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سال نوزدهم شماره 2 (تابستان 1399)

Technological progress and changes have affected the field of medicine and health. Also, the electronic health record is used for convenience of treatment, prevention and diagnosis, but it has advantages and disadvantages that we have studied them in this research.

Qualitative research methods and Grounded theory  were used for the sociological study of electronic health record, and in order to achieve a comprehensive theory in this field by using the theoretical saturation method, twenty experts in the fields of medicine, policy, sociology and informatics that They were familiar with electronic health records, were selected from the community of experts as the statistical population and by using the three stages of open, axial and selective coding, important concepts and categories were extracted in each stage.

The most important result of the research is multidimensional effects of electronic health record. Electronic health record by reducing emotional interaction and prioritizing registered data reduces the intimacy in the patient- physician relationship, and recording data in the specific political and economic environment of the country bring a fear of social stigma and disclosure, especially when system security, investing, and training employees face some problems, and the constant changes of managers reduce their risk-taking and positive effects.

In order to have a proper system and comprehensive and pervasive use of electronic health record, cultural, managerial and technological changes are necessary. Cultural contextualization in the society and among individuals, risky and efficient management and the use of integrated information systems along with system security can increase efficiency. Moreover, this efficiency will lead to research, development and progress.

The increasing prevalence of Covid 19 virus in the world has various consequences for people involved in the treatment process of patients with this virus. Accordingly, the main purpose of this study was to identify and prioritize the psychological consequences of Covid 19 virus in nurses.

This study is based on the applied purpose and in terms of how to collect data in the field of descriptive survey studies. The analysis approach in this study is mixed and a combination of qualitative and quantitative methods. The statistical population of this study consists of nursing professors and medical specialists of Lorestan University of Medical Sciences. Using purposive sampling method and according to the principle of theoretical saturation, 14 professors and specialists were included as the research sample. The statistical population of the quantitative ward also included the managers of hospitals providing services to coronary patients in Lorestan province, which were selected as a research sample by 35 people using non-probability sampling method. Identification of psychological consequences was performed using analysis of interview data with Atlas.ti software and prioritization of consequences using a triangular fuzzy method.

Analysis of interview data led to the identification of 16 psychological consequences affecting nurses. Prioritization of these factors showed that depression, decreased concentration and apathy are the most important psychological consequences of Covid virus 19.

Developing supportive strategies to maintain the health of nurses should be a priority in future plans, and a separate part of the annual hospital costs should be allocated to this important matter.

Estimation of cost functions is an appropriate tool for optimal resource allocation in hospitals. The present study aimed at estimating cost function for hospitals affiliated to Shiraz University of Medical Sciences.                              

 In the current cross-sectional study, inputs, costs and resources data for 28 hospitals were gathered from hospital statistics and information system. Required data were collected monthly for two years (2015-2016). Then, The Cobb-Douglas cost function was estimated using panel data analysis. STATA 14 was used for data analysis.

Estimates showed that hospitalschr('39') cost elasticity concerning the inpatient and outpatient admission were 0.555 and 0.058 for large hospitals, and 0.769 and 0.099 for small hospitals (P<0.01). Among hospitals inputs, the cost of a physician with coefficient 0.175 in large hospitals and 0.481 in small hospitals (P<0.01) was most cost driver. In studied hospitals, average cost (36,406,480 Rial) was higher than marginal cost (26,548,020). Moreover, scale economies index were in small, large, and all hospitals were 0.868, 0.613 and 0.729, respectively. The number of active bed, length of stay and teaching activity had a positive effect on hospitals cost (P<0.01).

According to the findings, to control costs, the hospital should manage most cost drivers, such as physicians and pharmaceutical costs. Moreover, According to the average and final cost and scale economies index, hospitals should expand their service provisions with current inputs and resources in order to reach the optimum point of output.

 The operating room is one of the most sophisticated workplaces, consisting of a vast array of electrical, gas and radiation equipment that are more susceptible to accident than other hospital departments. Therefore it is important to observe safety tips in this section. The purpose of this study was to evaluate the standard of safety in operating rooms of hospitals affiliated to Mazandaran University of Medical Sciences in 2019.

 This study was a descriptive cross-sectional study. The statistical population consisted of all operating rooms of hospitals affiliated to Mazandaran University of Medical Sciences. The tool used was a checklist that was completed by researchers by observation and interviewing on-site. Safety standards have been evaluated in terms of the physical space of the operating room, fire safety, personnel safety, patient safety, infection control. Data were analyzed by SPSS version 21.

 The operating rooms of university-affiliated hospitals were 80.10% secure in overall safety. The patientchr('39')s safety area, with 83.34%, had the shortest distance from the standards and the infection control safety area, with 74.24%, had the highest distance from the standards. The highest and lowest scores were related to the safety standard related to the operating room of hospitals (2) and (1).

 According to the findings, the operating rooms of the studied hospitals are generally in desirable compliance with safety standards. However, it is essential to pay attention to problem areas to increase the safety factor for staff and patients in the operating room, so appropriate remedial measures should be taken to ensure complete safety of the operating room for all components.

A large number of hospitals and medical healthcare centers catch fire every year. Nowadays, one of the most significant challenges that hospital designers and health providers faced with is fire safety. This study conducted to determine a comprehensive model for fire safety in hospitals by reviewing related studies.

This study was conducted using a comprehensive review to find a research paper published on fire in hospitals. Electronic databases such as PubMed Scopus google were searched using the proper search strategy. 

 Overall, 14 studies were obtained. The findings were analyzed qualitatively through thematic synthesis and divided into some main themes: essential sections and divisions of hospitals in the field of fire, emergency exit patterns, materials and construction status, Flammable consumables materials in hospitals, and appropriate firefighting equipment.

 The dangers of medical equipment and flammable material, the types of firefighting equipment in the hospital building, architectural safety issues regarding the degree of fire resistance of structures, roofs, doors, walls, and emergency exit stairs are crucial points To protect staff and patients in hospitals that should consider simultaneously.

 Hemodialysis is one of the effective therapies in patients with chronic renal failure. Along with increasing life expectancy as a benefit of this treatment; this type of service can threaten the quality of life of recipients. Therefore, the present study was conducted to investigate the effectiveness of emotional schema-based therapy on improving the quality of life of dialysis patients.

 The current semi-experimental, applied study was designed and implemented as pretest-posttest research with a control group. All outpatients treated with dialysis instrument in medical centres affiliated to Tehran University of Medical Sciences in 2009-2010 were the statistical population of the study and the quality of life questionnaire related to kidney patients used for data collection. After the research team performed the treatment protocol in 8 sessions of 90 minutes in the intervention group, the research data were analyzed using SPSS24.

 The results of the study showed that the treatment protocol based on emotional schema therapy influence all aspects of quality of life and increase the mean score compared to the pretest. Also, there is a significant difference between the groups, both in the general dimension and specific dimension of dialysis patientchr('39')s quality of life.

 As the study findings show, it can be stated that emotional schema therapy is effective in improving the quality of life of dialysis patients and can be used as a useful intervention to improve the quality of life of patients.

The fourth industrial revolution consists of combining network devices with cloud computing methods and analyzing large data and artificial intelligence, which makes it possible to call such an infrastructure smart. In a Smart Hospital, all things and devices are designed to be connected and integrated, thus achieving better patient care, increasing efficiency and reducing time waste. Therefore, the aim of this paper was to recognize the components of smart hospital based on disruptive technologies of industry 4.0.

This applied research has been done in two phases using qualitative approach in winter 2019. In the first step, the components of smart hospital were recognized from previous studies. In the second step, research experts evaluate conceptual model by Delphi method. The expert panel consists of 15 individuals active in information technology in healthcare according to targeted sampling.

According to research results the main components of smart hospital are eight technologies: Internet of things technology, robotic, blockchain technology, cloud computing, big data, augmented and virtual reality technology, additive manufacturing and artificial intelligence.

According to components of smart hospital, Hospitals managers should equip their organization and adopt process and equipment by disruptive technologies. Due to sanctions, investment in Iranian knowledge-based companies active in new technologies field and Joint venture with them can be a suitable solution for healthcare policymakers.

One of the fundamental changes in the health system of Iran in recent years is the "health system reform plan", that the effects of which should be examined from various dimensions. The purpose of this study is to determining the effect of health system reform plan on health indicators in population covered by Ahvaz University of Medical Sciences.

In this descriptive-analytical study, the data of the selected health indicators of Ahvaz University of Medical Sciences in the period before and after the health care system reform plan (from 2012 to 2018) was collected, described and analyzed with SPSS.

The highest rate of change in mortality indices was between 2013 and 2015, orderly in U5MR, IMR & NMR, With the mean difference 13.282, 10.825 & 7.955 (P=0.001, P=0.002 & P=0.004). The highest rate of change in Care Coverage for Children Under-five, is between 2014 and 2015 with mean difference of 11.335 and about the Antenatal Care Coverage, between 2014 and 2017, with mean difference 10.050 (orderly p=0.002 & p>0.001). MMR was not significant.

The time trend analysis on health indicators confirms that the changes in the early years of the reform plan have been a lot, then it has slow down. Most of the change in health indicators is related to years of 2015 and 2016. The findings indicate that the latest health reform plan in Iran has improved the mortality indices (Reduce in NMR, IMR & U5MR), Care Coverage for Children Under-five and Antenatal Care Coverage (6+). Health reform plan has not affected on MMR.