elahe khorasani

 During the COVID-19 pandemic, different drug protocols were used to treat and manage patients. Considering the diversity in these protocols and the high costs associated with the disease, we aimed to evaluate the costs and effects of the most common therapeutic protocols among critically ill COVID-19 patients.

  In this retrospective cross-sectional study,  a total of 235 critically ill COVID-19 patients  were randomly selected from those hospitalized in the Intensive Care Units of Alzahra Hospital, Isfahan, Iran, between July and December 2020. The study assessed demographic data, outcomes (mortality rate), severity of the disease (SOFA score), and average direct costs of each therapeutic regimen. Statistical analysis included Cox-Regression analysis and Kaplan-Meier survival curve.

 We identified 21 therapeutic protocols based on prescribed medications, with six protocols being the most commonly used. The protocol containing dexamethasone + methylprednisolone showed the highest survival probability (0.79) with a median length of hospital stay of 17 days. Cost evaluation revealed that the dexamethasone protocol had the lowest average cost per patient, while the dexamethasone + methylprednisolone + remdesivir protocol had the highest. Hoteling costs accounted for 45% of the total costs, followed by medication costs (25%).

 The dexamethasone + methylprednisolone therapeutic regimen demonstrated the highest effectiveness in terms of survival probability and was also associated with the lowest average cost per patient.

In some areas, risk management has been adequately developed, but in the field of supply chain, it has been less developed and addressed. Based on the conclusion of previous studies, it can be noted that the economic, environmental and social risks are integral to the sustainable supply chain. The main objective of this research is to identify and rank key factors of sustainable supply chain in the company of freshness dairy products. To identify the risks of the sustainable supply chain based on the research background and views of the managers and experts of the refined dairy products company, the risks were identified in the Delphi questionnaire. The relationship between risk factors and supply chain Sustainability of the Pair Comparison Matrix and the AHP multi-criteria decision-making technique to prioritize the key drivers of sustainable supply chain and risk were utilized through Expert Choice software. The results of prioritizing sustainable supply chain factors based on the risk management approach showed that supplier risk was recognized as the most important risk in the sustainable supply chain of the dairy company. The prioritization of the related risks is as follows: supplier risk, supply risk, operational risk, demand risk and financial risk. Overall operating risk in the supply chain is significant at 0.123 per cent in terms of the risk of supply chain dairy products. Which accounted for 12.3% of the total.

Context: 

In recent years, antimicrobial resistance (AMR) has become a global public health threat. Health system decision-makers need valid and reliable situation analysis to better plan for mitigating this threat.

 This scoping review investigated the research gaps in AMR publications in Iran and provided an evidential base to support the identification of priority research to better address antibiotic resistance needs in Iran.

 A search of academic databases, including Scopus, Institute for Scientific Information (ISI), Web of Science, MEDLINE/PubMed, EMBASE, and Iranian Database of Medical Literature (IDML), was performed in February 2018. The identified studies evaluated the resistance or susceptibility of antibiotics against any bacteria in an Iranian population. Title, abstract, and full-text screening were conducted, and the included studies were accordingly analyzed with respect to the study protocol.

 From 37,769 identified studies, 1,718 studies met all inclusion criteria. These studies evaluated the susceptibility of 131 antibiotics to 82 types of bacteria by conducting 3,509 antibiotic resistance tests. Ofloxacin, ciprofloxacin, and gentamicin had the highest number of studies, samples, and tested bacteria. Regarding the characteristics of the studies, 306 studies had an insufficient explicit definition of study characteristics, 231 studies published their results more than three years after conducting them, and 803 studies (46.7%) were published in local journals.

 Considering the importance of the AMR crisis, this scoping review debates the low quality of reporting in AMR-related publications in Iran despite extensive research.

The significant increase of type 2 diabetes and its complications in individuals requires developing new approaches to control this disease. The present study aimed to evaluate the efficacy of pioglitazone and insulin combination therapy, compared to insulin therapy in patients with type 2 diabetes.

Medline, Cochrane Library, and Embase were searched for Randomized Controlled Trials (RCTs) comparing pioglitazone in combination with any insulin-containing regimen and the same insulin regimen alone in patients with type 2 diabetes. Hand searching was conducted in journals, congresses, and RCT registration databases related to diabetes. There were no restrictions on the language and publication year of articles. RCTs were evaluated based on the inclusion and exclusion criteria; the quality of studies was evaluated using the Jadad and the Cochrane collaboration’s tools. After evaluating and extracting the data, the
common results of the selected papers were entered in RevMan. Furthermore, in the cases that studies were homogeneous, meta-analysis was performed; in the cases that studies were heterogeneous, the findings were reported in a qualitative form.

From the first found essays, 12 were elected for studying, including a total of 3208 patients with type 2 diabetes. The trial duration was between 12 weeks and 34.5 months. The study results presented a reduction in HbA1c and insulin dose in the combination therapy with pioglitazone arm. In our meta-analysis, the mean reduction in HbA1c was equal to 0.64%, i.e., significant [95% Confidence Interval (CI): -0.86 to -0.41, P<0.00001].

This systematic review indicated that in patients with type 2 diabetes, the addition of pioglitazone to the insulin regimen, compared to the insulin regimens, reduced HbA1c.

Although widely used, first-line injectable medicines for the treatment of multiple sclerosis (MS) remain an issue of efficacy and adherence. Recently, new oral medications for MS have contributed to dramatic improvements in MS treatment. This study aims to evaluate the safety and efficacy of oral disease-modifying drugs (DMDs) used in relapsing-remitting MS (RRMS).

A systematic review was conducted on related databases including PubMed, Scopus, Cochrane, and Web of Science up to April 2020. The screening of the studies and their quality assessment was carried out independently by the two authors.

Three studies fulfilled the predefined criteria of inclusion. One of them compared teriflonomide with subcutaneous interferon beta-1a (IFN β-1a), another compared oral fingolimod with intramuscular (IM) IFN β-1b, and the third article compared oral fingolimod with IM IFN β-1a. No eligible study was found for dimethyl fumarate (DMF). The results indicated that while the efficacy of fingolimod was more than IFN β (IM β-1a and β-1b), teriflunomide 7 mg had less efficacy than subcutaneous IFN β-1a. Regarding safety, the results indicated that the proportion of diabetic patients with adverse events (AEs) in the fingolimod group was higher than in the IFN β-1b group and the overall occurrence of AEs was similar between teriflunomide and IFN β-1a groups.

There is evidence for the effectiveness of fingolimod in reducing annualized relapse rates (ARRs) and improving magnetic resonance imaging (MRI) findings, but the evidence does not support the effectiveness of teriflunomide and further studies are required to determine its efficacy. Also, fingolimod is associated with more side effects than IFN β-1b, but there is no evidence to suggest any difference in side effects between teriflunomide and IFN β-1a.

Since at the time of this study fusidic acid was not available in the pharmaceutical market of Iran, this study was designed to investigate the economic aspects of the availability of fusidic acid for the treatment of topical infection in Iran.

A decision tree model was used to compare circumstances, in which only mupirocin and fusidic acid were available. Medical and hospitalization costs were considered as direct medical costs. Budget impact analysis and sensitivity analysis were performed to examine the robustness of the base-case analysis.

It was assumed that a 50/50 ratio exists between burn patients to other patients. The treatment cost of 1000 cohort hypothetical patients was estimated at $54766 when mupirocin was the only available treatment choice and $15951 when fusidic acid was available as well. In other words, overall, $39 per patient was saved when physicians could consider fusidic acid as another choice of treatment.

The availability of fusidic acid appears to be reasonable because it reduces the costs of skin infection treatment. It also improves antibiotic consumption appropriateness.

The present systematic review focused on the prevention or treatment of three main types of pelvic floor dysfunctions (PFDs) specifically pelvic organ prolapse (POP), urinary incontinence (UI), and fecal incontinence (FI) using physiotherapy and pelvic floor muscle exercises (PFMEs). With regard to the breadth of the problem, there is not much evidence grounded on the best management. The main purpose of this systematic review was to evaluate the effects of physiotherapy and PFMEs on the prevention and treatment of pregnancy-related PFDs; namely, POP, FI, and UI. Therefore, this review incorporated studies comparing the use of physiotherapy and PFMEs with every other existing interventions.

This systematic review and meta-analysis was conducted on randomized-controlled-trial (RCT) articles and quasi-RCT designs through a search in the studies published with no time limits until December 2017 in the databases of PubMed (Medline), Web of Science, Scopus, Embase, Cochrane Library, and ProQuest. The meta-analysis was also applied for data synthesis. Moreover, heterogeneity was assessed using Cochran’s Q test and I2 index.

A total number of 26 RCTs were examined in this review in which the outcome variables were related to POP, UI, and FI prevalence; POP, UI, and FI severity, as well as pelvic floor muscle (PFM) strength and endurance. In most articles, UI prevalence or severity in intervention groups had significantly improved compared with those in controls. The number of studies examining POP and FI was also relatively low. In two studies, FI severity or prevalence in intervention groups had significantly enhanced in comparison with those in control groups; however, FI prevalence in two articles had been reported lower in intervention groups than that in control groups although no significant difference had been observed. There was also no significant improvement in intervention groups in two other studies in this respect. Besides, three articles had not reported traces of improvement in POP, as well as a significant difference between intervention and control groups. Nevertheless, two studies had found a significant improvement in POP in this regard. Based on meta-analysis results for the variable of PFM strength, Cochran’s Q test (P<0.001) and I2 index (90.02) indicated heterogeneity between studies; so, a random-effect meta-analysis was applied to estimate overall effect sizes. The overall mean differences following intervention between the study groups were also equal to 6.94, with a 95% CI (1.36 to 12.52).

It was concluded that physiotherapy and PFMEs might have effects on pregnancy-related UI, but they had not consistently reduced FI severity or prevalence and failed to constantly improve POP

Socioeconomic inequality is one of the important issues in cardiovasculardiseases (CVDs). The aim of this study was to investigate the distribution,relation betweenselected cardiac risk factors,type of CVD,and the socioeconomic status (SES) in the hospitalizedpatients with heart disease in Isfahan,Iran.

This analytical,cross-sectional study was conducted in Isfahan in 2013. Thepopulation consisted of all patients with CVD admitted to the public,private hospitals. Thesample size was 721. Data collection was conducted through one researcher-made questionnairewith three sections: demographic,disease,and SES questionnaires. To determine the SES of thepatients,the indicators of income,housing status,occupation,family size,and education wereused. Data analysis was conducted in two statistical levels of descriptive,inferential.

69.1% of the patients were placed in the poor status,and there was no wealthy statuswithin the subjects. The five most frequent CVDs were chronic ischemia,unstable angina,arrhythmia,congestive heart failure (CHF),and acute myocardial infarction (MI),respectively.The three highest frequent risk factors in the patients were hypertension (HTN) (47.2%),diabetes (33.6%),and hyperlipidemia (32.6%). Regression analysis of the risk factors,thetype of heart disease on the SES revealed that there were statistically significant differencesbetween patients who were smokers (P,0.030),those who had valve disease (P,0.010),adjusted for age,gender,and marital status.

Our findings showed that the frequency of CVD risk factors were higher in lowerSES groups,thus SES can be a strong predictor for the occurrence of the CVD risk factors aswell as the CVDs.

The system of safety management in higher education centers can prevent the complications caused by harmful issues to students and bring their potential talents closer to perfection. Therefore, this study aimed to design a safety management system (SMS) in higher education centers of Iran in 2016.

This study was a descriptive study of qualitative type. This study was conducted in three independent phases, including (1) evaluating theoretical concepts, (2) developing an initial system by determining the points of sharing and differentiation of the evaluated systems, and (3) validating the SMS using the Delphi technique. Consensus on opinions and identifying similarities and differences of reviewed studies have been used for qualitative data analysis, and the descriptive statistics (sum of scores and mean) by means of SPSS version 21 has been used for quantitative data analysis.

In the first stage, 108 indexes were identified by reviewing the studies and evaluating the SMS in the world’s educational and noneducational organizations for the 12 main categories of SMS. In the Delphi phase, 83 components were identified as a key index of the SMS in higher education centers of Iran. Furthermore, the average mean of participants’ views on the dimensions of the SMS for higher education centers has been 4.32, with the highest average mean of 4.59 related to the dimension of the facility and the firefighting department and the lowest mean of 4.10 for the student dimension.

The indexes presented in this study will provide a fairly complete tool for designing SMS in higher education centers, which by applying it will provide a good opportunity to improve the performance of these systems over time.

CONTEXT:

Health system reform plan refers to conducting some fundamental, systematic, and sustainable changes.

The aim of the present study was to evaluate different required inputs of Iran Health Transformation Plan from experts' viewpoints.
SETTINGS AND DESIGN: The data of this qualitative study were collected using semi-structured interviews.

SUBJECTS AND METHODS:

The purposive sampling method led to 18 participant selection and then they were interviewed. Interviewees were assured about confidentiality of information.
STATISTICAL ANALYSIS USED: The thematic analysis method and MAXQDA software were employed for analyzing the data.

There were 4 main themes and 35 subthemes extracted including management requirements for health development plan, human resources, information resources, and financial resources. Each theme had subthemes such as “resource allocation,” “development of required standards for human resources,” “human resources' motivation,” “failures in IT infrastructures,” “hospital information management software,” “guidelines and instructions,” “costs controlling,” and “financing the plan”.

Results of the present study put significant emphasis on the path of improving the effectiveness and efficacy of applying the discussed inputs, which can be a light for revising past policies and taking better future steps, it also can be a resource guide for policy-makers and managers of the health-care system.

One approach to improve efficiency in health care is to identify patients with high risks of readmission so that resources should be distributed in a way they would benefit targeted care. A model named LACE (length of stay, acuity of admission, Charlson comorbidity index (CCI(, and number of emergency department visits in preceding 6 months) has been proposed to predict patient readmission which is widely used due to its simplicity to rank factors’ risks. The aim of this study is to determine if LACE Index could be used to predict Iranian hospital readmission.
This was a prospective cohort study in which the prediction of readmission for patients admitted to the cardiac intensive care of Shahid Beheshti Hospital of Qom during April to June 2012 within one month after the discharge was evaluated based on 4 items of LACE index. Following-up readmission states by making calls within a month after discharge. Purposive sampling was used to select the sample, patients having four most prevalent chronic heart diseases in the CCU of the hospital were selected and at last sample size was 109 patients. We used logistic regression, the phi and Spearman correlation coefficient to analyze data using SPSS18. the significance level was considered as 5% in all tests.
Among the items of LACE model, 48.6% of patients stayed at the hospital for 4 to 6 days. Only 11 patients (10.09%) referred to the hospital after a month. None of the components of the LACE index could enter the stepwise logistic regression model.
Considering that LACE model with its four items is a weak in predicting readmission, in order to improve the model in predicting the readmission of cardiac patients, it is recommended that individual variables and factors associated with the service providers be added to it.

Nowadays, oral cancer is considered one of the most important diseases related to oral health. The objective of the present study was to determine the dental students’ knowledge in Isfahan about oral cancer and the comparison of the level of student's knowledge in different years of education.
The present study was a cross-sectional-analytical one conducted in 2013. The population of study included the dental students of private and state University of Isfahan which 255 students were randomly selected. The data were collected using questionnaire and were then analyzed using SPSS software program and Kruskal-Wallis and Mann-Whitney.
From private and public dental schools in Isfahan, 56% and 44% of dental students were involved. Regarding performing routine clinical oral examination, 81% of the participants answered positively, which showed no significant difference among the years of education of the participants (P=0.116). Regarding the examination of patients with oral lesions, 46% of them answered positively, which the difference between the years of education was highly significant (P≤0.001).
The findings of the research indicated that the level of knowledge of dental students of Isfahan city regarding the detection of oral lesions was not sufficient. Although, the students did not perform common examinations for exploring oral cancer, they did not have sufficient knowledge regarding some of the risk factors and oral lesions related to cancer. Therefore, it is necessary that a comprehensive curriculum be developed in this regard for their education.

Medical errors are one of the greatest problems in any healthcare systems. The best way to prevent such problems is errors identification and their roots. Failure Mode and Effects Analysis (FMEA) technique is a prospective risk analysis method. This study is a review risk analysis using FMEA technique in different hospital wards and departments.
This paper systematically investigated the available databases. After selecting inclusion and exclusion criteria, the related studies were found. This selection was made in two steps. First, the abstracts and titles were investigated by the researchers and, after omitting papers which did not meet the inclusion criteria, 22 papers were finally selected and the text was thoroughly examined. At the end, the results were obtained.
The examined papers had focused mostly on the process and had been conducted in the pediatric wards and radiology departments, and most participants were nursing staffs. Many of these papers attempted to express almost all the steps of model implementation; and after implementing the strategies and interventions, the Risk Priority Number (RPN) was calculated to determine the degree of the technique's effect. However, these papers have paid less attention to the identification of risk effects.
The study revealed that a small number of studies had failed to show the FMEA technique effects. In general, however, most of the studies recommended this technique and had considered it a useful and efficient method in reducing the number of risks and improving service quality.

Now, oral cancer is considered one of the most important diseases related to oral health. The objective of the present study is to determine knowledge of dental students of dental schools in Isfahan about oral cancer and the comparison of the level of student's knowledge in different years of education.
The present study is a cross-sectional-analytical one conducted in 2013. The population of the study included dental students of private and state university of Isfahan that 255 students were selected randomly. The data was collected using questionnaire. The data, after being collected, was analyzed using SPSS software program and the descriptive statistical techniques of Kruskal-Wallis and Mann-Whitney.
From private and public dental schools in Isfahan 56 percent and 44 percent of dental students were involved. Regarding performing routine clinical oral examination, 81% of the participants answered positively, which did not have significant difference among the years of education of the participants(P=0.116). Regarding the examination of the patients with oral lesions, 46% of them answered positively, which the difference between the years of education was highly significant (P≤0.001).
The findings of the research indicated that the level of knowledge of dental students of Isfahan City regarding the detection of oral lesions was not sufficient and although students did not perform common examinations for exploring oral cancer, they did not have sufficient knowledge regarding some of the risk factors and oral lesions related to cancer; therefore, it is necessary that a comprehensive curriculum be developed during their education.

Moral hazards are the result of an expansive range of factors mostly originating in the patients’ roles. The objective of the present study was to investigate patient incentives for moral hazards using the experiences of experts of basic Iranian insurance organizations.
This was a qualitative research. Data were collected through semi-structured interviews. The study population included all experts of basic healthcare insurance agencies in the City of Isfahan, Iran, who were familiar with the topic of moral hazards. A total of 18 individuals were selected through purposive sampling and interviewed and some criteria such as data reliability and stability were considered. The anonymity of the interviewees was preserved. The data were transcribed, categorized, and then, analyzed through thematic analysis method.
Through thematic analysis, 2 main themes and 11 subthemes were extracted. The main themes included economic causes and moral-cultural causes affecting the phenomenon of moral hazards resulted from patients’ roles. Each of these themes has some sub-themes.
False expectations from insurance companies are rooted in the moral and cultural values of individuals. People with the insurance coverage make no sense if using another person insurance identification or requesting physicians for prescribing the medicines. These expectations will lead them to moral hazards. Individuals with any insurance coverage should consider the rights of insurance agencies as third party payers and supportive organizations which disburden them from economical loads in the time of sickness.

Equity is one of the pivotal aims and priorities of the pharmaceutical system. The World Health Organization report in 2000 clarifies the important role of equity in health-care systems. Equity and efficiency are prominent features of health-care system operation. Pharmaceuticals play an important role in the cycle of health services. The aim of this study was to evaluate the equity in access to pharmaceutical services in selected cities of Isfahan Province, Iran.
This research is a cross-sectional analytical study. A valid, reliable questionnaire including 25 questions was prepared to measure patients’ access to their prescribed medicines and also to determine their socioeconomic status (SES). Totally 800 questionnaires were completed by patients who attended pharmacies in selected cities of Isfahan Province. Equity in access was evaluated using concentration and Lorenz curves.
Nearly 66% of the samples were categorized in moderate-to-extremely poor SES. The highest rate of access to pharmaceutical services was found in Borkhar and Meymeh (98.9%) and the least was in Natanz (90.5%). The concentration index (CI) for access to pharmaceutical services was 0.029 in Isfahan Province, and thus equitable access to pharmaceutical services was estimated to be about 97% in this province.
The CI for access to pharmaceutical services was 0.029 in Isfahan Province. The findings show that the pattern of accessibility is not significantly different between the cities with various development indicators and is not related with various SES. This could be considered as one of the positive features of pharmaceutical policy in Iran.

This paper has two objectives. First, it establishes a model for scoring the access to pharmaceutical services. Second, it develops a model for measuring socioeconomic indicators independent of the time and place of study. These two measures are used for measuring equity in access to pharmaceutical services using concentration curve. We prepared an open-ended questionnaire and distributed it to academic experts to get their ideas to form access indicators and assign score to each indicator based on the pharmaceutical system. An extensive literature review was undertaken for the selection of indicators in order to determine the socioeconomic status (SES) of individuals. Experts’ opinions were also considered for scoring these indicators. These indicators were weighted by the Stepwise Adoption of Weights and were used to develop a model for measuring SES independent of the time and place of study. Nine factors were introduced for assessing the access to pharmaceutical services, based on pharmaceutical systems in middle-income countries. Five indicators were selected for determining the SES of individuals. A model for income classification based on poverty line was established. Likewise, a model for scoring home status based on national minimum wage was introduced. In summary, five important findings emerged from this study. These findings may assist researchers in measuring equity in access to pharmaceutical services and also could help them to apply a model for determining SES independent of the time and place of study. These also could provide a good opportunity for researchers to compare the results of various studies in a reasonable way; particularly in middle-income countries.

Completed medical records have an important role in hospital evaluation and one thing that usually reduces evaluation score of medical records department and hospital clinical wards is such defects. Therefore, regarding the importance of this matter, this study was done to study recording status of medical records by physicians in a training hospital. This study was an analytic-descriptive and cross sectional one. The population was inpatients medical record in 2012 and the number of samples was 389 medical records which were chosen by stratified sampling. Finally, after collecting data, they were analyzed by SPSS 13 software both descriptive and inferential statistics and presented in statistical tables. Findings showed that the highest percent is allocated to the presence of progress notes and the lowest percent to recording time of physician first visit. Progress notes was the most incomplete item in wards of NICU, cardiovascular, psychiatric for men, surgery for women, intensive care, emergency, children and psychiatric for women. In wards of CCUII, internal for women, newborns C, and internal for men, lack of physician stamp on summary sheet was the most incomplete item. Progress notes, medical history sheet, and summary sheet were more completed after doing quantitative analysis and using defect eliminating checklist than medical records before November. By attaching defect eliminating form on medical records, we force physicians to complete incomplete records and they understand that completion of these forms will be controlled and these forms have to be completed otherwise records will be referred to them again for completion.

Diabetes is the fourth leading cause of death in societies. Diabetes is not only considered just a disease but also is an interwoven network of environmental and genetic risk factors with different pathophysiology which is very costly. The aim of the present study is to investigate the utilization pattern of patients with diabetes in the centers of the City of Isfahan. The present study is a cross-sectional study which employs a descriptive method. In this study, the medical records of patients with diabetes referring to five diabetic care centers (a private center, a state-run center, a charity services center, a sub-specialized eye care center, and a subspecialized center for diabetic foot treatment) in the first half of 2013 were investigated. The data analysis was conducted using Microsoft Excel. Most of the admitted patients were referred ones and the least of them were introduced by other centers. In the second level, visits to specialists and visits to ophthalmologists had the highest frequency. In the charity center, visits to internists had the highest frequency. In the state center, visits to ophthalmologists had the highest frequency. Regarding the favorability of the degree of diabetic patient's access to services in the City of Isfahan, policy making for public screening for identifying latent cases of diabetes and including patients in treatment cyclesin order for preventing the incidence of side effects and diabetes in the members of patient's families seem necessary.

nowadays، complaints handling is considered as a necessary part of healthcare systems for enhancing patients'' satisfaction. The present study is to determine the state of the complaints handling of the visitors of Isfahan educational hospitals in order to identify the challenges available in this process. the method of the study is descriptive and its design is retrospective cross-sectional. The research environment is Isfahan educational hospitals among which two hospitals were selected for the study; one of them was a subspecialty hospital and the other was a general one. The population of the study includes the complaint cases of the visitors of the hospitals'' complaint unit in 2012. In one hospital، there were 1203 cases and in the other there were 125 ones. To collect the data، a checklist، whose face and content validities were confirmed، was used. The data were extracted from the cases and using a frequency table created by Excel software program was described. based on the results obtained from the study، it can be claimed that in one of the hospitals، the most cases of complaint were about the quality of services (63. 6%) and public as well as welfare affairs of the hospital (43. 1%). The complaints about the medical staff (45. 45%) and administrative staff (54. 5%) had the most proportions. In the other hospital، the proportion of the complaining the medical staff had been increasing during the year، however the total number of the complaints had been decreasing. After the medical staff، nursing staff (39. 5%) assigned the second rank of complaint proportion in the hospital to itself. the results obtained from the study can be as an experience for reforming the future performance of hospitals. In general، the results of the complained individuals in the hospital A indicate that the most proportion of the complaints was about the physicians and learners and the least proportion was about the technicians and experts of anesthesia and operating room. It seems that the reason for these results is first the physicians'' and learners'' unawareness of patients'' bill of rights. This bill of rights should be considered as important in teaching learners as other scientific contents. In the hospital A، the reason for complaining the physicians had not been recorded، which by recording them، we can be aware of the weaknesses available in this regard and do appropriate deeds to improve them. But، in general، the quality of services and public as well as welfare issues are the topics considered as important in this research.

Addiction is one of the most serious social damages and due to its progressive nature in all aspects, adversely affects people’s physical and psychological health. Hence, this paper investigates the characteristics of drug addicts in a drug rehabilitation center in the city of Isfahan. In this cross-sectional study conducted in 2012, the population consisted of all addicts that referred to Shefa Drug Rehabilitation Center. A sample of 201 individuals was selected randomly. Two questionnaires were drawn up to collect data; the first questionnaire examined demographic characteristics and the second was the 71-item Minnesota Multiphase Personality Inventory short form. Chi-square test, Fisher’s exact test and Kruskal-Wallis test were used in SPSS20 to analyze the data. Overall, 98% of participants were men, 65.7% were married, and 13.3% were unemployed. Depression and hypomania were respectively the most and the least prevalent disorders among individuals with high-risk psychological profiles of clinical scales respectively. Psychopathic deviation and schizophrenia were seen among the unemployed more than the employed ones. Considering the fact that depression was the most common personality disorder among the addicts participating, it is recommended that this disorder be given priority in investigations in the treatment programs of these patients. In addition, the scales of disorder, schizophrenia, mental infirmity, mental deviation, and paranoia had a significant relationship to aggression, delirium and hallucination, which must be taken into consideration in the treatment of such patients.

Induced demand in healthcare is referred to as provision of unnecessary services or the patient by health services providers, while the patient is not aware of their unnecessity. Apart from being unethical, this practice can potentially disturb the supply and demand balance in the health market, pose financial load on the patient, thread the patient’s health by imposing possible side-effects, and lead to waste of the limited national health resources. This study, thus, was aimed at investigating the nature of the phenomenon in Iran, as perceived by the healthcare experts. A qualitative research design was adopted. Data was collected using semi-structure interview. Participations were selected by purposive sampling method. Thematic analysis was used for extracting and categorizing the major domains of induced demand. Four major categories of health services in which induced demand occurs were extracted from the interview data, including para-clinical services, medical services, surgical services, and pharmaceutical services. These health services domains account for nineteen specific health services with the potential of induced demand. The study identified the health services domains in which induced demand frequently takes place. This information can help policy-makers to devise strategies for alleviating the problem.

To develop a clear criteria for classifying the patients in triage unit of a tertiary healthcare center according to five-level triage system. This study is a qualitative study being conducted in five stages at Vali-Asr Hospital of Qom in 2013. After two survey, the experts were interviewed using focus group discussion (FDG) and study was continue with. Data were analyzed through studying the opinions of the specialized teams'' members, summarizing and classifying the data in qualitative phase. Changes proposed in the triage form communicated by Iran''s emergency department according to the participants'' opinions include informing all the patients in the emergency department of some necessary information. Therefore, three parts of medical and medicinal history, vital signs and level of consciousness were added to the first part of the form and necessary emergency facilities were also added to the third level of triage. Measuring each item added to the general part of the triage form provides more precise diagnosis and more scientific classification, since the level to which the patient belongs should be identified based on medical history, clinical signs and level of consciousness.

Considering the quality of care from views of patients is an important aspect in improving health services and expected value of patient. So the value chain is a strategic tool in health care organizations to create value and achieve the goal of continuous improvement in quality. In this paper we discuss the role of value chain in promoting quality of health care.This study was review which was done the first half of 2012. For searching related articles and documents, the main value chain keyword and sub keywords ​​quality and satisfaction were used in the database. Title, abstract and full text investigated respectively, and then 43 of them selected for evaluation.Findings were classified in several parts. These findings include the concept of quality, planning achieve to value-based quality, value chain, its use in health care organizations, describing components, logic planning implementation strategies, value adding healthcare service delivery strategies and value adding support strategies.In this paper, we try to noted different aspects of the value chain, two important parts of value chain including value adding healthcare service delivery strategies and value adding support strategies. Value chain can be an important tool for managers in order to planning and improve the quality.

Social loafing is the phenomenon of people deliberately exerting less effort to achieve a goal when they work in a group as compared to when they work alone. People who feel they are being treated unfair in an organization would be more likely to show this phenomenon. This study investigated the social loafing among nurses and its relationship with organizational justice in Tohid Hospital in Sanandaj, Iran. This was a correlational descriptive-analytical study conducted in 2012. The study population was all nurses working in Tohid Hospital in Sanandaj, Iran. Data were collected using a valid questionnaire. For data analysis SPSS-20 software was used, the descriptive statistics being frequency distribution, mean, standard deviation, and the Spearman, Mann-Whitney, and Kruskal-Wallis tests. The highest organizational justice component was found to be organizational justice (0.086 ± 3.39), and the mean of social loafing was higher in comparison with organizational justice. According to the Spearman test, all organizational justice components had inverse relations with social loafing. Only distributive organizational justice was significantly related to social loafing (p<0.05). It can be concluded that the personnel are highly sensitive to distributive justice and managers need to create the feeling that the organization has a fair distribution of resources. Hospitals should try to minimize the negative effects associated with loafing by creating an environment that discourages social loafing. One way to achieve this goal is to try to impress the personnel by telling them that their functions are important, such that they feel their job is important and that the role of nurses in connection with the patients is of value and significant.