International Journal of Hospital Research
Volume:4 Issue: 4, Autumn 2015

Working in hospital is stressful, and this may result in deviant behaviors of clinical staff and thus irreparable damages to the patients’ health. It is, therefore, crucial to empower hospital workers in managing job stress to ensure high quality of healthcare. Psychological and social capitals have been shown to influence organizational behaviors of the employees. The aim of the present study was to investigate the impact of psychological capital (PC) and social capital (SC) on job stress and deviant behaviors in clinical staff.
A random sample of 375 individuals was randomly selected from among the clinicians of hospitals of Tabriz City (North-western Iran). Data were collected using valid and reliable questionnaires. The obtained data were summarized using descriptive statistical methods. The relationship between the variables was explored by Pearson’s correlation coefficient and multiple regressions analysis.
Findings: Higher PC and SC negatively predicted both job stress and deviant behaviors. In addition, the negative correlation between PC and job stress was found to be stronger in the employees with higher SC.
Our study, hence, suggests promotion of PC and SC in clinical staff as an effective approach to empower them in managing stressful situations. Increased PC may also alleviate the rate deviant behaviors in clinicians, resulting in higher performance of healthcare human resources.

Endometrial hyperplasia (EH) is an abnormal overgrowth of endometrium that may lead to endometrial cancer, especially when accompanied by atypia. The treatment of EH is challenging and previous reports have provided conflicting results. Metformin (dimethyl biguanide) is an anti-diabetic and insulin sensitizer agent which is supposed to have antiproliferative and anti-cancer effects and the potential to decrease cell growth in endometrium. While some studies evaluated the anti-cancer effect of metformin, studies on its potential effect on endometrial hyperplasia are rare. To address this knowledge gap, in this comparative trial study, we evaluated the effect of additive metformin to progesterone in patients with endometrial hyperplasia. In this clinical trial, 64 women with endometrial hyperplasia referring to Arash hospital from 2014 to 2015 were randomized in two groups. The progesterone-alone group received progesterone 20 mg daily (14 days /month, from the 14th menstrual day) based on the kind of hyperplasia and progesterone +metformin group received metformin 1000 mg/day for 3 months in addition to progesterone. Duration of bleeding, hyperplasia, body mass index (BMI), and blood sugar (BS) of the patients were then compared between the two groups. A mean age of 44.5 years, mean BMI of 29 kg/m2 and mean duration of bleeding of 8 days, was calculated for the study sample. There was no significant difference in age, BMI, gravidity, bleeding duration, and duration of disease at baseline between two groups. While all patients in the progesterone +metformin group showed improvement regarding bleeding and hyperplasia, only 22 out of 32 patients in the progesterone-alone group showed the corresponding improvement, with the difference between two groups being significant (P = 0.001). Although the difference between two groups in the post treatment endometrial thickness was not significant (P = 0.55), post treatment BMI in the progesterone +metformin group was significantly lower than the progesterone-alone group (P = 0.01). In addition, the reduction in BS in the progesterone +metformin group was significantly larger than that in the progesterone-alone group (P = 0.001). Our results indicated that administration of progesterone 20 mg/day plus metformin 1000 mg/day can significantly decrease bleeding duration and hyperplasia, BMI and BS in women with endometrial hyperplasia.

Motivated employees are probably the most valuable resource of the contemporary organizations. Evidence shows the significant impact of perceived organizational justice on the attitudes of employees, including their trust. To further investigate the issue in the context of health organizations, this study aimed to explore the relationship between perceived organizational justice and employees’ trust among the staff of Kerman University of Medical Sciences (KUMS), Iran.
Overall, 285 employees were selected to participate in the study based on stratified sampling and Cochran formula. Organizational justice was measured by Niehoff and Moorman questionnaire in three dimensions of distributive, interactional, procedural justice. The trust in managers was measured in the dimensions of competence, benevolence and reliability, and institutional trust was quantified based on situational normality, vision, strategy, communication, and structural assurance using the corresponding inventories developed by Elonen et al. The reliability of the study tools was confirmed by Cronbach’s alpha of 89% for organizational justice and 86% for trust in managers and institution. Data were summarized using descriptive methods and analyzed by Pearson’s correlation coefficient, t-test and multiple regressions analysis.
Findings: A significant positive relationship was identified between the perceived organizational justice and trust in managers and institution. Among the three dimensions of organizational justice, procedural justice showed the strongest relationship with trust in managers and institution compared with distributive and interactional justice. Perceived organizational justice and trust were not significantly different between the sex, age, job tenure, employment status, and educational level groups.
The research results provide evidence that organizational justice is a predictor of employees’ trust in their managers and institution. Given the importance of employees’ trust in their organizational commitment, this study recommends improvement of organizational justice as a pathway towards enhanced human resources productivity in the medical education organizations.

MThe Emergency Severity Index (ESI) triage is commonly used in clinical settings to determine the patients’ emergency severity. However, the reliability of this index is not sufficiently explored. The present study examines the inter-rater reliability of ESI by comparing triage ratings as performed by nurses and physicians.
This prospective cross-sectional study was performed in Imam Reza Hospital in Tabriz, Iran. The stratification of 588 patients by the triage nurses were compared with that by the physicians. Cohen's un-weighted Kappa, and linear-weighted Kappa, and quadratic-weighted Kappa were used to quantify the agreement between the two groups.
Findings: While the un-weighted Kappa was calculated to be 0.172 (95% CI: 0.115- 0.228), the linear weighted Kappa and the quadratic-weights Kappa were obtained as 0.312 (95% CI: 0.253- 0.370) and 0.482 (95% CI: 0.363- 0.601), respectively.
Compared with data from the literature, the inter-rater reliability of ESI triage between the surveyed nurses and physicians was low to moderate. This finding emphasizes the need for retraining the triage staff on robust stratification of the patients in order to achieve a higher reliability in ESI triaging. Our results also provide motivation for further large-scale studies to estimate the average reliability of triage in Iranian EDs and if proven to be low, taking interventional measures.

Operating room scheduling is key to optimal operating room productivity. The significant uncertainty associated with surgery duration renders scheduling of surgical operation a challenging task. This paper proposes a novel Stochastic Operating Room Scheduling (SORS) to schedule surgery cases with uncertain durations. The model considers various surgical operation constraints in teaching hospital, including assignment of residents for each surgery under attend supervision, chronologic curriculum plan for training residents, balanced distribution of operations between surgeons, and the infection prevention constraints. A two-stage mixed-integer programming model (SORS), with the total operating rooms idle time and over time as the objective function was developed. The L-shaped algorithm was used for solving the programming model. The performance of the SORS in proposing optimal scheduling solutions was extensively compared with that of deterministic models as well as the performance of manual scheduling obtained from clinical data. Our results showed that SORS offers higher performance in proposing operating room scheduling solutions as compared with the deterministic computational approaches. Furthermore, comparison of the SORS-proposed schedules with the practical schedules indicated that SORS can remarkably reduce the operating room idle time and over time, demonstrating the utility of this model in clinical practice. A novel validated computational operating room scheduling model was developed which can potentially be employed to achieve higher operating room efficiency.

The large contribution of hospitals to the function and expenditures of the healthsector makes their constant monitoring and evaluation inevitable to improve the overall performance of the health system. Built on that, the present study aimed to evaluate the trend of performance of hospitals affiliated with the public hospitals (in Guilan Province, Iran) affiliated with Ministry of Health and Medical Education (MOHME) using the Pabon Lasso framework.
All (21) hospitals affiliated to Guilan University of Medical Sciences (GUMS) were monitored within 2010-2015. Data of BOR, BTR and ALS of these hospitals were collected using a form completed by the university’s Office of Vice-chancellor for Clinical Affairs. The Pabon Lasso diagram was set up by dividing the area between BOR (horizontal) and BTR (vertical) axes into four Zones based on the average of BOR and BTR values. A second Pabon Lasso diagram was also set up with the cut-off point being standard average BOR and BTR values as suggested by MOHME. The data of BOR and BTR of the target hospitals were then mapped onto the diagrams.
Findings: The number of hospitals in Zone 1 has decreased from 6 to 3, and the number of hospitals in Zone 3 has increased from 5 to 6 during 2010 to 2015. Based on MOHME’s evaluation criteria, the average BOR of the surveyed hospitals has increased from the moderate level in 2010-2011 to the favorable level in 2014-2015. Moreover, the 5-year average BTR of these hospitals maintains far above the minimum favorable threshold, and the 5-year average ALS of these hospitals falls in the moderate range. In 2014-2015, while 23.8% of the hospitals are located in Zone 3, 71.42% are located in Zone 2, and there is no hospital located in Zone 1.
AOur results suggest that the performance of GUMS hospitals has been on an increasing trend in the recent years. Nonetheless, when considering MOHME’s evaluation criteria, most of the hospitals are still located in the second Zone of Pabon Lasso Model, which corresponds to low BOR and high BTR. This information recommends avoidance of further bed development, and rather using under-utilized beds in high demand healthcare services in order to achieve higher hospital performance in future years.

Split sagittal osteotomy is a common operation that may induce inferior alveolar nerve (IAN) damage, potentially leading to sensory deficit, numbness, and pain. Investigations in Iran to evaluate the adverse effects of sagittal split osteotomy surgery are rare; so questions have been raised about the success rate of operation and the frequency of unwilling outcome. To address these concerns, we have conducted a prospective study evaluating the rate of IAN damage related to mandibular advancement by sagittal split osteotomy in Iranian population. In this prospective study, 66 patients including30 men (45.4%) and 36 women (54.5%) with Class II malocclusion and mandibular retrognathism who were undergoing mandibular advancement surgery (SSO) were recruited from 2013 to 2015. All patients were followed for 1 year after the surgery. Chi-square or Fisher’s exact was used test to compare categorical variables and the numerical variables were compared by t-test. P < 0.05 was considered significance level. The study sample included, with the mean age 32.3±12.04. The rate of nerve disturbance was 75.8%. Yet, 78.9% of patients were satisfied with the results of the surgery. Our study indicated that IAN disturbance after split sagittal surgery is frequent in Iran. The situation indicates the need for caution on considering split sagittal surgery as a safe medical technique.

During crisis, hospitals have great responsibility in saving life and protect health of the damaged individuals. Fulfilling this responsibility relies on preparedness of hospital staff, particularly the clinicians to face the relevant challenges. Given the lack of adequate information on the topic from Iran, the present study aimed to explore the technical crisis preparedness of healthcare staff in a sample Iranian hospital.
A cross-sectional study was conducted. A sample of 265 clinicians were randomly selected from among clinicians of a hospital in Tehran (Iran Capital), based on Cochran's formula. Data were collected using a researcher-made inventory containing 28 multiple-choice questions related to the technical preparedness and three questions related to the attitudes of respondent towards relevant training programs. Data were summarized using descriptive statistical methods and analyzed by Mann-Whitney and Kruskal-Wallis tests.
Findings: The respondents expressed a moderate self-assessment of their technical crisis preparedness. Females, the age group of 51-60 years, work experience group of 21-30 years, married participants showed a significantly higher level of technical preparedness, compared with other respective groups (P Our result highlights the significance of assigning crisis management to the adequately experienced individuals. Training programs and maneuvers should be constantly held to provide clinicians the opportunity to enhance their crisis preparedness. Specific organizational arrangements are required to be made to encourage staff take the advantages of training opportunities and help them overcome the relevant barriers.