مجله بیمارستان
سال چهاردهم شماره 2 (تابستان 1394)

In the process of telemedicine, the use of digital techniques for the diagnosis of diseases has made physicians to use ring resources and high bandwidth in data transfer for archiving and storing patient information. The aim of this paper is to introduce an efficient way of multi-stage compression of mammographic image data based LM algorithm and artificial neural networks. First, the data derived from mammographic images are given to multi-layer neural network and the proposed structure allows the sample images to be formed with the minimum damage and the degree of compaction in the first layer. The compression process of the mammography images was implemented using images of 128 women aged 46.41±6.55 with a BMI of 36.78 ±5.5 collected from three specialized clinics in Sabzevar. The analysis yielded a mean square error (MSE) of 4.24 with the highest difference ratio of 33.46 and compression ratio of 8: 1in the output of the algorithm. The system performance was acceptable based on the accurate design of the software, and therefore it demonstrated high efficiency in practice. Given the reliability of software output in the compression and release and the fact that mammographic images are not completely degraded during compression, the diagnosis in the discovery stage is highly consistent with the diagnosis in the reality. Therefore, this system has the capacity to be implemented in hospitals for archiving mammography images and its application is justifiable.

Effective hand hygiene can reduce health care infections. The prevalence of poor hand hygiene compliance will lead to increase morbidity and mortality and costs.

the aim of this paper was assessment of hand hygiene process of nurses by clinical audit methods in a selected public hospital in Tabriz.

the type of study was interventional by using clinical audit that was conducted for 7 months in surgery, internal, children and women units in a selected public hospital in Tabriz in 1392-1393.. Study was conducted in two phases: pre-intervention and post- intervention. The target sample was nurses on all shifts (morning, evening, night). Methods and tools of study were monitoring performance checklist and hand washing observation.checklist was developed by WHO guideline and nation guideline.

the total number of opportunity of pre-intervention was 252 that it increased to 336 opportunities by the implementation of interventions. The overall rate of compliance with the hand hygiene standards in pre-intervention was 59.94%and after the implementation of interventions improved to 80.56%.

this study shows that promotion and training programs have important role to improving hand hygiene standards.

Because nurses are the largest group of health care providers and emergency department is known as a high risk ward in terms of occupational injuries this study aimed to identify occupational nursing hazards in the emergency department in training hospitals affiliated to Tehran University of Medical Sciences. The study conducted on 250 emergency department’s nursing cadre of hospitals affiliated to Tehran University of Medical Sciences. Subjects were selected by Simple random sampling method. Data collection process was accomplished through questionnaire that its reliability and validity were confirmed. Data analysis was done using the descriptive snd analytic statistics. The level of occupational injuries (2.87 ± 0.55) was average. Based on the result, Psychosocial and institutional (3.58 ± 0.47) and Ergonomic (3.57 ± 0.71) hazards were the most prevalent occupational hazards respectively. Also chemical hazards were the least important source of occupational injury among emergency nursing cadre. There was a statistical significant relationship between occupational injuries and variables of hospital, years in practice, education, type of employment and training courses in occupational hazards (P<0.05). Nurses faced various risk factors in different domains in terms of occupational injuries. In order to eliminate these risk factors need to be running in different domains. Applying ergonomic approach, developing appropriate educational programs, providing adequate training in this area, and else can result in reduce of occupational injuries and increase their productivity.

The goal of clinical risk management is to improve the quality of health care organization’s services and to ensure the safety of their patients. In this way, this research has identified and evaluated the potential failures of an Intensive Care Unit (ICU) in one of Tehran hospital by Failure Mode and Effects Analysis (FMEA) approach to eliminate its errors. This research is a descriptive one in which data were gathered qualitatively by direct observation, document review, and Focus Group Discussion (FGD) with the process owners in an Intensive Care Units (ICU)s of one of Tehran non-governmental hospital in 2014. According to a FMEA method, data analysis was quantitative based on failures’ Risk Priority Number (RPN). By FMEA, 378 potential failure modes in 180 ICU tasks were identified and evaluated. Then with 90% reliability, totally 18 failure modes with RPN≥100 are identified and analyzed as a non-acceptable risks. Identifying 18 failures as not accepted risk from identified 378s, and identifying causes, analyzing and then suggesting correction actions shows the FMEA high capability to identify, evaluate, prioritize and analyze potential failure modes in a such complex and critical hospital ward, ICU.

One of the duties of family physician is to form health records and recording the provided services. The present study was conducted to evaluate health records in family physician program in Northern Province of Iran. This cross-sectional study was carried out in 2011. 139 of centers implementing family physician program in three provinces of Golestan, Mazandaran and Gilan were selected through systematic random sampling as the study samples, and recording the performance of all family physicians was evaluated. For data collection, a researcher-made questionnaire was used, the validity and reliability of which were confirmed. Data were analyzed by SPSS18 at p<0.05 as the significant level. Out of the 189 family physicians studied, the profile of patients referred to the second level and the associated results were recorded in referral record forms completely by 43 physicians. Out of 1890 families studied, 1559 were reported with health records, among which 892 were filled out completely. Out of 5869 families studied, 4229 patients were examined at least once by their family physician during the periodic examination; 1919, patients were found with complete records respectively. There was a significant difference between rates record of referral to a specialist registered in the Northern Province of Iran (P=0.001). The quality and quantity of health record formation as well as the records of services provided have not been according to the expectations and appropriate interventions are therefore needed in this regard.

Abstract Food and nutrition section is one of the most important parts of hospital for improving the patient's health and satisfaction. Having no relevant standards causes nosocomial infections and develop health risks. With implementation of HACCP standards, many shortcomings will decrease in the nutrition section of hospital. The aim of this study was to determine the nutritional mentioned system standards at studied hospitals. This cross - sectional study was conducted at Kermanshah University of Medical Science's teaching hospitals in 2013. Tool that used was HACCP questionnaire; for Data collecting from hospital's nutrition section, observation, interviews and questionnaire filling were used. The mean score and percentage for five areas of HACCP standards in seven studied hospitals were 3/58 and 70/23%, which were desirable. There were no significant statistical relationships between the mean scores of hospitals. Although the situation was assessed desirable, the potential infections will be prevented and patients and staff's satisfaction will be obtained.by standards observance and improving the quality of food in cooking and distribution.

Depression is a common disorder in patients treated with hemodialysis,that has increasing. relevance of this study evaluate Correlation between social support and depression in patients undergoing hemodialysis of Kerman This cross - sectional study of all patients on hemodialysis was performed in 1392 in Kerman. Samples was 182 patients. Data were collected through questionnaire 1 - Demographic characteristics, 2 - Standard Questionnaire Beck's Depression Inventory (BDI) and 3 - ESSI social support questionnaires. Using descriptive statistics (mean and SD) and Pearson correlation coefficient were analyzed in SPSS software. 68.1% of the subjects had some degree of depression. 83% of people also had good social support. In examining the relationship between depression and social support, the test was done, it was clear that there was a significant association between depression and social support (P =0.005) so that increasing social support, depression decreases. The results showed that the high prevalence of depression in these patients. Appears in the dialysis patients, special attention should be paid to psychosocial problems. Nurses can also to prevent depression in these patients white identify individuals at increased risk of social support.

Approximately, more than 60% of the hospital cost allocate to hospital human resources. The study aimed to examination the number of nurses in the poisoning ward in a general hospital in Shiraz. This applicable study was conducted as a descriptive-analytical study. Study population was the patients who referred to a hospital poisoning ward in Shiraz in 2012. The medical records were examined. Each month selected as a stratum and in each stratum samples selected through a simple random sampling. Data collected from the statistics office and patient records (physician's orders and nursing notes) using a data collection form. Linear programming techniques in lingo (version 8) software were used to the data analysis. Two nurses in morning, two in evening, three in night and seven in all shifts were at least required nurses in the poisoning ward of the general hospital. The number of available nurses in the ward was more than estimation. The nurses in the morning and evening shifts were over the examined number in the ward. Moreover, the nurses obtained from quantitative methods such as linear programming were lower than those calculated experimentally by nursing managers. It is recommended to Hospital administrators to use these techniques to the appropriate distribution of staff in wards.

The hospital is one of the most important institutions in the modern health care system and the most important functions of the Organization is accountability. Accountability is a driving force that brings pushing up the main factors that Accountable for their performance. The aim of this study was to Situation Analysis of Performance Accountability in Hospitals at Tehran University of Medical Sciences. This cross-sectional analytic study was performed in 12 hospitals at Tehran University of Medical Sciences. The data were collected via the performance accountability checklist. The analysis was carried out with the SPSS 19 software and Statistical methods used are descriptive and analytical statistics(Pearson correlation). In general, the condition of performance accountability of hospitals was "good". The strategic planning variables had the highest mean (1.85±0.21) and Stakeholder Participation had the lowest mean (1.12±0.46). there was a positive significant correlation Between all variables (except Motivational) with performance accountability. Weakness in any part of the performance can affect other parts and have the negative impact on the total performance of hospital. with regard to The current situation of the performance accountability of hospitals and the importance it, to address deficiencies the accountability performance must be given top priority of managers.

Hospitals are best places to provide prevention and health promotion services along with healthcare services. This study aims to determine the effect of health promoting hospitals’ standards on hospitals indicators in Fatemieh hospital, Shahroud, Iran. This is a comparative study and was conducted in Fatemieh (case) and Khatamolanbia (control) hospitals in 1392. The standards of health promoting hospitals as an independent variable were established in Fatemieh hospital. Data related to indicators of leaving hospital with personal satisfaction, Cardiopulmonary Resuscitation (CPR) and neonatal mortality were collected in both hospitals in second half of 1391 and first half of 1392. Data analysis was performed by Chi-square and Fisher tests. To analyze the data SPSS version 16 was used. Finally, the results were displayed as comparative tables. The neonatal mortality rate in case hospital before and after the intervention was 7.28 and 14.03, while this rate in control hospital was respectively 5.26 and 10.83. The percentage of leaving hospital with personal satisfaction in case hospital before and after interventions was respectively 3.43% and 2.93% and success of cardiopulmonary resuscitation in this group was respectively 56.1% and 61.3%. There was no significant relation between establishment of standards of health promoting hospitals and indicators of leaving hospital with the personal satisfaction and neonatal mortality in Fatemieh hospital, while the significant relationship was observed between the success of cardiopulmonary resuscitation and the standards of health promoting hospital in this hospital(P=0/001). Initial results show that establishment of health promoting hospitals’ standards in Fatemieh hospital have positive effects and leading to improvements of a number of indicators.

One of the most important factors that move every organization being to achieve goals is job motivation of staff. Thus, a main task of an organization managments is to pay attention to the Factors influencing the motivating employees. So this study aimed to The Examination Relationship organization climbt and job content with job motivation in Isfahan city hospital.

the method is descriptive – correlation. The statistical population was consisted Hospital staff in Isfahan. Sample size was estimated to 141. In order to collect the data, the questionnaires of organization climate, job content, job motivation. For analyzing the data, Pearson correlation coefficient and regression, Anova, LSD, methods were applied.

the result showed between organizational climate and job motivation (0/42) and the job content and job motivation (0/36) and a significant positive correlation relationship the level of P≤ 0/01. The organizational climate (0/18) and the job (0/18) determine the variance of job motivation. ANOVA test showed that there were significant differences in job motivation by type of employment.

With regard to the impact of organizational climate and the job content in job motivation, Managers should pay attention to these two factors.

Patient safety is one of important indicators in quality control of health services and Medical errors, especially medication errors are the most common causes of the safety-threatening, therefore this study was conducted to assess the rate and type of nurses medication errors. This study was Descriptive – analytical and sectional that carried in a private hospital in Mashhad. In this study population census was used and the entire population was considered as the sample. A researcher – made questionnaire was used for data collection. The validity and reliability of the questionnaire were confirmed. The collected data were analyzed using descriptive statistics and T-TEST and ANOVA in SPSS, version 15. Three errors, giving medication to the patient without physician prescription, no attention to complications due to medication errors and giving medication sooner or later, Respectively with The highest frequency and giving Past the expiration date of the medication to the patient, Giving the wrong medication to a patient and not giving prescribed medication to patient Respectively with The lowest frequency are Among medication errors. the nursing managers must to reduce medication errors more attention to raises holding in service classes for nurses, reform of nurses processes and their attitudes promotion towards the importance of patient safety.

The evaluation of medical tourism center service quality in Tehran city by using fuzzy SERVQUAL approach Abstract in the recent decades Medical Tourism Industry because of its benefits such as high profits, creating more jobs and other profits has received a massive attention by local countries. High qualities of medical services in medical centers of destination countries are one of the most important factors of spreading and developing this industry. So, in regard to this subject, in this research I will focus on the quality of services provided by Medical Tourism Centers where providing medical aids to the foreign patients in city of Tehran. In this research which is functional in term of purpose and surveying descriptive in term of essence; we will analyze the quality of services provided by Medical Tourism Centers in city of Tehran by taking poll from 154 foreign tourists who had been hospitalized in 10 selected hospitals from the March to the April of 2014. With regard to the problems caused by ambiguity and complication in term of conceptualizing and giving weight to the items and dimensions, Graded Integration method and terms of fuzzy set are used in this research. Except doctors and professional medical staffs, negative gap and dissatisfaction were observed in all cases in p≤. /05 extent. In regard to the almost ideal condition of doctors and professional medical staffs and modern medical facilities and equipment, appropriate medical costs with services as the main factors of developments of Medical Tourism Industry, it is possible to increase Iran’s bazar portion of Medical Tourism Industry. Keywords: Medical tourism, Service quality, Seroquel model, Fuzzy set theory, Graded mean integration method. Keywords:

Knowledge management plays an important role in the success of organizations. Many factors like organizational culture affected on knowledge management. So, the aim of the study is to investigate the relationship between organizational culture and its dimension with knowledge management.

Cross-sectional descriptive analytical study was conducted in 2013. Study samples were 322 employees of 3 hospitals related to the Zahedan University of Medical Sciences who were selected through stratified-randomized sampling method. The data were collected by standard questionnaire of organizational culture and researcher made questionnaire of knowledge management and analyzed descriptively inferentially using SPSS version 18.

Test results of this study indicate that there is a positive and significant relationship between organizational culture and knowledge management. Other objectives of the test results indicate that among Components of organizational culture (clan, market, adhocracy) and knowledge management, there is a significant positive relationship and also, there is a negative and significant relationship between organizational bureaucratic culture and knowledge management.

Organizational culture is one of the main tools of a successful implementation of knowledge management in organizations. Changes in the organizational culture in order to establish knowledge management in educational- medical hospitals related to the University of Health and medical sciences of ZAHEDAN should be such That organizational tribe culture and organizational adhocracy culture to be considered in relation to other cultures.