مجله پیاورد سلامت
سال دوازدهم شماره 4 (مهر و آبان 1397)

  In today’s competitive market conditions of hospital industry, in addition to the quality of clinical services, a hospital should also concentrate on Hotelling Services Quality designed for the patient and his entourage. The purpose of this study was to investigate the effect of hoteling quality on patient loyalty. The research method of the study was descriptive-survey with an applied goal. The research instrument was a questionnaire whose validity and reliability were verified by face-to-face survey and Cronbach's alpha. The sample size according to Cochran formula for unknown population was 385 patients in two private hospitals of Tehran that were randomly selected. The data were analyzed by descriptive and inferential statistics such as multivariate linear regression test. According to the findings of the study at 95% confidence level, the quality of human resources (p<0.001), the quality of hospital welfare services (p<0.001) and the quality of administrative affairs and workflow (p=0.002), the quality of cleaning and sanitation services (p<0.001) and the quality of building and hospital facilities (p=0.033) have a positive effect on patient loyalty. Also, two other dimensions, that is, the quality of hospital equipment and facilities (p=0.317) and the quality of hospital nutrition services (p=0.123) did not have a meaningful effect on patient loyalty. From patients' perspective, the hotelling quality in the studied hospitals has a direct impact on patient loyalty, and its improvement will increase patients’ loyalty in those hospitals

  Artificial intelligence is a branch of computer science that has the ability of analyzing complex medical data. Using artificial intelligence is common in diagnosing, treating and taking care of patients. Warfarin is one of the most commonly prescribed oral anticoagulants. Determining the exact dose of warfarin needed for patients is one of the major challenges in the health system, which has attracted the attention of researchers. The purpose of this study was to determine the exact dose of warfarin needed for patients with artificial heart valves using artificial neural networks (ANN). A total of 9 multi-layer perceptron ANNs with different structures were constructed and evaluated based on a dataset including 846 patients who had referred to the PT clinic in Tehran Heart Center in the second half of the year 2013. Finally, the best structure of ANN for warfarin dose was investigated. All simulations including data preprocessing and neural network designing were done in MATLAB environment. The effectiveness of ANNs was evaluated in terms of classification performance using 10-fold cross-validation procedure and the results showed that the best model was a network that had 7 neurons in its hidden layer with an average absolute error of 0.1, turbulence rate of 0.33, and regression of 0.87. The achieved results reveal that ANNs are able to predict warfarin dose in Iranian patients with an artificial heart valve. Although no system can be guaranteed to achieve 100% accuracy, they can be effective in reducing medical errors.

  Workplace spirituality is an active process that strengthens people and motivates them to do purposeful activities. According to studies, several factors can promote workplace spirituality. Factors which are studied in this research include job motivation, psychological ownership, mental maturity, and moral behavior. The aim of this research is to prioritize the factors affecting workplace spirituality in Tehran University of Medical Sciences (TUMS) in 2017. This is a correlational descriptive study. The sample included 1230 staff members, of whom 294 were selected using Morgan table. To collect data, 5 questionnaires were used. And for data analysis, structural equation modeling and Amos and SPSS software were applied. The findings showed that psychological ownership (path coefficient 0.110), mental maturity (path coefficient 0.172), and moral behavior (path coefficient 0.871) had an effect on workplace spirituality, but job motivation (path coefficient - 0.090) had no effect on it. Also, moral behavior, mental maturity, and psychological ownership had the greatest effect on workplace spirituality, respectively; but job motivation had no effect on it. According to the results of this study, putting moral behavior as the basis, promoting mental maturity, and emphasizing psychological ownership in order of prioritizing effective factors caused workplace spirituality to increase among employees.

  Diabetic foot ulcer is one of the most painful complications of Diabetes and affects various aspects of a person's life. Therefore, involvement of the patient in self-care can minimize its complications. The purpose of this study was to identify the effective factors in the Diabetic foot self-management for designing a managed-care based app for people with Diabetes who have risk factors for foot ulcers or wound infections. In this cross-sectional study all physicians and nurses employed at ‘Diabetes and Metabolic Diseases Research Center’ of Tehran University of Medical Sciences who had a history of working with Diabetic patients at various levels of Diabetes and foot ulcers participated. The data collection tool was a questionnaire based on the likert scale that made by researchers, which included demographic and clinical information, education and lifestyle management and capabilities of application for self-management in Diabetic foot patients. Finally, descriptive statistics used to analyze the results in SPSS. After reviewing the rate of experts’ agreement with the components of the survey, all the cases over 51% approval rate were considered as required components. According to the opinion of the physicians respectively capabilities of application, education and lifestyle management and patient information and according to the opinion of the nurses’ education and lifestyle management, patient information and capabilities of application were important respectively. Beside proper treatment of the disease, self-management strategies can be effective and useful. Effectiveness of the patients’ self-care by acquiring the necessary skills and involvement in self-care might be achievable.

  One of the common problems of children all over the world is short stature. Due to the high costs of treatment, the present research studied the cost-effectiveness of growth hormone (Somatropin) for the treatment of children with short stature in Kerman Province. This research is an economic evaluation. The population of the study consisted of all persons who had medical records in the health insurance office of Kerman province, of whom 49 were selected as samples. The cost was calculated from the perspectives of patients and insurers. This information was collected through a researcher-made form by interviewing the patients and reviewing the records of health insurance office. To calculate the outcomes, QALY and Increase in Height were used. For cost effectiveness analysis, the ICER formula and TreeAge software were employed and compared with a threshold of 3 times GDP per capita. The findings showed that the share of patients' treatment costs was 5,092,964,520 and the expenses of Health Insurance Organization of Kerman province was 71,175,443,448 rials. Based on Qaly criterion, incremental cost-effectiveness ratio was 743,133 and 9,846,567 rials from the perspective of the patient and of the health insurance organization, respectively. Sensitivity analysis of non-deterministic parameters of the model showed that they had no effect on the cost-effectiveness of treatment with growth hormone. According to the results, the treatment of short-stature children with growth hormone is cost-effective, and this result can be considered by health system policy makers.

In past studies, few researchers have addressed the simultaneous effects of human capital in health and education indicators on the economic growth of the country, and especially, provinces of the country. Therefore, the current study examined the simultaneous effects of human capital in health and education indicators on the economic growth in Iran s’ Provinces This was an applied, analytical, descriptive study, and the research community consisted of the country's provinces. The data were collected through documentary-library research and from the databases of Iran Office for National Statistics, and Central Bank; afterwards, they were analyzed via unit-root and chow tests, using Generalized Method of Moments (GMM) and Eviews 9. The results showed that each percent of rise in family health expenditure, fertility rate, and life expectancy increased the provincial economic growth respectively by 0.033%, 0.71%, and 1.83%. In addition, 1% rise in mortality rate decreased the provincial economic growth by 0.43%. Educational expenditure influenced the provincial economic growth by a coefficient of 0.08, and credit capital asset acquisition, by a coefficient of 0.048. Human capital is considered a long-term investment in health and education sectors which should be an important priority on the agenda of provincial policymakers

Backgrounds andAim One of the effective strategies for targeting chemotherapy in the treatment of cancer is the use of lipid nano-carriers. In this study, an optimal formulation of niosomal drug containing doxorubicin has been developed to better fight cancer cells.
Material and Niosomal vesicles were prepared using phosphatidylcholine (22%), span60 (52/5%), cholesterol (22/5%) and DSPE-PEG2000 (5%) by thin-film method. Doxorubicin were loaded into the niosomes using inactive loading method. Their physico-chemical features were assayed using Zeta-Sizer, FTIR and SEM, and drug release amount was calculated at 37° C and 44° C. At the end, the toxicity of the nano drug carrier system was measured on the KG-1 cell line of the bone marrow cancer by MTT method. Niosomal vesicles containing Doxorubicin showed the size of 160.37±65.2 nm, 94.18% drug encapsulation efficiency -58.11± 1.24 mV of zeta potential and polydispersity index (PDI) of 0.234±0.02 The prepared niosomal system presented drug controlled release and FTIR investigation showed almost no interaction between nano-carrier containing drug and the drug itself. As well, morphological examination of nano-carriers using SEM microscopy revealed that they have spherical structures. Also, cellular studies showed that drug toxicity was higher in encapsulated conditions compared to non-encapsulated conditions. The results of this study, meanwhile confirming the proper physicochemical characteristics of the system and being Slow-release system indicate that this nano-carrier anionic increases the toxicity of the drug for the KG-1 cell line of the bone marrow, thus, this niosomal nano-carrier can be a suitable carrier for drug delivery to cancer cells.

Libraries need strategies, such as marketing, to provide services to patrons. The purpose of this research is to compare the components of marketing in academic libraries of Tehran University of Medical Sciences (TUMS) and Shahid Beheshti University of Medical Sciences (SBUMS) based on the 7ps Marketing Mix Model. This is a cross-sectional, comparative study with an applied approach. The population members are 77 librarians working in 20 academic libraries at TUMS and SBUMS. A census sampling was performed for data collection. The data collection tool was a researcher-made questionnaire that was completed through interview. The data were analyzed by SPSS (ver. 20) using Chi-square analysis, independent samples t-test, and Mann-Whitney test. There was no significant difference in gender, work experience, and level of education between the librarians of the two universities. Mean scores for people, physical evidence, promotion, and process in the libraries of SBUMS were higher than those of TUMS. Only the price factor (the fee paid by users for goods and services) in libraries of TUMS was significantly higher than those of SBUMS. Besides, for product factor (lending books and returning services, audio-visual resources, and access to databases, etc.) and place (library website or building and user interface), there was no significant difference between the studied libraries of the two universities, as well (p>0.05). Overall, the marketing scores of TUMS libraries were lower than those of SBUMS. Nevertheless, SBUMS must also pay attention to marketing for library services, especially for product factor