مجله بیمارستان
سال چهاردهم شماره 3 (پاییز 1394)

Myocardial Infarction (MI) is the most common cause of death in developed and developing countries. Based on World Health Organization prediction, MI will be the leading cause of death in the world up to 2020. The main goal of acute myocardial infarction therapy is reperfusion which is performed by two treatment approaches, although these two methods use for unique complication treatment but they are different in treatment cost and quality; Since the costs of health care is growing, this study aimed at identifying affected differentiated costs among patients with acute MI with the purpose of providing a framework to compare two treatment methods. In presented model in current study, with the purpose of select affecting cost attributes utilized hybrid of Genetic algorithm and decision tree approach as a new method and compare its result using random method. Study result presented classifies error reduction up to 0.2 compare with random method error. Then, based on selected attributes, presented a framework comparing two treatment methods. Also, in the majority of direct cost and total cost, Primary Angioplasty was cost effective more than Thrombolytic Therapy, but in indirect cost, we achieved some results dissimilar to physician's expected results such as kidney failure. Suggested approach in this research can be a guidance to physicians and insurances institutes in acute myocardial infarction treatment policies.

Backgrounds and Informal payments are paid to individuals and organizations offering health services, either in cash or non-cash and are formed outside formal payment channels. The aim of current research is the study of identifying the ways of informal payments, causes, effects and policies dealing with it. This paper is a review study, based on articles identified by search on authoritative sites (Medlib, SID, Pub Med, Science Direct and Google Scholar) using keywords (informal payment and unofficial payment), in which 128 articles were extracted and refined step by step. Finally, 20 articles were selected according to aims of the study. The findings of this study consist of five important sections, which include the definition of informal payments, the existence causes of informal payments, effects of informal payments, and statistics of informal payments in the world and Iran and policies of dealing with informal payments. Due to the high prevalence of informal payments and severe negative effects on justice and good governance, policy-makers must focus on this issue and decrease such effects. Although strategies to control informal payments are limited, following strategies are proposed: Regulation payment and medical tariffs, regulating power abuse, providing incentives and increasing feeling of responsibility for healthcare professionals, and changes in public perception.

Patient transfer require the wide variety of functions such as collaboration, appropriate communication and coordination between hospitals and the Center for Treatment Guidance and Information(CTGI). This study aimed to determine the factors influencing the coordination of patient transfer and also to explain the situation of the CTGI in coordination of patient transfer process. A qualitative study conducted using three Focus Group Discussions(FGD) and 30 interviews with participants who were involved in the process of patient transfer in a referring hospital, six receiving hospitals and CTGI. purposive sampling was used to select study participants. Data was analyzed using content analysis. The identified factors influencing the coordination of patient transfer were categorized in four main themes including weakness in the exchange of clinical information, data constraints, weakness of legal protections and implementation of guidelines and weakness in managing the patient and 18 sub-themes. The weakness of Coordination of patient transfer process arises from the lack of pursuing a specific procedure for requesting admission and ineffective interactions and information exchange. In order to maintain uninterrupted medical treatment the coordination of patient transfer should be promoted. The CTGI should maintain its position as a supervising authority.

Quality of Life among Nurses working in medical affiliated Zahedan hospitals Introduction There is close relationship between the quality of life and the human health. Nurses as the most important of health Provider should have a good quality of life. This study aimed to evaluate the quality of life and related variables among nurses working in Zahedan medical affiliated hospitals. In this descriptive analytic study the Iranian version of SF-36 was used to assess the quality of life. The logistic regression was used to determine quality of life Predictors. Data analyses were conducted in Stata (ver.,12). 300 women (77.9%) with a mean age of 31.6 ± 6/6 years were studied. The mean of work experience was 7.55± 6.8 years. The most quality of life score was related to Physical domain (39.6 ± 11.8) and social function had the least score(8.2±6.7). The marital status, overtime work, working shift Pattern and work experience(yrs.) were the Predictors of quality of life. This study showed that quality of life is not good among nurses. The low quality of life, can affect the quality of nursing services. Nursing administrators can help to improve quality of life with setting up overtime shift and adjusting overtime with work experience.

Considerable attention has been paid recently to medical errors in health care system. Taking into account that nurses spend more time with patients in comparison with other staff, they are more prone to human errors. The present research was done to investigate nurse's errors in delivery emergency ward of one of the Tehran University of Medical Sciences hospitals. In the present coss-sectional study, first, task analysis was conducted for nursing proffession, using Hierarchical task analysis (HTA) technique. Following, the Human Error Probability (HEP) was determined employing SPAR-H method and dependences of performance-shaping factors (PSFs) and action and diagnosis activities were identified. Finally, after determinig the level of dependency, the Final Diagnosis HEP was calculated. Assessment of risk level was done using the risk's probability and intensity tables. According to the results, for the four groups of understudy tasks, the lowest errors were belonged to the subtask "working with serum pumping machine'' with the error level of 0.055 and the highest error probability related to the subtask '' transfusion of blood products'' with the error rate of 0.78. Moreover, special responsibilities of the wards had the highest level of undesirable risks. The analysis of identified errors in the present study shows that due to high work demand, insufficient time, and the need for accurate administrative monitoring and providing required arrangements, the main causes of errors can be attributed to high level of stress and complexity in the tasks of this ward.

Nurse emotional intelligence have an effect on their job satisfaction and service quality. The object of this study was to determination of the relationship between emotional intelligence (EI) and communication skills (CS) in nurse by consideration of the importance of this relationship in the urgent ward of hospitals. 253 nurses from 15 hospitals of Iran University of Medical Sciences (IUMS) were selected by the Census Sampling method. They supplemented Golmans EI questioner and CS questioner that was made based on researchers’ literature review and Shunon model of communication. Validity and reliability of the tools were computed by Alpha-choronbakh and data were analyzed by one-way ANOVA test and Pearson and Spearman correlation test by SPSS software version 18. EI mean was 78.31 that the highest score was for self-cognitive dimension (20.83) and the lowest score was for self-management dimension (18.19). The total mean of CS was 70.90 and there was a powerful correlation between EI and CS in this study (r=0. 775, p<0/01). There were powerful correlation between CS and fourth dimensions of EI in this study. Based on this study results, hospital managers and health system policy makers must prepare conditions to run educational courses to teach EI and its dimensions and improvement of CS technics in nurses, especially in urgent wards to continuous improvement of quality of nurse and urgent services in the health system.

Context: one of the most important components in patient- physician relationship is the visit length. Its shortage is a concern for most patients and could affect the visit quality. The objective of this study was to measure and compare visit length of specialists with the existing standards. A cross-sectional study was conducted in Qazvin of general hospitals in 2013. A sample of 428 patients, who were referred to the outpatient clinics of the general hospitals, was randomly selected to participate in the study. Studied specialties were Internal Medicine, Surgery, Pediatrics and Obstetrics and Gynecology. A Checklist was used to collect data and be included related factors to physician and patient. Analysis was done using SPSS-19. The results showed that the average length of outpatients visits was 4.67(2.43) minutes which illustrate a significant difference from standards (p=0.000). Among the specialties, pediatrics had longest visit time 2.55(7.08) and internal physicians had the shortest 1.82(3.93). Visit time was shorter than other developed and developing countries. Various variables which affect the visit time were identified in this study, so decision makers could use the results to improve outpatients visit quality.

Physiotherapy information system is one of health information systems that is used to increase the efficiency and effectiveness of physiotherapy department. Studies have shown that due to usability problems, user interaction with some information systems is difficult. The objective of this study is to evaluate user interaction problems with physiotherapy information system. This study is a cross-sectional, descriptive research which is done using heuristic evaluation method. In this study the user interaction problems of a physiotherapy system using in 105 hospitals were identified, classified and rated based on their severities by three evaluators. Data were gathered using a data collection form designed in Excel. In this study 82 unique interactive problems were identified. Most of them with 28% (n=23) were related to unconformity of system design with real world conventions. The mean severity of these problems was major. The lowest numbers were related to the problems; lack of help and documentation in the system and error prevention, with major and minor severity respectively. A number of systems, which are used in many health care centers, such as evaluated system in this study suffer from several problems that endanger user interaction with the systems and can lead to error and patient harm. To identify and eliminate this sort of problems we recommend that usability evaluation of these systems to be carried out regularly to enhance users satisfaction, workflow and patient safety.

Using vein is one of the important ways to providing water, electrolytes, drugs and supplement material for patients in hospitals and other therapeutic centers. Phlebitis that means inflammation of superficial veins is a side effect of using peripheral cannulae. This study proposed to determine the incidence of phlebitis related to peripheral cannulae, and its predisposing factors. This prospective and follow up analysis study was done in adults medical surgical units, include orthopedy, neurology, gynecology, general internal, general surgery and ear, nose throat units. Two hundred ninety seven cannulae related to 297 patients were monitored. Phlebitis is defined by the presence of at least two of the following symptoms, local pain, redness, swelling, warmth and palpable venous cord. The mean of patient's age was 40.82±19.48 (12-91) years. The incidence of phlebitis was 14.1% and factors such as diabetes (P=0.001) and smoking (P=0.007) were identified as relevant to the development of phlebitis. Odd Ratio for diabetes and smoking were 3.107(CI=1.310-7.372, 95%) and 3.736(CI=1.736-8.039, 95%) respectively. The overall incidence of phlebitis was low, when compare with other similar studies. The high incidence of phlebitis in diabetics, smokers and old patients needs special nursing interventions to minimize severity of this problem.

Patient safety is key to the trust in any health care system nowadays. Medication errors, as a key safety threatening factors, could increase patients’ length of stay and healthcare costs in hospitals and might lead into injury and finally death. Therefore, this study seeks to compare the incidence and proposed solutions of Iran and selected countries in order for preventing medication errors. This is a review article searching in such databases as SID, IranMedex, Pubmed, Scopous to identify and select its related papers. At last, 24 studies were considered for this study. According to the results of studies, shortage of nurses, nurses’ inexperience, job stress, physicians’ handwriting and lack of information on medications were the highly frequent incidence causes. Training courses on medicine dispensing and hands-on training were the most important solution. Given the existing gap between the medication errors incidence rate of Iran and selected countries, the latter’s experiences such as transparency and responsibility and active role of hospital pharmacies could be utilized by the former.

The Pabon Lasso graphical model is a method for evaluation of hospital efficacy as one of the most important part of health system in developing countries. This study aimed to evaluate the efficacy of educational hospitals of Qom Medical University by Pabon Lasso model and to compare the efficacy indexes by national standards. This descriptive study conducted in 2011 to 2013 in educational hospitals of Qom Medical University. Data collected by approved forms of health ministry and bed occupancy percentage, bed turnover rate, and average length Of Stay were calculated for each hospital and was used in Pabon Lasso model. Statistical test of data for comparing to national standards is conducted by one sample t-test. The mean of bed occupancy and bed turnover was 76.9±9.8 percent and 100.6±35.4 times that were higher than national standards significantly. In addition, the average length Of Stay was 3±1.1 days that was same as standard. Highest efficacy calculated for IZ hospital and lowest efficacy observed in KA and NE hospitals. Moreover, ZA Hospitals reached to highest efficacy in 2013. The mean of bed occupancy and bed turnover was high and were higher than national standards. Also, based on Pabon Lasso model only IZ and ZA hospitals have excellent efficacy.

Background & Since privatization in hospitals is increasing, conducting research in various fields of private hospitals and comparison with public hospitals is felt. Thus, this study aimed to investigate the relationship between job satisfaction and burnout among nurses employed in selected public and private hospitals in Shiraz, Iran. This was a comparative-correlational study. The study population was composed of nurses employed in public and private hospitals in Shiraz city in 2012. The sample size was estimated to be 320 using cochran formula. The data collection tools were the questionnaire of Spector job satisfaction” and “Maslach burnout”. The study was conducted in two private and two public hospitals in Shiraz. After obtaining permission to visit hospitals and distribute questionnaires among nurses, the data were collected randomly. Descriptive level of percentage, mean, standard deviation and inferential level of Pearson correlation and MANOVA and T test were used. The findings indicated that there was a significant and negative relationship among job satisfaction and three dimensions of burnout in both public and private sectors (p<0.001). In addition, the results showed that there was a significant difference among the emotional exhaustion and depersonalization between private and public sectors (p<0.05). However, there was no significant difference regarding job satisfaction and reduced productivity performance of these two sectors. According to the findings, by increase in the nurse's job satisfaction, particularly in the public sector, the adverse effects of burnout can be prevented.