sajad delavari

Drug prescription is one of the strategic issues in the field of health. Rational prescription of medicine and efforts towards appropriate, safe and efficient use of medicine are one of the main missions of health policy makers in the country. This study was conducted with the aim of reviewing the studies was done in the country in the field of drug prescription pattern.

The present research was a scoping review using the Arsky and O'Malley protocol. The English and Persian databases examined in this study were Scopus, Web of Science, PubMed, Magiran and SID. Searched keywords were Prescription, Rational Use, Rational Utilization, Rational Consumption, Overconsumption, Overutilization, Utilization Management, Inappropriate Utilization, and Iran in English and Persian. Original research articles published in journals in English or Persian that estimated WHO prescribing indicators were included to the review. Studies published in other languages, books, theses, conference papers, review studies, articles whose full text was not available and articles published before 2010 were excluded from the study.

In the first stage 2846 citations were retrieved. After considering all inclusion and exclusion criteria 22 full articles were reviewed. About 70% of articles were published in English. 74% of studies focused on the prescription of a specific group of providers and 13% focused on drug administration in elderlies. The average number of drugs per prescription varied from 2 to 4.5 items in different studies. The percentage of prescriptions included antibiotics reported between 8.8 for elderlies’ home health care to 97.6 for dentists’ prescriptions. The prescriptions included injections also varied from 9.3 to 58.9 in medical interns and general practitioners in Kerman.

The trend of drug prescription reflects the success of the country's policies toward rational use of drugs. However, to achievement the global standards, the implementation of policies to improve the prescription pattern in the country should be a priorities of health system.

The advantages of telemedicine for the elderly are well known, but there are scattered studies on how to better prepare, implement, and evaluate it for older people in the world. It seems necessary to conduct a study to identify the managerial requirements for providing telemedicine to older people. Therefore, the present study aims to review the managerial requirements for providing telemedicine services to the elderly.

This review study was conducted based on the 5-step approach of Arksey & O’Malley. Related studies were identified by searching in three databases of Scopus, Web of Science, and PubMed as well as searching for gray literature in Google Scholar. This search was limited to articles published from 2010 to 2022. Inclusion criteria were the study of the managerial requirements of telemedicine in three stages of preparation, implementation and evaluation, publishing from 2010 to 2022, written in English or Persian language or having English abstracts with sufficient evidence for extraction, and availability of full texts. There were no restrictions regarding the country of study. The studies with no access to their full texts were excluded. 

In total, 209 primary concepts, 55 unique concepts, 21 primary themes and 7 main themes regarding the preparation, implementation and evaluation stages were extracted. Out of 38 reviewed studies, 34 were related to the preparation stage, 32 related to the implementation stage, and 13 related to the evaluation stage. The need for organizing resources and manpower in the preparation stage, the need for monitoring, preservation and maintenance in the implementation stage, and the need for evaluation of long-term outcome and scalability of technology in the evaluation stage had the highest level of importance compared to other requirements.

The number of studies on managerial requirements of telemedicine in the implementation and evaluation stages is lower than the studies on the requirements in the preparation stage. It is necessary to identify these requirements in all stages. This study provides valuable information about managerial requirements for providing telemedicine services to the elderly, which can help managers and policy makers in the health system in promoting the quality and accessibility of telemedicine services for older adults.

The present research aimed at investigating the optimum use of resources in hospitals by estimating and comparing the utilization and cost of consumables in a large hospital in Iran during 2017-2018. The data were collected from the accrual accounting system, store invoices and executive management department. Descriptive statistics were performed. Excel was used for data analysis. Syringe and surgical gas had the highest and lowest cost items, respectively, among the hospital consumables. Surgical gas had also the greatest growth of consumables cost from 2017 to 2018 (114%). Emergency department and ICU had the highest consumption among hospital departments. Moreover, greatest increases in consumable costs were observed in laboratory (258%), and osteology (72%) and digestion (72%) departments. The findings also showed that although utilization of most of consumables had a decreasing trend, their cost increased (overall 45%) The high rate of general inflation, lack of utilization plan for consumables, and lack of supervision and monitoring system on resource consumption are among the reasons for the increasing trend of resource cost. Two last issues can be addressed by hospital administrators in order to control consumables cost.

General practitioners are considered the main resource of any health system. The performance of General practitioners significantly affects public health. Jon's satisfaction is affected by numerous factors. The aim of the article is to synthesize the literature studying the factors associated with physician satisfaction. Two databases including Scopus and Pubmed were searched. Primary research studies were included only if they reported on the provision of factors that affect general practitioners’ job satisfaction. All studies except systematic reviews were also excluded. Quality assessment of the systematic reviews included in the umbrella review evaluated by assessing the methodological quality of systematic reviews tool checklist for systematic reviews. Factors affecting physicians' job satisfaction are divided into five groups. Personal Factors: (Health status, Work-family conflict, Life satisfaction),  Demographic Factors: (Age, Gender, Marital status, Race), Practice factors: (Years of experience, Getting responsibility and recognition for work, Patient characteristics, Being a foreign/ internationally trained doctor)Organizational factors,: (Autonomy in the work, Task delegation, Working conditions, Working hours, workload, Diversity of work, relations and contact with colleagues, Being involved in teaching medical students, Administrative burdens,  Work environment, Non-financial incentives, Work engagement, Hospital type, and structure,  Management, and leadership, Opportunity for professional development, Access to resources), Financial and economic factors (Payment methods Income). Physician satisfaction is a dynamic entity totally related to both personal-related and job and work-related factors. This review supports the understanding of the factors that influence job satisfaction as an essential factor that leads to better health outcomes.

General practitioners (GPs) are one of the main healthcare providers. The purpose of this study is to determine the factors affecting the job and financial satisfaction of GPs in Iran.

In this study, participants were 666 GPs in Iran in 2016 who were selected by simple random sampling method. Data collection was done during two national conferences of the Iranian General Practitioners Association. The data collection tool was a researcher-made questionnaire. To analyze the collected data, t-test, ANOVA, Pearson correlation test, and logistic regression analysis were used.  

It was reported that 56.25% of GPs had high job satisfaction, and 39.66% had high financial satisfaction, respectively. Job and financial satisfaction was higher in female GPs (60.40% and 46.18%) than in male GPs (52.87% and 27.27%). Married GPs had higher job and financial satisfaction (57.50% and 36.29%) than single GPs (51.28% and 34.7%). Job satisfaction of GPs working in the private sector (24.15%) was higher than in the governmental sector (17.83%), while the GPS working in the governmental sector had higher financial satisfaction.

Gender, job status, economic expectations, perceived relative income, patient satisfaction, and marital status are factors affecting with job satisfaction of GPs in Iran, while gender, job sector, the ratio of actual income to target income, perceived relative income, and age are factors affecting their financial satisfaction.

Achieving financial goals is one of the health systems goals, especially for those in low- and middle-income countries. Since financing equity, is an objective of Health Transformation Plan (HTP) implementation in Iran, this study examined this plan toward improving equity in healthcare Financing, using four payment indices: Out-of-Pocket Payment (OOP), Catastrophic Health Expenditure (CHE), Fair financial Contribution Index (FFCI) and Impoverishing Health Expenditure (IHE).

Articles published in English on equity in financing related to HTP were searched and retrieved in the Web of Science, Scopus, PubMed, and Embase databases between Jan 2014 and Dec 2020, following PRISMA guide-lines. Overall, 1319 papers were retrieved initially, and 31 were selected for analysis.

After implementation of HTP, OOP index has decreased between patients and households. No consistent trend was evident for CHE. HTP reforms have a limited effect on the FFCI. The one study on IHE has shown an upward trend for this index. In general, in the early years of HTP, there was a higher downward trend in equity in financing indicators than in subsequent years.

HTP has made significant accomplishments in equity, such as the financial protection of patients in healthcare centers, but fail to achieve this plan goals, significantly reduced its value. Therefore, it is necessary for managers and health policy makers around the world, with scientific and principled solutions, to prevent loss of their reform plans positive achievements.

Students and graduates in the field of health management will be future managers of the health field. Improving the skills of health system managers as one of the main pillars of health service organizations is essential to meet the health needs of the community. Therefore, this study aimed to identify and prioritize the key skills required by healthcare management graduates as future managers of the health system.

This study was performed in three steps using the method of content analysis, Delphi, and factor analysis. In the first step, a semi-structured and interactive in-depth interview was used to determine the skills required for managerial jobs in the health system, and the data were analyzed based on the content analysis method. The sample size was 14 health experts. In the second step, a Delphi study was designed to build consensus on skills. The participants scored 44 skills extracted from the interviews through a three-point Likert scale from disagree to agree (from 1 to 3), then the skills were divided into several component groups through factor analysis.

In this study, 44 key skills needed by managers and graduated students in the field of health service management were identified in 10 components.

Costs and resources allocated to the training of health service management graduated students should be based on the need of the labor market and workspace.

Reinfection with Coronavirus Diseases 2019 (COVID-19) has raised remarkable public health concerns globally. Therefore, the present retrospective cohort study intended to investigate COVID-19 reinfection in registered patients of Fars province in Iran from February 2020 to April 2021. The patients’ data, including the COVID-19 infection, symptoms, comorbidities, and demographics, were collected using the Health Information Systems (HISs). The patients were divided into three groups in terms of the duration between the initial infection and reinfection, including 28-44, 45-89, and more than 90 days. Following the univariate analysis, logistic regression was used to investigate the factors effective on COVID-19 reinfection.  A total of 213768 patients had a positive Polymerase Chain Reaction (PCR) test. The reinfection rate was 0.97% (2079 patients). Of these re-infected individuals, 14.9%, 18.5%, and 66.6% had their second positive test 28-45, 45-89, and ≥90 days later, respectively. The mean duration between the initial infection and reinfection was 130.56 days (29-370 days). The chance of reinfection was significantly higher in the youths (Odds Ratio (OR)=2.055; P<0.001), men (OR=1.283; P<0.001), urban population (OR=1.313; P<0.001), and healthcare providers (OR=4.453; P<0.001). The patients with chronic pulmonary diseases, chronic kidney diseases, and malignancy were 1.421 (P=0.036), 2.239 (P<0.001), and 3.437 (P<0.001) times, respectively, more likely prone to reinfection.  The results of this study showed that there is a higher risk of reinfection in several vulnerable groups including healthcare providers, young individuals, residents of urban areas, men, and individuals with underlying diseases.

Rumors concerning various aspects of the fight against COVID-19, vaccination, in particular, have become one of the main challenges for managers and policymakers who have to deal with different aspects of the disease. This necessitates the recognition of the factors that influence the prevention and spread of these rumors.

The current study aimed to investigate the link between health literacy among adults and their acceptance of COVID-19 vaccination rumors in Iran.

This cross-sectional study was conducted from November 15 to December 15, 2021, in different provinces of Iran.The study population included Iranian adults, aged 18 years and older, who were selected using the snowball sampling method. The data collection tools involved two questionnaires:the Health Literacy Questionnaire, which consists of 33 items, and the COVID-19 Vaccine Rumor Questionnaire which assesses 17 rumors related to COVID-19 vaccination collected from various news sources.

The number of completed questionnaires was 1158 out of 2163 questionnaire visits (74% response rate). Univariate analysis showed that health literacy had a statistically significant association with sociodemographic variables of gender, marital status, ethnicity, place of residence, and level of education. The results of data analysis also demonstrated a significant correlation between the average of rumors’ acceptance and thesociodemographic variables of gender, marital status, ethnicity, place of residence, and level of education. The results of the Pearson correlation coefficient test showed a significant and negative relationship between health literacy and rumor belief (P= 0.000, r=-0.590), indicating that those with a higher level of health literacy had a lower level of rumor acceptance.

Based on the findings of the present study, health literacy has a significant effect on reducing the credibility of rumors and other misinformation among community members. Macro-level decisions and policies are needed to improve factors such as health literacy and can help individuals identify and track rumors and make decisions based on reliable information on vaccination.

Development and assessment of clinical decision-making skills are essential in midwifery education because of their role in mothers' and infants' safety. Therefore, the present study's primary objective was to evaluate the relationship between experience levels and clinical decision-making skills using the key features (KFs) examination.  

One hundred and two midwifery students in five different education levels participated in this cross-sectional study through convenient sampling. Twenty KFs questions were designed based on the principles of the KFs examination. The participants' information, including grade point average (GPA), theoretical and practical scores of the obstetrics course, were collected. KFs scores were compared according to students' training semester by one-way analysis of variance (ANOVA). Pearson correlation was conducted to explore the correlation between KFs scores and GPA as well as theoretical and practical scores. All statistical analyses were performed at a significance level of 0.05 (p≤0.05). We used five kinds of effect size calculators, which include mean difference (MD), standardized mean difference (cohend), partial Eta-squared, Cohenf, and partial omega-squared.   

There was no correlation between KFs scores and the grade point average, theoretical exam scores, and practical exam scores. KFs scores linearly rose as the learners' level increased with a mean± SD score of 7.61±1.09 during the third semester compared to 11.55 ± 1.89 during the eighth semester (p=0.001). The effect size of this result was large (partial omega square=0.35, partial eta square=0.38 & cohen’s f=0.73). The largest SMD was related to the comparison of KFs scores between the eighth and third semester (MD=3.58, SMD=2.554 [CI 95%: 1.719-3.389], p-value═ 0.001), and the lowest was related to the comparison between the third and fourth semesters (MD=0.354, SMD= 0.2 [CI 95%: -0.421-0.821], p=0.987).   

Establishing proficiency in clinical decision-making skills is a linear process greatly enhanced by experience, clearly shown by the present study results. Using KFs examination and obtaining extensive evidence to its benefit can allow us to renegotiate proficiency evaluation methods for students in clinical fields. the education curriculum should focus more on identifying clinical KFs skills than merely teaching knowledge about disease processes.

The health sector will face a shortage of manpower during crises. The sustainability and  retention of human resources during these conditions are vital. The purpose of this study was to explain possible policies and strategies to strengthen health workers during the crisis and prevent them from leaving the organizations and hospitals.

This was a scoping review research to find strategies for retention of human resources during epidemics. English and Persian databases were searched and relevant studies were selected and reviewed. The key pieces of information obtained were then categorized. Finally, suggested efficient policies and strategies were summarized and reported.

A total of 168 different articles were collected. After excluding irrelevant studies, 21 articles were selected and fully reviewed. The results were classified into six main categories of policy-making as well as strategies to implement them.

Considering the epidemic situations, in order to strengthen and support human resources in times of crisis, it is recommended that policymakers and decision-makers of the health sector focus their attention on six major topics including education reform, financial support, psychological support, social and welfare support, professional support, and development of infrastructures in deprived and crisis-stricken areas. The important point about suggested strategies is that they need to be in accordance with the ongoing situation of their target societies, as we know that underdeveloped, developing and developed countries have a different set of circumstances and therefore require different priorities and policies.

Today, a new disease, called coronavirus disease 2019 (COVID-19), has affected the entire world, especially in the economic aspect. This disease has severely disrupted the global economy. Therefore, in this study, we aimed to investigate how people’s income was affected by the early phase of the COVID-19 pandemic in Iran. We used an online questionnaire in the Persian language, which was available from April 18 to April 28, 2020. The survey asked the participants about their job and income during the COVID-19 pandemic as compared to the pre-COVID period. Fifty-seven percepts of participants were unemployed or experienced a drop in their income during the COVID-19 outbreak. Therefore, the global economy should be supportive of people during epidemics.

While logical use of medicine is a priority in all health systems, people do self-medication- mainly using Nonprescription Drugs or Over the Counter (OTC) drugs- for different reasons. Self-medication is rising in many developing countries that could increase healthcare expenditure. The present study aimed to find the self-medication rate and predisposing, enabling, and need factors affecting it based on the Anderson behavioral model in the Iranian population. The present study uses 22470 households’ data acquired from Iranian utilization of healthcare survey at the national level (2016). Due to the study objective, the data of 13005 people who were over 15 years old and had outpatient healthcare needs two weeks before the survey. The survey included a binary question about self-medication, which is considered a dependent variable. Age, gender, marital status, literacy, job status, socio-economic status, location, basic health insurance, complementary health insurance, and need for health services were considered as independent variables. Data were analyzed using logistic regression. The self-medication rate was calculated at 26.3% that was different among different subgroups of the population. According to the model estimates, married (OR = 0.80, CI = 0.71-0.91) and housekeepers (OR = 0.79, CI = 0.67-0.93) had significantly lower self-medication. Moreover, the urban population (OR = 1.29, CI = 1.17-1.43), people without basic (OR = 1.32, CI = 1.10-1.58), and supplementary (OR = 1.18, CI = 1.04-1.35) health insurance and also people who had two or higher number of outpatient healthcare needs had significantly more self-medication (OR = 2.96, CI = 2.67-3.29). It can be concluded that need, enabling, and predisposing factors are respectively the main determinants of self-medication behavior. From a policy point of view, increasing effective health insurance coverage with a focus on people who have more health care needs can be helpful.

Evaluation has become an inseparable part of education process which gives feedback to students and professors to improve education quality. This study aimed to elicit preferences of professors and students about attributes of evaluation methods in theoretical courses in Kermanshah University of Medical Sciences, Iran, in 2018.

Discrete choice experiment (DCE) method used for eliciting preferences of participants of the study. A narrative literature review and interview with eight professors and ten students conducted to determine attributes and levels of evaluation methods in the university. Furthermore, experimental design used for making final choice sets of the evaluation methods. We included 213 students and 30 professors in the study. Conditional logistic regression model performed to data analysis.

Most of the professors (36.67%) preferred to allocate up to 30% of evolution scores to midterm examination. However, the most percentage of students (30.45%) were agree to include midterm examination up to 15% of total scores. The majority of students prefer to examination questions compromise just presented materials, while 70% of professors prefer to include additional texts for evaluation examinations. In case of quiz examination, professors in comparison with students prefer that quiz should have higher proportion of total scores. DCE analysis indicated that professors and students preferred a mix of questions in examinations. In addition, additional resources beyond what is taught in class made utility for professors and disutility for students. Quiz, also, increased the utility of an evaluation package in professors.

The findings showed that there is a gap between preferences of professors and students regarding some attributes of evaluation methods such as student’s discipline, examination materials, and quiz. Further studies are needed to examining other attributes of evaluation methods in theatrical and practical courses in Iran and other contexts.

 Public support plays a crucial in managing public health crises. Communicating with the public during a pandemic has a major role in gaining public support. Public information-seeking behaviors are the core element of epidemic communication..

 The current study aimed to investigate the Iranian information-seeking behaviors during the first three weeks of the COVID-19 pandemic in Iran.

 In this cross-sectional study, the use of web search queries to monitor the COVID-19 pandemic in Iran from December 2019 to March 1 2020, is investigated. The Iranian search queries for COVID-19 were evaluated from December 30, 2019, to March 1, 2020. Google trend reports were used to retrieve data on the number of search queries. Queries were categorized into “epidemic news”, “necessary protective equipment”, “prevention strategies”, and “treatment”. To analyze the data, segmented regression was applied. Also, the daily percent change (DPI) was estimated.

 The frequency of Google searches for COVID19-related queries first increased during the period of 18 - 23 February 2020 (DPC: 34.0; P value < 0.001), and then declined to March 1, 2020 (DPS: -3.9; P value < 0.001). The most prevalent query was “Epidemic news” (54%), followed by “necessary equipment” (33%). The frequency of these two queries increased from 18 - 23 February. "Prevention strategies" was the most common search category on March 1.

 When an epidemic begins to spread, people try to get the “latest news” and “what they need to protect themselves”.

Preventing violence is important especially in the Middle East, where many countries are struggling with violence. Knowing the affecting factors could help public policy makers to decrease violence level. Thus, this study is aimed to analyze health and other socio-economic factors that could affect interpersonal violence in middle eastern countries.

From international organization databases, we collected the panel data of Middle Eastern countries from 1990 to 2016 on prevalence of interpersonal violence as dependent variable and per capita income, life expectancy, democracy index (DI), urbanization and unemployment as explanatory factors. Several panel data diagnostic tests were performed for selecting a suitable model of estimation. The variables were entered in the model in logarithmic form. Because of heteroscedasticity, cross-sectional dependence and serial correlation of residuals, feasible generalized least squares (FGLS) was used for estimation of mentioned model using Stata 14.2.

The means of interpersonal violence prevalence and life expectancy were 2462.2 (SD = 232.4) per 100 000 population and 73.5 (SD = 4.5) in the Middle East, respectively. Urbanization (β = -0.0925, P < 0.01), life expectancy (β = -0.0362, P < 0.01), per capita income (β = -0.0046, P < 0.01), unemployment (β = 0.0007, P < 0.01) and democracy (β = -5.83e-06, P < 0.01) had significant relation with interpersonal violence.

Life expectancy as a proxy for health is one of the main predictors of interpersonal violence, as literature supports. That is, if a society is healthier, the burden of interpersonal violence will be lower. Thus, health policy makers should consider health status as a preventive factor of violence, which is stated in health as a bridge for peace by the world health organization.

Health systems aimed to increase health utilization. Habits and behavior about using health facilities, which is called health-seeking behavior, are different among different cultures and influenced by different factors. The present study is aimed at investigating Iranian Southern population health‑seeking behavior and its influencing factors.

A sample of 397 people was selected using proportional stratified random sampling for this cross‑sectional study. They were asked to fill a questionnaire about their health‑seeking behaviors (seeking treatment, inattention to treatment, and self-medication) and socioeconomic factors. Data were analyzed using regression models including linear, ordinal, and logistic regressions.

Near 80% of participants reported self‑medication and most of them prefer public hospitals as their first point of contact with health system compared to others such as family physician. Using linear regression revealed seeking treatment has significant relationship with age (P = 0.037), living place (P = 0.018), and having complementary insurance (P = 0.013). Self‑medication behavior has relation with age (P = 0.015), gender (P = 0.039), education years (P = 0.031), living place (P = 0.005), having complementary insurance (P = 0.001), and satisfaction with health‑care providers (P = 0.003) in logistic regression. Using ordinal regression, it was found that inattention to treatment has a relation with education years (P = 0.044), living place (P = 0.042), having complementary insurance (P = 0.049), and severity of illness (P = 0.031).

Southern population does not accept family physician as the first point of interaction with the health system, and they prefer to go to public hospitals directly. Moreover, self‑medication is a prevalent behavior among the population and thus their acceptance of health care is low. Based on the findings, it can be suggested providing more satisfying health care, increasing insurance coverage, and informing population could lead to better utilization of health‑care services.

Management style is one of the factors that could cause staff unwillingness for sharing information and ideas that ultimately leads to dominance silence culture in organizations. This study aimed at determining the relationship between management style and organizational silence in hospitals affiliated by Tehran University of Medical Sciences. This study was an analytical, descriptive cross-sectional study conducted in 2016. The study population included all employees of General Hospitals of Tehran University of Medical Sciences with 4251 employees that 354 among this population were selected as samples with stratified random sampling method. Organizational silence questionnaire by Vakola and Bouradas was used for data collection. The reliability of the questionnaire was α = 0.83 assessed by Cronbach’s alpha method. Data were analyzed using a t-test, ANOVA and Pearson correlation coefficient and also post-test experience if necessary. SPSS19 software was used for analyzing the data. The results showed that there was a positive and meaningful relationship between exploitative-authoritative and benevolent-authoritative styles and organizational silence (P<0.001). Furthermore, organizational silence in Baharloo and Shariati hospital compared to other hospitals were more common. Given that the type of management style on organizational silence is very important, managers should support free and open communication to reduce organizational silence.

Clinical reasoning plays an important role in the accurate diagnosis and treatment of diseases. Script Concordance test (SCT) is one of the tools that assess clinical reasoning skill. This study was conducted to determine the reliability and concurrent and predictive validity of SCT in assessing final lessons and gynecology exams of undergraduate midwifery students. At first, 20 clinical scenarios followed by 3 questions were designed by 2 experienced midwives. Then, after examining the content validity, 15 scenarios were selected. The test was used for 55 midwifery students. The correlation of SCT results with grade point average (GPA) was measured. To evaluate the concurrent validity of SCT, the correlation between SCT scores and the final exam of the gynecology course was measured. To measure predictive validity, the correlation of SCT scores with comprehensive exams of midwifery was calculated. Data were analyzed using SPSS software. Descriptive statistics, Pearson correlation, and coefficient Cronbach's alpha were used for analysis. The test’s item difficulty level (IDL) and item discriminative index (IDI) were determined using Whitney and Sabers’ method. The internal reliability of the test (calculated using Cronbach’s alpha coefficient) was 0.74. All questions were positively correlated with the total score. The highest correlation coefficient was related to GPA and comprehensive test with the score of 0.91. The correlation coefficient between SCT and the final test (concurrent validity) was 0.654, and the correlation coefficient between SCT and comprehensive test (predictive validity) was 0.721. The range of item discriminative index and item difficulty level in this exam was 0.39-0.59 and 0.32-0.66, respectively. SCT shows a relatively high internal validity and can predict the success rate of students in the comprehensive exams of midwifery. Also, it showed a high concurrent validity in the final test of gynecology course. This test could be a good alternative for formative and summative tests of clinical courses.

Organizational efficiency should be continuously measured to plan for improvement, informing about organizational performance, and guiding the university toward its goals. In this study, the authors measured the efficiency of schools affiliated to Tehran University of Medical Sciences as one of the most important universities in Iran, in 2011 and 2012.
In this research, the efficiency of schools was measured using Data Envelopment Analysis (DEA) technique in three dimensions of education, research, and development. Several indices in each dimension were assumed as input. Data were collected from university documents and analyzed by output oriented approach using Win Deap software.
Findings revealed that the efficiency scores of four schools including public health, pharmacy, nursing and midwifery, and advanced technologies were 100 in both years. In 2011, the efficiency scores for other schools were as follows: medicine 73.1, dentistry 57.6, rehabilitation 82.33, paramedical sciences 80.26, and management and medical information 60.26. These scores were respectively 73.76, 85.26, 71.63, 94.16, and 94.86 in 2012.
This research could successfully measure the efficiency of schools. Moreover, it can help decision makers to improve the performance of schools by determining the optimized output.

specifying the determinants of healthcare expenditure is one of the most important challenges in the health sector. The current study was aimed to assess factors affecting government health care expenditure in Iran.
to identify short-term and long-term determinants of healthcare expenditure in Iran during 1971-2007, Auto Regressive Distributive Lag (ARDL) bound testing approach to co integration was used. The explanatory variables were defined into economic, demographic and supply side categories. The data were collected from the official websites of the Iranian Statistics Centre, Central Bank of Iran, and the Ministry of Health.
we found health care expenditures as necessary goods in both short-term and long-term. In long-term, per capita income (β = 0.815, P-value = 0.033), elderly population (β = - 1.790, P-value Government health expenditure is necessary goods in both short and long run. Thus governmental health care expenditure does should grow proportional to increase in national income. This could result to decrease in out of pocket payment.