فهرست مطالب roya malekzadeh

Health tourism is a branch of the tourism industry that is of interest to many countries of the world due to its high demand and good income. Therefore, considering the importance of health tourism and the existing potential in Mazandaran province, this study was conducted with the aim of identifying and analyzing the factors affecting the development of the health tourism industry in Mazandaran province.

The present study was conducted using a qualitative method with a content analysis approach. For this purpose, 17 health tourism industry experts and health tourists were selected using the purposeful sampling method. Semi-structured interviews were used to collect data. The interviews were conducted until we reached a point of theoretical data saturation.

The findings showed that the health tourism industry in Mazandaran province is affected by structural, process and contextual factors. The structural factors included issues related to infrastructures, potentials/attractions, institutional factors, and expert human resources for health tourism destination. The process factor included issues related to drivers of health tourism, provision of health services and destination situational factors. The contextual-field factor included issues related to sociocultural contexts, potentials and attractiveness of tourism, and economic capacity.

Despite the importance of services related to health tourism and considering the increasing demand of this industry, travelers who travel to Mazandaran province need a variety of services, and the need to pay attention to quality service development in tourism destinations is evident. Therefore, the provision of other essentials for health tourists such as infrastructure, destination attractions, financial capacities, sociocultural conditions, human resources, situational factors are  the requirements for the development of this industry.

An organization's safety culture is the product of its values, attitudes, beliefs, and behavioral patterns that define the organization's commitment and framework for managing safety and health. The purpose of evaluating the safety culture is to identify the current state of the safety culture raise the awareness of the employees in this field evaluate the interventions related to safety and track the changes that have been made. The present study was conducted to analyze the status of patient safety culture among the employees of hospitals covered by Mazandaran University of Medical Sciences in 2022.

The current descriptive, analytical, and cross-sectional study was conducted in 1401 on 440 employees of medical and educational hospitals covered by Mazandaran University of Medical Sciences. The sample size was calculated using Cochran's formula and the sampling method was simply random. The tool used in the Standard Patient Safety Culture Questionnaire (HSOPSC) The questionnaire had 42 questions, and 12 dimensions of the patient safety culture including dimensions of general understanding of the patient, organizational learning and continuous improvement, discipline within hospital departments, non-punitive policy in cases of errors, issues Work related to staff, manager/supervisor expectations and actions to promote patient safety, open communication channels, feedback and exchange of information about errors, hospital management support, teamwork among hospital departments, hospital handovers and transfers, and frequency of incident reporting. Unwantedness was measured based on a five-point Likert scale. The average score of less than 2.5 indicates a low patient safety culture, between 2.5 and 3.75 an acceptable state of safety culture, and 3.75 and above indicates the patient safety culture is a strength of the hospital. The study was conducted with IR.TUMS.SPH.REC.1400.289 code of ethics. Analysis was done using Spss 24 software and independent t-tests, one-way analysis of variance, and Friedman.

Most of the participants (47%) were 30 to 40 years old and had work experience of 1 to 10 years (44.6%). Also, most of the studied people (59%) were on rotating shifts. The overall status of patient safety culture in hospitals covered by Mazandaran University of Medical Sciences was 64.4% with an average of 3.22±0.43, so 86.1% of the participating employees considered the patient safety status as an average. Among the dimensions of patient safety culture, the highest and lowest scores are respectively related to the dimensions of "teamwork within hospital departments" with a mean and standard deviation of 3.90±0.79 (78 percent) and "hospital delivery and transfers" with a mean, and the standard deviation was 2.75±0.92 (55%). According to the single-sample independent parametric T-test, the score obtained from the status of patient safety culture in covered hospitals was higher than the average standard score of 3 (P<0.05). Patient safety culture in people with higher service experience had a better condition than people with less experience (P<0.05). No significant difference was observed in the status of patient safety culture in different work shifts of the participants (P<0.05). Also, teaching hospitals had a better average patient safety culture than non-teaching hospitals (P<0.05).

Based on the findings, hospital transfers were identified as one of the weakest areas. The implementation of appropriate training courses, such as workshops and in-service training, for correct patient transfer and handover is recommended. Additionally, empowering staff to freely question and critique decisions and actions of senior personnel regarding patient safety concerns is crucial.

Mazandaran University of Medical Sciences, paying full attention to the national priorities and being aware of its competitive advantages, has chosen eleven academic fields (disciplines) in order to achieve academic distinction and achieve thematic scientific supremacy while forming scientific excellence centers. In order to fulfill its academic mission, this university has developed a strategic plan and a draft operational plan with dozens of specific strategies. The use of these strategies can lead to targeted development in the short term, in the medium term to the leadership position of the country's scientific community, and in the long term, to the authority and supremacy of the international scientific community in selected fields of knowledge.

After-discharge follow-up is one of the branches of managed care used for information exchange, health education, early diagnosis of symptoms, symptom management, and high-quality aftercare services. The present study aims to elucidate the managed care of COVID-19 patients after discharge from hospitals affiliated with Mazandaran University of Medical Sciences, Mazandaran Province, Iran.

The present cross-sectional study was conducted in 2019. The study sample included all COVID-19 patients discharged from public, private, and social security hospitals affiliated with Mazandaran University of Medical Sciences. The census method was used to recruit 14625 discharged patients. The data collection tool was based on the information registration form “Follow-up of the treatment process of discharged COVID-19 patients,” which was prepared in three sections (demographic, clinical characteristics, and follow-up of the treatment process) based on the opinions of 15 experts. Data analysis was carried out via the chi-square test in SPSS software, version 21.

The findings of the demographic section showed that 35.8% of COVID-19-related admissions were over 65 years old. Intensive care unit (ICU) admissions were necessary for 13% of cases, with the highest ICU admission rates among those aged 65 and above. Based on the findings of the clinical characteristics section, the most common underlying disease (46.7%) was diabetes, and the most common symptom upon admission was fever (higher than 38°C) (44.8%). Also, according to the findings of the “treatment follow-up” section, 7.04% of the discharged patients were readmitted, and 14.5% of patients infected their family members with COVID-19. Also, 57.82% adhered to the health and safety protocols and self-quarantine at home, which varied in different months. 

Follow-up after the discharge of COVID-19 patients as one of the branches of managed care increased the compliance with health principles and decreased the rate of COVID-19 infection of the patient’s family members and the readmission of patients. Therefore, appropriate follow-up after discharge is suggested as a low-cost method to shorten the recovery period of patients, prevent other family members from contracting this disease, and detect the worsening of disease symptoms among discharged patients.

With the epidemic of coronavirus, based on the content of some hadiths, including the famous hadith "La'Adwi", and combining and comparing it with some teachings of traditional medicine, some appearanceists declared that all diseases are non-contagion. This attitude was in opposition to modern medicine and in denial of the spread of infectious diseases, which resulted in non-observance of health issues and consequently led to the spread of the disease, increase in the costs of the health sector, and the negative view of researchers towards Islamic teachings.

The current research was carried out using reliable library sources, related articles, and the content analysis method. This inferential study aimed to investigate “disease transmission from the viewpoint of medical jurisprudence and hadith" and then adapt the findings to new medical results.

Findings of the present research revealed that the superficial attitude towards the hadiths and its teachings is harmful, and the attitude towards the hadiths in this matter, including the hadith of La'Adawi, is controversial from the point of view of many scholars. Moreover, some of its narrators are unreliable and the fact that the source of this hadith is the Prophet of Islam is questionable. In terms of implication, in addition to its conflict with the facts of human experience in the medical field, there are many analyzes for it. Assuming the acceptance of the negation of the spread of the disease in this hadith, it should be said that only the transmission of a specific infectious disease such as "Scabies" in animals that was the subject of question in the hadith was denied.

By taking into account the problems of authenticity, reliability, and the implication of the hadith concerning the non-transmission of the disease, as well as definivity of some hadiths regarding the possibility, existence, and spread of the disease, taking health care measures, quarantine, avoiding the disease, and observing social distancing during the disease outbreak is a rational, legitimate, and bligatory decision to make.

To increase the accountability of hospitals and ensure that patients receive appropriate treatment at any time of the day, resident physicians perform the necessary diagnostic and therapeutic procedures during non-office hours. This study aimed to analyze the resident physician program from theory to practice.
The present study was a qualitative one. The participants included 27 experts selected from university and hospital managers as well as specialist doctors. Data were collected through semi-structured interviews based on purposive and snowball sampling and the process of data collection continued until data saturation. Then, the interviews were transcribed, meaning units were determined, data were coded, the identified codes were categorized based on similarities and differences, and the themes were identified and finally analyzed and interpreted using the content analysis method.
In the present study, 4 main themes, 11 subthemes, and 46 components were identified using framework analysis. The themes related to the goals and outcomes of the program, the accountability of the centers, and the indicators had the same results in theory and practice, and this program improved them. However, regarding financing, monitoring, and implementing the program, as well as payments, there was a wide gap between theory and practice.
Considering the opportunities, threats, strengths, and weaknesses of the resident physician program, the results of this study can propose a comprehensive model based on the perception of health managers and experts involved in the implementation of the program. Therefore, it is suggested to consider local conditions and patterns in prioritizing the criteria for fields of study.

 The Intensive care unit (ICU) in hospitals is known as the bottleneck of performance control where the compliance with standards is very important; to achieve quality management goals, the provided services must comply with the predetermined requirements. Hospital performance evaluation is needed for giving feedback on the efficiency of hospitals and effectiveness of services. This study aims to evaluate the performance of the ICUs in hospitals affiliated to Mazandaran University of Medical Sciences in Iran during the coronavirus disease 2019 (COVID-19) pandemic.

 This is a descriptive/analytical study that was conducted in 2021. The study samples were 19 ICUs in medical and teaching hospitals affiliated to Mazandaran University of Medical Sciences, which were selected by census method. The data collection tool was a researcher-made questionnaire. The content and face validity of the questionnaire was confirmed based on the opinions of a panel of experts and its construct validity was confirmed by the confirmatory factor analysis. Its reliability was reported 0.82 using Cronbach’s alpha coefficient and its composite reliability was 0.91. Data analysis was performed by non-parametric tests of Wilcoxon, Friedman and Kruskal-Wallis in SPSS software, version 21 and Splus applications.

The highest level of compliance with the standards was in the area of management and leadership (4.74±0.93), followed by the areas of medical equipment (4.53±0.52), nursing processes (4.53±0.66), space, structure and facilities (4.47±0.39), safety (4.3±0.69), functioning (4.0±11.04) and manpower (4.19±0.42). The lowest level was related to the field of infection control with a mean score of 3.42±1.24. This difference in ranks between different areas was significant according to the results of Friedman test (P<0.05).

 The overall performance of the ICUs of study hospitals is favorable, but they need more attention and effort in the area of infection control. They are recommended to train and monitor the measures of infection control.

Epithelial ovarian cancer (EOC) is a deadly gynecological cancer among women worldwide. Ministering ovarian cancer with classic chemotherapy medications can cause various side effects. Thus, in recent years, the anticancer potential of medicinal plants has been noticed in complementary cancer treatment due to their high efficacy and low toxicity. The anti-proliferative potential of Xanthium strumarium leaf and seed extract against several cancer cell lines was reported; however, there is no report on the effect of its root so far.

In this study, the antitumor effect of X. strumarium root extract was evaluated on the SK-OV-3 ovarian cancer cell line, and metabolic alterations were identified.

Cancer cells were cultured and ministered with different concentrations of ethanolic root extract. The antitumor effect of the root extract was determined byMTT assay, and cell metaboliteswas extracted. Finally, the metabolome profile was characterized and analyzed by 1H NMR-based metabolomics.

The IC50 value of the root extract of X. Strumarium was 30g/mL after 48 hours, which exhibited anticancer activity against SK-OV-3 ovarian cancer cells. Aminoacyl-tRNA synthesis, glycerolipid metabolism, fatty acid biosynthesis, and biotin metabolism were the most affected metabolic pathways involved in the growth inhibition of cancer cells.

In the current study, the ethanolic root extract of X. Strumarium reveals antitumor activity against SK-OV-3 ovarian cancer cells and could affect vital metabolic pathways.

The preceptorship model is a training and learning approach, evaluation of benefits of challenges of which can contribute to the improvement of education quality and training of efficient nurses. The present study aimed to review the challenges and benefits of the preceptorship model in nursing clinical education.

This study was conducted as a narrative review. To select articles, Farsi databases such as Magiran, Google Scholar, SID, and Barakat Knowledge Network System using keywords of “preceptorship”, “nursing education”, “challenge”, “preceptor”, and “nursing student” were searched. In addition, databases of Google Scholar, Scopus, Science Direct, PubMed and Web of Science were investigated applying keywords of preceptorship, nursing education, nursing student, challenge and preceptors. Inclusion criteria were Farsi and English articles published up to 2020 with no time limits, access to full texts of the articles and relevance to the research objective. In the end, 10 out of 160 extracted articles were considered appropriate and entered into the study.

In this study, the challenges of the preceptorship model were related to preceptors (high workload and insufficient time for education), preceptees (students’ lack of desire for direct care and lack of motivation) and the education atmosphere (insufficient support by school managers and poor correlation between theory and clinic). On the other hand, the benefits of the preceptorship model were related to students (reduced clinical errors and development of nursing skills) and education (ensuring compliance with the policies and procedures of the organization and targeted internships)

According to the results of the study, despite the numerous barriers to the implementation of the preceptorship model, it has many benefits. Therefore, our findings could help clinical instructors and nursing education authorities eliminate the challenges of the implementation of the model, which increases the quality of students’ clinical education.

The health care environment is changing rapidly, and nurses are exposed to a variety of ethical issues and moral conflicts. Therefore, the present study aimed to explain the experiences of nurses regarding moral conflicts in the educational and medical centers of Mazandaran University of Medical Sciences in 2019.

The present qualitative study was conducted in educational and medical centers of Mazandaran province. Semi-structured interviews were used to collect data. Inclusion criteria include nurses with at least one year of work experience in the hospital who were willing to share their experiences of moral conflicts. Graneheim, U.H., and Lundman, B. Qualitative Content Analysis were used for analyzing the content.

In the present study, in-depth and semi-structured interviews were conducted with 22 participants (16 women and 6 men). In total, 3 main themes and 11 sub-themes were extracted from the data analysis. The subjects include "organization-related factors", "factors related to effective communication", "dilemma of morality versus law".

According to the findings of this study, managers and other members of the healthcare team should support nurses in the face of ethical challenges. Furthermore, continuous in-service training courses should be provided for nursing staff.

Protecting healthcare workers on the front line of Coronavirus disease 2019 (COVID-19) is very important. The aim of this study was to investigate the incidence of COVID-19 in hospital staff and its relationship with influenza vaccine in 2020.

A descriptive-analytical study was performed in 4446 staff working in public hospitals in Mazandaran province, Iran. The sample size was calculated using the Cochranchr('39')s formula and the participants were selected by simple random sampling. Demographic and therapeutic information were collected using an electronic checklist. Data were analyzed by descriptive statistics and Chi-square test and analysis of variance using SPSS V21.

In this study, 1388 (31.21%) cases were infected with COVID-19 and 3058 (68.79%) had no history of the disease. In people with and without COVID-19, 384 (27.66%) and 761 (24.88%) were men, respectively. According to findings, the rate of COVID-19 infection was lower in individuals who received influenza vaccine compared to non-infected people, but there was no significant difference between these groups in receiving influenza vaccine within a year ago (P = 0.07).

In present study, the influenza vaccine did not have a protective role against COVID-19. Moreover, it did not influence the severity of the disease and cannot be helpful in making a prognosis of COVID-19.

Paying attention to the changing needs of society in health and the need for a responsive education system in line with the needs of society, shows the need to review educational and research structure of medical universities in a country. The purpose of this study was to explain the learned experiences of academic members on the structure of educational and research institutions.

This qualitative study was performed in 26 faculty members of medical sciences graduated from foreign universities using purposeful sampling. Individual semi-structured interviews were performed and the participants were asked about organizational structure, the function, and organizational hierarchy of the university where they had studied. Interviews were recorded and handwritten, coded, and analyzed according to the conventional content analysis approach.

We extracted four main themes, 12 sub-themes, and 75 items from the data. Main themes included type of organizational structure, strategies, management of resources, and educational infrastructures. The sub-themes were as follows: the organizational structure of educational and research institutions and traditional structure, new structure, entrepreneurship, change management, interdisciplinary insight, human resources, national resources, physical resources, educational centers, educational groups, fields of study, and research centers.

Planning system of every country (centralized/decentralized) was found to affect the type of organizational structure of educational and research institutions. Therefore, universities and research institutions are needed to design a suitable structure consistent with the needs of society and their own goals.

An appropriate and applicable model of hospital performance assessment can potentially lead to accountability, quality of service, and patient satisfaction. The purpose of this study was to identify the effective factors on hospital performance assessment.

In this qualitative study, in order to elucidate the experts’ experiences of hospital performance assessment, based on purposive sampling, individual semi-structured interviews were conducted with 27 health services management professors, university and hospital managers, national accreditors, and the authorities in charge of quality improvement of hospitals in Mazandaran Province. Interviews were recorded, transcribed, codified, classified, and analyzed based on the conventional content analysis approach.

The participants’ experiences indicated the need to take into account all dimensions influencing performance assessment as well as a balanced measurement of the structure, process, outcome, control, and context of the hospital that provides services. Totally, 5 main themes and 18 sub-themes were extracted from the data analysis.

The results of this study indicated that a comprehensive performance assessment system needs to measure all dimensions of hospital performance. It is therefore recommended that in hospital performance assessment, in addition to traditional attention paid to resources and facilities, hospital processes, the outcomes of proper implementation of processes, control, and the context in which the hospital provides services also be taken into account.

The Deming model is an effective method for comprehensive quality management.

This study aimed to investigate the effect of inclusive quality management on the educational accreditation results of the educational hospitals in the Mazandaran Province, Iran.

This interventional study was conducted in 5 hospitals. In this study, the Deming cycle validation model was employed. This model, which is based on the checklist for the educational centers of the Ministry of Health and Medical Education, has 91 benchmarks for 81 standards. Descriptive statistical methods (Wilcoxon and Friedman nonparametric tests) were used to analyze the data.

A significant difference was observed among the accreditation scores of the hospitals before and after the intervention (P<0.05). The accreditation score obtained by the educational centers improved by 41.1, 37, 15.7, 53.2, and 49.2 units. Besides, the intervention outcomes in all areas of accreditation, except facilities management, space, facilities, equipment, and resources, were significantly different.

The use of the Deming cycle has proved effective in performing the educational accreditation of the centers, which can be achieved with continuous and proper implementation. This study can help improve the standards of education of the educational centers.

Improving patient safety is one of the main goals of health systems and employees need to be continuously examined for patient safety culture. The aim of this study was to assess patient safety culture in hospitals affiliated with Mazandaran University of Medical Sciences in 2020.

A descriptive-analytical study was performed in 370 employees working in public, private, and social security hospitals. The sample size was calculated using the Cochranchr('39')s formula and the subjects were selected using simple random sampling. The Hospital Survey on Patient Safety Culture (HSOPSC) consisting of 42 questions and 12 dimensions was administered. Data analysis was done applying independent t-test and one-way analysis of variance.

Among the participants, 43.47% aged 40-50 years old, 42.74% had 1-10 years of work experience, and 60.07% had shift works. The dimensions of HSOPSC with highest and lowest scores were organizational learning and continuous improvement (4.00±0.89) and hospital delivery (2.51±0.97), respectively. Almost half of participants (51.36%) had no record of any incident in the past 12 months.

Patient safety culture was moderate in hospitals studied. Hospitals are recommended to focus more on patient safety by holding training courses for transfer of patients, and establish a reporting system and encourage staff to report errors.

The rapid spread of COVID-19, lack of standard treatment, time constraints, and lack of resources are challenges around the world. Considering the importance of ethics in providing care to patients with emerging diseases, this study was conducted to explain the ethical challenges in care and treatment for patients with COVID-19. The present study was conducted by qualitative content analysis during 2019. Participants were 22 infectious disease physicians and nurses of COVID-19 care wards with at least five years of experience in hospitals of Mazandaran province. Data were collected through semi-structured interviews based on the purpose and method of snowball after obtaining informed consent from participants and continued until data saturation. Data analysis was performed using Granheim Lundman method. Guba and Lincoln proposed criteria were used for the accuracy and robustness of the study. In the present study, five main themes and 18 sub-themes were extracted. Respect for patients' rights, maintaining patient independence, preventing the effects of stigma and discrimination against patients, lack of comprehensive support, and lack of support and accountability of the authorities were the main ethical challenges in caring for patients during the admission period. According to the findings of the study, solutions to address ethical challenges, protect patients' rights and provide quality care through informed and ethical decision-making to increase patient satisfaction and improve their health are recommended.

Hospital performance measurement is an essential part for providing feedback on the efficacy and effectiveness of services. The purpose of this study was assessment and comparing of hospital performance using “Accreditation Pattern”, “Organizational Excellence Pattern “and Program Chain (IPOCC) Patterns. 

This descriptive-comparative study was conducted in 2019 in the educational and medical centers of Mazandaran University of Medical Sciences. The statistical population included 180 top, middle, and operational managers of five educational and medical centers covered by the university. Samples were selected in a census. Data collection instruments were obtained through; demographic questionnaire, " the "Iran Hospital Accreditation Questionnaire" of the Ministry of Health and Medical Education and the research instrument developed by the “Organizational Excellence Questionnaire” and the "Program Chain Pattern Questionnaire”. Face validity, content and its structure were performed using confirmatory factor analysis and its reliability by Cronbachchr('39')s alpha coefficient method and composite reliability. Data was analyzed using SPSS. 21.

In assessment the performance of the hospital with Accreditation Pattern, Organizational Excellence Pattern and Program Chain Pattern, respectively, the dimensions of para clinical services (4.12±0.5), processes (69.4±0.57) and control (3.21±0.65) were the highest scores and the dimensions of prevention and health (2.62±0.75), society results (56.36±0.62) and outcome (2.98±0.62) were the lowest scores. The results of one-way analysis of variance showed that there was a significant difference between the dimensions of hospital performance assessment patterns (P <0.001).

The highest score of the hospitals with the Patterns of accreditation, organizational excellence and program chain were in the dimensions of para clinical services, processes and control, respectively, and in the dimensions of results and Context, less attention was paid to the performance of the hospitals. Therefore, it is recommended to pay attention to the results of service delivery and Context standards such as teamwork and organizational culture along with process, Input and control standards to balance hospital performance assessment standards.

Epithelial Ovarian cancer is the leading cause of cancer mortality among women all over the world. As chemotherapeutics has many side effects, researchers have focused on the potential use of medicinal plants as natural antitumor agents. Xanthium strumarium studied in this work as an herbal anticancer agent. This study aimed to evaluate the antitumor effect and metabolic alterations caused by the root extract of X. strumarium on human ovarian cancer cell line (A2780cp), using NMR-based metabolomics approaches. Cells were cultured and treated with different concentrations of the ethanolic plant extract. Antitumor activity determined by MTT assay and cell metabolites extracted for NMR spectroscopy. 1H NMR spectroscopy was applied, and outliers were analyzed using multivariate statistical analysis techniques. The extract exhibited antitumor activity against ovarian cancer cells with an IC50 of 6 μg/ml after 48 hours of treatment. The most affected metabolic pathways in the experimental groups were limited to tyrosine metabolism, nucleotide metabolism, fatty acid biosynthesis, and glycerolipid metabolism. Our data showed that the ethanolic root extract of X. strumarium has antitumor activity on the ovarian cancer cells and can affect vital metabolic pathways. However, further studies required to validate this activity.

Regional territory of the health care system in the field of the country provides the opportunity to the participation in the programs of the Ministry of Health based on the advantages and talents of the region and enables the programs to be improved further. The purpose of this study is to explain the reform of territorial planning, transformation and innovation in higher level of education in Iran.

Using keywords from the articles’ title or abstract in books prepared by the Educational Deputy of the Health Ministry and from the databases like Magiran, SID, Iranmedex, Google Scholar for studies in Persian from 1380 to 1395. English articles with Keywords” Territorial planning, Transformation in medical science education, Innovation in medical science education” were searched in PubMed, Science direct, Google Scholar between 2000 and 2016.

This search initially found 1790 articles, in which there were only 22 articles, and 7 books having inclusion criteria. Nine of them were English and the rest were Persian.The results showed that universities from every metropolitan area interacting with each other, conducted Health Ministry policies.The Comprehensive Education Program contained 12 general policies and orientations. In order to conduct it, 11 packages for developing and innovating in medical education along with a monitoring program were developed. In other countries with the implementation of a targeted inter-university interaction program, transformation and innovation arose in the environment of  academic places.

Regional territory reform leads to Transformation and innovation in medical education and also providing resources, expanding educational opportunities and attracting faculty members’ contribution will make the program be successful.

Emergency department is one of the most important and risky areas in the hospital. Adherence to safety standards significantly contributes to increased patient satisfaction and service quality. The aim of this study was to evaluate the patient safety dimensions in emergency departments in educational hospitals affiliated with Mazandaran University of Medical Sciences applying operational planning.

This descriptive-analytical study was carried out in 2019 and data was collected using the National Health Accreditation Standard Questionnaire. Questionnaire items were categorized according to the operational modeling into input, process, outcome, control, and contextual dimensions. Statistical analysis was performed in SPSS V21.

The total mean score for patient safety in emergency departments was 3.82 ± 0.20 which was relatively good. The highest and lowest scores were in the control (4.36 ± 0.10) and contextual dimensions (3.02 ± 0.77), respectively. Educational hospitals had higher scores in overall patient safety and safety in structural, process, and outcome dimensions. Non-educational hospitals were found to be better in control and contextual dimensions.

According to current study, patient safety should reach a more desirable level in emergency departments. Operational planning is a useful model in identifying the major stages of service delivery and designing appropriate interventions.

In order to move towards excellence, hospitals should adopt new management techniques such as organizational excellence model. The purpose of this study was to assess the performance of an educational hospital applying organizational excellence model and operational planning.

This descriptive-analytical study was conducted in Sari Imam Khomeini Hospital, 2018. The research population included all hospital managers and nurses. Data were collected by EFQM excellence model. Its validity was approved and its reliability was 0.92 using Cronbach's alpha coefficient. Data were classified according to IPOCC approach into input, process, output, control, and context and analyzed in SPSS V18.

The scores for empowerment and results sections were 319.82 (63.96%) and 313.38 (62.67%), respectively. The highest distribution of components and scores according to IPOCC approach were in results (40.2%) and structure (3.25 ±0.44). One-way ANOVA showed significant differences between the dimensions of IPOCC (P<0.001).

The hospital investigated, was found to be in a relatively appropriate condition according to EFQM excellence model. Therefore, having a systematic perspective and proper control over therapeutic processes and contextual aspects such as organizational culture along with processes, structures, and results are suggested to balance the standards.

A Balanced Scorecard model is a performance evaluation methodology that provides a broad perspective on identifying the weaknesses and strengths of an organization's activities. The purpose of this study was to assess the performance of the hospital using a Balanced Scorecard Model and a Program Chain Pattern. This descriptive study was conducted at Imam Khomeini Educational Center in Sari. The data collection instrument was a "Balanced Scorecard Questionnaire” and completed by census of all managers and head nurses. The specialized panel of "Balanced Scorecard" questionnaires was categorized in the form of a Program Chain Pattern into dimensions of Input, process, outcome, control and Context. The content and face and structure validity were performed using confirmatory factor analysis. Reliability was measured by Cronbach's alpha coefficient and composite stability. To analyze the data, SPSS. 21 was used. The hospital with the mean of internal processes (3.43 ± 0.42) scored the highest scores in the dimensions of the scorecard, and the financial dimension with the average (3.57 ± 0.56) and the client dimension the mean (2.97 ± 1.07) and learning with the mean (2.93 ± 0.89) had the lowest score. The highest distribution and scores in the Program Chain Pattern were in the process dimension (58.8%) and control dimension (3.62 ± 0.56), respectively. There was a significant difference between the dimensions of the Balanced Scorecard Model and the Program Chain Pattern (P value < 0.0001). The most important aspect of the Balanced Scorecard is a process. Considering all the effective dimensions in performance, especially the dimensions of the Output, Input and context along with the process and control dimensions for assessing the performance of the hospitals is recommended.

Background and Increase in cesarean section (C-Section) is a health system problem around the world. The aim of this study was to compare the rate of C-Section and indications for that before and after implementation of Health System Reform in the hospitals of Mazandaran province, Iran. This descriptive cross-sectional study was conducted analytically. The indications for C-Section were recorded based on curative treatment checklist before implementation of the Health System Reform (2013) and after that (2016). Data were analyzed in SPSS V21 applying t-test and Chi-square. The rate of C-Section was significantly lower only in governmental hospitals after implementation of the Health System Reform (P< 0.05). Among the indications of C-Section, only the previous C-Section had a significant difference before and after the Health System Reform in total hospitals in the province (P<0.002). Significant differences were found between previous C-Section (P<0.025) and its increasing trend, and post-term pregnancy (P<0.027) and decreasing trend before and after the Health System Reform in governmental hospitals. Other indices were not significantly different between public, private, and Social Security Organization hospitals (P<0.05). Implementation of Health System Reform was effective in decreasing the rate of C-section in governmental hospitals. It is hoped that with appropriate implementation of the program, along with cultural and social programs, we could get closer to Iran’s scientific goals and decrease the rate of C-Section according to global standards

Background and In order to increase the accountability of hospitals and ensuring proper medical treatments at any time of the day, physicians residing in non-administrative hours have active physical presence in the hospital and perform the diagnostic and therapeutic measures required. The purpose of this study was to assess the implementation of resident physician program in Mazandaran province, Iran.
A qualitative study was carried out in which the participants included 27 individuals from university authorities, hospital managers, and specialists. Data was collected by semi-structured interviews using purposeful and snowball methods and continued until data saturation. Then, transcription of interview data was done to determine the meaning units, coding, classification based on similarity and proportion, and identifying themes using content analysis.
According to the framework of the resident physician program, 13 primary themes and 47 secondary themes were extracted. This program improved the centers’ responses, indicators, and processes. But some themes such as finance, infrastructures, monitoring, implementation of the program, and payments to doctors were found as challenging issues requiring more attention.
Considering the opportunities and threats, and the strengths and weaknesses of the resident physicians program, current findings could provide managers and healthcare authorities with a more comprehensive approach to the present situation.

The lesson plan is one of the effective factors in the educational process. The main purpose of the lesson design is to facilitate learner learning. The present study aims to provide comprehensive information for use in medical science education. Using structured review criteria, this study examines the status of the design of the lesson plan and existing barriers. Using the keywords of the lesson plan, course design, teaching quality, effective teaching, curriculum, and medical science, the search for relevant articles was done in the databases.Databases are Science Direct, Irandoc, Google Scholar, Pudmed, SID, Scopus, Web of Science, Iranmedex, Magiran. Using the process of structured studies, using the process of structured studies, data was studied. In this study, the lesson plan was examined from various aspects.
The results showed that more than half of the lessons were in a moderate condition. Most of the weaknesses were related to minor goals and behavioral goals, assessment methods, teaching aid and how to use it. The presentation of the lesson plan in the classroom was not in desirable condition, most faculty members agreed to formulate the lesson plan before the start of the training, but the high workload, the constraints of facilities and training facilities, and the high number of students prevented the preparation of the course. The lesson plans were based on the curriculum, and the classroom teachers were guided by the lesson plan. Considering the necessity and importance of developing lesson plans in improving the quality of student's education, holding workshops on teachers can provide their knowledge and attitudes for the formulation and implementation of lesson plans.