ali ebrazeh

Since 2019, the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) virus has spread systematically, causing extensive immune responses and significant damage to other organs. This non-randomized, open-labeled, clinical trial was conducted to evaluate the effect of therapeutic plasma exchange (TPE) on critically ill coronavirus disease 2019 (COVID-19) patients.

This single-center clinical trial was performed at Shahid Beheshti Hospital affiliated with the Qom University of Medical Sciences, from March to June 2020. A total of 60 patients with serious or life-threatening COVID-19 infection were included in the study. Patients in the intervention group (30 patients) received systemic corticosteroids and interferon and TPE were performed for them.

Of the 60 patients studied, 48% died, while about 52% were discharged. Mortality was significantly lower in the intervention group than in the control group (20% vs 77%, respectively). The severity of the disease was significantly lower in the intervention group than in the control group (20% vs 77%, respectively), although the median days of hospitalization and ICU admission were higher in the intervention group than in the control group. No side effects were observed in the intervention group during the first 72 hours after TPE.

TPE can provide a longer lifeline and a lower mortality rate in critically ill COVID-19 patients. Therefore, we recommend that TPE, systemic corticosteroids, and interferon, along with other standard treatments, be used as part of the treatment protocol for critically ill COVID-19 patients.

During the Covid-19 pandemic, many measures were taken to limit communication and break the chain of infection. One of these measures was holding university classes virtually. The present study was conducted with the aim of investigating the virtual education status from the perspectives of students of Kurdistan University of Medical Sciences during the Covid-19 pandemic.

This cross-sectional study was conducted in 2022 among Kurdistan University of Medical Sciences students who had experience in the in person and virtual classes. The questioner used included 4 sections demographic characteristics and the level of individual skills in the field of IT, the advantages and disadvantages of virtual education, the comparison of the face to face education with virtual learning, and the acceptance rate of virtual classes. Chi-square and Wilcoxon tests were used at a significance level of P<0.05.

A total of 406 students participated in the study. Easy access to online materials (56.8%) and reduced interaction with the professor (70.4%) were the most important advantages and disadvantages of virtual education, respectively. The face to face (traditional) education was more effective than virtual training in terms of increasing knowledge and clinical skills, and competence (P<0.05). Acceptance rate (69% vs. 37%) and student activities (60% vs. 33%) were significantly higher in traditional education compared to virtual education (P<0.05). Also, there was a significant difference between the schools in regard to the effectiveness and acceptibility of traditional education compared to virtual education (P<0.05).

Considering the significant difference in the effectiveness and acceptability of traditional education compared to virtual education, the importance and necessity of implementing virtual education programs in recent years after the Covid-19 pandemic and the possibility of universities' tendency to combine virtual education with traditional education in the future, it is important to try to improve virtual education infrastructures and provide solutions to solve problems and improve virtual programs.

Nurses may be threatened with professional moral courage while providing care to patients with Covid-19. The present study aimed to evaluate the professional moral courage of nurses caring for patients with Covid-19.

This study was a cross-sectional study. In this study, 200 nurses working in COVID wards participated by convenience sampling method. Data collection tools were personal profile forms and valid and reliable tool of professional moral courage. Data were analyzed using descriptive statistics and inferential statistics (ANOVA And T-TEST) under SPSS software version 16.

The overall score of nurses' professional moral courage was 56.25±7.02. Other findings of the study indicated that among the personal characteristics of nurses, professional moral courage and organizational position (P = 0.005) and nursing work experience in the COVID ward (P = 0.003) had a statistically significant relationship.

Considering the average state of moral courage and the fact that the average score of supervisors is lower than that of nurses, it is obligatory for nursing managers to plan for the promotion of professional moral courage of nurses to face future crises. The most important of these actions can be holding educational workshops with ethical themes for nurses and students so that they can obtain professional moral courage in their profession in more desirable way.

Physical access to health services is determined by the geographic location of the patient. This study aims to distribute the bases and hospitals of Mashhad City, Iran, and the extent of coverage of the bases in traffic accidents.

This research is a descriptive cross-sectional and applied study. The study population for high-accident points includes 21142 missions carried out regarding traffic accidents as well as 37 points related to 115 emergency bases in 2014. The information needed by the researcher was collected by receiving the files of the injured from the statistical unit of the center. By forming the database of the road network in Mashhad City in a geographic information system environment as communication links and defining emergency centers as facilities, the radius of emergency centers was drawn using the service area method. 

In this study, the areas that needed more services and the number of provider centers was less compared to the covered area were identified. After matching the distribution map of the bases with the distribution of accidents, the areas with the lowest distribution of accidents and the highest service of emergency medical services, as well as high accidents and less service were obtained. 

The distribution of bases and hospitals does not have a proper distribution situation, which can lead to the lowering of the desired level and the creation of illogical concentration. To cover the emergency missions, it is necessary to set up emergency bases and complete the existing hospitals in the city.

The Covid-19 pandemic inevitably turned most classrooms into virtual classrooms. Elearning and classroom management style are two important factors known to affect the quality of education. This study was conducted to investigate the relationship between classroom management styles and teachers' attitudes toward E-learning in Abadan University of Medical Sciences.

In this cross-sectional analytical study conducted in 1399, teachers of basic and clinical sciences of Abadan University of Medical Sciences were surveyed by census method. The research tools were two questionnaires: classroom management style and teachers' attitudes toward E-learning. Data analysis was performed using Wilcoxon test and regression through SPSS 21 software.

76 male teachers and 69 female teachers participated in the study. In the field of E-learning, the highest and lowest mean were related to multimedia education (1/57 ± 3/92) and feeling of satisfaction (1/3 ± 3/04), respectively. In the field of classroom management, education had the highest mean (3/03 ± 0/3) while human resources had the lowest mean (2/49 ± 0/34). No significant relationship was observed between attitudes toward E-learning and classroom management.

A positive attitude towards E-learning and dissatisfaction with classroom management can make the educational process difficult for both teachers and students. It is recommended to use new educational methods and strengthen the E-learning infrastructure, train and motivate teachers and avoid island management.

Health system services are not reliable without quality assessment. It is important to explore gaps between standard services and the existing situation to improve the quality of health system. This study aimed at studying the quality assessment of electronic referral system in one of the major provinces of Iran.

This study was a cross-sectional study, utilizing SERVQUAL model. The population comprised 3 groups totaling approximately 11,004 people. The sample size allocated to each city was determined in proportion to each city’s population. A sample of 384 patients who had used electronic referral service at level 2 and received outpatient services made up the population of the study. The data were collected through a two-part questionnaire. The validity of the questionnaire was confirmed by 10 experts, including senior and mid-level managers and medical science university faculty members. The questionnaire assessed demographic data and the patients' perceptions and expectations. The data were analyzed using descriptive statistics and analytical statistics such as nonparametric mean comparison tests, in view of the normality assumption, including Wilcoxon test, Mann-Whitney and Kruskal-Wallis. Spearman correlation test was used to determine the intensity of correlation between the study variables. The significance level of all tests was considered 0.05.

There were identified gaps throughout all dimensions of health services among the studied clinics (P <0.001). The biggest gap was observed in the empathy dimension (0.57) and the smallest one was observed in the tangible dimension (-0.38). The gap between the services provided to patients was different in terms of guarantee, gender (P = 0.005), empathy, level of education (P = 0.028) and reliability based on the particular city considered (P = 0.028).

In the hospitals implementing the electronic referral system in Golestan province, there is a gap in all dimensions and it indicates that the expectations of the recipients have not been fully met in virtually any of the dimensions.

Providing quality services and meeting the needs of clients in the health system of countries are emphasized by policy makers. In order to stay competitive, it is important to introduce the organization to others. Therefore, this study was conducted to investigate the relationship between accountability and quality of health services and their relationship with organizational prestige in public hospitals in Abadan and Khorramshahr in 2019.

This descriptive-analytical study was performed by the census method in three hospitals under the auspices of Abadan University of Medical Sciences. Data were collected using a questionnaire of health care quality from patients and questionnaires of fast-response organizations and organizational prestige from hospital staff. Data analysis was performed by SPSS software using descriptive statistics and Pearson’s correlation test.

The quality of medical services in the studied hospitals was moderate (63.54±15.42). Findings also showed that the response rate of hospitals was very good (62.12±15.59). Finally, the status of organizational prestige has been evaluated very well in terms of hospital staff (26.44±5.45). There was no statistical relationship among organizational prestige, service quality, and accountability.

In summary, in addition to responding quickly to patients' needs, improving the quality of services for hospital recognition and hospital prestige is also important and should be considered.

The number of major abdominal surgical procedures is increasing around the world. A large number of the patients complain about postoperative pulmonary complications (PPCs) after abdominal surgery and show symptoms of breathing pattern disorder. Therefore, this study aimed to investigate the effect of deep breathing exercise on the oxygenation of patients undergoing major abdominal surgery.

This single-blind randomized clinical trial was conducted on 40 patients who needed major abdominal surgery in Qom, Iran, in 2014. The participants were divided into two equal experimental (n=20) and control (n=20) groups. The cases in both groups received routine care, however, those in the experimental group exercised repeated deep breathing four times per hour for two consecutive hours after the surgery as well. The condition of the patients in both groups was similar in terms of position, mobility, and oxygen therapy. The patient’s oxygen saturation, respiratory rate (RR), heart rate, and the severity of pain in the surgery site were measured. The collected data were analyzed in SPSS software (Version. 18) using paired t-test, independent t-test, Mann-Whitney U test, Wilcoxon rank-sum test, Multiple regression analyses, Chi-square test, and Fischer’s exact test. A p-value less than 0.05 was considered statistically significant.

Based on the study findings, the deep breathing exercise significantly reduced the surgery site pain and mean blood pressure and increased O2 saturation in the experimental group after the intervention (P<0.05). Moreover, there was a statistically significant difference between the experimental and control groups, and a significantly higher O2 saturation was observed in the experimental group after deep breathing exercise post-operation (β=2.01, P<0.001).

Deep breathing exercises can reduce the severity of pain in the surgery site and mean arterial blood pressure and increase O2 saturation in patients after major abdominal surgery.

Abstract

Paying attention to human resources is one of the basic principles for increasing productivity and quality of services in hospitals. Therefore, the present study was designed to compare the level of job satisfaction and job stress, and the association between these two components in nurses, operating room, and anesthesia staff

This is a descriptive causal-comparative study, performed in December 2019 in Zabol hospitals with the participation of 175 nurses, operating room, and anesthesia staff. A three-part questionnaire consists of demographic information, job satisfaction, and job stress was used to collect Data. Then analysis of data was performed using SPSS 20 and the Pearson correlation coefficient, independent t-test, and ANOVA.

In this study, it was found that nursing group had the highest job satisfaction and anesthesia and operating room staff had the lower job satisfaction. Also, the highest and lowest levels of job stress were related to anesthesiologists and nurses, respectively, and the differences in both variables were significant between the three groups. Moreover, the results showed that there was a significant negative correlation between job satisfaction and job stress, totally.

Due to that anesthesia staff was in a more unfavorable situation than the others, we recommended that management planning and policies in hospitals be done by occupational groups and design and carry out the studies to assess the needs for each group.

One of the main pillars of sustainable development is health and wellness which is an integral part of improving the quality of life. Lack of hygiene facilities and human resources and their inadequate distribution in urban and rural areas are major problems in providing health services in third world countries. The main and important reasons for inequalities in the distribution of health sector resources include inappropriate and poor budget allocation to the health sector, inadequate and long-term planning. This study was conducted to determine the degree of development of Abadan, Khorramshahr and Shadegan cities in terms of health indicators using numerical taxonomy model.

This descriptive study was conducted in 3 cities of Abadan, Khorramshahr and Shadegan in Khuzestan province in 2016. The data collection tool was a checklist containing information needed to calculate 15 health indices that were collected from Abadan Medical School Deputy of Health. The numerical taxonomy of these cities was evaluated in terms of degree of development of health indicators.

According to the values of the upper and lower limits of homogeneity distance and the values of the shortest distance between cities, it was found that all cities (regions) were homogeneous and were in the same group. Finally, the results showed that Abadan is considered to be developed (0.47), Shadegan under developed (0.78) and Khorramshahr undeveloped (0.81).

Regarding the results obtained for improving the health status and managing the health sector, it is suggested that a comprehensive development-based program to be developed for reducing gaps and inequalities in terms of health indicators and to pay specific attention to the main development indicators of health care system based on population in each region.

The novel coronavirus, formerly named as 2019 novel coronavirus (2019-nCov) caused a rapidly spreading epidemic of severe acute respiratory syndrome (SARS) in Wuhan, China and thereafter, progressed globally to form a pandemic of coronavirus disease 2019 (COVID-19) in numerous countries; and now confirmed cases are reported from several provinces of Iran. Now various medical centers, clinicians and researchers around the world share their data and experiences about COVID-19 in order to participate in the global attempt of controlling the pandemic. The current report investigates the clinical presentations and paraclinical findings of the first confirmed cases and mortalities in the initiation of the outbreak of COVID-19 in Iran.

Patient safety improvement requires ongoing culture. This cultural change is the most important challenge that managers are faced with in creation of a safe system. This study aims to show the results of initiatives to improvement in patient safety culture in Fateme Al-zahra hospital. In the quasi-experimental research, patient safety culture was measured using the Persian questionnaire on adaptation of the hospital survey on patient safety culture in 12 dimensions. The research was conducted before (January 2010) and after (September 2012) the improvement initiatives. In this study, all units were determined and no sampling method was used. Reliability of the questionnaire was tested by Alpha Chronbakh (0.83). Data were analyzed using descriptive statistics indices and Independent T-Test by SPSS Software (version 18). 350 questionnaires were distributed in each phaseand overall response rate was 58 and 56 percent, respectively. According to Independent T-test, Management expectations and actions, Organizational learning, Management support, Feedback and communication about error, Communication openness, Overall Perceptions of Safety, Non-punitive Response to Error, Frequency of Event Reporting, and Patient safety culture showed significant differences (P-value<0.05). Teamwork within hospital units, Teamwork across units, Hospital handoffs and transitions, and Staffing did not reveal any significant differences (P-value>0.05). The mean score of Patient safety culture was 2.27 (from 5) and it was increased to 2.46 after initiatives that showed a significant difference (P-value<0.05). Although, improvement in patient safety culture needs teamwork and continuous attempts, the study showed that initiatives implemented in the case hospital had been effective in some dimensions. However, Teamwork within hospital units, Teamwork across units, Hospital handoffs and transitions, and Staffing dimensions were recognized for further intervention. Hospital could improve the patient safety culture with planning and measures in these dimensions.

Protecting households from risk of impoverishment due to out‑of‑pocket costs in health care is a major challenge for health systems. Therefore, this study aimed at evaluating some health expenditure of inpatient and outpatient care as well as assessing the predictors of catastrophic costs for inpatient care in one of central provinces of Iran. In this cross‑sectional study, 760 household were selected by multistage sampling method in Markazi province of Iran and interviewed in order to complete a standard questionnaire. Catastrophic costs were evaluated in a scale that varied from 0 (no money for care) to 100 (spending all income and wealth). Patients who were paid over 20% of household financial sources or 40% of month income were regarded as being exposed to catastrophic costs. Negative binomial model with robust estimator logit function was used for prediction of catastrophic costs. Based on data analysis, 42.6% of hospitalized subjects encountered catastrophic costs. Moreover, 11.2% households faced catastrophic cost among all participated households and 39.3% were reported to need inpatient need care. Multivariate regression model showed that age range 40-59 years and beingin the lower levels of wealth index were significant predictors of facing catastrophic costs (P < 0.05). Lack of money is the most important cause of un‑seeking care. Hospitalizations due to inpatient care needs, household members aged 40-59 years old, especially with chronic diseases and nonrich status of the household were the highestpredictors of facing catastrophic costs. Reducing out‑of‑pocket costs can increase health care utilization.

Hospital readmission is considered as one of worrying issues for patients, healthcare providers, and hospitals due to influencing costs and quality of hospital cares as well as imposing extra burden on patients and their families. This study was conducted to predict patient readmission based on LACE index in internal ward of Hajar Hospital, Shahrekord. In this descriptive, analytical study which was conducted cross-sectionally from January, 2013 to June, 2013, the probability of readmission of patients hospitalized in internal ward of Hajar Hospital was estimated within one month after discharge, based on the data extracted from the medical file of each patient and asking patients to answer questions about each one of the components existing in LACE index checklist at discharge. Of 120 individuals participating in the research, 67 patients were female. The mean hospitalization duration of patients was three days. 62.4% of the patients had a history of cardiovascular, diabetes, and renal diseases of moderate level. Based on statistical results of chi-square, readmission of the patients was significant only for different age groups and with different education (P<0.01), but exhibited no significant difference for gender, marital status, occupation, and insurance (P>0.05). In regression analysis, the difference in LACE index score had a confidence interval of 0.611, standard deviation of 0.053, and significance of 0.040 in the individuals with and without history of readmission for readmission diagnosis. The groups at high risk need more healthcare training in view of lower education; therefore, it is recommended that the patients who obtain the score of higher than eight based on LACE index be particularly included in training programs.

Enjoining good and forbidding (EGFE) evil are two fundamental topics in Islam. Many verses and narratives underscore the social, religious and political duties implied by enjoining good and forbidding evil. After all, these two divine treasures have been neglected because of indulgence and forgetfulness. The prime reason for this negligence seems to be the obliviousness of employees in different organizations throughout the country. The purpose of this study is to assess a hospital employees&#039; knowledge of enjoining good and forbidding evil.
This cross-sectional analytic descriptive study was done in a hospital of Isfahan province in 2012. The data were collected from the employed staff of the hospital in all the organizational ranks. No sampling was done in this census study and the data were elicited from all the members of the population. The data collection instrument was a 28-item questionnaire whose validity and reliability were confirmed. The data were analyzed using SPSS 16 software.
In the current study, 50.9% of the participants were men and 49.1% were women. The percentage scores of the staff knowledge of the bounden duties of EFGE were 72%; effects of EFGE 73%; moralities of EFGE 85%; virtue examples 78%; and evil examples 72%. The overall knowledge of EFGE turned out to be 76%. There was a meaningful difference between the moral dimension in men and women as the women’s knowledge was higher (P=0.045). Based on the analytical results of analysis of variance (ANOVA) test, there was no meaningful difference between the scores of the EFGE with demographic variables (P> 0.05).
The results indicated that the knowledge of the hospital staff of enjoining good and forbidding evil was satisfactory. Requisite training of the knowledge of enjoining good and forbidding evil, its effects, and the evil examples could result in the promotion of their knowledge score.

Enjoining good and forbidding (EGFE) evil are two fundamental topics in Islam. Many verses and narratives underscore the social, religious and political duties implied by enjoining good and forbidding evil. After all, these two divine treasures have been neglected because of indulgence and forgetfulness. The prime reason for this negligence seems to be the obliviousness of employees in different organizations throughout the country. The purpose of this study is to assess a hospital employee's knowledge of enjoining good and forbidding evil.
This cross-sectional analytic descriptive study was done in a hospital of Isfahan province in 2012. The data were collected from the employed staff of the hospital in all the organizational ranks. No sampling was done in this census study and the data were elicited from all the members of the population. The data collection instrument was a 28-item questionnaire whose validity and reliability were confirmed. The data were analyzed using SPSS 16 software.
In the current study, 50.9% of the participants were men and 49.1% were women. The percentage scores of the staff knowledge of the bounden duties of EFGE were 72%; effects of EFGE 73%; moralities of EFGE 85%; virtue examples 78%; and evil examples 72%. The overall knowledge of EFGE turned out to be 76%. There was a meaningful difference between the moral dimension in men and women as the women’s knowledge was higher (P=0.045). Based on the analytical results of analysis of variance (ANOVA) test, there was no meaningful difference between the scores of the EFGE with demographic variables (P> 0.05).
The results indicated that the knowledge of the hospital staff of enjoining good and forbidding evil was satisfactory. Requisite training of the knowledge of enjoining good and forbidding evil, its effects, and the evil examples could result in the promotion of their knowledge score.

Health care organizations, especially hospitals, must focus on patient safety as their main strategy. Cultural change is the most important challenge that they are faced with in creating a safe system. The present article aims to improve the patient safety culture with an assessment of the safety in Fatemeh Zahra Hospital, Najafabad, Iran. This descriptive and cross-sectional research was conducted in 2010. Patient’s safety culture was measured using the Persian adaptation of the Hospital Survey on Patient Safety Culture. This survey was validated by the opinion of 15 experts. The reliability of the questionnaire was determined by Cronbach’s alpha and was 0.846. The questionnaire was sent to all medical employees of Fatemeh Zahra Hospital. Data were analyzed with t-test and one-way ANOVA by SPSS Software. A P-value of less than 0.05 was considered as statistically significant, and 95% confidence interval was calculated. Overall, 196 of the 350 individuals responded to the surveys. The overall response rate was 56%. Supervisor expectations and actions gained 76% of all scores, teamwork within hospital units 75%, organizational learning 73%, feedback and communication about error 70%, transitions 69%, communication openness 68%, management support 65%, teamwork across units 62%, non-punitive response to error 54%, and staffing gained 48%. 64% of all employees had no reports of error. The mean patient safety score was 3.36 (out of 5). According to t-test results, there was no significance difference between patient safety scores in direct and indirect contacts with patient (P = 0.373). Moreover, according to the results of ANOVA, there was a significant difference between the scores of the maternity department and midwifes, and other wards and employees (P < 0.000). There was no significant difference between the patient safety culture scores of employees of different wards, work experience in the ward (their current place of work), work experience in the hospital, and type of contact with patients (P < 0.05). Although the total score of patient safety culture was acceptable, non-punitive response to error, staffing, teamwork across units, and management support are in need of immediate intervention. The hospital can improve the patient safety culture by planning and taking action in these areas.

In recent years, attention of the health care managers is attracted to three factors including promotion of services quality, accessibility and procurement of financial resources of relevant organizations. The aim of this study is to consider the executive status of guideline of managed health care for preoperative assessments of ENT patients at Bazarganan Hospital in 2005. The present research is conducted on 140 cases in descriptive form. The research information is collected by using a check list. Indexes and method of descriptive statistics are used for the data analysis and statistical study. Of one hundred and forty ENT patient records, in 136 (97%) of the cases American Society of Anesthesia criteria had been registered. Vital signs, patient histories and CBC were recorded in 137 (98%), 138 (99.5%) and 139 (98.3%) patients recordes, respectively. Eight (69.7%) over 60 years old cases had been X-rayed. EKG has been performed on all fifteen cases over 40 years old. Thirty nine (28%) recordes contained internist and cardiologist counselling. Assessment of guidline indicates very good status. Application of managed care guidelines of preoperative assessment in ENT surgeries could play a crucial role in reducing complication of ENT surgeries and the improvement of the implication of the guidelines.