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Background: Cost of Quality is an approach that helps organizations evaluate the extent to which their resources are used to prevent poor quality activities, assess the quality of provided services, or evaluate the number of resources that are wasted due to the internal and external failures occurring in a system. The research objective was to measure the Cost of Quality(CoQ) in a medical device division of a hospital in Qazvin, Iran. Methods: We performed a qualitative study in the medical device division in a public hospital affiliated with Qazvin University of Medical Sciences, Iran in 2020. To measure and report the (CoQ) in the division, the Prevention-Appraisal-Failure (PAF) model was used. Data were collected through document review, semi-structured interview, and group discussion, which were entered into the Excel software to calculate their distribution and frequencies using the descriptive statistics method. Results: Among different cost categories, the highest amount of expenditures belonged to internal and external failure costs. Results also revealed that several factors were responsible for the failures, including lack of knowledge of personnel about the proper use of medical devices; failure to periodically perform calibration on due dates; lack of adequate supervision; stress and work pressure among employees; and lack of managerial commitment toward the importance of preventive maintenance. Conclusion: In order to decrease the number of failures occurring in a working system, it is required to increase personnel's knowledge about the proper use of medical devices, perform calibration of devices on due dates, increase managerial commitment toward preventive and quality appraisal activities and apply systematic supervision.

Background The COVID-19 pandemic has had an adverse effect on the mental health of population worldwide. This study was conducted to systematically review the existing literature to identify the individuals at higher risk of anxiety with a view to provide targeted mental health services during this outbreak. Methods In this study, the studies focusing on anxiety prevalence among the general population during the COVID-19 pandemic were searched in the PubMed, EMBASE, Scopus, Web of Science (WoS) and Google Scholar from the beginning of Covid-19 pandemic to February 2021. Results 103 studies constituting 140732 people included in the review. The findings showed that anxiety prevalence was 27.3% (95% CI, 23.7%; 31.2%) among general population while the prevalence in COVID-19 patients was 39.6% (95% CI, 30.1%; 50.1%). Anxiety was significantly higher among females and older adults (p≤0.05). In addition Europe revealed the highest prevalence of anxiety 54.6% (95% CI, 42.5%; 66.2%) followed by America 31.5% (95% CI, 19%; 47.5%) and Asia 28.3% (95% CI, 20.3%; 38%). In the general population the highest prevalence of anxiety was in Africa 61.8% (95% CI, 57%-66.4%) followed by America 34.9% (95% CI, 27.7%-42.9%), Europe 30.7% (95% CI, 22.8%-40%) and Asia 24.5% (95% CI, 20.7%-28.9%). Conclusion During the COVID-19 crisis, through identifying those who are more likely to be suffered from mental disorders at different layers of populations, it would be possible to apply appropriate supportive interventions with a view to provide targeted mental health services during the outbreak.

BackgroundThis study was conducted to systematically review the existing literature examining the prevalence of anxiety among hospital staff and identifying the contributing factors to address the complications of this disorder and develop effective programmes for reducing the complications of this mental health problem.MethodsWe searched the electronic databases including PubMed, EMBASE, Scopus, Web of Science and Google Scholar from January 2020 to February 2021. To perform meta-analysis, the random effects model was used. To assess the statistical heterogeneity of the included studies, the I2index was used, and 95% CI was estimated. Data analysis was performed by R software.ResultsIn the final analysis, 46 articles with the total sample size of 61 551 hospital staff members were included. Accordingly, anxiety prevalence among healthcare workers (HCWs) was 26.1% (95% CI 19% to 34.6%). The prevalence rates of anxiety in health technicians and medical students were 39% (95% CI 13% to 73%) and 36% (95% CI 15% to 65%), respectively, indicating a much higher prevalence than other hospital staff members. Furthermore, a positive significant relationship between prevalence of anxiety among HCWs and their age was approved (pConclusionThe findings show a moderately high prevalence rate of anxiety in hospital staff. Due to the high prevalence of this mental health problem in health technicians, medical students and frontline health workers, it is highly suggested that healthcare institutions offer mental health programmes for these working groups in order to appropriately manage anxiety during the COVID-19 pandemic.

Background: A few studies have reviewed and revised ICU admission criteria based on specific circumstances and local conditions. The aim was to develop ICU admission criteria and compare the cost, mortality, and length of stay among identified admission priorities. Methods: This was a cross-sectional study conducted in an intensive care unit of a training hospital in Qazvin, Iran. The study was conducted among 127 patients admitted to ICU from July to September 2019. The data collection tool was a self-designed checklist, which included items regarding patients' clinical data and their billing, type of diagnosis, level of consciousness at the time of hospitalization based on GCS scale or Glasgow Coma Scale, length of stay, and patient status at the time of discharge. Descriptive statistical tests were used to describe study variables, and in order to determine the relationship between study variables, ANOVA and Chi-square test were used. Results: A set of criteria were designed to prioritize patient admissions in ICU. Based on the defined criteria, patients were categorized into four groups based on patient's stability, hemodynamic, and respiration. Study findings revealed that a significant percentage of patients were admitted to the ward while in the second and third priorities of hospitalization (26.8 % and 32.3 %, respectively). There was a statistically significant difference in the four groups in terms of patients' age, total cost, and insurance share of the total cost (P-value < 0.05). Conclusion: Study results emphasize the necessity to classify patients based on defined criteria to efficiently use available resources.

Introduction: Although depression and anxiety have been widely investigated among patients with chronic obstructive pulmonary disease (COPD), experiencing stressful life events and its effect on increasing risk of exacerbations was rarely assessed. This study aimed to clarify the association between facing with stressful events among COPD patients and their disease severity leading to hospitalization. Material and methods: A prospective study was conducted among 128 COPD patients from the population of Qazvin, a north-west, industrialized city of Iran from December 2017 to December 2018. Patients were followed up for one-year and their related measures were gathered. To compare variables among patients stratified by reporting stressful life conditions, Pearson’s chi-square and Fisher’s exact tests were used. Furthermore, to assess the effect of several covariates on the response variable, a logistic regression modelling was applied. Results were reported in form of odds ratios and their 95% confidence intervals. Results: Study findings affirmed that patients who had experienced stressful situation had lower BMI, were retired, experienced more frequent exacerbations, and reported higher levels of anxiety/ depression. Moreover, those with stressful conditions were among current or former smokers (p < 0.05). Logistic regression analysis revealed that facing with stressful situations was significantly associated with the severity of COPD disease (OR 1.9; 95% CI 2.5 to 5.6), smoking habit (OR 2.8; 95% CI 1.6 to 4.2; OR 1.5; 95% CI 1.4 to 2.2), and hospitalization during one-year follow up (OR 1.2; 95% CI 1 to 3.3). Conclusions: To improve health outcomes of COPD patients, close attention should be given to their psychological disorder and appropriate strategies should be applied to reduce patients’ exposure to stressful life events and subsequent anxieties.

Background: The uneven distribution of human resources in the health sector, especially in the medical profession, is a global phenomenon that poses a significant challenge to the population's access to quality health services. The aim of this study was to investigate the influencing factors on the retention of specialists and subspecialists working in training hospitals of Qazvin University of Medical Sciences in order to provide appropriate suggestions and practical solutions to increase their chances of survival in these areas. Methods: This research is a descriptive-analytical study using conjoint analysis technique conducted between 2017 and 2018 among physicians. The study was conducted among 109 physicians who met the inclusion criteria of the study. DCE questionnaire was used to collect the research data. The collected data were entered into STATA software version 13 for statistical analysis and were statistically analyzed by Probit and Logistic regression models. Results:The results show that the probability of physicians' retention in the city of work is 1.2 times higher if they were allowed to work in the private sector (β = 1.2). Providing proximity to the family also doubles the chances of physicians' retention (β = 2.2). Provision of adequate educational facilities (β = 1.07), moderate clinical facilities (β = 1.18) and favorable accommodations (β = 1.12) also increase the likelihood of physicians' retention in the workplace. Conclusion: Considering all factors identified as the preferences of physicians due to the limitations of resources and the existing legal requirements cannot be applied in planning and policy making in the field of health care. However, being aware of these factors and then considering legal considerations that are considered mandatory by the Ministry of Health and Medical Education can greatly help in making effective policies in the area of physician retention.

Educational interventions are helpful strategies to empower communities encountering the threat of pandemics like Covid-19. This study was carried out to examine the effect of educational intervention on anxiety control and improvement in public quality of life. A quasi-experimental study. The study was conducted among individuals referred to healthcare centers of Qazvin province, Iran, in 2020. Given that Qazvin consists of nine urban healthcare centers, two centers were selected by a simple random selection method. After considering inclusion and exclusion mentioned criteria, 240 individuals were selected to participate in the research and were randomly assigned into two groups of experimental and control. Following the educational intervention, all study variables, including knowledge score, anxiety level, and quality of life, improved significantly in the experimental group compared to the pre-intervention phase (P

Socioeconomic and lifestyle factors are regarded as important influencing issues regarding a wide range of chronic diseases, including chronic obstructive pulmonary disease. This study aimed to explore the role of such factors as determinants of disease exacerbation among COPD patients. A cross-sectional study was conducted among 150 COPD patients who were referred to an outpatient respiratory care center in Qazvin, Iran, to undertake respiratory function tests from December 2017 to June 2018. Disease severity was determined by the Initiative for Chronic Obstructive Lung Disease (GOLD) index. Odds ratios were applied to find out factors associated with exacerbation. Study findings affirmed that within COPD severity groups, there were significant differences among patients in terms of educational level, smoking status, income, and occupation. Factors associated with severe COPD were found to be smoking (OR 3.6, 2.6-4.2), lower education (OR 1.4, 0.9-2.6), insufficient income (OR 2.3, 0.6-3.1), and unsupportive family (2.7, 1.5-3.6). Due to the obtained evidence about the effect of socioeconomic status on the prognosis of the disease, it is suggested that clinicians should also consider the nonclinical and social aspects associated with the disease in advancing patients' therapeutic procedures and management algorithms.

Purpose Nowadays, the importance of infant birth weight (IBW) as a key factor in determining the future of physical and mental development of children is a growing concern. The purpose of this paper is to investigate the relationship between maternal characteristics and IBW among pregnant women who were referred to health centers in Qazvin city in the year 2016. Design/methodology/approach A descriptive-analytical study was conducted among pregnant women in 28–36 weeks of gestation who referred to healthcare centers and facilities affiliated by the Qazvin University of Medical Sciences in April–June 2016. The associations between maternal physical activity, mothers’ socioeconomic status and birth weight were examined by SPSS Software Package version 16 through linear and logistic regression tests. Findings Linear regression modeling suggested that maternal weight (p=0.001), income (p=0.04), gestational age of delivery (p=0.00) and pre-pregnancy BMI (p=0.02) were positively associated with birth weight, while occupational and heavy physical activity (p=0.003 and 0.008, respectively) were negatively associated with IBW. In this study, low birth weight infants are compared to those with normal weight belonged to mothers who have spent more time in doing heavy physical activities (OR=1.11, 95% CI 1.01–1.23). Also infants with low birth weight compared to others in the normal weight category were born from mothers with lower pre-pregnancy BMI (OR=0.65, 95% CI 0.62–0.78), gestational age of delivery (OR=0.82, 95% CI 0.79–0.86), maternal weight (OR=0.86, 95% CI 0.84–0.88) and income (OR=0.79, 95% CI 0.69–0.83). Practical implications The study findings revealed that certain maternal characteristics could play a significant role in IBW. Despite the importance, in most of developing countries (particularly Iran), future mothers are not advised about an appropriate weight gain during pregnancy or the optimal level of physical activity in such a period of time. Therefore, counseling pregnant women and giving them proper information on appropriate perinatal care would be helpful in order to have pregnancies with optimal outcomes. Originality/value The authors applied several statistical methods to analyze IBW among mothers with different maternal characteristics and predict birth weight based on contributing factors.

Background and aimSigns and symptoms of schizophrenia may have serious impacts on patients’ quality of life leading to concern about different aspects of their lives. This study presents a systematic review and meta-analysis of the studies examining the quality of life among patients with schizophrenia and its relationship with patients’ characteristics.Materials and methodsA total of 40 studies were extracted from searching of relevant databases published between 2000 and 2020. Descriptive data and correlation coefficients between patient’s characteristics and quality of life were extracted and the results were reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses standards and meta-analysis of pooled studies.ResultsIn total, 8363 patients with schizophrenia participated in 40 studies which used Schizophrenia Quality of Life Scale revision 4. The total score of quality of life (QOL) in the study subjects was reported to be 40.66. Weighted effect size analyses revealed a significant relationship between QOL and variables including patients’ age and duration of the disease. Furthermore, the highest (the worst) score of QOL in schizophrenia patients was observed in Europe 47.04 (95% CI 41.26 to 52.82) and the Euro region 47.05 (95% CI 41.18 to 52.92).ConclusionOverall, the QOL among patients with schizophrenia was in a good status, which could be improved through considering different life aspects of people living in various contexts. In fact, clarifying the determinants of QOL would be a key step in the provision of future treatment efforts.

Background: Lack of timely access to needed services in the emergency department of hospitals can bring many harmful effects to the patients. One of the important factors in providing timely services is the presence of sufficient number of nurses whom have been entrusted with acceptable volume of services. Objective: The aim of this study was to estimate required number of the nurses in an emergency department of a training hospital in Qazvin. Methods: This study was descriptive, cross-sectional that conducted in an emergency department of a training hospital in Qazvin in 2016. The method used to estimate required number of nurses was WISN (Workload Indicator of Staffing Needs) which was introduced by World Health Organization as a simple, applicable and logical approach for health human resource planning. Required data was gathered through direct observation, interview and document review. Findings: As the results, in the emergency department, there was a need for 56 nursing staff while regarding to 52 available workforce, a significant shortage of four personnel was proved. In addition, work pressure was calculated to be 0.93 depicting burden of workload on current nursing staff. Conclusion: Emergency departments in every hospital are the most significant sectors that need special attention in terms of human resource planning. Application of a simple, logical scientific method for estimating required number of health workforce in hospitals can be beneficial for the whole health system. Keywords: Estimate, Health human resources, Emergency department, Timing and workload survey, WISN

Background and Objectives: The work-family conflict has many negative consequences, such as absenteeism, employee turnover, and reduced performance. This study aimed to investigate and compare perceived work-family conflict among clinical and non-clinical employees working in hospitals affiliated to Shahid Sadoughi University of Medical Sciences. Methods: This descriptive analytical cross-sectional study, was conducted on 210 employees working in Shahid Sadoughi educational hospital in Yazd city, 2016. Data collection was performed using Carlson work-family conflict questionnaire. Data analysis was carried out by t -test, Spearman correlation coefficient, and one-way analysis of variance. Results: The mean perceived work-family conflict among the study population in terms of three dimensions of time, pressure, and behavior, were 18.11+4.23, 7.91+5.09, and 18.16+4.71, respectively, which showed a significant difference between clinical and non-clinical employees (p

Background: Managers’ communication skills and leadership style have influential effect on organizational effectiveness. Objective: The aim of the study was to evaluate the level of communication skills and type of leadership style among managers and its association with organizational effectiveness from the viewpoints of employees working in hospitals affiliated by Shahid Sadoughi University of Medical Sciences in Yazd. Methods: This analytical and cross-sectional study was conducted among a sample of 400 employees working in three training hospitals of Yazd who have been selected using a randomized clustered method in 2016. Three standard questionnaires including communication skills by Burton, leadership style, Burdens and Metzcus and organizational effectiveness were used by Parsons used to collect data. Findings: Study findings revealed a significant reverse relationship between managers’ leadership style and their communication skills (P=0.001, r=-0.682) and a direct significant relationship between organizational effectiveness and the latter (P=0.001, r=0.913). Results also confirmed a reverse association between leadership style and organizational effectiveness which was not statistically significant (P=0.669, r=-0.032). Furthermore, the direct influence of communication skills on organizational effectiveness was much more severe than indirect influence of communication skills on organizational effectiveness with a moderating role of leadership style. Conclusion: Developing effective communication and influencing interaction among managers and organizational employees are mentioned as an important strategy for successful organizations to achieve their determined goals in an appropriate manner. Keywords: Communication skill, Leadership style, Organizational effectiveness, Structural equation modeling

Positive patient safety climate can improve the adherence of care services to safety standards and consequently promote safe surgery as fundamental healthcare services. This study aimed to investig...

BackgroundPatients with end-stage renal disease undergoing haemodialysis experience a variety of stressors leading to decreased level of quality of life (QoL). Thus, in this study, we aimed to review the current literature and identify factors affecting the health-related QoL (HRQoL) in these patients.MethodsA total of 147 studies were extracted from databases of Web of Science, PubMed, Scopus, Google Scholar, and Embase published between January 2000 and December 2020. Data were analysed using R software and results were reported with reference to Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.ResultsA total of 623 728 patients undergoing dialysis participated in 147 studies in which QoL was assessed by means of two valid questionnaires, including Short-Form 36 (SF-36) and Kidney Disease Quality of Life (KDQOL)-short form V.1.3. Total HRQoL score for patients undergoing dialysis measured by KDQOL was 64.25 (95% CI 55.67 to 72.82). Based on SF-36, the mean score of mental health items was higher than the mean score of physical health condition. Furthermore, meta-regression based on the geographical place of residence revealed that the highest QoL in patients was observed in Japan, 66.96 (95% CI 63.65 to 70.28) and Brazil, 58.03 (95% CI 53.45 to 62.6).ConclusionStudies conducted on HRQoL among patients undergoing dialysis recommend useful strategies to clinicians, letting them assess patients’ QoL in terms of a wide range of physical, mental and environmental aspects.

Introduction: This study aimed to investigate the relationship between managers’ attitude toward power distance and the way of dealing with employees in hospitals affiliated with Qazvin University ...

Introduction: Health human resources have a significant role in delivering healthcare services to population. Health planners and policy makers should guarantee that adequate number of workforce wi...

Purpose Measuring healthcare service quality provides an objective guide for managers and policy makers to improve their services and patient satisfaction. Consequently, the purpose of this paper is to measure service quality provided to surgical and medical inpatients at Kerman Medical Sciences University (KUMS) in 2015. Design/methodology/approach A descriptive-analytic study, using a cross-sectional method in the KUMS training hospitals, was implemented between October 2 and March 15, 2015. Using stratified random sampling, 268 patients were selected. Data were collected using an importance-performance analysis (IPA) questionnaire, which measures current performance and determines each item’s importance from the patients’ perspectives. These data indicate overall satisfaction and appropriate practical strategies for managers to plan accordingly. Findings Findings revealed a significant gap between service importance and performance. From the patients’ viewpoint, tangibility was the highest priority (mean=3.54), while reliability was given the highest performance (mean=3.02). The least important and lowest performance level was social accountability (mean=1.91 and 1.98, respectively). Practical implications Healthcare managers should focus on patient viewpoints and apply patient comments to solve problems, improve service quality and patient satisfaction. Originality/value The authors applied an IPA questionnaire to measure service quality provided to surgical and medical ward patients. This method identifies and corrects service quality shortcomings and improving service recipient perceptions.

Background: Quality improvement in delivering healthcare services is the main mission of every health system. Safe surgery checklist was introduced by World Health Organization (WHO), and hospitals were required to use it to reduce the risk of surgery-related mortality and morbidity. This study aimed to determine study hospitals’ compliance with safe surgery checklist in 2016.Methods: A retrospective, descriptive study was done in training general hospitals affiliated by Qom University of Medical Sciences from April to June 2016. All surgery checklists in this period were collected, and its use regarding to each operation was mentioned. Data were entered into SPSS version 20 and analyzed through descriptive statistical tests and One-way ANOVA. Results: A total of 1771 surgeries in six university hospitals performed in three months study period and their related surgery checklists were investigated. The overall use and completion rate of checklists were 74%. Among which the sign-in, time-out, and sign-out items compliance were 58%, 16%, and 26% respectively. Conclusion: The overall compliance rate of safe surgery checklist was satisfactory except for time-out and sign-out processes. Complimentary training and regular assessment of checklist utilization could be suggested to ensure the positive attitude among operating room’s staff about the value of such a safety tool in improving patient safety.

Background: Musculoskeletal disorders (MSDs) of the neck and shoulder are the most common and most influential factors causing disorder in the performance and absenteeism of work in administrative personnel. Aim: To identify risk factors which affect musculoskeletal disorders of neck and shoulder areas in headquarters staff of Kerman University of Medical Sciences. Methods: The present cross-sectional study was conducted in 2015 on 282 headquarters personnel of Kerman University of Medical Sciences (Kerman, Iran). The desired headquarters staff were selected from seven Deputy Vice-Chancellors of Kerman University of Medical Sciences, including Deputy of Health; Deputy of Treatment; Deputy of Education; Deputy of Students and Cultural Affairs; Deputy of Food and Drugs; Deputy of Management Development and Resource Planning; Deputy of Research and Technology, and data were gathered by using a standard Nordic musculoskeletal questionnaire NMQ (Nordic) and were analyzed by using SPSS version 16. The impact of various factors on the most common complications (neck and shoulder pains) was analyzed separately through logistic regression analysis and detailed Odds Ratio (OR) was calculated for each individual. Results: The occurrence of neck and shoulder pains in headquarters staff were 42.14% and 40.71%, respectively. In the prevalence of neck pain variables such as marital status (single than married p=0.01, OR=0.24), work experience (p=0.03, OR=1.07 ), education (bachelor’s degree and lower than master’s degree and higher p=0.003, OR=2.69), right / left-handedness (left than right p=0.03, OR=0.33), weight (p=0.04, OR=1.04), place of work (p

Introduction: Discharge against medical advice (DAMA) is a critical issue which negatively affects treatment outcome and imposes higher costs on healthcare organizations. Thus, this study aims to assess factors, leading to this phenomenon, in teaching hospitals.Methods: This descriptive analytical study was conducted in August 2014 in three teaching hospitals of Yazd province, Iran. Data were collected using a self- constructed form which has been filled on the basis of telephone call interview with patients selected by random sampling technique. To apply statistical analysis, the SPSS 20 Software was used.Results: Discharge against medical advice was 6.8% out of total admissions in three under study hospitals. The main reasons were patient factors (50.57%), medical staff factors (35.63%) and hospital environmental factors (12.64%).Conclusion: According to the findings; modification of patients’ discharge process, better cooperation with social work department and interaction with charity organiza...

Background: In recent years accreditation programs have been developed to assess the quality of care and patient safety in hospitals. Quality is a multidimensional concept with patient satisfaction as one of the important facets. This study aimed to test any relationship between patient satisfaction and hospital accreditation. Material and Methods: A cross-sectional study of seven hospitals in Hamadan, Iran, was conducted in 2013. Patient satisfaction was analyzed through a self-made questionnaire and data on hospitals’ accreditation scores were obtained from the Curative Deputy of Hamadan University of Medical Sciences. Statistical analysis was done using SPSS 20. Results: Our research found out a strong relation between satisfaction scores and length of stay, hospital type, human resources condition, information, communication and education, medical equipment and physical structure, accessibility to clinical services, emotional support, management and coordination of care. Findings also revealed a significant negative association between hospital accreditation and patient satisfaction except for the domain of emotional support. Conclusion: Findings support healthcare managers with helpful information about the variables that are related to patient satisfaction. This understanding will make them capable to meet needs and preferences of patients more effectively. Study also confirmed the importance of developing an accreditation system based on outcome parameters and providing responsive services to patients which can positively impact their satisfaction. Bangladesh Journal of Medical Science Vol.16(1) 2017 p.77-84

Introduction: The speed of service delivery in hospitals, especially emergency services is very important to reduce deaths and disabilities. The aim of this study was to investigate the mortality rate and its relationship with holidays in the hospital settings.Methods: A retrospective, cross-sectional study was conducted in 2014 in Yazd, Iran. Emergency departments of two teaching hospitals were selected as a sample and required information was received from the nursing offices and HIS system of the two hospitals. Data analysis was done through the SPSS20 statistical software. We used descriptive statistics and and logistic regression for data analysis.Results: It showed that the age of patients and the number of emergency personnel among other variables had direct effects on mortality rate. In other words, the mortality rate had statistically significant relationship with the age of patients and the number of personnel. The findings indicated that an increase in the age of patients would lead to ...

Background: One of the most important methods for improving the fair access of people to health services is the family physician program, which is facing many challenges. One of these challenges is the lack of policymakers' understanding of physicians' preferences regarding the provisions of the family physician contract. Therefore, this study was aimed to investigate general practitioners' preferences regarding the type of family doctor contract in one of the underprivileged regions of Iran. Methods: An analytical-cross-sectional study was conducted among 150 general practitioners (GPs) who registered in Ministry of Health and Medical Education (MoHME) family physician plan and were working in the health network of deprived regions in Iran. A discrete choice experiment (DCE) questionnaire was developed by the researchers and then distributed to GPs. Results were analyzed using Ordered Logistic Regression. Data were collected using a questionnaire designed by orthogonal method in SPSS 20. Data analysis was performed using logistic regression model in Stata 13 software. Results: Findings revealed that “type of employer” had the most significant effect on GPs’ preferences (OR = 2.5), followed by “allocating quota for admission to medical specialty courses after 5 years” (OR = 2.25), being allowed to give medical services to population without geographical restriction (OR = 2.8), being allowed to provide services out of the defined service packet (OR = 1.4), and “decreased length of contract” (OR = 0.93). Conclusion: The amendment of the provisions of the family physician contract in accordance with physicians' preferences increases the probability of their participation in and compliance with the family physician program. However, the compliance of the provisions of this contract with relevant international standards and upstream laws of the country should be maintained as much as possible.

Background Recent literature has mentioned that people with sleep disorder, experience insulin sensitivity reduction and accordingly higher levels of blood glucose. Objectives This study aimed to investigate the relationship between sleep quality and blood lipid composition in patients with diabetes referring to Minoodar health center in Qazvin, Iran in 2017. Methods Sleep duration and quality were assessed in 347 patients with diabetes using the Pittsburgh sleep quality index (PSQI). The glycosylated hemoglobin A1c (HbA1c) test was used to measure the glycemic control and total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were used to determine blood lipid composition of the patients. Multiple regression analyses were applied to examine the associations between sleep measures and HbA1c and lipid parameters using SPSS version 20. Results The patients in the poor sleep quality group had higher levels of fasting blood sugar (FBS) (146.07 ± 57.06 versus 132.8 ± 53.3 mg/dL, P = 0.02), body mass index (BMI) (29.1 ± 3.9 versus 27.6 ± 4.2 kg/m2, P = 0.005) and total cholesterol (209.9 ± 53.4 versus 193.4 ± 45.8, P = 0.02). Furthermore, the patients with short sleep duration had higher total cholesterol level compared with long sleep and medium sleep duration group (202.3 ± 50.2 versus 196.6 ± 47.7 and 195.7 ± 47.4, respectively, P = 0.05). Among different PSQI measures, subjective sleep quality was associated with lower TC and TG in unadjusted models (β = -0.0.1, P = 0.05). Furthermore, greater sleep disturbance was positively linked with higher levels of TC and TG (β = 0.1, P = 0.01 and β = 0.02, P = 0.05). Conclusions In an Iranian population with diabetes living in Qazvin city, sleep disorder is common and as study findings revealed sleep quality was recognized as an influencing factor on some of the lipid profiles, including TC and TG. Thus sleep assessment of patients with type 2 diabetes to find the early recognition of their sleep disorder should be considered an important part of the patients' treatment.

Background: Self-medication is a serious danger in every health sector which potentially brings harmful side effects for the society. The aim of this research was to investigate self-medication and its contributing factors among residents of Yazd province in Iran in 2014. Methods: A descriptive, cross sectional study was conducted in 2014 using a self-constructed questionnaire. A total of 580 families living in Yazd in the time period of study were contributed to fill out the questions organized in two sections of demographic and self-medication factors. Data were analyzed by SPSS software version 16 through appropriate descriptive and analytical statistical tests. Results: Self-medication was reported in 53.4% of the cases. The most frequent self-prescribed medications were related to pain killer drugs (26.6%). There was a significant statistical relation between self-medication and households’ age, occupation and income, level of parents’ education, number of children and place of residence. Among different reasons for self-medication the most important one was reported to be accessibility (3.44+1.3). Conclusion: Due to the considerable prevalence of self-medication and its harmful effects on every society, such an issue should be appropriately controlled through legal regulations particularly in the area of selling dangerous drugs. Furthermore, provision of proper information and warning the population about harmful side effects can be helpful in this regard.

ObjectivesHospitals as integrated parts of the wide-ranging health care systems have dominant focus on health care provision to meet, maintain and promote people's health needs of a community. This study aimed to assess the service quality of teaching hospitals of Yazd University of Medical Sciences using Fuzzy Analytical Hierarchy Process (FAHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS).MethodsA literature review and a qualitative method were used to obtain experts' viewpoints about the quality dimensions of hospital services to design a questionnaire. Then, using a self-made questionnaire, perceptions of 300 patients about the quality of delivered services were gathered. Finally, FAHP was applied to weigh each quality dimension and TOPSIS method to rank hospital wards.ResultsSix dimensions including responsiveness, assurance, security, tangibles, health communication and Patient orientation were identified as affecting aspects of hospital services quality among which, security and tangibles got the highest and lowest importance respectively (0.25406, 0.06883). Findings also revealed that in hospital A, orthopedics and ophthalmology wards obtained the highest score in terms of quality while cardiology department got the lowest ranking (0.954, 0.323). In hospital B, the highest and the lowest ranking was belonged to cardiology and surgical wards (0.895, 0.00) while in hospital C, surgical units were rated higher than internal wards (0.959, 0.851).ConclusionFindings emphasized that the security dimension got the lowest ranking among SERVQUAL facets in studied hospitals. This requires hospital executives to pay special attention to the issue of patients’ security and plan effectively for its promotion.

BACKGROUND: Decreasing hospitalization as a result of chronic obstructive pulmonary disease (COPD) exacerbations is a major objective in an effective process of the disease management. This study aimed to investigate the association between physical activity level in COPD patients, and specific-cause hospitalization in a prospective study of patients referred to a pulmonologist office in Qazvin, Iran. MATERIALS AND METHODS: A prospective study was conducted among 150 patients with COPD from the population of Qazvin, a North West, industrialized city of Iran, from December 2017 to December 2018. Participants were enrolled among patients who referred to an outpatient respiratory care center to undertake respiratory function tests. Patients were followed up for 1 year and their related measures were gathered and recorded at two phases including baseline and 12 months. To assess the effect of several covariates on the response variable, a multivariate regression analysis was applied. Results were reported in the form of odds ratios, incident rate ratio (IRR), and their 95% confidence intervals (CIs). RESULTS: The study findings revealed that individuals with severe pulmonary obstruction (

Purpose Failure modes and effects analysis (FMEA) is a practical tool to evaluate risks, discover failures in a proactive manner and propose corrective actions to reduce or eliminate potential risks. The purpose of this paper is to apply FMEA technique to examine the hazards associated with the process of service delivery in intensive care unit (ICU) of a tertiary hospital in Yazd, Iran. Design/methodology/approach This was a before-after study conducted between March 2013 and December 2014. By forming a FMEA team, all potential hazards associated with ICU services – their frequency and severity – were identified. Then risk priority number was calculated for each activity as an indicator representing high priority areas that need special attention and resource allocation. Findings Eight failure modes with highest priority scores including endotracheal tube defect, wrong placement of endotracheal tube, EVD interface, aspiration failure during suctioning, chest tube failure, tissue injury and deep vein thrombosis were selected for improvement. Findings affirmed that improvement strategies were generally satisfying and significantly decreased total failures. Practical implications Application of FMEA in ICUs proved to be effective in proactively decreasing the risk of failures and corrected the control measures up to acceptable levels in all eight areas of function. Originality/value Using a prospective risk assessment approach, such as FMEA, could be beneficial in dealing with potential failures through proposing preventive actions in a proactive manner. The method could be used as a tool for healthcare continuous quality improvement so that the method identifies both systemic and human errors, and offers practical advice to deal effectively with them.