saber azami

Quality Assessment Frameworks (QAFs) are essential in monitoring progress in the primary health care (PHC) system. Different QAFs are used in countries to assess PHC quality.

This study aimed to review and compare the QAFs and highlight the most frequent quality indicators and dimensions.

This state-of-the-art review was conducted on PHCQAFs. Required data were collected through search in Scopus, Web of Science, and PubMed databases, World Health Organization and World Bank websites, and Ministry of Health websites up to January 2022. The main keywords were quality, “primary healthcare”, PHC, “primary care”, “primary health services”, “basic healthcare”, assessment, evaluation, monitoring, measurement, improvement, indicator, OR index, pattern, framework, and model. Comparative tables were used to compare the defined quality dimensions (QDs) and quality assessment indicators (QAIs).

Finally, 14 PHCQAFs were retrieved, containing 94 QDs and 785 QAIs. Three PHCQAFs were proposed at the international level and others at the national level. Accessibility, coordination, and safety were the most frequent QDs, and QAIs related to smoking, alcohol and substance abuse, diabetes care, vaccination, chronic heart disease care, respiratory/infectious disease care, hypertension care, population coverage, community participation, customer satisfaction, maternal and child health, adverse event, health information management, staff empowerment, referral system, and patient rights were the most frequent among PHCQAFs.

The current study illustrates the similarities and differences between PHCQAFs and highlights important QDs and QIs in PHC. Also, it provides a ready way for health policymakers to address key quality aspects that can help countries accelerate progress in the quality of PHC

 Public hospitals account for approximately 80% of the health system resources while producing only 20% of the public sector's output.

 This study aimed to analyze the current administration structure (strengths, weaknesses, solutions, and proposed models) of Iranian public hospitals.

 This study is qualitative research with a phenomenological approach. The required data were collected using semi-structured interviews with 58 national experts in the field of hospital management who were selected based on the purposive sampling method. Data were analyzed using the conventional content analysis method.

 Nine main themes and 34 sub-themes were identified in the weaknesses. The strengths contained four main themes and 16 sub-themes. The proposed solutions had five main themes and 22 sub-themes, and the proposed models from the experts' points of view were composed of four main themes and six sub-themes. The important weaknesses were low commitment and motivation, poor financial management and budgeting, and centralized decision-making and management. The strengths included strong infrastructure, extensive service delivery, government support, and positive social functions. The most important proposed solutions were complying with the requirements of structural reform, development of related assessment indicators, public-private partnership, payment system reform, delegation, manpower management, hospital organizational structure, and reform of the tariff system. Finally, the model of the Board of Trustees, while maintaining government ownership but observing the legal requirements of this structure, was the main suggestion of experts on reforming the structure of the administration of public hospitals in Iran.

 According to the expert’s opinions, the current structure of Iranian public hospitals has many problems. Managers and policymakers can make the necessary corrections based on the solutions and models proposed in this study.

Context: 

Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries.

 The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients.

Data Sources:

 A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies.

Data Extraction: 

To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used.

 Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care.

 Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (mRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

To compare the stewardship of road traffic accidents (RTIs) prevention in three pioneer countries and three similar ones to Iran. In this descriptive comparative study, the United States of America, Sweden, and Brazil as the pioneer countries in RTIs prevention were compared to the India, Pakistan, and Turkey as the countries socioeconomically similar to Iran. Embase, PubMed, Scopus, IranDoc, IranMedex, SID, and MagIran were searched. Also a hand search conducted on websites and search engines using related keywords. In the pioneer countries in RTIs prevention there was a delegation to a particular organization. In the other three countries a part of the Ministry of Transportation had the overall responsibility of RTIs. In Iran there was uncertainty in the stewardship of RTIs prevention. There was little evidence on the role and activities of health systems in RTIs prevention. It seems necessary to define a lead agency organization on RTIs prevention in Iran with sufficient authority and resources. This study also recommends conducting reliable studies to investigate the possible roles that the health system of a country can assume regarding the RTIs prevention.

Thrombocytopenia (TCP) is a common disorder during pregnancy. Its prevalence among pregnant women is four times greater than nonpregnant women. This study aimed at determining the global prevalence of TCP among pregnant women. This systematic review and meta-analysis was conducted in 2018. The PubMed, Scopus, Google Scholar, Magiran, and IranMedex databases were searched using the following key words: “TCP,” “pregnancy,” “pregnant,” “pregnant women,” “gestational,” and “platelets.” The titles and the abstracts of the retrieved studies were screened to identify potentially relevant studies. Articles were included if they were the reports of original researches, included data on the prevalence of TCP among pregnant women, were in English or Persian, and had been published from January 1, 2000 to September 1, 2018. Eligible studies were appraised using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. Finally, a data collection form was used to extract data. The overall prevalence of TCP among pregnant women was estimated using meta-analysis and the Comprehensive Meta-Analysis Software. Heterogeneity was evaluated through the Chi-square test and the I2 statistic, and funnel plot was used to evaluate the possibility of publication bias. Among 1592 studies retrieved during literature search, sixteen were included in meta-analysis. The overall prevalence of TCP among pregnant women based on the random effects model was 8.4% (95% confidence interval: 6.9%–10.1%). The lowest TCP prevalence was 4.3% in Taiwan, while the highest prevalence was 15.3% in Ghana. Gestational TCP was the most common cause of TCP among pregnant women. With a global prevalence of 8.4%, TCP in pregnancy affects around one-tenth of pregnant women in the world. Thus, timely diagnostic, preventive, and therapeutic measures are needed to effectively manage TCP in pregnancy.

One of the most important effects of many drying lakes in the world is increasing the emergence and outbreak of different diseases. For this sake, the present study aimed to systematically review the effects of lakes drying on human health. The present systematic review was designed and conducted in 2017. Data were gathered by search-ing the Science Direct, Cochrane Library, Google Scholar, Scopus, PubMed, and Web of Knowledge databases, along with hand search of key journals and unpublished resources and contact with experts. There was no spe-cific time span for the search. Overall, 22 articles were selected with 20 articles about Aral Lake drying. Almost all studies were cross-sectional and retrospective. In 8 studies, the participants were children. Seventeen articles lakes drying have adverse effects on human health. Based on the type of effect, the studies were classified into 7 categories (respiratory problems, reproductive system problems, kidney and urological diseases, cancers, anemia, and diar-rhea). Most studies depicted the harmful effects of lakes draught on human health; they had low level of evidence as they were mostly retrospective and cross-sectional. There is not enough evidence to accept or reject with high level of certainty the very effects of lakes drying on human health. To provide such evidence we sug-gest conducting middle and long term cohort and observational studies with scientific bases.

  To perform a systematic review and meta-analysis of self-immolation epidemiology and characteristics in Iran. This was a systematic review and meta-analysis study. PubMed, Scopus, Web of science and Science Direct were searched for English literature and SID and Magiran for Persian in the time period of 2000 to 2016. The retrieved studies were screened and reviewed then quality assessed. Random Effect model was applied for meta-analysis. The qualitative data were analyzed by content analysis method. After literature screening, 39 studies included in the analysis. Women were subject to self-immolation more than men. The rate of self-immolation estimated to be 4.5 cases in every 100,000 populations and it was the reason of 16% of hospitalized burns. The average length of hospital stay calculated to be 12.24 (95% CI: 8.85-15.59) days. The total burnt surface area was 65.3% (95% CI: 56.71-73.89). Death due to self-immolation was 62.1%. The major risk factors of self-immolation were having mental health issues, family problems and characteristics and problems in relation/communication with spouses. Despite the low rate of self-immolation in Iran, it comprises one sixth of the hospitalized burns. The mortality rate of self-immolation also is high and this highlights the importance of providing special care. Psychological consultations and mental health screening in the primary health care would help to prevent the self-immolation

To systematically review the epidemiological patterns and interventions for prevention of road traffic injuries (RTIs) among elderly. Searching keywords including: accident, trauma, road injury, road traffic injuries, aging, old, elder, strategy, intervention, road traffic crash prevention and traffic accident in databases including, Google scholar, SID, IranMedex, PubMed and Scopus. English and non-Persian articles, articles presented in congresses, articles that considered elderly people to have age under than 60 years were excluded. The reporting quality of articles was assessed by two experts using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) check list. RTIs compromised 23.6% of total injuries among elderly. The most frequent injuries were about car accidents (51.4%). Pedestrian injuries composed 48.1% of the RTIs. Head and neck (32.1%) were most injured body parts. There was a significant difference between elderly and non-elderly people in terms of RTIs associated mortality (Odd=2.57 [1.2-5.4 CI 95%]). Overall 25 main domains of intervention and 73 subordinate domains were extracted in five categories (human, road and environment, tools and cars, medical, legal and political issues). According to the notable prevalence and fatality of RTIs, lack of sufficient studies and valid evidence of the present study can provide an appropriate evidence for better interventions for RTIs prevention among elderly

This study aims to investigate the effectiveness of mechanical thrombectomy compared with thrombolytic therapyin patients with acute stroke.

This study is a systematic review on clinical studies, as the Cochrane library, PubMed, Google Scholar, Web of Science,and Embase databases were searched. The time span selected to retrieve articles is 1990 to 2017. The quality of the articles foundwas evaluated by the CONSORT checklist. Fixed effects and random effects models were employed for meta-analysis. Results weresubject to sensitivity analysis in specified curtained interval, CMA (Comprehensive Meta-Analysis software): 2 software was used tocarry out the meta-analysis task, and alpha was set to 5%.

The eight papers found met the inclusion criteria. Patients in mechanical thrombectomy group had a significantly higherimprovement rate compared to the thrombolytic therapy group [OR 1.71 (1.182.48), P = 0.005]. There were no significant differencesbetween mechanical thrombectomy and thrombolytic therapy groups regarding intracerebral hemorrhage ([OR 1.03 (0.71 - 1.49),P = 0.88]). Mechanical thrombectomy was more effective in reducing mortality rate of patients, however, this difference was notsignificant ([OR 0.84 (0.67 - 1.05), P = 0.12]). The effectiveness of mechanical thrombectomy is superior to thrombolytic therapybased on the improvement rate, 90-day mortality and symptoms of intracerebral hemorrhage OR: 2.23 (1.77 - 2.81), P < 0.00001; OR0.79 (0.60 - 1.05), P = 0.10, and OR 1.02 (0.61 - 1.70), P = 0.95, respectively.

Through some good criteria for selecting appropriate patients, mechanical thrombectomy can be superior to throm-bolytic therapy in patients with acute stroke.

Application of anti-clot drugs such as recombinant tissue plasminogen activator (rt-PA) to treat patients with strokes isconsidered as a standard treatment employed through two techniques: intra-arterial and intravenous thrombolysis. The currentstudy aimed at comparing the clinical effectiveness of these two injection techniques.

The current systematic review searched Google Scholar, Web of Science, Embase, Cochrane, and PubMed databases. Thetime span of the searching was from 1990 to 2017. The quality of the selected articles was evaluated. The fixed effects and randomeffects models were used in the meta-analysis. The results were subject to sensitivity analysis in the specified interval. CMA.2 (Com-prehensive Meta-Analysis 2) software was utilized to conduct the meta-analysis;αvalue was considered 5%.

Eight studies met the inclusion/exclusion criteria. Intra-arterial thrombolysis was more effective to reduce mortality rate(odds ratio (OR) = 0.40; 95% confidence interval (CI): 0.17 - 0.92; P = 0.032). Intra-arterial thrombolysis was more effective to improvesymptoms compared with intravenous thrombolysis (OR = 3.28; CI: 1.91 - 5.65; P < 0.001). Neurological dementia was bigger in theintra-arterial thrombolysis group compared with that of intravenous thrombolysis group. The mean of recanalization was 49% and50.8% in the intra-arterial and intravenous thrombolysis groups, respectively; the difference between the results was not statisti-cally significant (P > 0.05). Intracranial hemorrhage value was 11.33 % and 9.52 % in the intra-arterial and intravenous thrombolysisgroups, respectively, which was not statistically significant (P > 0.05).

In spite of the low number of robust evidence, it can be concluded that intra-arterial thrombolysis can be more effec-tive than intravenous thrombolysis.

Context: Despite considerable attention given to health statistics of road traffic crashes (RTCs), the epidemiological aspects of injuries resulting from RTCs are not fully understood in Iran and other developing countries. The aim of this review was to study the epidemiological pattern and issues arising due to RTCs in Iran..
Evidence Acquisition: The scope of this study involves data from a broad range of published literature on RTCs in Iran. Data collection for this study was conducted by searching for keywords such as traffic accidents, traffic crashes, motorcycle accidents, motorcycle crashes, motorcycle injury, motor vehicle injury, motor vehicle crashes and motor vehicle accidents, Iran and Iranian in various databases such as Embase, PubMed, Google Scholar, Scopus, Magiran, Iranian scientific information database (SID) and IranMedex..
This study comprised of 95 articles. It is evident from this review that a large number of severe RTCs occur due to collision of two or more vehicles and most of the victims are males aged between 30 and 39 years. Male pedestrian, drivers and passengers are more likely to be severely injured in comparison to females. One of the most prevalent causes of death among adults involved in the RTCs are head injuries and the majority of deaths occur prior to hospitalization. Mortality rates for RTCs are higher in summer, especially during midnight among all age groups. The most common individual and environmental risk factors associated with RTCs include lack of attention, getting trapped in the car, listening to music, fatigue and sleepiness, duration and distance and negligence of seatbelt usage while driving..
The findings of the current study will be beneficial in prevention of RTCs and its associated complications and hence will be vital for policy makers, health service managers and stakeholders..

Due to the importance of holding effective scientific Olympiads for medical sciences students, this study aimed to evaluate experts’ viewpoints in regard to their necessity, costs, achievements, barriers and solutions.
In this qualitative study, required data were collected using open-ended questions through self-development questionnaires, which were filled out by experts. Data were analyzed through content-analysis methods. To select participants, a purpose-based sampling method was applied up to the point of information saturation. Thus, this study was performed with 20 individuals.
The main necessity and philosophy of holding Olympiads expressed by the experts were: promoting health sector performance, extension of interrelationships between universities, development of scientific competition and incensement of students’ creativity. The majority of participants believed that the achievements of holding these Olympiads are negligible versus their costs. The most important barriers were: absence of appropriate relationships between universities, lack of proper support for holding these Olympiads, the low motivation of professors, noninterested students and the shortage of resources and facilities. Furthermore, the most important solutions included: performance evaluation of previous Olympiads, increasing incentives and motivations as well as suitable planning.
According to experts’ viewpoints, although holding scientific Olympiads is necessary for medical students, during past years, the achievements of such Olympiads versus theirs costs seem negligible and there are lots of barriers in the path of achieving their goals and philosophy.

Nowadays self-medication is one of the most common public health issues in many countries, as well as in Iran. According to need to epidemiological information about self-medication, the aim of this study was to systematic review and meta-analysis of prevalence and cause of self-medication in community setting of Iran. Required data were collected searching following key words: medication, self-medication, over-the-counter, non-prescription, prevalence, epidemiology, etiology, occurrence and Iran in Google Scholar, PubMed, Scopus, Magiran, SID and IranMedex (from 2000 to 2015). To estimate the overall self-medication prevalence, computer software CMA: 2 applied. In order to report the results, forest plot was employed. Out of 1256 articles, 25 articles entered to study. The overall prevalence of self-medication based on the random effect model was estimated to be 53% (95% CI, lowest= 42%, highest=67%). The prevalence of self-medication in students was 67% (95% CI, lowest=55%, highest=81%), in the household 36% (95% CI, lowest=17%, highest= 77%) and in the elderly people 68% (95% CI, lowest=54%, highest=84%).The most important cause of self-medication was mild symptoms of disease. The most important group of disease in which patients self-medicated was respiratory diseases and the most important group of medication was analgesics. The results show a relatively higher prevalence of self-medication among the Iranian community setting as compared to other countries. Raising public awareness, culture building and control of physicians and pharmacies’ performance can have beneficial effects in reduce of prevalence of self-medication.

Excellence and quality models are comprehensive methods for improving the quality of healthcare. The aim of this study was to design excellence and quality model for training centers of primary health care using Delphi method. In this study, Delphi method was used. First, comprehensive information were collected using literature review. In extracted references, 39 models were identified from 34 countries and related sub-criteria and standards were extracted from 34 models (from primary 39 models). Then primary pattern including 8 criteria, 55 sub-criteria, and 236 standards was developed as a Delphi questionnaire and evaluated in four stages by 9 specialists of health care system in Tabriz and 50 specialists from all around the country. Designed primary model (8 criteria, 55 sub-criteria, and 236 standards) were concluded with 8 criteria, 45 sub-criteria, and 192 standards after 4 stages of evaluations by specialists. Major criteria of the model are leadership, strategic and operational planning, resource management, information analysis, human resources management, process management, costumer results, and functional results, where the top score was assigned as 1000 by specialists. Functional results had the maximum score of 195 whereas planning had the minimum score of 60. Furthermore the most and the least sub-criteria was for leadership with 10 sub-criteria and strategic planning with 3 sub-criteria, respectively. The model that introduced in this research has been designed following 34 reference models of the world. This model could provide a proper frame for managers of health system in improving quality.

A pacemaker implantation is considered major life event for cardiovascular patients, so they will probably have very interesting experiences of living with this device. The aim of this study was to explore the experiences of cardiovascular patients living with the pacemaker. In this qualitative study, 27 patients were chosen through purposive sampling to achieve data saturation, and their experiences were examined using semi-structured interviews. The patients’ statements were recorded with their consent and analyzed using content analysis method. Participants’ experiences included three main themes: “Problems and limitations,” “feeling and dealing with pacemaker”, and “sources of comfort” and 10 sub-themes including: physical problems, financial problems, social problems, the first encounter, the feeling of living with the pacemaker, how to cope with pacemaker, satisfaction with pacemaker, good family support, hospital and hospital staff performance, and role of religious beliefs. Planning to solve social problems, identifying and changing feelings of patients using pacemakers, reinforcing the resources of comfort especially family support seem to be necessary steps for improving quality of life and impact of using pacemaker.

Gestational Diabetes (GD) is one of the major public health issues. The purpose of the present study was to perform a systematic review and meta-analysis to assess the risk factors and prevalence rate of this disorder in Iran. This systematic review and meta- analysis article was prepared using the databases of Science Direct, Pub-Med, Scopus, Magiran, Iranmedex and SID, Google search engine, Gray Literature, reference lists check and hand searching using keywords such as «prevalence», «gestational diabetes mellitus», «GDM», «risk factor*», «Iran» and «Postpartum Diabetes». The selected papers were fully reviewed and the required information for the systematic re-view was extracted and summarized using extraction table in Microsoft Office Excel software. Twenty-four of 1011 papers were quite relevant to the objectives of the review so they were included. The mean age of the participants was 29. 43±4. 97 yr and the prevalence of GDMwas 3. 41% (the highest and the lowest prevalence rates were 18. 6% and 1. 3% respectively). Among the influential factors mentioned in the literature, poten-tial causes of GDM are gestational age, history of gestational diabetes, family history of diabetes, body mass index, abortions and parity, and history of macrosomia. Considering the high prevalence of postpartum diabetes and its related factors in Iran, strategic planning for disease prevention and reduction is inevitable.

healthcare organizations is being increasingly used. The aim of this study was to clarify PSC status in Iranian hospitals using a meta-analysis method.Nowadays, for quality improvement, measuring patient safety culture (PSC) in Methods SID and IranMedex using the search terms including patient safety, patient safety culture, patientsafety climate and combined with hospital (such as “hospital survey on patient safety culture”),measurement, assessment, survey and Iran. A total of 11 articles which conducted using HospitalSurvey on Patient Safety Culture (HSOPSC) questionnaire initially were reviewed. To estimateoverall PSC status and perform the meta-analyses, Comprehensive Meta-Analysis (CMA) softwarev. 2 was employed. Six databases were searched: PubMed, Scopus, Google Scholar, Cochrane Library, Magiran, units” dimension received the highest score of PSC (67.4%) and “Non-punitive response to error” the lowest score (32.4%). About 41% of participants in reviewed articles evaluate their hospitals’ performance in PSC as ‘excellent/very good’. Approximately %52.7 of participants did not report any adverse event in the past 12 months. The overall PSC score based on the random model was 50.1%. “Teamwork within hospital Among the 12 dimensions of HSOPSC questionnaire, the “Non-punitive response to error” achieved the lowest score and could be a priority for future interventions. In this regard, hospitals staff should be encouraged to report adverse event without fear of punitive action.The results of this study show that Iranian hospitals’ performances in PSC were poor.

Accreditation is a widely used mechanism to keep organization adherent to the established standards. The aim of the study was to identify barriers towards promotion of accreditation in the Iranian hospitals, and exploring the potential overcoming strategies. A qualitative study design was adopted. Data were collected using a questionnaire with open questions about barriers to and potential solutions of accreditation implementation in Iranian hospitals (N= 116). Thematic analysis was used to extract the major concepts. Limited knowledge of the personnel, inadequate training of the staff and lack of commitment of managers and physicians were identified as the most important challenges towards successful implementation of accreditation. Respondents enumerated extensive training, involvement of chief managers, and adapting the hospital’s organizational culture as the potential drivers of accreditation in the Iranian hospitals. The three categories of barriers to accreditation as well as the suggested overcoming strategies are interconnected, all of which pointing towards the need for extensive training for developing the required infrastructure, at least in terms of human resources, for promotion of accreditation in the Iranian hospitals.

Patient Safety Culture (PSC) is the essential context for ensuring patients’ safety. While in many countries, nation-wide research has been conducted to identify context-specific PSC factors, there is lack of such large-scale studies in Iran and most researches into PSC are local, limited, and use different methodologies. In the absence of nation-wide research into the field, this study aimed at meta-analyzing the available scattered data to gain insight into priorities associated with development of PSC in Iran. Three major databases of references and abstracts, including PubMed, Google Scholar, Cochrane Library, Magiran, SID and Iranmedex were comprehensively searched. A total of 11 articles exploring PSC in Iran using the standard HSOPS instrument were reviewed. CMA2 standard was adopted for meta-analysis of the literature data. Data were summarized using descriptive statistics. An overall PSC grade of 50.5% was identified for the Iranian health settings. While “Teamwork within hospital units” scored the highest (67.4%), the lowest score was related to “Non-punitive response to error” (32.4%). Nearly 41% of surveyed samples in the publications perceived PSC status in their hospital to be “Very good” and 52.7% reported no adverse events during the past 12 months. Our analysis identified a low PSC grade and adverse event reporting score in the Iranian health settings. “Non-punitive response to error” was found to be the major challenge of developing PSC, hence the priority area for future relevant interventions.

Angiography remains as the gold standard for the diagnosis of cardiovascular diseases (CVD). The aim of this study was to assess the quality of angiography services in Shahid Madani Hospital, Tabriz, Iran. A cross-sectional study was conducted in 2013 in Shahid Madani Hospital. A sample of 203 CVD patients who had received angiography services was surveyed. Data was collected using valid and reliable questionnaire with 42 items related to 12 aspects of service quality. Total score service quality was derived by combining the scores of Performance and Importance as perceived by the patients. Scores > 8 was considered as ‘High’, 6-8 as ‘Moderate’, and <6 as ‘Low’. A moderate overall score of 7.00 was given to the angiography services quality. While continuity, communication, and autonomy gained high scores, choice of provider, prompt attention, and quality of basic amenities, and confidentiality scored moderately, and support groups, dignity, safety, and prevention received low scores. The moderate assessment of angiography services quality shows that there is a considerable room for improving these services. To this end, prevention and safety should receive the first priority in services quality improvement plans. Possible useful strategies in this regards include briefing the patients about the adverse effects of the drugs, trading them training on control and prevention of cardiovascular disease, and empowering them for self-care.

Burns are a major factor in injury mortality. The aim of this study was to explore the possible causes of fatal burns using Haddon’s Matrix. This is a qualitative study using a phenomenological approach. We collected elicitation interview data using nine corroborators who were the most knowledgeable about the index burn event. Immediately after recording, the data was verbatim. Each event was analyzed using Haddon’s Matrix. Interviewees provided detailed information about 11 burn cases. Overall, 202 burn-related factors were extracted. Using Haddon’s Matrix, 43 risk factors were identified. The most common included the lack of basic knowledge of burn care, the use of unsafe appliances including kerosene heaters and stoves in hazardous environments such kitchens and bathrooms, poor burn care delivery system in hospitals, poor and unsafe living conditions, financial issues, and other factors detailed in the article. Our findings suggest burn related prevention efforts should focus on improving human living conditions, promoting the use of safe heating appliances, providing public burn-safety precautions education, and improving the quality of care in burn centers and hospitals.

The present study tended to review the current situation of the international relations management filed in terms of using foreign scholars and experts and holding continues training courses for foreign students at the Tabriz University of Medical sciences during the Years 2005-2010. In this descriptive study، two checklists were designed and used for obtaining the data. Of the two check lists، one was used for situation analysis of the inviting foreign scholars and experts and the other was taken into account for analysis of holding short-term training courses for foreign students through literature review and the panel meetings of the experts and there were also a total of 65 questions. Census sampling method was used to evaluate the foreign scholars and holding training courses for foreign students. Then، the results showed that Tabriz University of Medical Sciences has performed poorly in inviting foreign scholars and experts. Therefore، none of these regulations، prioritization، planning، evaluation، survey، and feedback was considered even at the minimum level. Further، in terms of holding short-term training courses for foreign students were reviewed; none of the desired statements was met in short-term training courses neither.

Evidence-based care is defined as combining research findings with caring skills. The current study aimed at a systematic review of obstructions, facilitators, awareness, knowledge, function, perception, and results of interventions in evidence-based care in Iran. In the present survey different data base searching methods and manual search were applied using the key words of “evidence-based”, “evidence-based medical”, “evidence-based nursing”, “evidence-based practice”, “evidence-based care”, “evidence-based activity”, “evidence-based education”, “applying research results”, “research application”, and their combinations with the key words of “obstructions”, “facilitators”, “awareness”, “knowledge”,” function”, “perception”, and” Iran”; and their English synonyms in data bases of PubMed, Medlib, Magiran, SID, CINAHL, Google Scholar, and Iranmedex to collect articles. Out of 819 articles, finally 25articls were used for this study. The most important barriers of evidence-based practice were lack of facilities, lack of time, and lack of expertise in research methods. The rate of familiarity with evidence-based practice specific terms was low (44.22%). Reference books were considered as the most important information sources. Awareness, knowledge, function, and usage of evidence-based practice was low (<50%). Main concepts of evidence-based practice from providers’ point of views were scientific and professional care, patient-oriented and considering service quality. Interventional studies had a positive effect on the improvement of evidence-based practice. Weak knowledge, weak attitude, and time shortage. are among the most significant barriers of evidence-based care in Iran. These problems require more accurate planning and more favorable policies on the part of medical science authorities.

The increasing pressure on health systems to improve quality of health care, require them to develop novel conceptual framework and indices aimed at evaluating decision variables in the contemporary complex community. Customer Quality is a newly introduced concept addressing capability of patients in contribution to healthcare process and cooperation with healthcare providers for an improved healthcare services provision. This concept has been suggested to be regarded as a new dimension to quality of healthcare delivery. To further explore the potential impact of this factor on clinical outcome and health care performance, this study surveys Customer Quality among angiography patients. In a cross-sectional study, 202 cardio-vascular patients from Educational-Medical Shahid-Madani Center (Tabriz, Iran) were surveyed in 2013. A 19-item 5-point Likert-type Customer Quality questionnaire was used for data collection. Based on cumulative score of response to the questions, the patients were categorized into four ordinal self-management-capability groups: 1-19: belief in the importance patient role in healthcare process improvement; 20-50: having adequate confidence and knowledge to participate in healthcare provision; 50-80: being ready to take action to improve health care outcome; >80: maintaining care practices even under stressful situations. The data were summarized using descriptive statistical methods. T-test and ANOVA were used to compare the mean values. The mean Customer Quality was calculated to be 60.42±10.07. While ~84.4% of the patients fell in the third self-management-capability category, ~86% stated that they can help prevention of diseases or decrease the risks related to their health, ~97.% believed that their participation in provision of healthcare services is important to their health improvement, ~83% stated that after receiving treatment from the medical teams, they themselves are responsible for their health, 75% of patients consider themselves as a member of health team, and ~53% stated that they are not informed about development and prognosis of their disease. Our results clearly indicate the positive attitudes of cardiovascular patients towards contributing to healthcare process and self-care. Despite strong implication of of this positive attitude in attaining a high Customer Quality level, its potential impact on healthcare performance remains untapped due to the limited knowledge of patients on the nature of their diseases and the associated health-care and health-efficacy. Our findings implies the need for systematic inclusion of training services in health setting for increasing the awareness of patients on different aspects of their diseases and improving their communicative and self-efficacy skills, in order to attain higher Customer Quality-based healthcare outcome.

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The aim of this study was to assess the infrastructures and barriers of effective accreditation in East Azerbaijan hospitals.

In this triangulation (qualitative-quantitative) study, all the managers of 43 hospitals in East Azerbaijan were selected. The authors developed an 8-item questionnaire for quantitative section of the study which its validity was improved by experts’ comments and its reliability was assessed by half-structure methods (9. =α). In addition, two open-ended questions were used in qualitative section of the study. Quantitative data were analyzed using descriptive statistics, t-test, and ANOVA test using SPSS version 20 statistical software packages. Qualitative content analysis was used to analyze the responses to the two open-ended questions.

Seventy-six percent of the managers agreed to implementation of accreditation in hospitals and believed that accreditation could improve the health services and increase the patient and staff satisfaction. Fifty percent of the participants had lack of required knowledge about the accreditation and they declared that the hospitals managed by them were not prepared to implement accreditation with respect to resources, manager’s commitment, staff skills and knowledge. In Tabriz hospitals, resources and infrastructures were mentioned to exist in a significantly higher proportion than other cities (P < 0.01). Important barriers were explored to include the lack of the following: manpower, participation of clinicians, resources, appropriate documentation and information systems.

Considering the barriers and lack of infrastructures in the hospitals of East Azerbaijan to achieve an effective accreditation, it is essential to eliminate the existing barriers and provide appropriate infrastructures.