 75.06%, respectively. In multiple regression analysis, nurses’ participation in maneuvers and their work experience exerted the strongest influence on disaster nursing core competencies. Nurses who had practice during maneuvers had higher competency scores by 19.63 units than those who had no practice (p=0.0001). Moreover, the competency scores of nurses with more than 11 years of work experience were higher by 11.42 units than the others (p=0.0001). According to the results of the current study, strategies such as disaster drills and continuing education programs need to be developed for nurses to improve their disaster core competency.

Nurses are one of the frontline workers after disasters, particularly after radiologic incidents. Despite their importance, little is known about the nurse’s competencies in facing these events. This mini-review was aimed to determine competency of nurses in radiologic incidents. This mini-review was conducted using scientific electronic databases and library resources such as Scopus, PubMed, Magiran, SID, IranMedex using the keywords competency, nurses, and radiologic incidents to identify published papers from 1990 to 2017. Total of 991 papers were identified, of which 14 of them were considered relevant and were included in this study. Studies have shown that nurses' competencies in radiation incidents has variation. The most important of these competencies are on factors including the use of protective equipment and measures for the removal of pollution, triage, management of vulnerable groups, care of trauma, and psychological support. Nurses have varying abilities in different factors in disasters. Therefore, it is necessary to implement care and treatment plans to equip nurses with useful knowledge regarding radiation accidents

Reduction of inappropriate use of health services can decrease health care costs without harming the quality of services. This study aimed to investigate inappropriate admission and hospitalization at Afzalipour Hospital of Kerman, Iran.

Inappropriate admission and hospitalization were assessed via a cross-sectional study on 400 patients in Kerman Afzalipour Hospital, Kerman, Iran in 2015. The Iranian version of the Appropriateness Assessment Protocol was used for data collection. Chi-square tests and logistic regression were used to analyze the data.

The rate of inappropriate admissions and hospitalization were 7.6% and 9% respectively. There was no significant relationship between inappropriate admissions and any of the studied variables; however, there was a significant relationship between inappropriate hospitalization and age, length of stay and hospital departments.

If standard measures of admission and hospitalization execute correctly, unnecessary hospitalization rate can be reduced, so more patients can be treated and cost and workload of hospital personnel can be moderated.

Research priorities are important in preventing of waste resources and making the researches based on the real needs.This study aimed to determine the research priorities of disasters management in order to manage disasters more effectively in Kerman. In this applied and descriptive study, all organizations responsible for crisis management were studied by using quantitative and qualitative methods on different stages. Data were collected through field research and documentary study. Content analysis and descriptive statistics were used (average and total points) for data analysis. The main priorities of this research includes the role of education in reducing damage from disasters; preparing the roadmap of province (main, secondary, rural, dirt roads); establishing a city database; applying the optimum methods of coordination in inter-agency and intra-agency and activation mechanisms, evaluation of building standards in the province (with particular emphasis on housing in flood-prone areas); disaster risk assessment in city and villages and providing solutions to solve water shortage. The priorities process should be carried out periodically based on actual needs; also the specified priorities implemented after a review and careful monitoring in phases.

Changes in diseases pattern and increase in demand have necessitated private hospitals’ involvement in the health system. The purpose of this study was to analyze the private hospital industry in order to identify its strengths and weaknesses.
This qualitative study was carried out through phenomenological approach. The study participants consisted of 17 experts and chief managers of private hospitals and were selected through purposive and snowball sampling. Data collection was conducted through semi-structured interviews. The data were analyzed using framework analysis method.
The challenges of the private hospital industry, in the format of Porter’s diamond model, included 4 main themes and 21 minor themes. The most important challenges of private hospitals were shortage of medical equipment and facilities, old hospital building and physical environment, nursing shortage, lack of job security, and poor of management skills. The strengths of private hospitals were patient satisfaction with welfare services, good relationship between healthcare personnel and patients, and observance of the patient rights charter.
Dominance of profit on the private sector's management viewpoint, lack of state financial support, limitations on signing contracts with a variety of supplemental insurances, and poor government monitoring are the major causes of problems in private hospitals. The realization of private-public cooperation in community health improvement can be expected through increased government support and the improvement of the quality and quantity of human, informational, and physical resources.

Employees’ silence is common in organizations, and is mostly neglected. Employees are indifferent towards their supervisors, work quality and organization. Organizational justice is a factor that can diminish employee's silence. The aim of this study was to determine the relationship between organizational justice and headquarters employee's silence in Kerman University of Medical Sciences (KMU).
This study was a descriptive-correlational and cross-sectional research. The population included all 400 employees at KMU headquarters, among whom 147 members were selected as the sample using Cochran’s formula. In this study, two questionnaires were used: organizational justice questionnaire with a reliability of 0.91 and employees’ silence questionnaire with a reliability of 0.92. For data analysis, Pearson and Spearman correlation, regression testing, by SPSS software were used.
The findings showed that there was an inverse relationship between organizational, distributive, procedural, and interactional justice with employee's silence in Kerman University of Medical Sciences. The regression findings showed that the variable “distributive justice” had the strongest negative effect on employee's silence.
Encouraging employees to provide positive ideas, identify the existing problems, and reduce undesirable behavior like employee's silence can make employees operate more efficiently. Organizational justice is based on fair treatment, and it determines the employees’ reaction to organizational decisions. Therefore, it can partly remove problems and lead to the decline of employee's silence.

Employees are an important resource for any organization and the organizations success can be obtained through continuous learning efforts by the staff and creating and applying knowledge. Therefore، the present study aimed to study the relationship between Organizational Learning and Organizational Success.

This was a descriptive cross sectional study and the research population consisted of medical schools staff in Kerman. Because of the small size of population، all employees (n = 300) were examined in 2013. Data was collected using two questionnaires whose validity and reliability (Cronbach''s Alpha= 0/09) was confirmed. Data analysis was conducted through SPSS 18 software.

According to the results، Organizational Success and the Organizational Learning in the schools under study were at an undesirable level. Therefore، Due to the sensitive and effective role of Universities in the development of social، economic and cultural development، one should make it possible to observe all organizational learning components to achieve success and better performance of universities.

Glucose-6-phosphate dehydrogenase is one of the most common genetic deficiencies, which approximately 400 million people in the world suffer from. According to authors'' initial search, numerous studies have been carried out in Iran regarding molecular variants of this enzyme. Thus, this meta-analysis presented a reliable estimation about prevalence of different types of molecular mutations of G6PD Enzyme in Iran. Keywords «glucose 6 phosphate dehydrogenase or G6PD, Mediterranean or Chatham or Cosenza and mutation, Iran or Iranian and their Persian equivalents» were searched in different databases. Moreover, reference list of the published studies were examined to increase sensitivity and to select more studies. After studying titles and abstracts of retrieved articles, excluding the repeated and unrelated ones, and evaluating quality of articles, documents were selected. Data was analyzed using STATA. After performing systematic review, 22 papers were entered this meta-analysis and 1698 subjects were examined concerning G6PD molecular mutation. In this meta-analysis, prevalence of Mediterranean mutation, Chatham mutation and Cosenza mutation in Iran was estimated 78. 2%, 9. 1% and 0. 5% respectively. This meta-analysis showed that in spite of prevalence of different types of G6PD molecular mutations in center, north, north-west and west of Iran, the most common molecular mutations in people with G6PD deficiency in Iran, like other Mediterranean countries and countries around Persian Gulf, were Mediterranean mutation, Chatham mutation and Cosenza mutation. It is also recommended that future studies may focus on races and regions which haven''t been taken into consideration up to now.

In recent years، the financial relationship between the physician and the patient and some issues such as informal payments for health care have arisen as an unethical but common problem in many countries، including the Islamic Republic of Iran. Such issues are a threat to the professional reputation of physicians، and can have their own causes in different parts of the world. This study attempts to assess the causes of informal payments and the manners in which they are done in the hospitals of the Kerman Province in Iran in 2012. This study was carried out using qualitative research methods، and semi-structured interviews. Structured interviews were conducted on a purposeful sample of 45 participants including patients، providers and policy makers in the Kerman province in Iran in 2012. This study was authorized by the ethics committee of Kerman University of Medical Sciences، and the consent form was completed by all participants. In this study the participants were asked questions regarding reasons for informal payments، and data were analyzed using content analysis. There are several reasons for making informal payments، which include cultural، legal and quality factors. A number of reasons for asking informal payments by providers were discovered، including those related to tariffs، structural factors and ethical factors as well as to demonstrate the skill and competence of service providers. Most of the reasons discovered for informal payments in Iran are similar to other countries in the world. They showed that inadequate funding of the health systems and inadequate formal payments to providers are the most important supply-side factors leading to informal payments. Given that qualitative studies usually cover potential reasons only، further studies are needed to investigate the matter more extensively.

Informal payments for health care, which are common in many countries, can have negative effects on health care access, equity and health status as they lead people to forgo or delay seeking care, or to sell assets to pay for care. Many countries are putting reforms in place with the aim of reducing informal payments. In order to be successful, such policies should be informed by the underlying causes of such payments. This study attempts to explore why, how, and in what ways informal payments occur. We conducted face-to-face interviews with a purposeful sample of 45 participants, including patients, healthcare providers and officials, in Kerman province in Iran, in 2010. The research participants were asked about the nature of informal payments, the reasons behind both asking and making those payments. We analysed the data using content analysis. We found that people make informal payments for several reasons, namely cultural, quality-related and legal. Providers ask for informal payments because of tariffs, structural and moral reasons, and to demonstrate their competence. Informal payments were found to be more prevalent for complex procedures and are usually asked for directly. Informal payments are present in Iran’s health system as in other countries. What makes Iran’s condition slightly different from other countries is the peculiarity of reasons behind asking informal payments and the disadvantages associated with these kinds of payments. Iran could overcome this dilemma by precise investigation of the reasons to inform appropriate policy formulation. Some policies such as raising salaries, justifying the tariffs and cost-sharing, defining a benefits package of services, and improving accountability and transparency in the health system could be taken by the government to alleviate the problem.

According to some evidences, medical graduates do not evaluate their skills and capabilities to perform professional responsibilities at an acceptable level. In other words, there is a disagreement among authorities and experts of medical education in this regard. This study aimed to survey the challenges of general physician-education system in Iran. This applied study was carried out by qualitative method. A purposeful sample of 23 informants participated in the study. Semi-structured interview was applied for data collection and Data were analyzed using framework method.Results A total of 23 subthemes classified under 6 major themes were identified. Major themes included strategies of general practice education, structural issues, incomprehensiveness of courses and curriculum, educational fields, educational problems, and resources. Due to several issues, the effectiveness of general physician-education in Iran is faced with serious challenges. Incompatibility of education with real needs of the community is one of the most important issues. Therefore, general-physician education should move toward becoming more practical and empowering medical students to manage health centers should be taken into account in a systematic and efficient manner.

Management information systems are an effective factor in improvement of manager's decision-making procedure. This study investigates the relationship between establishment of management information systems and organizational structure in governmental offices in the city of Kerman. This is a cross-sectional study and the study population includes experts working in the governmental offices in the city of Kerman. The size of sample was 385 experts based on cluster sampling method. Data were collected by a questionnaire comprised of two sections of management information systems and organizational structure (formality, complexity and centralization). The questionnaire was valid with 83% for management information system and 82% for organizational structure using content validity method. The reliability was 92% and 88% respectively by test-retest technique and correlation coefficient. Data were analyzed by entering to SPSS software and using Spearman's rank correlation, Kendall tau correlation coefficient and Log linear Model. There was a significant direct relationship between management information systems and centralization variable with correlation coefficients (Kendall 408/0 and Spearman 309/0). The relationship between management information systems and formality variable was significant but inverse with correlation coefficients of Kendall 0.314 and Spearman 0.238. The establishment of management information system in governmental offices increased the centralization of decision-making in management levels and the horizontal complexity, and decreased organizational formalities and hierarchy.