mohammad zarezadeh

Identifying stakeholders and understanding their characteristics is crucial for achieving objectives efficiently. Concurrently, there is a growing movement towards utilizing technology, particularly electronic (e) prescribing, to enhance quality, safety, and efficiency within the healthcare system. To strengthen and support the e-prescribing system, collaboration among all stakeholders is essential. This collaboration will help establish a robust electronic health information infrastructure and improve healthcare delivery for all members of society.

This study aims to identify barriers to the acceptance of e- prescribing from a stakeholder perspective. It employs a mixed-methods approach, combining quantitative and qualitative research. Data collection involved focus groups to identify and prioritize stakeholders, while interviews were used to extract barriers. Following data collection, the interest-power matrix was utilized for analysis.

The findings revealed that the primary barriers identified by stakeholders, including physicians, hospitals, and insurance companies were as follows: a lack of awareness among doctors regarding costs, deductibles, and billing; insufficient training for stakeholders on e-prescribing; inadequate infrastructure; lack of forecasting for necessary financial resources; insufficient training for relevant personnel; poor communication with insurance companies; intermittent system outages and slow performance; lack of insurance coverage for certain tests; the presence of multiple insurance systems; and ineffective communication channels between doctors and insurance agents.

Infrastructure challenges are significant barriers to the full implementation of e-prescribing which must be addressed. To improve implementation issues, continuous monitoring of prescription systems is recommended. Overall, it is advisable to reform the infrastructure, integrate insurance systems, adopt electronic signatures and standards for electronic prescriptions, and provide practical training. Health policymakers can facilitate the adoption of e-prescribing by taking measures to eliminate the barriers identified in this study.

 Emergency medical services (EMSs) organize care provided to patients in out-of-hospital settings, playing a crucial role in minimizing physical and psychological harm resulting from diseases and emergencies. Consequently, pre-hospital emergency is an integral component of healthcare systems, requiring performance standards to improve outcomes for injuries and other illnesses. Thus, the effective utilization of modern management methodologies is essential in this context.

 The current study aimed to determine the impact of the Lean Six Sigma (LSS) program on performance standards of pre-hospital emergency.

 This single-group quasi-experimental study with a pretest-posttest design was conducted on 50 pre-hospital emergency personnel in Koohdasht County in 2023 using a census method. The research tool included a performance standard measurement checklist, completed through observation before and after implementing the LSS method. Data were analyzed using the paired t-test in SPSS v.18 software.

 The findings revealed that the majority of participants held bachelor’s degrees (54%), were contractual employees (56%), and were all male. There was a statistically significant difference in the mean score of the performance standards in the personnel (p=0.001), equipment (p<0.001), and overall (p<0.001) dimensions before and after the intervention.

 Based on the findings, the implementation of the LSS program was able to enhance the performance standards of pre-hospital emergency in the personnel and equipment dimensions, and overall. Hence, the use of this method is recommended in other centers and other dimensions affecting the performance standards of pre-hospital emergency.

Since the emergence of COVID-19 disease and its spread, many people have been globally infected. Also, evidence has shown that some specific conditions and underlying diseases result in more severe symptoms in the patients. Therefore, this study aimed to investigate the relationship between demographic characteristics and underlying conditions with symptoms in patients with COVID-19 in one of Iran's major hospitals.

The present cross-sectional and descriptive-analytical study was conducted from February 20th, 2020 to August 20th, 2021. The sampling method was census. The data were collected from the statistics department, medical records, HIS, and they were analysed via SPSS software version 25 using descriptive statistics and statistical tests such as Spearman, Mann-Whitney, and Chi-square.

Among the 7,236 patients with a definite diagnosis of COVID-19, most (53.2%) of the subjects were men and the total death rate was 8%. There was a positive correlation (p-value=0.000) between age and length of stay. About 69% of the patients had symptoms related to the disease in their CT scan and 39.5% had an oxygen level of less than 93%, which roughly 2.6% of them were intubated. There was a significant relationship between patients' age, sex, and length of stay with their discharge status, first symptoms of disease, and patient’s underlying conditions. Also, there was a significant difference in patients' discharge status based on having some early symptoms, gastrointestinal symptoms, and underlying conditions.

The findings of this study emphasize the importance of early detection and management strategies, especially for individuals with specific risk factors. These insights are crucial in guiding healthcare practices and policies to effectively combat the ongoing pandemic. Also, the study outcomes provide valuable insights for healthcare professionals and policymakers, aiding in the development of targeted interventions and patient-centered care protocols.

The World Health Organization recommends that women be continuously supported by a favorite companion during labor. Currently, there is no strong evidence on specific support measures by midwifery in relation to improving the delivery process.

The present retrospective cost analysis study was conducted during 2021-2022. The reports of 243 deliveries were checked in the patients’ files in selected hospitals of Yazd city. Data analysis was done using SPSS26.

According to the study objectives, the desired delivery outcomes included type of delivery, postpartum complications, postpartum bleeding, and length of the active phase of labor, resuscitation of the newborn, hospitalization of the newborn, and Apgar score of the newborn in the first and fifth minutes. There was a statistically significant difference in delivery, postpartum complications, length of the active phase of labor and hospitalization of the newborn in the neonatal unit, resuscitation of the newborn, and the amount of nutrition of the exposed group compared to the non-exposed group. Among the desired performance indicators, patient length of stay and total cost per person between the exposure and non-exposure groups, the mean score of the cost per person had a statistically significant difference between the two groups (P<0.001).

Generally, the presence of a companion midwife next to the mother in the delivery room improves some of the outcomes of the mother and the baby. It is recommended to carry out studies in this field along with checking mothers' satisfaction with companion midwives.

This research was conducted with the aim of determining the relationship between the implementation of the strategic plan and the performance of the hospital. The importance of knowing the factors affecting the implementation of the strategic plan and its identification leads to better planning and the correct implementation of the strategic planning process.

The current research is a descriptive analytical research, in terms of cross-sectional time and practical results, and it was carried out in 2018. The research population is all the people who have played a role in the drafting of the strategic plan. This research has used the census, which filled the questionnaire in a high percentage of the statistical population. After collecting the data, the information was entered into the software and SPSS version 16 software was used to analyze the data.

The relationship between the implementation of the strategic plan and the performance of the hospital is direct and strong. Among all parts of the strategic plan, customer management plays a more important role than other parts of the strategic plan in improving the performance of the hospital.

In order to have optimal performance in a hospital, we need detailed strategic planning, and this plan must be implemented carefully and properly monitored so that it can bring us optimal performance.

This study was conducted to investigate the efficacy of psychological capitals training on the psychological resilience and mental empowerment of employees with work-family conflict at the Sarkhoon and Qeshm gas company. It was a quasi-experimental study with a pre-test, post-test, control group, and a follow-up period of four months. In the spring of 2021, the statistical population included employees with work-family conflicts at the Sarkhoon and Qeshm oil and gas company. Using a systematic sampling technique, 27 employees were selected and randomly assigned to experimental and control groups. Two and a half months of psychological capitals training (10 sessions) were administered to the experimental group. Work-Family Conflict Questionnaire (WFCS), Psychological Resilience Questionnaire (RQ), and Mental Empowerment Questionnaire (PES) were among the questionnaires utilized in this study. The study’s data were analyzed using Mixed ANOVA and SPSS-23 software. Psychological capitals training had a positive effect on psychological resilience (P<0001, Eta=0.57, F=33.68) and mental empowerment (P<0001, Eta=0.48, F=23.28) among employees with work-family conflict. According to the findings of the present study, training in psychological capitals is an effective method for enhancing psychological resilience and mental empowerment among employees experiencing work-family conflict.

Despite technical advances in medical diagnosis and treatment, the malpractice of health providers has increased, which can lead to a decrease in people's trust. Medical malpractice means unintentional failure to perform a task, which includes misdiagnosis, treatment plan error, or disease management error. This study was conducted in 2018 to investigate the causes of health providers’ malpractices in cases referred to Forensic Medicine Organization in Yazd.

This was a cross-sectional and applied study conducted in 2019 in Yazd province. The research population included all the cases of complaints about health providers’ malpractices in cases referred to Forensic Medicine Commission of Yazd Province in 2108. Data were collected by a two-part checklist and were analyzed by SPSS 16 software.

Out of 96 cases examined in 2018, 53 of the plaintiffs were men, and 43 of them were women. Most of them were in the age group of 20-40, and the most of complaints were related to government hospitals. Regarding the cause of malpractice, the highest frequency was related to carelessness, non-compliance with government regulations, and a combination of several factors, negligence and lack of proficiency, respectively. Moreover, obstetricians and gynecologists (18.8 %), surgery (13.5 %), and anesthesia (10.4 %) reported the highest number of malpractice cases. Only 58.3 % of the cases were proved.

Identifying the root causes of medical malpractice, changing individual approach to systemic approach in dealing with error factors, increasing the awareness of the treatment staff of the rules and consequences of malpractice, and notifying health care providers of guidelines through safety committees can reduce malpractice of treatment staff, and consequently, reduce complaints from them.

Spread of COVID-19 worldwide created anxiety, stress. In the meantime, healthcare workers have been suffering from significant psychological distress due to providing direct care to the patient, side injuries and quarantine. The present research aims to investigate and identify the factors involved in reduction of psychological effects of COVID-19 by interpretive structural modeling.

This study was a mixed study (quantitative and qualitative). The study population included doctors, supervisors and nurses of the clinical departments of Khatam-ul-AnbiyaAbarkoh Hospital in Yazd. The participants were selected using the snowball sampling method. Semi-structured interviews were used to collect data. In the qualitative part of the research, mainly library studies and expert opinions were used. In the quantitative part of the research, the structural self-interaction matrix was used. The final analysis was performed by MATLAB2018.

The results show that the most psychological effects of Covid-19 are related to "appropriate measures to reduce the disease such as environmental ventilation" and "financial support of personnel" and "sufficient provision of personal protective equipment" and "dedicated sufficient manpower to the involved departments" (with a power of 8). And the lowest influence is related to "continuous training of stress management and constant presence of a psychologist" (with an influence of influence 5)

The basic factors in the research model include continuous stress management training, the presence of a psychologist, and inspection of infected areas. By the management team and providing adequate personal protective equipment.

Hazards have always been considered a threat to human life and preparedness to deal with risks for pre-hospital emergency as the first line of care and treatment is highly significant. Pre-hospital emergency (clinical) deals with different natural and man-made hazards which cause various harms. Preservation of disaster preparedness is one of the pre-hospital emergency concerns. In this regard.

The present study aimed to determine the priority of hazards and design preparedness programs based on health response.

The present study was based on a descriptive-analytical study that was conducted in Rasht, Iran in 2019. The method used in this study was a combination of quantitative and qualitative methods. In a qualitative method, the major threats and potential hazards of pre-hospital emergency were identified by reviewing the texts and searching for relevant articles. Afterward, its effectiveness and the significance of its risk or threat were evaluated using a researcher-made checklist. In total, 19 crisis liaisons from the organizations involved in crisis management in Rasht were questioned, 18 of whom responded to the checklist.

The results obtained from the opinions of the experts showed that the risk of earthquakes (88.8%) and seasonal flood (83.3%),among all the risks investigated, have a higher priority than traffic accidents (77.7%) and heavy snowfall (72.2%) in the society. The pre-hospital emergency is closely related to many various risks, among which the earthquake risk was chosen as the priority by the community of experts participating in this research. For the emergency of the earthquake, preparedness plans were produced based on the response plan of the health sector and the additional comments of the expert community.

Identification of high-priority risks and design of appropriate response plans will help those in charge to face and prepare in time and reduce damages.

Families are willing to spend their entire lives improving their children due to emotional attachments, which, in turn, increases their exposure to catastrophic health expenditures (CHEs). The present study aimed to estimate the level of exposure to CHEs and its determinants among households with pediatric cancer and oncology disorders.

This cross-sectional study was performed on 101 households with pediatric cancer and oncology patients who referred to Shahid Sadoughi Hospital of Yazd in 2021. The CHE in this regard was defined as the out-of-pocket payments for hypertensive care that equaled or exceeded 40% of the household capacity to pay. The data on each household were collected with reference to the patient's electronic file and through a questionnaire completed during an interview with the head of the household. The data were also analyzed with descriptive statistics and logistic regression in Excel (2019) and STATA ver.15.

Out of 101 households in the study, 43 (42.6%) incurred CHEs (based on a threshold of 40% of disposable income). Regarding the job of the heads of households, manual workers were vulnerable to CHEs up to 11.7 times more than employees and self-employed individuals (OR=11.7, p<0.05). Also, the lower the education level of the head of the household, the higher the risk of facing CHEs (OR=10.45, p<0.05). Similarly, the lower his or her income, the higher the CHE.

The results showed that households with pediatric cancer and oncology disorders were significantly exposed to CHEs. Due to the limited resources of the health system in the treatment of cancer patients and the need for expenditure control programs, it seems better to focus on cost control strategies for this group of patients.

The present study was conducted to investigate the efficacy of psychological capitals training on the job engagement and responsibility of the staff with work-family conflict in Sarkhoon and Qeshm gas Company. It was a quasi-experimental study with pretest, posttest, control group and tree-month follow-up period design. The statistical population included the staff with work-family conflict in Sarkhoon and Qeshm oil and Gas Company in the spring of 2021. 27 employees were selected through purposive sampling method and randomly accommodated into experimental and control groups. The experimental group received psychological capitals training (10 sessions) during two-and-a-half months. The applied questionnaires in this study included work-family conflict questionnaire (Carlson, Kacmar, and Williams, 2000), job engagement and questionnaire (Schaufeli, Salanova, 2002) and responsibility questionnaire (Carroll, 2010). The data from the study were analyzed through Mixed ANOVA via SPSS23 software. The results showed that psychological capitals training has been effective on the job engagement and responsibility in the staff with work-family conflict. According to the findings of the present study, psychological capitals training can be used as the efficient method to improve job engagement and responsibility of the staff with work-family conflict using concepts such as resilience, self-efficacy, optimism and hope.

Paying special attention to the development indicators of medical tourism (MT) can lead to the further development of this industry and tourists' satisfaction.

This study aimed to investigate MT development indicators in Yazd Reproductive Sciences Research Institute, Yazd, Iran in 2021.

In this cross-sectional study, 430 medical tourists referred to the Yazd Reproductive Sciences Institute, Yazd, Iran in 2021were studied. A researcher-made questionnaire with 46 questions and 10 dimensions was used in both internal and external environments to collect data. The Spearman correlation coefficient was also used to assess the correlation between the quantitative factors.

The reliability and validity of the scale were confirmed. The mean ± SD of the advertising and marketing index scored was lower than the other internal environmental indices (15.05 ± 2.16). Also, the economic factors and tourism infrastructure was lower than the other external environmental factors (9.8 ± 1.99, 8.53 ± 2.11, respectively). 

Given the importance of MT, top managers and relevant authorities should pay close attention to the criteria of advertising, marketing, and tourism infrastructure. MT demand can be improved by increasing the importance of advertising, implementing realistic advertising strategies, and developing adequate urban infrastructure and services.

The use of resilience engineering principles is a commonly used method for the assessment of crisis management in hospitals as a part of the health system. The present study aimed to evaluate crisis management based on the seven principles of resilience engineering in selected hospitals affiliated to Yazd University of Medical Sciences in 2021.

In this study, a crisis management evaluation questionnaire based on the seven principles of resilience engineering in hospitals was used. The reliability and validity of this questionnaire were confirmed by Azadian et al. in a previous study. The required data were collected from administrative and clinical managers and nurses. The mean score of the seven principles was obtained, making it possible to compare crisis management in all three selected hospitals (Shahid Sadoughi, Afshar, and Shahid Rahnamoun) in Yazd.

The mean score of resilience engineering principles was determined, and the overall crisis management score of each hospital was determined. The mean scores of crisis management were calculated at 136.53, 135.23, and 132.07 out of a total score of 220 in Shahid Sadoughi, Shahid Rahnamoun, and Afshar hospitals. Nonetheless, the mean score in flexibility and preparedness components in some hospitals was below 0.6 of the total score.

The situation of crisis management in all three hospitals was evaluated to be at a good level. However, some corrective measures were required to be implemented in some components to improve crisis management in all three hospitals. It is necessary to take appropriate measures to enhance the preparedness of the three hospitals in different aspects of crisis management, especially flexibility, to arrive at a more favorable level.

Antibiotics are widely used since they inhibit microorganisms without damaging human cells. Antibiotics are one of the most commonly used drugs in surgery because surgical site infection is the most common nosocomial infection and its prevalence reaches a maximum of 38%. Prescribing prophylactic antibiotics before surgery is a way to prevent infection at the surgical site, provided that its principles are observed. It is essential to study the ways of administering antibiotics to prevent overdose or misuse of these drugs. This study aimed to investigate the pattern of prescribing prophylactic antibiotics to patients admitted to the surgical wards of Shahid Sadoughi Hospital in Yazd, Iran and compare it with standard methods.

The present study was a cross-sectional, descriptive, and analytical study. For data collection, we used the patients’ medical records in Shahid Sadoughi hospital in Yazd, Iran.The sample size was 238 cases according to the total number of surgical records from 2019.3.21 to 2019.9.22. Out of 238 samples, 236 cases were considered acceptable and two cases were excluded as they were related to breast surgery, including mastectomy with axillary lymphatic dissection, reconstruction, and reoperation within six weeks of initial surgery. We excluded these cases because their number was not large enough to be able to generalize their results. Each case was randomly studied for each surgery, so that the share of each surgery was determined in proportion to their total number. A checklist was designed to collect the required information. This checklist included information about the patients' age, type of health insurance, type of general surgery ward, time of preoperative prophylactic antibiotics, type of preoperative prophylactic antibiotics, and duration of continued postoperative antibiotics. It also included two questions about re-admission resulting from wound infection and administration of oral antibiotics after discharge, as well as two questions regarding the compliance of prescribed prophylactic antibiotics with clinical guidelines. Significance level in all research tests was considered less than 0.05.

The results showed a significant relationship between the patients' age and the time of administration of preoperative prophylactic antibiotics, type of preoperative prophylaxis antibiotics, and administration of oral antibiotics after discharge based on clinical guideline (P <0.05). However, the type of preoperative prophylactic antibiotics seems to have been observed only in the age groups 1-15 and 46-60, as dictated by the standard method, while the oral antibiotic component has been prescribed for other age intervals after discharge except for the age range of 1-15 years. There was also a significant relationship between the type of general surgery and the time of administration of preoperative prophylaxis antibiotics, the type of preoperative prophylaxis antibiotics, and the administration of oral antibiotics after discharge according to the clinical guidelines; this means that the time of preoperative prophylaxis was prescribed. According to the clinical guidelines, except for thyroid and parathyroid surgeries, it was not observed in the other cases. The prescription of prophylactic antibiotics according to the standards was found to have been observed only in non-obstructive small bowel surgeries, open or laparoscopic hernia repair operations with mesh, and thyroid and parathyroid implants. It should be noted that in accordance with the administration of oral antibiotics after discharge with the type of surgery, in all cases except open or laparoscopic hernia repair surgery with antibiotics, antibiotics are also prescribed after discharge. Moreover, there was a significant relationship between the type of prophylactic antibiotics used before surgery and the type of preoperative prescription antibiotics according to the clinical guidelines, and the highest standard in the type of prescription antibiotics was related to cefazolin. In other cases, no significant relationship was observed between the compared variables.

The administration of prophylactic antibiotics in the general surgery department does not comply significantly with the standard instructions. It seems that the choice of prophylactic antibiotics is based on the surgeon's experience, patient characteristics, type of surgery, and the instructions available in different hospitals. However, it is essential to follow the recommendations mentioned in the instructions for timely administration of prophylactic antibiotics and their duration after surgery because long-term use of antibiotics leads to drug resistance and increased use of expensive, end-of-line antibiotics, which continues for a long time. The duration will have adverse effects on the economic and medical system of the hospitals as well.

 Based on predictions by the World Tourism Organization, the future of the world economy and international trade market will be dominated by the tourism industry, especially between 2020 and 2030.  Medical tourism, as a fast-growing and accelerating industry, will be a major contribution to the future of the tourism industry. This study was conducted with the aim of morphological analysis of the factors and key uncertainties affecting medical tourism in Yazd, Iran.

 The present study identified the key factors and uncertainties of medical tourism in Yazd using a mixture of qualitative and quantitative methods. The research sample included 24 experts selected using purposive sampling method. The data collection instruments were interview and a questionnaire. Qualitative content analysis and morphological analysis were used to analyze the data through SPSS21.

 After analyzing the interviews, 19 themes for capacities and 23 themes for obstacles were extracted. Then, 41 factors, prioritized based on two criteria of importance and uncertainty, were identified using Likert scale. In the second stage, 9 out of 41 factors that had more uncertainty and served as drivers were determined by experts.

 According to the results, it is recommended that a comprehensive medical tourism Plan should be prepared for Yazd province based on the drivers identified in this study and introduce the medical tourism capacities in Yazd to the target countries.

Given that few studies regarding the effect of Aloe vera (A. vera) on prevention of fever and neutropenia on acute lymphoid leukemia (ALL) disease, the aim was to evaluate the effect of A.vera on prevention of fever and neutropenia in children with ALL.

This randomized clinical trial study was conducted on 60 children with mean age 5.6± 2.9 years in Oncology department of Shahid Sadoughi hospital during 2018-2019. All these children were underwent chemotherapy. Then, the patients were randomly classified into two groups. The first group received 10 ml A. vera syrup (0.5 mg/ml) for 30 days (case group) and the second group did not receive A. vera syrup (control group). Complete blood count (CBC) tests and frequency of fever, infection, neutropenia, and hospitalization were evaluated in case and control groups before and after intervention. Wilcoxon, T test, and Chi Square test were used for data analysis.

Significant reduction was observed in case group in comparison with control group regarding the frequency of fever (0.19 ±0.107 vs 1.07±0.206), infection (0.81 ±0.2 vs 1.87± 0.236), hospitalization (0.37±0.178 vs 1.33 ±0.187), and neutropenia (0.11± 0.062 vs 0.80 ± 0.2) (p<0.01). Moreover, significant increase was observed in case group in comparison with control group considering neutrophil count (2597.5±243.1 vs 1106.53±161.6) and white blood cell (WBC) (4062.96 ± 276.6 vs 2566.67 ±175.5) (p<0.01). In addition, recovery of appetite was significantly greater in case group than control group (p=0.023). Furthermore, significant difference was observed in case group before and after intervention regarding these parameters (p<0.05).

According to findings, A. vera consumption decreased frequency of infection, neutropenia, fever, and hospitalization and increased WBC and neutrophil count.  Moreover, appetite was improved in these patients. Therefore, it seems that A.vera can be used for improving quality of life in children with ALL

Cost analysis is a management tool that helps the researchers to identify and manage high costs. The purpose of the present study was to calculate the cost of day bed and patient bed in the ear, nose, and throat departments of a teaching hospital and a private hospital in Yazd City, Iran.

The present descriptive, analytical, and retrospective study was conducted in the ear, nose, and throat departments of a teaching hospital and a private hospital in Yazd in 2016. Data were collected by studying the relevant documents and checklists. Data were analyzed using Excel software.

The costs of day bed occupancy were calculated as 7286715 rials and 2386715 rials in the ear, nose, and throat departments of the private and educational hospitals, respectively. The cost of a private hospital day bed was much higher than that of a training hospital considering the tariff approved in 2016. Income per patient per day was obtained as 2204643 rials in educational hospital and 1500130 rials in the private hospital. The income per patient per day was higher in the teaching hospital than the private hospital.

Hospitals should have a precise financial system in order to manage the day bed pricing based on the final costs and have realistic day bed costs. Given the high cost of staffing, hospitals should pay close attention to control these costs. Hospitals also need to adopt appropriate processes to consume the consumables logically and reduce their costs.

Hospitals are one of the greatest and most costly operational units of the health system and a study on its performance may be a criterion for operation and efficiency assessment of its resource consumption. The present study was done in 2017 with the purpose of assessing technical efficiency of the selected hospital under the coverage of Yazd University of Medical Sciences using Data Envelopment Analysis (DEA) in context of Health Reform Plan.

This research is a descriptive-analytical study was done in 2017. In this research in order to determine assessing the efficiency of Yazd University of Medical Sciences hospitals, 10 hospitals affiliated with this university were chosen. To collect data the information collection form including specifications of hospital as well as input and output index is used and the data before and after executing Health Reform Plan were collected and compared. The input-oriented DEA method is used for estimating technical efficiency of hospitals and data analysis is done by DEAP software and two-sample paired-t test SPSS21.

The average of hospitals that have been studied before and after the reform plan is 0.985 and 0.990 respectively. In management efficiency, it is respectively 0.986 and 0.992 before and after the reform plan and the efficiency average of the hospital's scale before and after executing the health reform plan is respectively 0.999 and 0.997. There is no meaningful relationship observed between hospitals' efficiency grades before and after the reform plan in these three technical, management and scale types of efficiency (P-value > 0.05).

According to results we could say the efficiency of the hospitals was not so affected by reform plan. It is recommended to assess the efficiency of the Stochastic Frontier Analysis (SFA) method on a linear basis in addition to identifying indexes that are effective in efficiency of hospitals.

Insurance deductions by insurers often lead to financial turmoil in hospitals. With due consideration to lack of hospital resources, hospital deductions double the problems stemming from limited resources, therefore, the investigation of hospital indicators which affect deductions can lead to cost reduction. This study aimed to explore factors affecting insurance deductions in hospitals in Yazd province before and after the implementation of Health Reform Plan.

This analytical-applied study was conducted in 2018. The study population consisted of all hospitals (N=11) affiliated to Yazd University of Medical Sciences. A form was designed by the researcher to collect data which were then analyzed by using descriptive statistics and Pearson correlation test.

The comparison of hospital deductions before and after the implementation of Health Reform Plan revealed an increase in deductions in all hospitals. There was also a significant and direct relationship between the number of hospital admissions (P=0.000), bed occupancy coefficient (P=0.034), and the number of active beds (P=0.001) with the amount of hospital deductions.

A significant amount of the hospital revenues are wasted due to deductions which can be reduced through analyzing the causes and finding solutions to remove them, training and educating hospital staff and authorities, and implementing effective mitigation strategies.

Equity in distribution of resources is considered as an importantpriority in health care systems. Equitable distribution of obstetrics and gynecology(Ob/Gyn) services in the country level is critical in maternal and neonatal health forqualitative promotion of maternal care in pregnancy, delivery, and post-deliveryperiods.

The present study aimed at determining regional disparity of obstetricsand gynecology services and its association with children and infants mortality rates.

This was a descriptive-analytical study conducted in 2015to investigate distribution of Ob/Gyn services using three indicators of number ofnursing and midwifery personnel, total Ob/Gyn specialists, and total delivery bedsamong 30 provinces of the country. Equity criteria in the present study includedpopulation, normal vaginal deliveries, cesarean sections, and total deliveries. Datawere gathered using a researcher-made form and Stata 12 was used to calculate Ginicoefficient. The association of Ob/Gyn services with children and infant mortalityrates was investigated using SPSS package and linear regression test.

The lowest Gini coefficient was observed in distribution of nursing andmidwifery personnel in delivery wards in terms of vaginal delivery (0.38 from 1)and the highest value was related to distribution of Ob/Gyn specialists in terms ofvaginal delivery (0.73 from 1). Infant mortality was significantly associated withnumber of nursing and midwifery personnel in delivery wards, and total number ofOb/Gyn specialists.

Considering new population policies in Iran and increased fertility rate,it is recommended to facilitate accessibility of the required services for the women,particularly those of reproductive age.

Turkey is having an important geographical and political position in the Middle East and has great influence on political developments of this region. Since coming into power of Justice and Development Party (AKP) Turkey has tried to have a more important place in the political development of the Middle East. Turkey by having a legacy of last Islamic Empire has tried to revive its influence in the Islamic World. In this direction in recent years Turkey has introduced herself as a successful political and economic model to the Islamic World and the Middle Eastern countries. The initial years of success in democracy, economic development, political stability and playing the role of a mediator in regional conflicts had been index of Turkey's model but in later stage successive failure occurred. The internal problems that Turkey is facing along with regional and international problems in political and economic fields showed that the Turkish model does not have the former attraction and in practice has failed.

Triage is a part of the organizational process in emergency departments that affects their functional outcome. Each emergency department has its own special strategic state that may require adjustments to its triage system for localizing the process. Therefore, sufficient documentation is required in this field and studying triage is necessary. The purpose of this study was drawing a scheme of the studies carried out regarding triage in emergency departments during 2013 and 2014. For this purpose, articles published in this field were searched in Pubmed internet gateway using triage, fast track, hospitals, health care, emergency, medical services and emergency service as keywords. Based on this search strategy, 119 articles were found and classified into 7 triage- related fields. Finally, distribution of the articles regarding place, subject, type and methodology of the study was evaluated using descriptive analysis.

Based on the Patient bill of rights, Patient children’s parents have right to receive an appropriate and effective treatment and care with respect and regardless of race, religious and cultural groups, as soon as possible. In this area, parents view point to education and health services could be a positive step in improving health services in relation to the child, and society. The aim of this study was to determine the parent’s satisfaction with respect of children's rights by medical teams in pediatric educational and treatment Centers of Tehran University of Medical Sciences. This study was a descriptive - analytical and in terms of time, a cross-sectional study in which 251 parents of children admitted to the pediatric educational and treatment hospitals affiliated to Tehran University of Medical Sciences participated that at least three days of the hospital admission of them passed. Sampling was in stratified method and data collection tool was a standard questionnaire designed based on patient's rights bill. For data analysis, descriptive statistics and Chi-square test was used. The research data were analyzed using SPSS version 13 software and analysis of descriptive statistics besides, the chi-square test. Results showed 75% of the parents to somewhat satisfied from health care team respect of patient bill of rights for their children. Satisfaction rate from respect to patient's rights about children's depends on hospital departments and parent’s job groups (P<0.05). Most complaints were related to nephrology (54%) and emergency (51%) departments. Also, most areas of dissatisfaction were related to not-introducing nurse to child, not-introducing financial and social aid centers and no-talking about the prognosis. Most of parents have satisfaction about application of provision of patient rights for their children but there are still substantial and meaningful differences between different parts of a hospital.

Quality of services extremely depends on how personnel have contact and interaction with the clients. Moreover, the personnel’s attitudes and their behaviors with the clients significantly affect clients’ perception of quality of services and consequently influence their satisfaction as well as their absorption to the services of an institution. This study intends to investigate the supervisor’s attitude towards the effect of persons or the personal element (as one of the elements of the service marketing mix) on choosing the hospital by the patients and their companions. This cross-sectional descriptive study conducted in the winter of 2012. The study participant involved 35 supervisors in Yazd educational hospitals of Shahid Sadoughi University of Medical Sciences; Shahid Rahnemoun and Afshar. The research data were gleaned via a researcher-made questionnaire on factors of the marketing mix which its validity and reliability were confirmed. Data analysis was performed using SPSS software. Results revealed that supervisor’s belief in the increasing of market share of a hospital services in public hospitals are consist of: 1-Physical evidence 2- Service or product 3- People or persons 4- Efficiency and quality 5- Process 6- Distribution 7-Promotion or propagation and 8- Price. Therefore, the significance of the personnel role in absorption of a definite patient involves the third element in choosing the hospital by the patients. Based on this study, since the third factor in clients’ (patients, etc.) choices of hospital are the personnel and persons who provide services, it is confirmed that in service-based organizations like hospitals, the most important elements of quality of services in retaining and absorbing new clients and surviving the organization are the personnel activities who has been connected with organization clients. Moreover, it is regarded as a vital factor in developing effective relationships with the clients as well as their absorption in the hospital.