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سال پانزدهم شماره 2 (تابستان 1395)

◦: Improper distribution of medical care in developing countries creates access inequality to these services in cities. The purpose of this study was to investigate inequalities in access to medical facilities in the metropolitan Kermanshah.
Materials The method of this applied study was descriptive – analytical. Due to the spatiotemporal nature of the research, geographic information systems (GIS) were used. Research data included hospital addresses and demographic data from statistical blocks of Kermanshah based on Iran’s 2011 census report. Using the neighborhood and overlap analysis in Arc/GIS software, the numbers of population/ households that had or had not access to medical centers were calculated. Also, the allocation of hospital beds for the population was evaluated.
•: In total, Kermanshah city has 13 hospitals with 2342 bed till 2014 that most of beds were in general hospitals. The statistics showed that the existing hospitals cover only 48.51% of population and 51.49% of households have no standard access. The number of existing hospitals cannot response to the citizen's needs. The ratio of hospital beds to population was 2.35.
•: What can be inferred from the results is that all residents have not equal access to medical care and also distribution of hospital centers was not proportionate with households and population distribution. There is injustice in access to medical facilities of Kermanshah city.

Since, energy consumption per square meter in hospitals is much higher than that of other types of service institutions, in this study, effort was made to define and prioritize energy consumption improvement projects in hospitals in order to take measures and optimize its.
The necessity of optimizing energy consumption in hospitals according to some scales including the average consumption and cost of water, electricity and gas for bed days and active bed were described, and calculated in the case. Then, improvement actions were identified using energy audit, interviews with hospital experts and conducted studies in hospitals. Also, projects with high importance were extracted regarding to impact on energy consumption indexes, expert opinion, aggregation, feasibility, and limitations such as prerequisite, synchronicity and post-requisite. Finally, specific criteria were identified in three dimensions, i.e., factors affecting the level of energy consumption, trying to execute project and risk and the projects were prioritized using questionnaire and FAHP.
The results showed that energy consumption in the studied hospital was higher than the world standards, this confirmed the necessity of optimizing energy consumption and using energy management systems. The results of prioritization also showed the first four priorities.
It seem necessary to use methods for saving energy consumption through the implementation of improvement projects in the hospitals. As the large number of such projects, as well as limited financial and capital resources, proposed method can be used by hospitals to select improvement projects with low risk and payback period.

Nowadays, Patient Safety is considered as a fundamental concept of the healthcare system. Hence, recognizing the effective factors such as: illegible orders, dosage errors, and drug usage can contribute to reducing the serious side effects leading to the patient's disability, prolonged hospitalization, and even death.
as a descriptive-analytical study, this research was cross-sectionally conducted with a sample of 1800 inpatient records in a teaching hospital during one year. The primary physician orders were examined through a self-managed checklist, including the items, such as: physicians’ ID and workshifts, and variables of legibility and recorded dosage. Data were processed via SPSS, regarding the descriptive statistics (like: frequency, …) and analytical statistics (like: chi-square, …).
of 1800 inpatient's records, 66.3% recorded by male, 17.6% records were illegible, 3.2% without stamping, 8.2% without signing, 11.9% without time, 4.9% without dating, 23% were not coherence and logical sequence 69.5% had not indicated to the 7 primary items, 17.8% without medicine dosage, 21.8% without pharmaceutical forms, 11.5% without usage time, 25.9% without usage method, 14.3% had scribbles and 13% lacked numbering also there were relation between demographic variables and medical recording errors .
it seems necessary for the physicians to try to improve the documentation of the patient records, such as: educating the newly arrived resident, considering commendatory techniques, and evaluating the records periodically.

Today, hospitals are facing with shortage of resources and increasing costs challenge. So cost informations and cost calculation of hospital services can be effective in the efficient allocation of resources and budget and tariff rates reforming. The purpose of this study is calculating the cost of services and incom of physiotherapy department of Sina hospital and comparison them with approved tariffs in 2013-2014.
This was a descriptive retrospective study. Data collection tool was forms related to costs of physiotherapy services and another related activity centers in 2013-2014.
Comparison of costs and revenues of physiotherapy unit revealed that this unit has been profitable segment for hospital. The costs of 13 provided services was less than tariffs. From total attributed costs to physiotherapy unit, workforce costs and depreciation of buildings and equipment costs had largest portions.
There are differences between real cost of services and approved tariffs in this study, that this difference showed itself in the form of financial profit, but with considering that this hospital is governmental, that is better tariff rate be closer to the real costs. Due to the high share of personnel and capital costs, pay special attention to these resources and their appropriate use and identifying and deletion the wasted costs can be effective in increasing efficiency and saving costs.

Intravascular imaging is the tool for the detection of coronary artery atherosclerosis in the coronary intervention procedure as the supplement of invasive angiography plays the major role in determining the degree of vessel stenosis and plaque pathology.
For retrieving second type studies, the Cochrane Library and Centre for Review and Dissemination (CRD) were searched. Studies which compared intravascular ultrasound technology with invasive angiography were included. Results of included studies were synthesized via qualitative method.
According to included studies the rate of target lesion revascularization after one year of follow-up, reported a statistically significant difference between intravascular ultrasound and angiography invasive alone, it seems that the rate of TLR was lower with intravascular ultrasound (P = 0/02). In terms of cost effectiveness, per prevented TLR, 0.48 QALY was obtained, which indicates a savings of 54, 000 US dollars per QALY.
Although intravascular ultrasound could be able to detect the damages of coronary arteries and will be aided physician in selecting the most appropriate treatment, but due to the high cost of an ultrasound catheter intravascular, the invasive angiography, coronary intervention is the choice of doctors and disease. It is suggested according to the cost savings per obtained QALY from prevented TLR, the use of intravascular ultrasound in coronary interventions, at least for the younger age group should be considered.

Nosocomial infections due to mortality and economic cost, are one of the causes of mortality in hospitalized patients. Gram-negative bacilli infections acquired in hospitals and hospital environment is one of the most important places of residence and publication of this type of bacteria. This study aimed to investigate the prevalence of gram-negative bacilli from the equipment of hospital in West of Golestan, 2015.
Methods and Materials: This Descriptive study was carried out on 1210 devices and equipments used in various wards of 7 teaching hospitals of Golestan province. Identification of the isolated colonies were based on biochemical standard tests.
352 positive microbial cultures (29.1%) were for the presence of gram-negative bacilli. The highest bacterial contamination is related to Enterobacter (10.7%). The among different hospital wards highest bacterial contamination is related to ICU (19.32%). The equipment under test, the highest contamination is related to laryngoscope blades (10.51%), phone (7.1%) and ECG sensor device and the monitoring interface (6.25%).
The findings of this research showed that microbial contamination with gram-negative bacilli of hospitals equipment is high in West of Golestan. Periodic assessments can be effective in the prevention of nosocomial infections.

The organizational learning in different theories and models in theoretical and practical dimensions has been influenced in organizations development. Learning provide good context for changing and development. Organizational learning capacity could be create good context for implementing clinical governance.
The kind of research was descriptive- Analitical and cross-sectional that it studied in during the first six month of 93 year. The statistical population was employees of Social Security hospital of Ardabil and samples was selected through method of random sampling that it was 170 samples. Tools were included: standard questionnaire of Gumeje et. al. for examining of organizational learning capacity in 4 dimensions and 4 questions for every dimension and questionnaire for clinical governance was questions 35, it was 7 questions for every dimension. Pierson correlation and enter regression analysis were used in order to analysis of data. Data is analyzed by SPSS18 software.
The result showed that the components organizational learning capacity has positive and significant effect on the implementation of clinical governance(R= 0/507) and it determine 0/44 of changes in clinical governance. Among the components of organizational learning capacity, management commitment with 0/644, and systematic approach with 0/498, open climate 0/446 and knowledge transfer with 0/261 have effected on implementing clinical governance.
According to main role of organizational learning on implementing clinical governance are suggested components of organizational learning especially management commitment and systematic approach develop for implementing its in hospital.

With attention to importance of the best transfer of practice, team learning, and process change, the clinical laboratories employees should be familiar with organizational learning. This research was aimed to assess and determine the capability of organizational learning among the clinical laboratories employees of Tehran University of Medical Sciences hospitals.
This study was a descriptive-analytical and cross-sectional research that induced among 85 employees of clinical laboratories of 5 hospitals with sampling by Cochran formula of general-teaching hospitals of Tehran University of Medical Sciences. The research tool was Gomez et al. questionnaire consisted of 4 sections and 17 questions. Likert scale was used for ranking of the questions. The data was analyzed using SPSS, T- test, Pearson and Welch method.
Findings: The average score of organizational learning among the employees of studied clinical laboratories was 3.11 which showed relative desirable situation. Also, management commitment as an element of organizational learning had significant difference among the clinical laboratories(p=0.002). Moreover, a significant correlation was found between employees, degree with knowledge transfer and integration capability(p=0.04).
The capability of organizational learning of the studied clinical laboratories is not desirable. Therefore, establishment of patient safety system, prevention and prediction of making errors by initiation of error registration system, efficient utilization of previous experience and events, using of opportunities, and promotion of the employees to report the errors are suggested by the researchers for improvement of organizational learning in these laboratories.

Today, due to the diversity of organizational structure and culture, the diversity in crisis management is the basic principle of crisis management. Crisis management consists of six components of flexibility, inclusion, trust, risk perception, adaptability and equity. This study aimed to investigate the perception of diversity in crisis management among hospital managers affiliated to Tehran and Iran University of Medical Sciences.
This study was a descriptive cross-sectional study. A questionnaire was used to collect the data with five likert scale. Validity of the questionnaire was tested by some experts and for reliability Cronbach's alpha coefficient was used. Spss software was used to analyze the data using the ANOVA, one sample t-test.
Findings: The highest level of perception of managers was regarded to inclusion and equity with the mean and SD of 3.19 ± .51 and the lowest level was adaptability with mean and S.D 2.73 ± 75. There was a statistically significant difference between the variables of sex job and position with different crisis management variables. The highest level of importance was regarded to inclusion and trust among the personnel and the lowest level is related to flexibility.
Employees working in different positions have different definitions of adaptability in crisis. It is necessary to perform further research and educate hospital manager’s duties.

Medical centers and hospitals need to expand internet and Application Service Providing (ASP) and to convert that in to a competitive, long-lasting choice. The present study was carried out with the aim of determining the relationship between the quality of service providing software systems and customer satisfaction in selected hospitals of Tehran University of Medical Sciences using similar hospital information systems.
This research is a correlation, descriptive analysis. The statistical group includes employees in the hospital revenue and clearance unit and the study was carried out through census and using Kim et al questionnaire. To analyze the data, descriptive statistics such as : frequency distribution percentage and average, inferential statistics like KS and Pearson tests were used.
There is a significant positive correlation between all the variable quality of aplication system provider and users satisfaction, that The severity of age include:system quality (r = 0.734 , P = 0.01 ) , service quality( r=0.721 , P = 0.01) and information quality(r = 0/521 , P = 0.01).So that is the more significant impact on the quality of the system, consent of the users.
there is a significant relationship Between the quality of Application Service Providing (ASP)with the Satisfaction of users in selected hospitals of Tehran University of medical sciences Although all variables have positive and meaningful relationship with user satisfaction, their average is less than moderate limit. so the health managers are advised to consider these issues in their management methods.

Partnership between public and private sectors is cooperation between organizations in these two sectors with common goal and elimination of restrictions. Governmental forces have an important role for public health policy framing and applying special programs for any country which are based on studies and preliminary interviews. In recent years the costs of health care services in developed and developing countries has grown exponentially. Public sector in all over the world are looking for alternative mechanisms for cost reduction. On the other hand an increase in capacity of social programs require a great amount of investment in infrastructures. Some of power centers began to use public- private partnership as a tool for reaching these goals. Generally the success of public- private partnership projects is estimated based on qualitative results of project like value for money analysis. This article studies the experience of applying different kinds of this model. Although its implementation experience is limited and there is no clear evaluation about it but four criteria of cost. Quality, flexibility and complexity is available in this model which should be investigated more carefully.