International Journal of Hospital Research
Volume:4 Issue: 3, Summer 2015

A sudden jump in blood demand during natural disasters may have strong negative impact on the performance of blood supply chain. Appropriate response to the emergency situations, requires predictive approach to determining the optimal allocation of blood supply chain resources for various disaster scenarios. The present study, thus, presents an optimization model aimed at decreasing blood shortage, blood wastage, and blood supply cost in emergency situations. This work is an extension of our previously introduced stochastic blood supply chain model, developed based on Robust Optimization concept. The aim of this model is to determine the optimal number and service areas of the blood facilities under different disaster scenarios, using mixed integer linear programming. While in our previous model the capacity of blood facility center was assumed to be constant, in the present work it is considered as an integer variable varying within a defined interval. The present model, hence, allows exploring the influence of capacity of temporary facilities on the total costs of blood supply chain. A change in the capacity of mobile units between -20% and +20%, was predicted to alter the total cost between 3.67% and -5.64% and the optimal number of required fixed blood facilities from 10 to 8 units, and to reduce the optimal number of the required mobile blood facilities from 50 and 37 units. Whilethe results of model analysis predicts a limited impact of the capacity of mobile units on the total cost, the capacity of these unities is anticipated to significantly influence the optimal number of both permanent and temporary facilities.

Vaccination is the major strategy to protect nurses against infection with hepatitis B virus. However, some nurses do not produce sufficient amount of anti-HBsAg antibody required for immunity against infection. Chronic occupational stress has been proposed as a risk factor to humoral immunity. Given that nursing staff are also at risk of occupational stresses, this study was designed to investigate the potential impact of occupational stress on anti-HBsAg antibody titration. A total of 115 nurses who were fully vaccinated against hepatitis B in triplicate format and whose titers of anti-HBsAg antibody were measured were participated in the study. Titration data was derived from laboratory archived or the HIS system. Occupational stresses and demographic features were recorded using a validated job stress questionnaire. Data were summarized using descriptive statistical methods and analyzed using ANOVA and t-test. Nurses with higher occupational stress exhibited significantly lower anti-HBsAg antibody titration. No significant difference in the level of anti-HBsAg antibody titration was observed between age, sex and BMI-score groups. Based on our results occupational stress may be an important risk factor to the effectiveness of vaccination against hepatitis B, which implies that stressed nurses are at risk of viral infection. Our study hence recommends urgent investigation of this hypothesis at larger scales, and if validated, taking appropriate measures to protect nurses against infection.

Hospital bed utilization is influenced by various factors which may be categorized into patient-related, physician-related, and administration-related issues. It could be argued that the causes of inappropriate hospital bed utilization would be perceived differently by the clinicians and the patients. Given the unique role of clinical practitioners in quality of care, their views on the causes of inefficient hospital resources use should be referred to in any improvement initiative. The aim of this study, thus, was to survey the factors influencing utilization of hospital beds as perceived by the resident doctors and nurses. This cross sectional study was conducted in an apex tertiary care public institution in northern region of India. All the resident doctors and nurses from 18 wards of 7 specialties and 7 super specialties were interviewed using a structured validated self-administered questionnaire. The data were summarized by descriptive statistical methods and analyzed using ANOVA and Chi-square tests. While a substantial percentage of clinicians perceived that hospital beds were inappropriately utilized, resident doctors were more convinced of inefficient hospital bed utilization than nurses. High expertise of the doctors, reputation the institution, and limited autonomy of residents were perceived as the causes for overstay. In addition, resident doctors considered lack of training, clear-cut job description, and long duty hours as the reasons for inappropriate bed utilization, while their nursing counterparts did not opine such. Most doctors agreed that lack of appropriate policy for and lengthy procedures of admission and discharge influence the hospital stay, whereas corresponding emphasis was not recorded among the nurses. Also, congruent with some previous studies, the majority of the nurses and doctors perceived that ineffective hospital information system, absence of standard operating procedures and quality assurance mechanisms in ward management could influence utilization of hospital resources. While nurses highlighted administrative factors as the major causes of overstay, the resident doctors perceived all examined factors, including patient-related, physician-related and administrative factors to be important, though in agreement with their nursing counterparts they gave a higher weight to the administrative issues. The information provided on the relative importance of factors contributing to patient overstay as perceived by the clinicians may help policy-makers and administrators to promote more efficient utilization of healthcare system resources. According to our study, administrative factors, including development of standard operating procedures and promoting quality assurance mechanisms in ward management should receive priority in intervention.

Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system, with more than 5.2 million people across the world being afflicted with. Magnetic Resonance Imaging (MRI) is a valuable investigative tool in the diagnosis of MS. This study summarizes the of findings from MRI studies on the central nervous system and paranasal sinuses between 2004-2014 in the population of MS patients in the Iranian Kermanshah Province. The clinical records of a total of 294 patients admitted to the neurology ward of Kermanshah’s Farabi Hospital of Kermanshah between 2004 and 2014 and diagnosed to be afflicted with MS were surveyed. The data were collected using a checklist prepared based on the McDonald Wibers standard criteria. The checklist consisted of 37 close-ended questions which assessed MRI findings in the central nervous system and paranasal sinuses of MS patients in 4 domains, including the most common early clinical signs of the patient, distribution of lesions, affliction with sinusitis, and demographic characteristics. The collected data were summarized using descriptive statistical methods and analyzed using hypothesis test. Married, housekeeper, and undergraduate patients showed the highest frequency among MS patients (59.5%, 50.2 %, 28.2 %, respectively). MRI test was rreported as signed in 94.9% of patients. While he most frequent anatomical sites afflicted with plaque lesions were white matter surrounding the ventricles (77.50%), the least frequent one was identified to be basal ganglia (1.7%). The anatomical site involved showed a significant relationship with the patients’ age (P = 0.006) and occupation (P = 0.036), respectively. Early clinical manifestations of the patient was significantly correlated with and the family history of affliction with MS (P = 0.036). No gross differences in the frequency of MS disease, among age, sex, and lesion pattern groups compared to other studies was identified. Observing sinusitis in patients afflicted with MS is suggestive of their random association.

Studies have shown that patients awaiting coronary angiography (CA) are often anxious. High level of anxiety can lead to physical and psychological stress with adverse effects on organs, especially heart. The information on state anxiety continual and the trait anxiety level in these patients is limited in the literature. This study was thus designed to investigate state anxiety continual and the trait anxiety level in patients undergoing CA. A cross-sectional study was conducted by enrolling 50 patients. A demographic questionnaire and Spielberger State and Trait Anxiety Inventory were used for data collection. T-test and repeated measure ANOVA test was used to compare the anxiety level at various states. The baseline state and trait anxiety mean levels in patients were low (34.36 ± 5.56, 35.9 8± 7.49, respectively). The highest level of both state and trait anxieties was observed 30 min before CA and it was significantly higher than the corresponding value at baseline state as well as the anxiety after CA (P < 0.05). Female patients were significantly more anxious than male patients both before and after CA (P < 0.05). The highest level of state and trait anxiety was observed immediately before angiography. Given the adverse effect of this problem on patients’ health, it is crucial to assess theses anxieties and take measures to control them in order to protect patients’ health. Training the nurses on this issue, provision of structured care and provision of information to the patients before CA may be effective in reducing the anxiety level. Female should be more focused on in the relevant interventions.

Knowledge Management (KM) has emerged as a pathway towards competitive advantage in current complex industrial environment. The aim of the present study was to explore the relationship between KM effectiveness and various organizational factors including social interactions (trust, communication and coordination), infrastructure factors (structure, information technology, organizational culture), and process factors (knowledge acquisition, conversion, application and protection) in nursing staff. A sample of 220 nurses was surveyed among the total of 392 nursing staff at Golestan Hospital of Ahvaz City situated at South Western Iran. KM effectiveness questionnaire (Lin, 2008), social interactions questionnaire (Huang and Li, 2009), and infra-structure and process questionnaire (Ghosh and Scott, 2006) were used as study tools. The data were analyzed by structural equation modeling (SEM) and partial least squares (PLS) methods. The results showed that social interactions, infrastructural factors, and process factors are significant predictors of the effectiveness of KM among nurses at both individual and organizational levels. Among other organizational factors, infrastructure factors have the strongest positive influence on KM. This implies that KM practices need to focus on promoting structure, information technology and culture to foster an environment for nurses that is knowledge-friendly.

Many Iranian public hospitals are faced with serious financial challenges such as shortage of income and heavy debts. Nevertheless, many of the healthcare services are often remained unearned for not being included in the clinical records or patient bill, resulting in considerable loss of legitimate hospital in­come. Given the limited studies in this area in Iran, the present study aimed to survey the undocumented healthcare services which are potentially income-generating, and the factors contributing to the deficient documentation. A cross-sectional retrospective study was conducted. A sample of 400 clinical records was selected from six hospitals affiliated with Shahid Beheshti University of Medical Sciences in proportion to the number of hospital beds and the rate of discharges. A checklist was developed to record the delivered healthcare services, which were incompletely documented or neglected in the patients’ bills. Using a researcher-made questionnaire, we also asked the opinions of financial managers, the income managers, the chief operators, and other personnel of the discharge unit, with regards to the human resources factors influencing clinical documentation and accounting. The tariffs for the health services were calculated based on the corresponding K value, extracted from the Cali­fornia Book of relative values of diagnostic and therapeutic services. Data were summarized and analyzed using descriptive statistical methods. NG tube insertion; CVP insertion, lumbar puncture, pleural tap and cut down were the five most frequently neglected medical services in the clinical records. Overall, 998 services for the amount of 75 million Rls were not documented. Only a minority of the personnel of the finance departments had a background of education in accounting. In addition, the majority of financial department personnel had not attended any train­ing course related to the documentation of healthcare services and discharge process. On average, 20 medical records are examined on a daily basis by a single operator in the pre-discharge stage, ranging from 13 to 25 records. In addition, the employees of the discharge units were found to have the dual task of examining clinical records and discharging the patients. Our study identified a number of potentially income-generating healthcare services that are often left unearned in Iranian hospitals. Identification of these services may help prevention of the associated income loss in future. We also identified a number of factors that may contribute to inaccurate documentation of health­care services. The importance of issue and the possible existence of other factors contributing to incomplete clinical documentation and hospital income loss recommend further large-scale studies.

Hospitals’ bed productivity has a remarkable effect on health system performance. The Pabon Lasso Model (PLM) is a useful tool for evaluation of inpatient beds performance and there is a growing trend in use of this technique in hospital performance evaluation. The aim of this study is to review the literature on PLM to gain insight into quality the results of these studies. By adopting a systematic review style, the full text of a total of 29 documents on the topic was reviewed. While in 81.3% (n=26) of the documents Pabon Lasso diagram has been represented complete and correctly, the results of a large fraction of the reviewed studies (59.6%) was limited to identifying the status of the hospitals in question the Pabon Lasso chart, without further analysis of the chart in the context of hospital resources. Our study hence recommends that future studies can draw further useful implications from the PLM model by focusing more on the interpretation of the results in the practical context of hospital management.