مجله علوم پزشکی صدرا
سال ششم شماره 3 (تابستان 1397)

The concept of lean management refers to the elimination of waste and creation of value in an organization. The aim of this study was to determine the effect of lean management on improving surgery ward processes in a private hospital in Tehran.

In this case study, the level of patients’ consent and their voluntary discharge both before and after the intervention were investigated. Spaghetti chart methods were used to implement lean management. All clinical, administrative, and paraclinical wards of a private general hospital in Tehran from January 2014 to July 2016 were studied. The data were collected using patients’ consent analysis questionnaires and researcher developed forms, and they were analyzed through descriptive statistics in Excel software.

The use of Spaghetti chart reduced the path in the process of discharging male patients was by 55%, 224 meter (from 408 to 184 m), and female patients by 41%, 224 m (from 546 to 321 m). The implemented interventions included the transfer of the Insurance Unit from the third floor to the ground floor and the transfer of the Discharge Unit from the first floor to the ground floor. The implementation of interventions reduced the frequency of voluntary discharge by 0.8% (from 6.8% to 6%), and it increased patients’ overall satisfaction by 8%.

Lean management in the hospital leads to the elimination of waste from the process of service delivery and the flow of activities performed. It is necessary to study the hospitals status quo, draw a picture of the forthcoming goals, determine the future status of the lean hospital management, and consequently, draw a map to move towards the lean hospital.

The periodic revision of school curriculum in different courses in every scientific discipline is one of the basic principles of the training process and it improves the quality of education. Therefore, this study aimed to investigate the level of correspondence between the basic and specialized courses of Public Health undergraduate program and job requirements. This cross-sectional study was performed on 66 Public Healthinterns/apprentices at Lorestan University of Medical Sciences in 2016. The Sampling was the census. The data
collection instrument was a questionnaire whose validity and reliability have been confirmed in previous studies. The data were analyzed using STATA software and descriptive and analytical statistics. The results showed that the use of specialized and basic courses of Public Health in doing job duties was high and medium respectively. According to the interns, the most practical specialized course was Mother and Child Health and the least practical course was Occupational Health. According to these interns/apprentices, more than 60 % of basic courses and more than 40% of specialized courses offered changed their knowledge and not their attitude and behavior. In both continuous and discontinuous interns/apprentices groups the satisfaction rate of their field of study was average and there was no significant difference between the two groups. According to the interns/apprentices, the correspondence between the curriculum of Public Health undergraduate program and job requirements was average Therefore, it is recommended that the number of active and passive immunization courses be increased. It is also suggested that one internship semester be offered in their education program.

The increase in morbidity and mortality rates owing to traffic accidents has become a major global concern. The use of epidemiological information pertinent to traffic accidents has a key role in prevention programs; therefore, the current study was done to determine the epidemiological characteristics of victims of traffic accidents who referred to Khatam Al Anbia Hospital in Zahedan. In this descriptive cross-sectional study, out of 466 traffic accident victims who referred to Khatam Al Anbia Hospital in Zahedan, a sample of 210 people were selected randomly. Data were collected with a checklist that included 4 sections: demographic information, accident, clinical features, and discharge information of injured patients. Data extraction and checklist completion were done by going to the hospital and studying the patients’ records. SPSS software version 16 was used for data analysis. According to results of the research, 82.9% of victims were male, 61% single, and 35.2% were in the age group of 16-25 years old. 35.2% were motorcyclists and most of the injuries (34.8%) were fractures. The body organs mostly affected by injury were head and neck (40.5%). Surgical procedures were performed for most victims (42.4%). 3.5% of victims died. The findings showed that male, single, and young people were more involved in traffic accidents than other groups. Therefore, the adoption of community-based prevention programs is one of the important recommendations of this study. In this regard, the use of media and schools to institutionalize the culture of driving and traffic can be highlighted.

One of the major problems that human societies are struggling with in the past few decades due to the gradual growth of modern life is the stress phenomenon. This phenomenon has become especially important and, by being globalized, it has increasingly affected the health of the workforce. Therefore, the purpose of this study was to analyze the effect of organizational changes on occupational stress among nurses considering the moderator role of trust in head nurses. With regard to the aim of the study, this study is practical and regarding data collection it is a preliminary study and a branch of field studies which was done cross-sectional at eight Tehran University teaching hospitals in 2017. The statistical population of the study was all the nurses working in the teaching hospitals of Tehran University of Medical Sciences (16 hospitals). 215 out of 230 nurses were selected by multi-stage cluster sampling method. The data collection tool was March Organizational Change Questionnaire (1981), Helicel and Slackome Job Stress Questionnaire (2010), and McCaffrey's Surveillance Trust Questionnaire (2010) whose validity and reliability were confirmed. In data analysis, Pearson Correlation test was used to examine the relationship between variables, structural equation modeling and Bootstrap test were used to measure the fit of the research model and hypotheses test using SPSS 22 and Amos22 software was used. The results showed that the research model has a good fit. If the trust in the head nurse is low, an organizational change with a coefficient of -0.60 at a 95% confidence level affects the nurses’ job stress, and if the trust in the head nurse is high, the effect of organizational change on nurses' job stress in the 95% confidence level is 0.77. Stress can, to a certain extent, have a positive impact on the performance of the individual in an organization, and if it exceeds a certain limit, it has a negative effect on the individual's performance in an organization. Therefore, in general, stress through trust leads to an organizational change.

Caregivers of stroke patients may be at risk of psychological problems. The aim of this study was to determine the prevalence of depression, anxiety, and stress among caregivers of patients with stroke. This was a descriptive and cross-sectional study. One hundred and twenty two caregivers of stroke patients who referred to Payambar Aazam Hospital in Bandar Abbas participated in this study. Convenience sampling was used. The Depression, Anxiety and Stress Scales (DASS-21) were used for data collection. The data were analyzed using Chi-square and ANOVA tests. Sixty eight percent of stroke patients’ caregivers suffered from mild to extremely severe depression. Approximately, two-third and half of the stroke patients’ caregivers experienced mild to extremely severe anxiety and stress, respectively. The results of the study showed that there was a significant statistical relationship between depression level and caregivers’ gender (2=11.15, p=0.01) and caregivers’ age (F=3.30, p=0.02). In addition, an association was observed between the caregivers’ level of anxiety and the patients’ gender (2=12.04, p=0.007) and age (F=5.93, p=0.001). The findings of this study indicated that there was a high percentage of depression and anxiety among the caregivers of stroke patients. In addition, half of the caregivers experienced stress. Since, male and younger caregivers experienced more depression, attention to this group is crucial. Moreover, the intensity of anxiety was higher in younger caregivers and those who were caring for male patients, so making interventions for this group is recommended.

Recently, one of the biggest achievements of public health programs around the world has been the decline in tobacco use. The purpose of this study was to determine the impact of economic, social and demographic factors affecting smoking in Iran. The current research was applied-descriptive. This study was conducted for 114826 Iranian households from 2007 to 2015, and the statistical information required by Stata13 software was extracted from raw data of household expenses and income in the Iranian Statistics Center. In this study, the double hurdle approach was used to distinguish between unwillingness to consume and the corner solution, and the coefficients were computed with Stata13 software. The marginal effects obtained for the dual hurdle model were: income (1.8), price (2.6), employment status (1.7), age (-0.5), house ownership status (-2.9), marital status (6.08), educational status (-1.4), presence of children under the age of 14 in the household (1.9), and gender (12.6). The marginal effects of the participation equation for consumption were: employment status (0.28), age (-0.1), house ownership status (0.15), marital status (-0.16), educational status (0.07), presence of children under the age of 14 (0.07), and gender (1.8).All coefficients were significant at the 5% level. The results showed that considering the marginal effects calculated for consumption equation, the effect of demographic factors on smoking was more than economic factors. Therefore, policymakers' attention to employment, marriage and housing of community members can be turned to reducing tobacco use and improving the general health.