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Background. The value of services in healthcare institutions such as hospitals is created by leveraging the knowledge, skills, and experiences of their healthcare staff. Therefore, knowledge transfer is necessary to empower the employees in the hospital. Since few studies have explored the impact of knowledge transfer on the empowerment of hospital employees, this study aimed to investigate the impact of knowledge transfer and its components on employees' empowerment in Qazvin teaching hospitals. Methods. In this descriptive-analytic and cross-sectional study, 330 teaching hospital staff members of Qazvin University of Medical Sciences were investigated between February 2020 and May 2020. The required data were collected using the Knowledge Transfer Questionnaire (De-Castro, et al., 2008) and the Empowerment Questionnaire (Spreitzer, 1992). The data were analyzed using the correlation method and structural equation analysis (SEM) as well as using SPSS-22 and AMOS software. Results. There was a direct relationship between the dimensions of knowledge transfer and personnel empowerment, and all examined dimensions were above average. Moreover, the dimensions of knowledge transfer also had a significant impact on personnel empowerment. Regarding the fit of the model, the values of GFI, CFI, and NFI indices were obtained above 0.90. In addition, the RMSEA index was 0.074, which indicated the good fit of the model. Conclusion. In summary, the staff's empowerment level was enhanced through the knowledge transfer. Therefore, it was recommended that the hospital managers should improve the level of workers' empowerment by implementing effective strategies, such as providing training courses for the employees.

Abstract Background Circadian rhythms, as an integral part of daily life, govern the scheduling, management, and coordination of living organisms. Given the irregular nature of shift patterns in nurses’ work schedules, investigating their implications is paramount to increasing Quality of Work Life (QWL) and productivity. The study aimed to investigate the impact of circadian rhythm on the efficiency of nurses working in hospitals in Qazvin, Iran, with QWL serving as a mediating variable. Methods This study employed a descriptive-analytical research design, utilizing cross-sectional data collected in 2022–2023 based on the implementation of Structural Equation Modeling (SEM). The number of participants was 378 nurses. The data were obtained by administering a questionnaire and various tools, organized into four sections: demographic information, the Circadian Questionnaire, the Quality of Work Life Questionnaire, and the Nurses’ Efficiency Questionnaire. The collected data were subsequently analyzed using SEM techniques within the R software. Results The findings demonstrated statistically significant variations in mean scores about gender and efficiency (p = 0.008), marital status and efficiency (p = 0.000), and employment type and efficiency (p = 0.002) among the study participants. There was a significant association between shift patterns and QWL (p = 0.004). Expressly, the confirmed results indicated a direct impact of circadian on QWL (with a path coefficient of 0.013), as well as an indirect impact on efficiency mediated by the variable QWL (with a path coefficient of 0.037) (p

Abstract Background The equitable distribution of healthcare resources represents a paramount objective in the realm of global health systems. Thus, the present study sought to assess the fairness in the allocation of health resources at Qazvin University of Medical Sciences (QUMS), both prior to and subsequent to the implementation of the Health Transformation Plan (HTP) using the Gini coefficient and the Hirschman–Herfindahl index (HHI). Methods This descriptive-analytical study aimed to investigate the distribution of healthcare resources among general practitioners (GPs), specialists, and subspecialists employed at QUMS between 2011 and 2017. Demographic data pertaining to the cities were obtained from the statistical yearbooks of the Statistical Center of Iran, while information regarding the healthcare workforce was extracted from QUMS records. The analysis utilized two key measures, namely the Gini coefficient and the HHI, to assess the fairness of resource distribution. Data analysis was performed using Microsoft Excel 2016 and the Stata statistical software. Results The highest number of GPs, specialists, and subspecialists was observed in 2014, 2017, and 2017, respectively, while the lowest number was recorded in 2016, 2011, and 2015, respectively. From 2011 to 2017, the Gini coefficient for GPs ranged between 0.61 and 0.63. Among specialists, the lowest Gini coefficient value was observed in 2015 (0.57), while the highest was recorded in 2017 (0.60). The Gini coefficient for subspecialists remained constant at 0.52 from 2011 to 2017. The HHI revealed a high concentration of GPs in the cities of Qazvin province. Although the disparity gradually decreased in the specialties of eye, ear, nose, and throat, and pediatrics, the concentration still persists in Qazvin. In general surgery, the index value is low, indicating some level of inequality. In anesthesia and neurology, the index value decreased after the HTP and reached 5700; however, achieving equality (below 1000) still requires further efforts. No significant change in the index was observed after the HTP in specialties such as neurosurgery, rehabilitation, and nuclear medicine. Subspecialists also exhibited a concentration in the city of Qazvin. Conclusion Based on the analysis of the Gini and HHI, it is evident that the distribution of GPs has not undergone significant changes following the implementation of the HTP. The Gini coefficient, which ranges from 0.4 to 0.6, indicates a high to complete level of inequality in the distribution of specialists and subspecialists. Moreover, the HHI exceeds 1000, reflecting a concentration of resources in specific areas. As a result, the HTP has not yet achieved its goal of ensuring a fair distribution of human resources. To address this issue, it is recommended to redesign distribution policies, including the allocation of physical health resources, such as specialized hospitals, beds, and medical equipment. Additionally, increasing student admissions in specialized and subspecialized fields and implementing tariff incentives can contribute to a more equitable distribution of resources. By aligning distribution policies with the principle of fairness, the healthcare system can better address the issue of resource distribution.

Background: Scene management in accidents reduces losses, speeds treatment, and facilitates immediate victim transfer. Learning the related skills through theory-based educational intervention makes this task possible. This study aimed to determine the effect of theory-based educational intervention on emergency medical personnel skills to manage the scene in chemical accidents. Materials and Methods: The present study employed a quasi-experimental design with pre- and post-intervention measurements. Using the random sampling method, 70 emergency medical technicians working in Qazvin Province, Iran, were selected and assigned to experimental and control groups. The data collection tools included demographic questions and scales to assess the theory of planned behavior. The intervention program consisted of 4 sessions. Data were analyzed by SPSS software, version 23 using descriptive statistics and analysis of covariance. Results: The Mean±SD age of the participants was 35.03±5.57 years, and 82.6% (57 people) were married. After the intervention, the Mean±SD scores of attitudes (40.11±4.77), subjective norms (15.06±4.27), perceived behavior control (18.53±2.55), and behavioral intention (8.49±2.27) increased significantly in the experimental group (P

Abstract Background A framework for increasing elderly participation in Primary Health Care (PHC) is a vital issue considering the growing population. After examining the situation and elderly participation in the provision of PHC in the health complexes of Tabriz City, the present study presents the framework of elderly participation in PHC. Methods This is a mixed-method study. First, we reviewed the models of elderly participation in PHC worldwide using a comprehensive search of literature. Then, we extracted the service providers’ and the elderly's views regarding the obstacles and solutions for the elderly participation in PHC in Iran using the interviews and focus group discussions (FGD). We conducted three FGDs (8–10 people) and seven individual interviews. Data were analyzed using the content analysis method. We developed the proposed framework for the participation of the elderly in PHC using a panel of experts and checked and confirmed the framework's validity using the Delphi technique with 11 experts from the content validity index and modified kappa coefficient. Results Based on the result of included studies in the systematic review, the characteristics of the participation models were classified into five areas: the characteristics of the service user, the main facilitator of the intervention, the type of ownership of the center, the subject and the method of participation. The solutions and obstacles, and problems presented by the service providers and users in different areas include 12 themes (elderly participation, home care, and self-care, respect for the elderly, cooperation of different organizations, service package for the elderly, referral system, planning for the elderly, considering insurance for the elderly, the role of informing the elderly, mental health of the elderly, physical space of centers and training of elderly caregivers) and 46 sub-themes. The final framework also includes five themes (approaches and strategies to attract participation, indicators, and consequences of participation of the elderly, implementation strategies of elderly care, implementation infrastructure and goals and areas of participation of the elderly) and sub-themes. Conclusion The results of the study indicate that the final framework obtained should be used based on a systematic model for elderly participation in PHC and should be implemented and followed up based on local strategies and specific indicators, considering all capacities.

Background: The pandemic of COVID-19 affect all healthcare systems globally, and its effect on different hospital performance indicators has been debated. The study aimed to compare the impacts of COVID-19 on hospital performance indicators using pre-and post-pandemic data from training hospitals.Methods: We conducted an observational cohort study of hospital performance indicators from two healthcare facilities affiliated with Qazvin University of Medical Sciences in the north-west of Iran. The R statistical software was used to analyze monthly data on three basic performance indicators, including bed turnover, average length of stay (LOS), and bed occupancy rate before and during the outbreak of Coronavirus disease-19 (COVID-19).Results: The pandemic had a remarkable effect on the level of bed turnover, the average length of stay (LOS), and the bed occupancy rate after one month from the COVID-19 outbreak (P

Abstract Background Adverse events have become a global problem and are an important indicator of patient safety. Patient safety culture is essential in efforts to reduce adverse events in the hospital. This study aimed to investigate the status of the patient safety culture, the frequency of adverse events, and the relationship between them in Qazvin's hospitals in Iran. Methods The present study is a descriptive-analytical study conducted in six hospitals in Qazvin, Iran, in 2020. The study population was nurses working in Qazvin hospitals. We collected data via a patient safety culture questionnaire and an adverse event checklist. Three hundred sixty nurses completed questionnaires. Multiple logistic regression was used to investigate the relationship between variables. Results The highest mean of patient safety culture was related to the organizational learning dimension (3.5, SD = .074) and feedback and communication about errors (3.4, SD = 0.82). The participants gave the lowest score to dimensions of exchanges and transfer of information (2.45,=0.86) and management support for patient safety (2.62,Sd = 0.65). Management's support for patient safety, general understanding of patient safety culture, teamwork within organizational units, communication and feedback on errors, staff issues, and information exchange and transfer were significant predictors of adverse events. Conclusion This study confirms patient safety culture as a predictor of adverse events. Healthcare managers should provide the basis for improving the patient safety culture and reducing adverse events through methods such as encouraging the reporting of adverse events and also holding training courses for nurses.

Abstract Background The hospital environment is very dynamic and faces many internal and external changes. Healthcare knowledge and technology are developing at a swift pace. This study investigated the relationship between succession and intellectual capital with entrepreneurship at the Qazvin University of Medical Sciences hospital, Iran. Methods The number of employees working in six hospitals was 2256, and according to Morgan’s table, the required number of samples was 331. We distributed three hundred sixty-five questionnaires considering 10% of sample loss. We used a multi-stage stratified sampling method. In the first stage, each hospital was considered a stratum. After that, occupational groups were considered the next stratum within each hospital, and based on the ratio, the required number of samples for each occupational group was randomly selected. We used the Sobel test to investigate the mediating role of intellectual capital and the structural equation model to fit the research model. Results Succession aspects, including culturalization, meritocracy, job promotion path, and the role of senior managers, have a positive and significant effect on intellectual capital. Succession is only effective on intellectual capital and does not affect the personnel’s entrepreneurship directly or through intellectual capital. Conclusion Conducting training classes and intervention programs and using localized succession models can create a suitable platform for increasing organizational creativity and entrepreneurship, motivating the hospitals’ personnel, and increasing intellectual capital.

Abstract Background Most surgical specimen errors occur in the pre-analysis stage, which can be prevented. This study aims to identify errors related to surgical pathology specimens in one of the most comprehensive healthcare centers in Northeast Iran. Methods The present study is descriptive and analytical research conducted cross-sectionally in 2021 at Ghaem healthcare center in the Mashhad University of Medical Sciences on the basis of a census sampling. We used a standard checklist to collect information. Professors and pathologists evaluated the validity and reliability of the checklist using Cronbach’s alpha calculation method of 0.89. We analyzed the results using statistical indices, SPSS 21 software, and the chi-square test. Results Out of 5617 pathology specimens studied, we detected 646 errors. The highest number of errors is the mismatch of the specimen with the label (219 cases; 3.9%) and the non-compliance of the patient’s profile in the specimen sent with the label (129 cases; 2.3%), and the lowest errors are the inappropriate volume of the fixator(24 cases; 0.4%), and they accounted for insufficient sample size (25 cases; 0.4%). Based on Fisher’s exact test results, there was a significant difference between the proportion of errors in different departments and months. Conclusion Considering the frequency of labeling errors in the stage before the analysis in the pathology department, the use of barcode imprinted in specimen containers, the removal of the paper request for pathology, the use of radio frequency chip technology, the use of the rechecking system and improving communication in different departments can be effective in reducing these errors.

Introduction: Ignoring outliers in data may lead to misleading results. Length of stay (LOS) is often considered a count variable with a high frequency of outliers. This study exemplifies the potential of robust methodologies in enhancing the accuracy and reliability of analyses conducted on skewed and outlier-prone count data of LOS. Methods: The application of Zero-Inflated Poisson (ZIP) and robust Zero-Inflated Poisson (RZIP) models in solving challenges posed by outlier LOS data were evaluated. The ZIP model incorporates two components, tackling excess zeros with a zero-inflation component and modeling positive counts with a Poisson component. The RZIP model introduces the Robust Expectation-Solution (RES) algorithm to enhance parameter estimation and address the impact of outliers on the model's performance. Results: Data from 254 intensive care unit patients were analyzed (62.2% male). Patients aged 65 or older accounted for 58.3% of the sample. Notably, 38.6% of patients exhibited zero LOS. The overall mean LOS was 5.89 (± 9.81) days, and 9.45% of cases displayed outliers. Our analysis using the RZIP model revealed significant predictors of LOS, including age, underlying comorbidities (p

Abstract Background Healthcare workers perform various clinical procedures for COVID-19 patients facing an elevated risk of exposure to SARS-COV-2.This study aimed to assess the healthcare workers’ exposure to COVID-19 in Qazvin, Iran in 2020. Methods We conducted this descriptive-analytical study among all healthcare workers on the frontline of exposure to COVID-19 in Qazvin province. We entered the participants into the study using a multi-stage stratified random sampling method. We utilized a questionnaire, "Health workers exposure risk assessment and management in the context of COVID-19 disease", designed by the World Health Organization (WHO) to collect data. We analyzed data using descriptive and analytical methods with SPSS software version 24. Results The results showed that all participants in the study had occupational exposure to the COVID-19 virus. So of 243 healthcare workers, 186 (76.5%) were at low risk and 57 (23.5%) at high risk of COVID-19 virus infection. Also, from the six domains mentioned in the questionnaire, health workers exposure risk assessment and management in the context of COVID-19 disease, the mean score of the domain of the type of healthcare worker interaction with a confirmed COVID-19 patient, the domain of health worker activities performed on a confirmed COVID-19 patient, the domain of the adherence to infection prevention and control (IPC) during health care interactions, and the domain of the adherence to IPC when performing aerosol-generating procedures in the high-risk group were more than the low-risk group. Conclusion Despite strict WHO guidelines, many healthcare workers are exposed at contracting COVID-19. Therefore, healthcare managers, planners, and policymakers can revise the policies, provide appropriate and timely personal protective equipment, and plan for ongoing training for staff on the principles of infection prevention and control.

Background: Surgical anxiety and pain are common complaints of hospitalized children, which can have devastating effects on the child's recovery process.Aim: The present study was performed aimed to investigate the effect of one session of eye movement desensitization and reprocessing (EMDR) on anxiety and pain of hospitalized children after appendectomy.Method: This clinical trial study was performed on 46 children hospitalized in the hospital affiliated to Isfahan University of Medical Sciences from December 2019 to February 2020. The subjects aged 12 to 16 years who underwent appendectomy and were randomly placed in two groups. The trait anxiety and demographic characteristics were assessed before the surgery. Six hours after the surgery, the intervention group received one session of EMDR along with the routine treatment, and the control group only received the routine treatment. State anxiety and pain were assessed in the two groups before, immediately and one hour after the intervention. P

Abstract Background Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) is still among the leading causes of disease burden and mortality in sub-Saharan Africa (SSA), and the world is not on track to meet targets set for ending the epidemic by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the United Nations Sustainable Development Goals (SDGs). Precise HIV burden information is critical for effective geographic and epidemiological targeting of prevention and treatment interventions. Age- and sex-specific HIV prevalence estimates are widely available at the national level, and region-wide local estimates were recently published for adults overall. We add further dimensionality to previous analyses by estimating HIV prevalence at local scales, stratified into sex-specific 5-year age groups for adults ages 15–59 years across SSA. Methods We analyzed data from 91 seroprevalence surveys and sentinel surveillance among antenatal care clinic (ANC) attendees using model-based geostatistical methods to produce estimates of HIV prevalence across 43 countries in SSA, from years 2000 to 2018, at a 5 × 5-km resolution and presented among second administrative level (typically districts or counties) units. Results We found substantial variation in HIV prevalence across localities, ages, and sexes that have been masked in earlier analyses. Within-country variation in prevalence in 2018 was a median 3.5 times greater across ages and sexes, compared to for all adults combined. We note large within-district prevalence differences between age groups: for men, 50% of districts displayed at least a 14-fold difference between age groups with the highest and lowest prevalence, and at least a 9-fold difference for women. Prevalence trends also varied over time; between 2000 and 2018, 70% of all districts saw a reduction in prevalence greater than five percentage points in at least one sex and age group. Meanwhile, over 30% of all districts saw at least a five percentage point prevalence increase in one or more sex and age group. Conclusions As the HIV epidemic persists and evolves in SSA, geographic and demographic shifts in prevention and treatment efforts are necessary. These estimates offer epidemiologically informative detail to better guide more targeted interventions, vital for combating HIV in SSA.

Background: The demand for home care services has increased not only due to the increase in the elderly population but also due to consumer preference and technological advances that allow for the provision of sophisticated home care. Home healthcare services aim to help people improve their performance, live a more independent life, improve their well-being, and help them stay at home, and avoid hospitalization. Objective: This study was conducted to compare the quality of life (QoL) of COVID-19 patients under home care at a hospital in Qazvin City, Iran. Methods: his study was a cohort study. The samples included two groups of patients, hospitalized patients due to COVID-19 and patients with COVID-19 who received medical and nursing care at home. Patients were matched for age, underlying disease, and severity of the COVID-19 disease. In this study, a 3-month follow-up on changes in QoL compared to before hospitalization and receiving care at home was performed using a QoL questionnaire (SF-12). Findings: The mean score of QoL in the home care group was 32.36±2.15 and in the hospitalized group, it was 29.70±2.94, which shows a statistically significant difference, and the quality of home care patients reported to be higher than hospitalized patients (P

Abstract Background Achieving equity in the distribution of health services is one major goal in the health system. This study aimed to determine equality in distributing health human resources (physicians) in the Qazvin University of Medical Sciences before and after the Health Transformation Plan (HTP) based on the Hirschman-Herfindahl index (HHI). Methods In this descriptive-analytical study, the statistical population was general practitioners (GPs), specialists and subspecialists in the Qazvin University of Medical Sciences from 2011-to 2017. We extracted demographic statistics of the cities from the Statistical Center of Iran. Physicians’ statistics were obtained from the Curative Affairs Deputy at the Qazvin University of Medical Sciences. We assessed inequality using the HHI. Results The highest number of GPs was in 2014, and specialists and subspecialists were in 2017. The lowest number of GPs, specialists, and subspecialists were in 2016, 2011 and 2015. The HHI for GPs in 2011–2017 was between 4300 and 5200. The lowest concentration for specialists before the HTP plan was the cardiologist with 3300, and after the HTP, the internal specialist with 3900. Also, the numerical value of this index for all subspecialty physicians after the HTP was 10,000, the highest level of concentration. Conclusion The values obtained from the HHI index indicate the high concentration and disproportionate and inequitable distribution of human resources in the health sector in this province. The number of specialists in some cities is still much less than acceptable, and some cities even have shortcomings in the critical specialists.

Introduction: Health workers, especially nurses, are facing a high risk of contracting the COVID-19 and consequent mental disorders such as stress, anxiety and depression. We aimed to study the relationship between anxiety, stress and the protective behavior of nurses during the Covid-19 pandemic. Material and Methods: This cross-sectional study was conducted on nurses working in COVID -19 referral hospitals in Qazvin, Iran, in 2020. Out of 645 nurses working in two hospitals, 260 of them were selected randomly. Three questionnaires including demographic and contextual information, COVID-19 anxiety, stress and precautionary behaviors against COVID-19 were used. Descriptive statistical methods, Pearson correlation, t-test and one-way analysis of variance and binary logistic regression analysis were applied at 95% confidence interval. Results: The prevalence of anxiety symptoms in nurses was 32.08%, the mean score of protective behavior was 18.45+5.66 and the maximum score was 22.06+4.7. The negative relationship between anxiety and nurses precautionary behavior) β=-0.36, P

Introduction: Recognizing the personality traits of employees and examining the role of these traits in motivating people’s safety can greatly lead to the formation of safe behavior of employees. Considering the significant importance of reducing adverse events and developing safe behaviors, the present study aimed to investigate the role of nurses’ personality traits in their safety behaviors with the mediating role of safety motivation during 2019-2020. Material and Methods: This is a descriptive-analytical study conducted among nurses working in educational hospitals affiliated by Qazvin University of Medical Sciences, from which 435 individuals were selected by multi-stage proportional sampling method. Data were collected using McCray and Costa Five-Factor Personality Questionnaire, Saleh Motivation Questionnaire (2010) and Safe Behavior Questionnaire (2016) and analyzed by SPSS software version 26 and AMOS software version 23. Results: The path coefficients between nurses’ personality traits and their safety motivation (0.557) and safety motivation with safe behavior of individuals (0.267) were statistically significant (p

Background and Objectives: The present study was conducted to investigate the status of performance indicators in hospitals affiliated to Qazvin University of Medical Sciences before and after the implementation of the transformation plan. Methods: This descriptive-analytical study was performed longitudinally based on hospital data. The data collection tool was a checklist including general characteristics of hospitals and performance indicators. Data analysis was performed using Interrupted time series analysis (ITS) and Statistical software for data science (STATA) v.15. Chow test was used to determine the structural fractures in the studied time series. Results: Hospitals’ performance indicators were examined. In the first month after the intervention, bed rotation increased significantly by 1.148 (P0.005). The length of stay after the intervention increased by 0.170 per month. In the first month after the intervention, the decrease in bed occupancy percentage was 41% (P=0.005) which is significant. The trend of bed occupancy percentage after the intervention was more than 2% per month (P

Objectives: One of the major duties of nurses is proper medication administration while maintaining patient safety, which requires sufficient knowledge and practice. Any gaps in knowledge used by nurses can lead to irreversible injury or death of the patient. This study is aimed to determine and compare the pharmacology knowledge and performance of nurses and nursing students in using the information resources in pediatrics wards. Method: This descriptive observational study was performed on 300 nurses and nursing students. Sources of knowledge and performance of nurses and nursing students were analyzed with researcher-made tools to determine their pharmaceutical knowledge, sources of knowledge, and attitudes by independent t-test, chi-square, one-way analysis of variance, Pearson, and Spearman tests. Result: Three hundred questionnaires were examined. The clinical experience of nurses and students was their most important source of information in drug challenges for 33.7% of the participants. About 24.6% of nurses obtained the required information from specialized books on pediatric medicine. About 17.1% of the participants attained their knowledge from multiple sources (e.g. various available sources such as the Internet, pharmacy books, software, and their experiences and colleagues), while electronic sources and the Internet were the sources of knowledge for 15.5% and 7.7% of the nurses, respectively. Concerning nursing students, 6.3% used books, 41.7% considered colleagues (clinical experiences), 20.8% employed electronic resources, 22.8% used the Internet, and 9.1% relied on multiple sources. There were significant differences in the knowledge and performance of the nurses based on their source of pharmacological knowledge (P

Summary: Background: More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels. Methods: We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km × 5 km resolution in 98 LMICs based on 2·1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution. Findings: Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205 000 (95% uncertainty interval 147 000–257 000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution. Interpretation: Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Funding: Bill & Melinda Gates Foundation.

BackgroundProstate cancer (PCa) is the second most prevalent cancer among men worldwide. This study presents estimates of PCa prevalence, incidence, death, years-of-life-lost (YLLs), years-lived-with-disability (YLDs), disability-adjusted-life-years (DALYs), and the burden attributable to smoking during 1990-2019 in North Africa and Middle East using data of Global Burden of Diseases (GBD) Study 2019.MethodsThis study is a part of GBD 2019. Using vital registration and cancer registry data, the estimates on PCa burden were modeled. Risk factor analysis was performed through the six-step conceptual framework of Comparative Risk Assessment.ResultsThe age-standardized rates (95% UI) of PCa incidence, prevalence, and death in 2019 were 23.7 (18.5-27.9), 161.1 (126.6-187.6), and 11.7 (9.4-13.9) per 100,000 population. While PCa incidence and prevalence increased by 77% and 144% during 1990-2019, respectively, the death rate stagnated. Of the 397% increase in PCa new cases, 234% was due to a rise in the age-specific incidence rate, 79% due to population growth, and 84% due to population aging. The YLLs, YLDs, and DALYs of PCa increased by 2% (-11.8-23.1), 108% (75.5-155.1), and 6% (-8.9-28.1). The death rate and DALYs rate attributable to smoking have decreased 12% and 10%, respectively. The DALYs rate attributable to smoking was 37.4 (15.9-67.8) in Lebanon and 5.9 (2.5-10.6) in Saudi Arabia, which were the highest and lowest in the region, respectively.ConclusionsThe PCa incidence and prevalence rates increased during 1990-2019; however, the death rate stagnated. The increase in the incidence was mostly due to the rise in the age-specific incidence rate, rather than population growth or aging. The burden of PCa attributable to smoking has decreased in the past 30 years.

Abstract Background Patient safety culture is an important factor in determining hospitals’ ability to address and reduce the occurrence of adverse events (AEs). However, few studies have reported on the impact of nurses’ perceptions of patient safety culture on the occurrence of AEs. Our study aimed to assess the association between nurses’ perception of patient safety culture and their perceived proportion of adverse events. Methods A cross-sectional survey was carried out among 2295 nurses employed in thirty-two teaching hospitals in Iran. Nurses completed the Persian version of the hospital survey of patients’ safety culture between October 2018 and September 2019. Results Positive Response Rates of overall patient safety culture was 34.1% and dimensions of patient safety culture varied from 20.9 to 43.8%. Also, nurses estimated that the occurrence of six adverse events varied from 51.2–63.0% in the past year. The higher nurses’ perceptions of “Staffing”, “Hospital handoffs and transitions”, “Frequency of event reporting”, “Non-punitive response to error”, “Supervisor expectation and actions promoting safety”, “Communication openness”, “Organizational learning continuous improvement”, “Teamwork within units”, and “Hospital management support patient safety” were significantly related to lower the perceived occurrence at least two out of six AEs (OR = 0.69 to 1.46). Conclusions Our findings demonstrated that nurses’ perception regarding patient safety culture was low and the perceived occurrence of adverse events was high. The research has also shown that the higher level of nurses’ perception of patient safety culture was associated with lowered occurrence of AEs. Hence, managers could provide prerequisites to improve patient safety culture and reduce adverse events through different strategies, such as encouraging adverse events’ reporting and holding training courses for nurses. However, further research is needed to assess how interventions addressing patient safety culture might reduce the occurrence of adverse events.

Background and Aim: Nowadays, patient safety culture is recognized as an important issue in providing high quality services for the patients around the world. Unsafe care and services can lead to mortality, disability, prolonged hospitalization and increased costs of treatment. Therefore, the present study aimed to identify the errors associated with the labels of pathology samples in Qazvin hospitals. Materials and Methods: This descriptive-analytic study was performed on the basis of a census sampling and included samples obtained from the operating rooms of five educational hospitals in Qazvin University of Medical Sciences in 2018. A standard checklist was used to collect information. Our professors and pathologists determined validity and reliability of the checklist by Cronbach's alpha of 0.89. Using SPSS 21 the results were analyzed by statistical indices. Results: Among 1164 biopsy samples, 6425 errors were detected. The highest error rates were related to lack of registration of the patient's age (564 cases; 48.4%), lack of registration of the name of the of the patients' fathers (562 cases; 48.2%), and lack of recording the number of biopsies (558; 47.9%) and the lowest rates of errors included empty container (10 cases; 0.86%), lack of recording the number of specimens (14 cases; 1.2%) and lack of using appropriate fixative (16; 1.37 %) respectively. Conclusion: Regarding the frequency of labeling errors in the pre-analytical phase in the pathology ward, use of bar code imprinted in the sample containers, lack of using paper applications, use of radio frequency chip technology, use of a re-checking system and improvement of communication in the operating rooms can result in reducing these errors.

Background: A significant amount of revenues and deductions exist in the hospitals each year. This study aimed to determine the number of deductions applied and identify its causes. Furthermore, we aimed to provide management strategies to reduce these deductions in Shafa Takestan hospital. Methods: This applied and interventional study was conducted with a cross-sectional design. The data collection tool was a checklist from the previous studies. Data were analyzed using descriptive statistics such as mean, percentage, and standard deviation as well as analytical statistics of the Wilcoxon test. Results: Before the intervention, among 405 non-global inpatient cases, about 323 (80 %) contained subtractions. After the intervention, among 555 non-global hospital admissions, about 264 (47 %) included deductions. Most deductions were related to health services insurance (75.38 %). Concerning each hospital ward, most deductions were related to surgery ward (38 %). Before and after the intervention, service deductions were included in 5.59 % and 4.57 %, respectively. Conclusion: Therefore, medical personnel should pay more attention to documenting patientschr('39') records and minimizing documentation errors. Moreover, to reduce patient record deductions, the health care staff should be familiarized with proper documentation procedures by conducting training sessions.

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where onchocerciasis has been previously detected. This threshold value was then used to classify IUs (more suitable or less suitable) based on the location within the IU with the largest mean prediction. Mean estimates of environmental suitability suggest large areas across West and Central Africa, as well as focal areas of East Africa, are suitable for onchocerciasis transmission, consistent with the presence of current control and elimination of transmission efforts. The ROC analysis identified a mean environmental suitability index of 0·71 as a threshold to classify based on the location with the largest mean prediction within the IU. Of the IUs considered for mapping surveys, 50·2% exceed this threshold for suitability in at least one 5 × 5-km location. The formidable scale of data collection required to map onchocerciasis endemicity across the African continent presents an opportunity to use spatial data to identify areas likely to be suitable for onchocerciasis transmission. National onchocerciasis elimination programmes may wish to consider prioritising these IUs for mapping surveys as human resources, laboratory capacity, and programmatic schedules may constrain survey implementation, and possibly delaying MDA initiation in areas that would ultimately qualify.

BACKGROUND: In medical organizations, utilizing evidence-based practice (EBP) helps nurses and patients make the best decision in health care in certain clinical settings. Hence, recognizing its educational barriers is so important. METHODS: The present study was a descriptive-analytical research that was conducted using a cross-sectional design in 6 teaching hospitals of Qazvin City, Iran, in 2014. The study sample consisted of 260 nurses. Based on the number of the nurses working in each hospital, the study sample was chosen by a stratified random method. Two questionnaires were employed to collect the required data. The first questionnaire was Evidence-Based Practice Questionnaire (EBPQ) that evaluates nurses’ understanding of EBP. The second questionnaire was related to measuring the barriers to utilization of research by the nurses that was developed by Funk et al. For analyzing the collected data, frequency distribution tables, analysis of variance (ANOVA), and linear regression coefficient were used. RESULTS: The total mean of EBP among the nurses was at a level above average. The subscales of knowledge/skill (3.74) and attitude (3.87) had a lower average compared to the subscale of practice (4.14). The total mean of the barriers was 3.07. According to the results of the present study, organization and adopter had the highest and lowest means, respectively. CONCLUSION: Identifying the barriers that affect effective EBP implementation can help nurses achieve their goals by removing these obstacles, building the necessary infrastructure, and providing human, physical, and financial resources.

BACKGROUND: As the second leading cause of death, cancer is among the most stressful life events. It affects not only the afflicted patients, but also their families. Hospitalization of children with cancer faces their parents with many challenges and problems. This study was made to explore the hospitalization-related experiences among the parents of children with cancer. METHODS: This qualitative phenomenological study was made in 2015–2016 in the hematology and oncology care unit of a teaching hospital located in Qazvin, Iran. Sampling was done purposefully and was ended once data saturation was achieved. Consequently, fifteen parents of children with cancer were recruited. Semi-structured interviews were held for data collection. The data were analyzed through the seven-step hermeneutic data analysis process proposed by Diekelmann and Ironside (1998). RESULTS: Two main categories were extracted from the data which included “the shadow of government administration” and “the role of support systems”. The former refers mainly to accommodations in hospital settings and the process of clinical care delivery, while the latter points to the parents’ psychological experiences of presence in hospital settings. These themes came under the overarching main theme of “lump in throat: the suffering of the parents of children with cancer”. CONCLUSION: Study findings reveal that parents’ experiences of hospitalization greatly depend on their perceptions of the environmental conditions of hospital settings. Moreover, the findings showed that negative hospitalization-related experiences could lead to many adverse consequences for patients, families, and healthcare providers.

Introduction: Future research is an interdisciplinary study that can influence all sciences. Students are Future human resources for health systems; whose futures research ability can be improved through education over the years. The purpose of this study is to determine the relationship between future research ability and quality of learning experiences of medical students of Mashhad in 2018. Methods: In this descriptive correlational study, the research population was all students of Mashhad University of Medical Sciences, 370 of whom were selected through two-stage stratified random sampling. Data collection tools included validity and reliability questionnaires of Parsa et al.'s future research ability and Neumann's quality of learning experiences. Data were analyzed using one-way ANOVA, multiple regression and Spearman correlation tests. Results: Students' future research ability was slightly higher than average (138.5±24.5) and Mean quality of learning experiences was moderate (34.2±7.1). There was a direct and significant correlation between the dimensions of futuristic ability and the dimensions of the quality of learning experiences that the severity of this relationship was weak (p0). Conclusion: Given the weak relationship between students' futuristic skill and the quality of their learning experiences, there are likely to be stronger factors that can predict or enhance students' futuristic skill. Therefore, more studies are recommended to identify the factors affecting it in higher education as a human resources producer to achieve optimal development and future.

Background: Diabetes mellitus has several complications. The Late diagnosis of diabetes in people leads to the spread of complications. Therefore, this study has been done to determine the possibility of predicting diabetes type 2 by using data mining techniques. Methods: This is a descriptive-analytic study that was conducted as a cross-sectional study. The study population included people referring to health centers in Mohammadieh City in Qazvin Province, Iran, from April to June 2015 for screening for diabetes. The 5-step CRISP method was used to implement this study. Data were collected from March 2015 to June 2015. In this study, 1055 persons with complete information were included in the study. Of these, 159 were healthy and 896 were diabetic. A total of 11 characteristics and risk factors were examined, including the age, sex, systolic and diastolic blood pressure, family history of diabetes, BMI, height, weight, waistline, hip circumference and diagnosis. The results obtained by support vector machine (SVM), decision tree (DT) and the k-nearest neighbors algorithm (k-NN) were compared with each other. Data was analyzed using MATLAB® software, version 3.2 (Mathworks Inc., Natick, MA, USA). Results: Data analysis showed that in all criteria, the best results were obtained by decision tree with accuracy (0.96) and precision (0.89). The k-NN methods were followed by accuracy (0.96) and precision (0.83) and support vector machine with accuracy (0.94) and precision (0.85). Also, in this study, decision tree model obtained the highest degree of class accuracy for both diabetes classes and healthy in the analysis of confusion matrix. Conclusion: Based on the results, the decision tree represents the best results in the class of test samples which can be recommended as a model for predicting diabetes type 2 using risk factor data.

Introduction: Existence of appropriate organizational culture can pave the way for achievement of success at universities of medical sciences, which play important roles in health promotion of communities. This study aims to investigate organizational culture status in staff of the Qazvin University of Medical Sciences based on Denison Model. Methods: This cross sectional study was conducted on 276 university staff at the Qazvin University of Medical Sciences in 2016 based on cluster sampling method. Research variables included four organizational culture domains namely involvement, consistency, adaptability, and mission culture. Data was collected by Denison's 60-item organizational culture questionnaire. Cronbach's alpha was used to determine reliability of the questionnaire which was 0.96. Results: In this study, the mean age and job experience of participants were 39.79±7.57 and 15.60±7.59 years respectively. The highest mean score was obtained in adaptability culture, but the lowest mean score was in mission culture. Mean score of organizational culture was 2.93±0.62, which was medium (normal). There was a significant relationship between organizational culture and staff's educational levels (p

Background: Research is one of essential elements for development of each country and is a pioneer and precursor in providing accurate and making decision. Objective: This study evaluated the results of comprehensive health plan projects of Qazvin University of Medical Sciences from 2009 to 2013. Methods:This descriptive-analytical study was performed in four steps. The first two steps included the formation of a leadership team and holding of meetings with representatives of 22 executive authorities of the province. The third step included the compilation of the executive proposals of each organization and fourth step, received final reports and evaluations. In each step, a variety of methods were used for data collection, including reviewing all the documents, expert panel, focused group discussion and stakeholder analysis, Delphi technic and nominating group. Findings: From 43 conducted projects, only 31 projects (72%) were completed by Qazvin University of Medical Sciences. As the results, projects were in the field of policy documents (n=10), regulation (n=1), educational packages (n=4), educational programs (n=5), health index (n=1), models (n=7) and applications (n=18). Conclusion: Some of the defined projects were essential in 2010 and their implementation could solve some of health problems of the province. It seems that implementation joint projects could solve complex and multi-dimensional problems by promoting and applying intersectoral collaboration between health sector and executive authorities of the province.

BACKGROUND: One of the significant goals of healthcare delivery organizations is to promote people’s health and provide high quality care. In this regard, health reform plan was designed in Iran. Therefore, the present study aimed to evaluate the performance of teaching hospitals after running of health system reform plan in Iran. METHODS: This retrospective-descriptive study was carried out in 4 hospitals (Avicenna, Velayat, Rajaee, and Qhods) affiliated with Qazvin University of Medical Sciences, Qazvin, Iran, in 2014. Data collection tool was the checklist of standard indicators of Iranian Ministry of Health, because the checklist is standard to measure hospitals’ performance. In this study, 19 indicators (performance indicators, personnel indicators, and financial indicators) were investigated. To fill out the indicators checklist, the statistics unit of Ministry of Health was used according to the reports of two consecutive years of 2013 and 2014. The collected data were analyzed using Excel software. RESULTS: In general, out of the 7 performance indicators that were investigated in the hospitals, increase was observed in four, and decrease was seen in three items. Out of the six personnel indicators, all of the hospitals experienced a rise; and out of the six financial indicators, four items increased and two decreased. CONCLUSION: The results of this study indicated that after one year of implementing health reform plan, the mentioned health care system experienced a remarkable progress in the hospitals. Providing the necessary infrastructures can help better conduction of the plan and promotion of the mentioned indicators by removing or decreasing the effect of some barriers.

Background: Quality is one of the factors affecting the success of service organizations. The quality of health services is from the patients' perspectives to the best service available in a timely, safe and economical manner. The aim of this article is to explain the concept of hospital services quality from patients and companions perspectives. Methods: The study was conducted using qualitative approach. The data were collected through semi-structured interviews Sampling was done purposefully and research interviews were ended once data saturation was achieved. Fifteen patients and thirteen companions were recruited. Findings were analyzed using Framework Analysis method. Results: The analysis of question about the concept of subjective quality of existence and the ideal quality led to emergence of themes including "emotional and psychological relations" and "customer-oriented" and "environmental and tangible factors”. Also, the themes for suggestion of quality improvement included "holding training classes", "improving facilities and amenities of health" and "improving human resource management." Conclusion: The findings showed that patients in addition to the physical problems of treatment location are concerned to human relations and even clinical treatment issues. In their opinion the relationships between patients and the medical staff, support and respect for the dignity, attention and importance of the personnel to patients and their personnel and environmental factors have a significant impact on the treatment process and the quality is satisfactory.

Background: Paying attention to patient safety is a basic right and a necessary issue in providing medical care, and failure to observe it leads to irreparable damage. One of the factors affecting an individuals’ performance in an organization is stress, which also endangers their health. Objective: To determine the relationship between patient safety culture and levels of job stress among the nurses working in the hospitals affiliated with Mazandaran University of Medical Sciences. Methods: The present study was carried out using a cross-sectional method in the hospitals affiliated with Mazandaran University of Medical Sciences in 2016. A multistage stratified sampling method using a Morgan Table was employed to select 380 nurses as the study sample from among 3,180 nurses. They were selected by a multistage stratified sampling method. The study instruments were Stinemetz Standard Job Stress Questionnaire and Hospital Survey on Patient Safety Culture (HSOPSC). After the required data were collected, they were analyzed using descriptive and inferential statistical methods (Pearson correlation, independent-samples t-test, and ANOVA) through SPSS version 23. Results: The results of the present study showed that 75% of the nurses experienced average and high levels of stress. Among different dimensions of safety culture, organizational learning and handoffs and transitions obtained the highest and the lowest scores, respectively (72.5 and 24.5). The mean score of safety culture dimensions was 51.52. The results of the Pearson correlation test showed that there was a direct significant relationship between different dimensions of safety culture among nurses and the level of stress (p≤0.05). Conclusion: According to the findings, patient safety should be considered as a strategic priority for the senior managers of the health system. In order to enhance patient safety, managers should pay special attention to evaluating safety culture in organizations that deliver health service, especially hospitals

Background: Discharge with personal consent is considered as one of the main problems in hospitalization condition since many patients leave the hospital prematurely against the doctor’s advice. Thus, the aim of this study was to identify the factors affecting the discharge with personal satisfaction in selected teaching hospitals of Tehran University of Medical Sciences. Methods: The present study was a descriptive and cross-sectional analysis that was carried out on patients discharged with personal satisfaction from selected training hospitals of the Tehran University of Medical Sciences in 2016. The sample size was 153 patients who were randomly selected from Sina, Shariati and specialized women hospitals. The data were collected through using a self-made checklist and telephone interview. The SPSS V. 18 software and statistical tests such as Chi-square and t-test were used for data analysis. Results: The most common causes of patient’s discharge with personal satisfaction was personal issues related to the sick and the highest among these causes was patient recovery. The least common causes of discharge with personal satisfaction was related to the hospital. There was no significant link of gender, age, place and insurance type with personal discharge, but there was a significant link between the discharges of the hospital with own agreement and type of the hospital (P < 0.05). Conclusion: Hospital staff education, motivating the staff to participate actively in obtaining consent from patients and informing the patients about the stage of their treatment and recovery should be considered as priority management activities.

Background: Providing healthcare services of the highest quality and quantity, based on the results of scientific research, is one of the main tasks of nurses. The aim of this study is to evaluate nurses’ perception of evidence-based knowledge, attitude and practice in selected hospitals of Iran. Methods: This study was a descriptive cross-sectional analysis that was conducted to investigate nurses’ perception of evidence-based practice (EBP). Two hundred-and-sixty nurses were selected randomly from six hospitals in Qazvin city in Iran to participate in the study. An evidence-based practice questionnaire was used to assess the dimensions of EBP. Descriptive and inferential statistics using frequency tables, t-student statistics, Pearson correlation coefficient and ANOVA were used for data analysis. Results: According to this study, nurses’ perception of EBP was generally above average (3.91 out of 7) and average of Practice, attitude and knowledge/skills were 4.14, 3.78 and 3.74 respectively. There was no statistically significant relationship among EBP dimensions and gender, age and job tenure (P-value > 0.05). There was a statistically significant relation between attitude of nurses and type of employment (P-value < 0.05). Conclusion: In this study, the mean of evidence-based practice among nurses was at a level higher than the average. The attitude of the nurses who were studied was moderate, but thanks to the low level of their knowledge about EBP, training programs based on needs assessments resulting from the findings of this study were suggested that could improve nurses’ knowledge of EBP.

Introduction: The length of stay (LOS) in hospitals is a widely used and important criteria for evaluating hospital performance. The aim of this study was to determine factors affecting LOS in teaching hospitals of Qazvin Providence. Methods: In this cross-sectional study, patients’ health records were randomly selected from archives in teaching hospitals of Qazvin in 2013. Data were collected through a data entry form and were analyzed using Kolmogorov–Smirnov, Kruskal–Wallis, and Mann–Whitney U tests at the significant level of 0.05. Results: The mean of hospital LOS was 5.45 ± 6.14 days. Age, employment, marital status, history of previous admission, patient condition at discharge, method of payment, and type of treatment had an impact on LOS (p

Background and Aim: Nurses’ main tasks include the provision of healthcare services at the highest levels of quality and quantity standards, and based on the findings of scientific research. The aim of the present study is to identify and determine the barriers of evidence-based practice among nurses of Qazvin hospitals, in Iran, at 2013. Materials and Methods: The present cross-sectional research was a descriptive- analytic study conducted among 260 nurses practicing in six hospitals of Qazvin in 2013. The barriers scale questionnaire developed by Funk, et al. was used to examine the four dimensions of evidence-based practice (EBP) barriers including adopter, organization, innovation and communication characteristics. To analyze the data, descriptive and analytic statistics were used. Results: The mean score of EBP barriers among subjects was 3.07 out of 4. Among the barriers, "organization" and "adopter" dimensions had the highest and lowest mean scores, respectively. There was no significant statistical relationship between gender and EBP performance, But a significant relationship was observed between organizational dimension with age, employment type and work experience. Conclusion: Since “organization” was found to be the main barrier to the use of research in nursing performance, policy-makers and administrators should pay attention to the use of research in performance, the establishment of a research culture in organization, the creation of appropriate infrastructures, and the allocation of sufficient time to the nursing personnel to have access to evidences.

Introduction: Efficient use of resources in organizations is one of the most important duties of managers. Appropriate allocation of resources can help managers to do this well. The aim of this study was to determine the cost of radiology services and to compare it with governmental tariffs (introduced by the Ministry of Health in Iran). Methods: This was a descriptive and applied study that was conducted using the retrospective approach. First, activity centers were identified on the basis of five main groups of hospital activities. Then, resources and resource drivers, activities, and hospital activity drivers were identified. At the next step, the activities related to the delivery of radiology process were identified. Last, through allocation of activities cost to the cost objects, the cost price of 66 services that were delivered in the radiology department were calculated. The data were collected by making checklists, using the hospital’s information system, observations, and interviews. Finally, the data were analyzed using the non-parametric Wilcoxon test, Microsoft Excel, and SPSS software, version 18. Results: The findings showed that from the total cost of wages, materials, and overhead obtained, the unit cost of the 66 cost objects (delivered services) in the Radiology Department were calculated using the ABC method (Price of each unit of Nephrostogram obtained $15.8 and Cystogram obtained $18.4). The Kolmogorov-Smirnov test indicated that the distribution of data of cost price using the ABC method was not normal (p = 0.000). The Wilcoxon test showed that there was a significant difference between the cost of services and the tariff of radiology services (p = 0.000). Conclusions: The cost of delivered services in radiology departments was significantly higher than approved tariffs of the Ministry of Health, which can have a negative impact on the quality of services

Objective (s): Medical tourism is quickly emerging as a symbol of global trade in health care. The aim of the study was to assess Qazvin’s hospitals preparedness in attracting medical tourists based on JCI patient-oriented standards. Methods: A descriptive study was conducted in seven hospitals of Qazvin in 2012. The patient-oriented checklist of JCI standards was used to collect data. Results: The results showed that among 7 standards, maximum score was belonged to Anesthesia and Surgical Care (77.5%) and minimum score was belonged to Patient and Family Education standard (52.5%). Finally, The Rahimian hospital acquired maximum score (85.4%) and the Kosar hospital acquired minimum score (5). Conclusion: The hospitals in Qazvin showed a relative preparedness in medical tourists. Standards in private hospitals were more acceptable than state teaching hospitals.

Employees are the most valuable assets of an organization; therefore, it is very important to understand their behavior. In this regard, the present study was carried out in order to examine the effect of organizational climate on job involvement among nurses working in the teaching hospitals of Qazvin Province, Iran. The present descriptive analytical study was done in 2017. To randomly select a specific proportion of nurses from each of Qazvin teaching hospitals, stratified sampling was used. In total, 340 nurses were selected. Data were collected using 3 questionnaires: Halpin and Kraft Organizational Climate Questionnaire, Job Involvement Questionnaire (Kanungo), and Allen and Myer Organizational Commitment Questionnaire. For data analysis, confirmatory factor analysis and structural equation modeling were used applying AMOS-24 software. The results of path analysis showed the effect of organizational climate on the nurses’ job involvement. Moreover, organizational climate influenced organizational commitment through the mediation of job involvement. According to values obtained for degree of freedom based on chi-square, goodness-of-fit index, root mean square error of approximation, and comparative fit index were in the defined range; therefore, the validity of the conceptual model was approved. Based on the results of the present study, managers of health organizations can achieve their goals by understanding the organizational climate of the hospitals and its effect on the employees’ job involvement and discovering strategies needed for organizational commitment improvement.

Background and Aim: Purchasing hospital equipment is one of the most important decisions made by managers and health professionals. Gray systems theory is an approach to deal with issues under uncertainty conditions where decision makers are facing a small number of unspecified data. The purpose of this paper is to apply the gray theory for the purchase of anesthesia machine . Materials and Methods: This study was a survey in which mathematical analysis was used. Data collection devices included documents, interviews and questionnaires. In order to solve multiple criteria decision making in uncertain conditions, a model based on gray system theory was used. Data analysis was performed using Excel software. Results: The findings show that among anesthetic equipment bought by public and private hospitals, brand A is superior to other brands. However, the gray possibility degree for the other brands is significantly different from brand A. Conclusion: In addition to helping to purchase anesthetic equipment for hospitals, the results of this study are also useful for companies manufacturing medical equipment to evaluate their situation in terms of the studied criteria and take appropriate measures to develop their strengths and improve their weaknesses.

Background and Aim: The Effectiveness and success of an organization depends on two factors; one is the employees’ Performances and the other is the level of understanding between managers and employees in prioritize of different job motivators. The aim of this study was to determine factors that affect staffs’ performances in Qazvin teaching hospitals based on the Herzberg’s theory. Materials and Methods: This research was a descriptive study. To achieve the main aim of this study, one hundred and ten employees were selected through a multi- stage sampling method .In this study, for data collection a self-report questionnaire was used. The five-point Likert scale was used to determine the degree of importance of any hygiene and multinational's factors affecting the performance of the employees. Results: Among hygiene factors, the prevailing place was for Job security with an average 4/39 and then followed by a suitable salary with an average 4/38 of 5 scores. Among multinational's factors, job responsibility with an average 4/38 and job interest with an average 4/38 were placed as the most important factors in employees’ performance. %70/8 employees mentioned that two factors of suitable salary and job security are the most important obstacle for improvement of employee’s performance. Conclusion : The data of this study reveals that, Attention and Planning in providing proper salary and job security as hygiene factors and sense of responsibility and success as motivational factors, may play a more effective role in improving employees’ performance than any other factors.

Background and Aim: Family physician is the core in the world efforts for quality improvement, cost effectiveness, and equity in the health care systems. The main purpose of this present study was to investigate situation of the family physician program and identify referral route in this program in six pilot cities in Khuzestan province . Materials and Methods: A cross-sectional descriptive study was conducted in 2011. Pre-designed checklists were used for collecting data. In this study, 15 healthcare team in six pilot cities for family physician program in Khuzestan province were examined and their specified referral levels for each city was investigated and compared with the national instruction to identify current gaps. Results: The least number of staff belonged to nutrition, nurses and physicions respectively. In the second referral level cities, Specialists did not welcome the program . In Mahshar, a second level city, five specialists have been registered to family physician program. In the third level, 28/5 percent of specialist were enrolled in this program. Conclusion : It seems that it is necessary to facilitate patient access to physicians under contract with family physician program and referral system in second and third levels. Therefore, establishing a motivation system for attracting specialist and improving their maintenance situation can also be beneficial.

Background and Aim: In many countries, hospitals have triple ownership (governmental or public, for-profit, and not-for-profit). Numerous studies have been performed in order to investigate the differences among these hospitals in accordance to expenditures, presentation of uncompensated therapeutic services, number of outgoing patients and other measurement devices of hospital performance. The aim of this research was to investigate the role of ownership on total Factors Productivity changes in Qazvin`s selected hospitals. Materials and Methods: Descriptive-analytic study was conducted in three periods of time from 2005 to 2007 in 8 selected hospitals of Qazvin. Inclusion criteria included the active beds and the value of intermediate consumptions in hospitals.The exclusion criteria included the total number of inpatient and surgical operations. Data collection tool, was researcher-designed checklist. Data were analyzed using DEAP 2/1 software and ANOVA, HSD and TUKEY tests. Results: There was a significant difference between the mean productivity of three hospital groups due to the existence of various ownership(p=%012), Also a significant difference was observed between the mean of technological efficiency of the three groups of hospitals(p=%006), No significant differences was found between the mean of technical efficiency of the three groups of hospitals(p=%23). Conclusion: Cause of the variation in total factor productivity in private hospitals, is due to their suitable production technology which is always improved. But in respect to their efficiency promotion and optimization of production and products, there was no distinguishing difference with other hospitals.

Background and Aim: The Effectiveness and success of an organization depends on two factors; one is the employees’ Performances and the other is the level of understanding between managers and employees in prioritize of different job motivators. The aim of this study was to determine factors that affect staffs’ performances in Qazvin teaching hospitals based on the Herzberg’s theory. Materials and Methods: This research was a descriptive study. To achieve the main aim of this study, one hundred and ten employees were selected through a multi- stage sampling method .In this study, for data collection a self-report questionnaire was used. The five-point Likert scale was used to determine the degree of importance of any hygiene and multinational's factors affecting the performance of the employees. Results: Among hygiene factors, the prevailing place was for Job security with an average 4/39 and then followed by a suitable salary with an average 4/38 of 5 scores. Among multinational's factors, job responsibility with an average 4/38 and job interest with an average 4/38 were placed as the most important factors in employees’ performance. %70/8 employees mentioned that two factors of suitable salary and job security are the most important obstacle for improvement of employee’s performance. Conclusion: The data of this study reveals that, Attention and Planning in providing proper salary and job security as hygiene factors and sense of responsibility and success as motivational factors, may play a more effective role in improving employees’ performance than any other factors. [ABSTRACT FROM AUTHOR]