yalda mousazadeh

Stevens Johnson syndrome (SJS) is a severe hypersensitive reaction and a life-threatening, immunologically mediated and usually drug-induced disease. Sulfonamides, allopurinol, and cold medicines are some of these allergen drugs. pregnant women comprise a subset of individuals at risk for SJS development. The aim of the article was to report a success pregnancy and delivery in a woman after 5 years of SJS diagnosis.

Case Report:

 This case report study was conducted at Imam Khomeini Hospital in Khalkhal, Iran. In this study, we discussed on the history of pregnancy and delivery in a woman 5 years following SJS diagnosis with vaginal stenosis resulting from Azithromycin and Naproxen treatment for cold. This study showed that there is a possibility of successful pregnancy and delivery in the people with SJS and long-term complications caused by it.

Health care providers must be careful concerning drug reactions, especially the occurrence of SJS, which is a potentially harmful and fatal condition.

Traffic injuries are one of the main causes of death worldwide. After decreasing mortality rates and improving the recovery of injured patients, long-term functional consequences need to be addressed. The purpose of this study was to assess the functional outcomes of road traffic injuries and their predictors six months after hospital discharge, based on the preliminary results from PTC.

A cross-sectional study based on PERSIAN Traffic Health and Safety Cohort Study was performed. Data were collected using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) with six domains (cognition, mobility, self-care, getting along with others, life activities, and participation), filled-in by 180 injured adults (age >18 years) at six-month follow-up after hospital discharge during October 2019. These patients were hospitalized after road accidents at two referral trauma centers, (from 23 September 2018 to 20 March 2019).

The majority of participants were men (82.7%), (Mean age =38.8). The mean score of WHODAS 2.0 was 17.8) SD=9.1). The highest score was estimated for the self-care dimension 3.3 (SD=1.8), and the lowest score for getting along with others 2.4 (SD=1.2). Age, gender, physiotherapy, injury localization including head and face, spinal cord, and upper extremity were predictors of WHODAS 2.0 score in various dimensions (p<0.05).

The current study identified some functional disabilities among patients sustaining road traffic injuries. It is evident from the results that a proportion of patients do not recover six months after the injury and suffer a disability, especially in self-care, mobility, and life activities, which potentially prevent them from returning to normalcy. In addition, age, gender, physiotherapy, injury localization was related to WHODAS 2.0 scores.

Trauma is one of the major causes of mortality across the world. Trauma patients have critical status and need timely, adequate, and organized care. The different consequences of trauma care among service centers around the world and even within a country revealed the need for careful evaluation. This study was designed and executed to collect experts’ opinions on the evaluation steps, related indicators, and improvement strategies in trauma care.

This qualitative study was based on a conventional content analysis approach. 2 focus group discussions (FGD) with 6 participants per FGD and 16 face-to-face in-depth interviews were conducted to collect the required information (from September 2018 to early 2019). Participants were selected through the purposive sampling method. The experts’ viewpoints were classified by the main and sub themes.

Four basic themes extracted from the interviews and focus group discussions including, trauma care importance (sub-themes: the involved individuals’ being young and productive and the effectiveness of trauma care); trauma care indicators (sub-themes: pre-hospital indicators, in-hospital indicators, and post-hospital indicators); stages of trauma care evaluation (sub-themes: evaluation prerequisites, finalization of indicators before the evaluation, determining evaluation time scope, determining evaluation dimensions, external and internal evaluation and use of evaluation results); trauma care improvement (sub-themes: balancing workload in trauma centers, enhancement of information system, considering extra-organizational dimensions in trauma care and empowerment of trauma care providers).

According to experts’ viewpoints, trauma is a very important issue, because it involves young people. They believed that having indicators covering all aspects of care assist health managers and policymakers to understand under-standard performance. These indicators should be used in the form of a specific evaluation program and related to Iran context. Besides, reforming macro policies, planning, development of infrastructures,and education was some recommendations of experts to improve trauma care.

Service quality (SERVQUAL) is a model that measure the quality by comparing expectations and perceptions of recipients of services to identify gaps. Identifying the gap may provide valuable insight for service improving. The students are the main recipients of services in educational organizations. So, this study was conducted to assess the educational services from the perspective of students of Health Services management at Tabriz University of Medical Sciences by the SERVQUAL model.

This descriptive-analytical study was conducted in 2018.  The participants were 85 students of various levels of Health Services management. The SERVQUAL questionnaire including dimensions of empathy, tangibles, reliability, responsiveness and, assurance was used to data collection. Descriptive analysis and T-test, ANOVA and correlation (Pearson and Spearman) tests were used to the data analysis.

The overall mean perceptions and expectations were 3.02 ± 0.5 8 and 3.78 ± 0.73 respectively. There was a negative gap in all dimensions of educational services (mean= -0.76). The greatest negative gap was in the dimension of assurance (-1.05). The other variables were ranked in this order, Responsiveness, Empathy and Reliability and Tangibles.  A statistically significant correlation was observed between the students’ expectations and educational level (P < 0.05).

Students’ expectations were higher than their perception based on results and quality of education based on SERVQUAL model was inappropriate. It is necessary to plan for improving the quality of education in all dimensions particularly in assurance domain.

Trauma is considered one of the major causes of death around the world. Increased costs of healthcare and differences in the quality of services among trauma centers indicate that measuring the performance of trauma care is necessary. the present study aimed to develop some trauma care performance indicators. This study was implemented between September 2017 and October 2018 in a four-stage process: a comprehensive literature review, sessions with a panel of five experts, two focus group discussions, sixteen semi-structured interviews, and a two-round Delphi survey. The study setting was East Azerbaijan province, Iran. Forty-six experts in different fields of medical sciences confirmed applicable indicators for trauma care assessment. A total of 140 indicators were found through a comprehensive literature review. After conducting expert panels, focus group discussions, and interviews, the number of indicators decreased to 57 cases and were entered into the Delphi survey. In the first phase of the Delphi survey, content validity ratio (CVR), content validity indicator (CVI), and modified kappa values were 0.64, 0.85, and 0.83, respectively. Sixteen indicators were changed or deleted and 6 indicators were separated. The members of the final expert panel agreed on 50 indicators in the second phase of the Delphi survey after omitting 7 indicators. Performanceindicators for trauma care evaluation were introduced in this study. They can be used by policymakers and health service providers to assess and improve performance and compare trauma centers in Iran and developing countries that have health systems similar to the Iranian health system.

Trauma caused by traffic accidents is one of the main causes of mortality in the world. The trauma is a time-dependent condition. Trauma scoring systems help service providers to determine the severity of the injury and mortality risk and provide appropriate and timely services. This study aimed to predict mortality risk in patients with traffic injuries in Tabriz hospitals.

This descriptive cross-sectional study included 11,238 traffic-injured patients. Databases of the emergency medicine service and forensic medicine were used to collect information. Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) scoring system, binary logistic regression model, odds ratio with 95% confidence interval, and sensitivity and specificity were used to predict mortality.

Overall, 71 cases of death were identified. Pedestrians had the most rates of deaths with 31 cases (43.66%). Head trauma with 31 cases (43.66%) was the main cause of death. Mean (standard deviation) of the GAP score was 21.8 (1.8). The death rates in high-, moderate-, and low-risk groups were 22.4%, 3.18%, and 0.42%, respectively. The likelihood of death in people with saturation of oxygen (SO2) ≤95 was 1.96 times higher than those with SO2>95. The likelihood of death increased by 0.001 times each year. Furthermore, when the GAP score was ≤18, sensitivity was 64%, and for the GAP score of ≤10, sensitivity was 15.5%.

GAP score seems to be a reliable and easy-to-use scoring method for predicting traffic injury mortality in an Iranian setting and yields reasonable results concerning international standards.

Administrative and financial affairs are one of the most important activities in any organization. Determining the processes related to these affairs is necessary. Therefore, the present research was designed and implemented to improve the administrative and financial processes of Management and Medical informatics school of Tabriz University of Medical Sciences by action research methodology.
Material and This was a qualitative study with action research approach. After understanding about the lack of transparency and time consuming of administrative and financial processes, it was planned to resolve this problem. The correct form of the processes was determined and presented after reviewing the jobs description, interviewing with personnel and drawing the flowchart of the administrative and financial processes. Then, an evaluation was done by selecting 20 percent of the processes and examining personnel’s performance and timing.
Current situation analysis showed that administrative and financial processes are done mainly based on individual experience and interest. The lack of coordination with school's educational and research timetable prevents timely performance of tasks. After taking action research steps, 49 processes were identified and documented. (accounting: 13, secretariat: 2, public affair administration: 7, staffing: 16, property: 7, and procurement: 4). The results of the evaluation showed that 97% of the processes were in accordance with the standard and the time spent on implementing the processes was reduced between 30% to 100%.
Action research, as part of a collaborative process between researchers and process owners promoted administrative and financial processes. In order to increase the readiness level of the financial department of the faculty and coordination with the education and research departments, adjusting the administrative and financial calendar at the beginning of the year predicting the action time before receiving the request receipt of the units was suggested.

The mission of health promoting hospitals is to change the treatment-based attitude to health-based and health promoting attitude to patients, personnel, clients and all groups of the society. The present study was conducted to investigate the awareness and attitude of the managers of teaching hospitals in Tabriz City towards health promoting hospitals. The present study was descriptive-analytic research. The study population included all the bosses and managers at different levels of teaching hospitals in Tabriz City. A researcher-made questionnaire was used to data collection. Data were analyzed using SPSS19 Software, descriptive statistics, t-test, analysis of variance (ANOVA) and Spearman’s correlation coefficient test. In the studied teaching hospitals, awareness and attitude of managers were significantly higher than mean. In addition, there was significant relationship between managers’ awareness and their attitudes (P The results of present study showed that the awareness and attitude of managers towards health promoting hospitals were at desirable level. This could be a basis for informing other personnel and establishing health promoting policy in hospitals. Regarding the readiness of hospitals, it seems necessary to determine a given and specific framework and policy in the Ministry of Health in order to establish health promoting hospitals.

Social responsibility is one of the most important elements of the organization's existential philosophy, especially organizations such as hospitals. This study was conducted to evaluate the perspectives of the managers and head nurses of public and private hospitals in Tabriz/ Iran about social responsibility.
This cross-sectional descriptive study was performed on 57 head nurses and managers working in public and private hospitals in Tabriz selected by census method in 2016. Data collection tool was a four-part questionnaire including 24 questions for assessing the status of social responsibility in the hospital. Data analysis was performed through SPSS 21 software.
From the perspectives of our subjects in public and private hospitals, patients were the most important group affecting organization's activities (mean scores: 3.73 and 1.82 respectively), approaching to international standards was the most important motivator (mean scores: 3.23 and 3.70 respectively) and attention to suppliers was the most important focus area (mean scores: 3.76 and 3.51 respectively).
According to the obtained results, most managers and head nurses, based on the type of hospital working in it, had a different conception of social responsibility. Therefore, it is suggested to provide the required trainings in relation to the necessity of establishing social responsibility in hospitals, regardless of the type of hospital.

Today, a major part of health system resources are allocated to hospitals. So, the control of these resources and correct and efficient use of them are the important tasks of management. This study was conducted to determine the deductions of Iran health insurance in the first half of 2014 in a public hospital in Tabriz.
Material and This was a cross sectional study. The study population included records of patients hospitalized in the first half of 2014. All cases with deduction were selected as sample. Data collection was performed using a researcher-made checklist. Checklist information was collected through records of patients and interview. Then, data were analyzed using Excel software.
Most deductions were related to physician visits (61116000 Rials), laboratory (46881797 Rials) and surgery commission (26114487 Rials), respectively. Most of the deductions were in October (70613244 Rials) and lowest deductions were in February (6838945 Rials). The most important factor of deductions was related to additional request.
According to deduction cases and the most important factor related to it (additional request), It can be concluded that greatest amount of deductions are due to employee's mistakes. In this regard, emphasis on clinical guidelines and physicians’ training is necessary. Negotiations and clarifying the amount of liability of insurance organizations can prevent deductions.

In order to optimal use of resources and reducing costs¡ many countries use different strategies such as downsizing. Therefore¡ this study was implemented to evaluate different downsizing methods in teaching hospitals of Tabriz and Ardabil cities.
Material and This study was a descriptive study conducted in 2015 and 2016 in order to identify downsizing methods in teaching hospitals in Tabriz and Ardabil cities. A researcher-made questionnaire was used for data collection. Its content validity was approved by five university professors in health economic and health services management. SPSS v20 software and descriptive statistics were used for data analysis.
Among 13 downsizing methods¡ 11 methods were used in Tabriz hospitals and 6 methods were used in Ardabil hospitals. Outsourcing and cooperation between hospitals were the most frequent methods. Cost reduction was the most important goal of downsizing. Also¡ performance evaluation was the most important control mechanism after downsizing.
The findings showed that the downsizing method especially outsourcing and cooperation have been used widely in teaching hospitals of Tabriz and Ardabil universities of medical sciences. It seems that precise planning¡ variety in applied methods and hospital circumstances are important factors in achieving the downsizing goals.

The aim of this study was to identify factors affecting self-medication and its pattern among the students of Tabriz University of Medical Sciences, Tabriz, Iran.
This descriptive cross-sectional study was conducted on 385 students of Tabriz University of Medical Sciences in 2012. The data collection tool was a researcher-made questionnaire. The validity of the questionnaire was reviewed and confirmed by 10 experts and its reliability was confirmed based on Cronbach's alpha index (α = 0.83). To investigate the relationship between qualitative variables, chi-square and Fisher’s exact tests were used. The significance level was set at 0.05 and data were analyzed using SPSS software.
Findings: In the present study, 154 (48%) students reported having self-medicated. Moreover, the rate of self-medication was higher among women than men (P = 0.024). A significant relationship was observed between field of study and self-medication (P = 0.035). The main reasons for self-medication were fever and headache (70.4%), previous experience of the disease (41.6%), and purchasing drugs from pharmacies during consumption (55.6%). Furthermore, the majority of self-medicated drugs were antibiotics (60%) and cold medicines (42%).
The study findings indicate a high prevalence of self-medication among students of Tabriz University of Medical Sciences. Therefore, it is necessary to reduce self-medication through provision of education and correct information.

Hospital emergency is an important and unique department and prolonged stay of the patients in this ward leads to a decrease in the ability to serve other patients in need. Therefore, this study aimed to evaluate the ability of FOCUS-PDCA methodology to decrease waiting time of the procedures and improve index of decision-making within 6 hours in emergency department (ED).
In this interventional before-after study, the effect of FOCUS-PDCA methodology on waiting time of the procedures and decision-making was evaluated in the ED of Sina Hospital, Tabriz, Iran in a 5-month period. Initially, a team of procedure definers defined the problematic procedures and suggested practical solutions to relieve them. Then, these solutions were practiced using appropriate programming, and finally the effects of these measures were analyzed using SPSS version 11.5 and independent t-test.
5 months after intervention, mean waiting time for receiving consultation was reduced from 28.1 to 17 minutes (p Based on the results of this study, it seems that carrying out FOCUS-PDCA methodology can decrease waiting time of the procedures and improve patient disposition index in the ED.

Planning plays an important role in improving children''s health and an evaluation system is necessary to planning. The purpose of this study was comparing and analyzing evaluation system of child care program in primary health care system in the Eastern Azerbaijan province based on Comprehensive Evaluation Model (CIPP). This is a cross sectional study. The process includes a review of current evaluation system، comparison and analysis of the system based on a comprehensive model and to assess and identify the strengths and weaknesses of the current systems. The quantitative methods (such as brainstorming، observation and interview) and consensus of study group about the results of the study were used for analyzing and interpreting results. It showed that not enough attention was paid to the context and performance and the content of evaluation just includes inputs and processes based on the finding. Specific criteria and impact were considered in four areas (context، input، process and outcome) and all levels which were according to the proposal and based on the CIPP model. Evaluation is a control process tool by higher levels and self-assessment by service provider is not considered in the current system. Evaluation includes quantitative aspects and not the quality of process. So، it is recommended that forecasting system that utilizes evaluation will result in improving future planning and a scientific model to be used in designing evaluation program.

Hospitals as key actors in health systems face growing pressures especially cost cutting and search for cost-effective ways to resources management. Downsizing is one of these ways. This study was conducted to identify advantages and disadvantages of different methods of hospital'' downsizing. The search was conducted in databases of Medlib, SID, Pub Med, Science Direct and Google Scholar Meta search engine by keywords of Downsizing, Hospital Downsizing, Hospital Rightsizing, Hospital Restructuring, Staff Downsizing, Hospital Merging, Hospital Reorganization and the Persian equivalents. Resulted 815 articles were studied and refined step by step. Finally, 27 articles were selected for analysis. Five hospital downsizing methods were identified during searching. These methods were reducing the number of employees and beds, outsourcing, integration of hospital units, and the combination of these methods. The most important benefits were cost reduction, increasing patient satisfaction, increasing home care and outpatient services. The most important disadvantage included reducing access, reducing the rate of hospital admissions and increasing employees’ workload and dissatisfaction. Each downsizing method has strengths and weaknesses. Using different methods of downsizing, according to circumstances and applying appropriate interventions after implementation, is necessary for promotion.

Hospitals face major challenges such as lack of resources, increase in costs, and particularly severelimitations by sanctions that lead to integration in hospitals. This study was conducted to identify and prioritize theindicators of integration and integrable hospital units based on the expert's perspective.
The present study was a three phase qualitative, applied survey. The first phase included a review of thefundamental concepts. The second phase included three focus group discussions with presence of experts to identifynecessary indicators for the implementation of integration strategy and the hospital units that can be integrated based onindicators. In the third phase, Delphi's questionnaire was prepared based on Likert's scale for prioritizing and choosingthe indicators and hospital units.
9 indicators and 29 hospital units were identified during focus group discussions. Consensus was achievedon 9 indicators and 23 units out of 29 units based on the three stages of Delphi's questionnaire. The most importantindicators were cost and parallelism in tasks (consensus = 95.2%). Service availability and responsibility(consensus = 71.4%) were the least important indicators. The supporting units had the greatest potential (45.45% oftotal units) of merging. Emergency, inpatient wards, management, and chairmanship units were not candidates forintegration according to the viewpoint of experts.
Integration will lead to efficiency in resources management, avoids parallelism in tasks, increasesservice availability, and reduces costs. Integration capability exists in many parts of the hospital; therefore, it can beused in the hospitals. Furthermore, it is necessary to define clear indicators for measuring the success of this strategy.

The aim of this study is determining views of hospital management board and experts of Tabriz University of Medical Sciences about hospital downsizing by outsourcing and integration mechanisms.

This study was done within three group discussions with the contribution of 20 managers and experts and the gathered was analyzed using content analysis.

After data analysis and extracting the codes، 5 main themes and 18 sub-themes were identified. Main themes were downsizing، its infrastructure and its requirements، different aspects of outsourcing in hospitals، determinative integration factors of internal and overall and downsizing challenges in Iran.

The aim of downsizing is to increase the efficiency and providing the best service to the patient. Hence، it is recommended making required laws and gaining the support of Health Ministry as well as medical sciences universities.