مجله طب نظامی
سال بیست و دوم شماره 7 (پیاپی 92، مهر 1399)

In the past, the war was mainly a "hard war" using military means, but now its form has changed to a more "soft war" type, which is basically diplomacy-based. Health professions have also recently entered this field, and nurses are using diplomacy because of their occupational nature, their various roles including advocacy. Given the proximity of the concept of advocacy to the nature of diplomacy and negotiation, we aimed to investigate the role of advocacy of nursing managers in nursing diplomacy.

This is a qualitative study with a conventional content analysis approach. Data were collected using in-depth unstructured interviews with 14 nurse managers at different levels through purposeful sampling.

After analyzing the data, three main categories of system advocacy (including subcategories: systematic thinking and holistic view, organizational affiliation), advocate for people (including subcategories: demonstrating the role of the nurse in service to people, the use of people-centered literature) and the use of advocacy in negotiation (including 3 subcategories: unifying positions with an emphasis on interests, finding common ground, focusing on the other sidechr('39')s concerns).

The findings of this study indicates that nursing managers are involved in diplomacy and relying on the advocacy role that is less paid attention in the clinic. They use it to achieve their organizational goals.

In difficult conditions, the military needs high-energy and macronutrient and micronutrient-rich nutrition during intense physical activity to achieve optimal levels of fitness. The aim of the present study was to evaluate the effects of Compact Food Bar (CFB) designed on cardiopulmonary endurance in military athletes.

Forty-five military personnels with aging between 20 and 45 years were assigned into two groups in this randomized, single blind, controlled clinical trial. Subjects in the intervention group received three packs, 700kcal each, of CFB supplemented with Functional compounds (Caffeine, L-arginine, and Propolis) designed, each day for 10 days. The other group consumed regular food used in military training courses with the same calories as control per day for the same period of time. The conditions for performing the activities in terms of some variables such as temperature, humidity, sports coverage, sleep, type of sports, and caloric activities were the same for all samples. Maximal oxygen uptake (Vo2 Max) as a measure of cardio-respiratory endurance in vitro with cardiopulmonary exercise test (CPET), anthropometric indices by body composition and physical activity with a pedometer were measured and recorded at the baseline and the end of the trial. Statistical analysis was performed using SPSS 16 software.

In the CFB group, Vo2 max, Vo2/HR and VE/Vo2 were significantly improved at the end of the study (P<0.01). Vo2 max, Vo2/HR, and VE/Vo2 were significantly increased in the CFB group compared with the control group (P<0.05), while there was no significant difference in the mean of VE/Vco2, and exercise ventilation (VE) (P>0/05). Body weight, body mass index (BMI), lean body mass (LBM), and body fat mass (BFM) did not alter in the CFB group at the end of the study (P>0.05).

The consumption of CFB supplemented with caffeine, L-arginine, and propolis has a more effective response to improved cardiopulmonary endurance in military athletes compared with the regular food group.

Psychological health is a condition that a person understands his/her abilities and can handle work pressures and increase own productivity. The purpose of this study was to investigate the relationship between nurseschr('39') psychological health with resilience and pain tolerance.

This is a descriptive-correlational study which conducted in 2020. The statistical population consists of patients in surgical wards of Shiraz 576-army and Namazi hospitals. 196 nurses were selected using simple random sampling. The research tool was a researcher-made questionnaire with 23 questions that its validity is confirmed by expert opinions and its reliability is calculated by Cronbachchr('39')s alpha of 83%. Artificial neural networks and SPSS18 software were used to analyze the data.

According to the statistical analysis of neural network in terms of importance, the most weighted effects of psychological health dimensions on patient resiliency were emotional adjustment (30%), social adjustment (22%), social-communication (20%), emotional intelligence (16%), and environmental factors (13%) of nurses. Also, a correlation between emotional adjustments with resilience is 67%, emotional intelligence with resilience is 43%, social adjustment with resilience is 51%, environmental factors resilience is 37% and social-communication with resilience is 48%.

The current findings showed that nurses can communicate to different patients by relying on their knowledge, experience and understanding of their mental states and to some extent understands them and, based on this understanding, have a positive effect on their resilience and pain tolerance.

Clinical studies show the effect of vitamin D on muscle strength in athletes. In addition, vitamin D deficiency is more common in people with higher physical activity than in others. Therefore, it seems vitamin D supplementation in the military can improve their health and physical performance.

This study is a double-blind clinical trial was done in Isfahan, Iran in 2019. According to the inclusion and exclusion criteria, 100 militaries were randomly assigned to two groups of supplement and placebo groups (n=50). Demographic data and physical activity of militaries were collected by questionnaires. For all of the participants, measurements of height, weight, waist circumference, fat and muscle mass of the body were conducted. Sport tests of speed and time of fatigue were done. Data analysis was performed by SPSS software, version 18.0.

The two groups of intervention and placebo were matched in terms of age, serum vitamin D level and level of physical activity. The mean of serum vitamin D level in the intervention group at the end of the study was higher than the placebo group (p <0.05). There were no differences in anthropometric indices (weight, waist circumference and BMI) as well as body composition between the two groups receiving vitamin D and placebo at the end of the study (p <0.05). Fatigue time more increased in the vitamin D supplement group than in the control group (p <0.05) but no difference was seen in the 10 m speed test (p <0.05). 

The findings of this study show that vitamin D supplementation can increase fatigue time in military force, but it does not influence body composition and speed.

Investigating the dimensions and components of research management satisfaction can identify appropriate executive solutions for the qualitative and quantitative enhancement of research projects. The purpose of the present study was to provide an appropriate theoretical and practical framework for evaluating satisfaction with research management and its application for evaluating researcherschr('39') satisfaction in a selected military medical university.

The present study was an applied study in terms of purpose and was a mixed qualitative-quantitative study in terms of methodology. In the first step, the main dimensions and components of researcherschr('39') satisfaction with research management extracted using literature review and expert opinion survey. In the second step, a structured questionnaire designed and standardized to measure the satisfaction of researchers in each of these dimensions. Qualitative and quantitative methods were used to assess the content validity of the questionnaire. Cronbachchr('39')s alpha used to assess questionnaire reliability. Finally, the questionnaire distributed randomly among 150 researchers and faculty members of a military medical university. The relationship between satisfaction with demographic and occupational characteristics of the respondents evaluated by ANOVA at SPSS-16 software.

Six dimensions and 15 components were identified to measure satisfaction with the research management system. The main dimensions of measuring satisfaction with research management included research leadership, capacity building, creating hope, organizational communication, research organization, and resource allocation. The highest satisfaction was related to creating hope (2.71±0.82) and the least satisfaction was related to resource allocation (1.79±0.31). There was no statistically significant relationship between demographic and occupational variables of respondents and satisfaction with research management (P>0.05).

Given that the least satisfaction of the researchers were in two dimensions of resource allocation and capacity building, it is recommended that research managers pay more attention to equitable distribution of resources in addition to creating new resources and developing financial and non-financial research capacities simultaneously.

Due to the unpredictability of crises, organizational resilience can provide the ability of the organizations to adapt to crisis situations without collapse or failure. The aim of this study was to explain and validate the components of organizational resilience in military hospitals.

The first phase of the qualitative study was conducted using framework analysis to identify components of organizational resilience in military hospitals. The study population consisted of 20 specialists in three military hospitals in Tehran, Iran who were selected for purposeful sampling. The second phase was carried out by exploratory factor analysis (EFA) to determine its validity.

The factors affecting resilience in military hospitals were classified into five main dimensions: hospital vulnerability and safety, disaster preparedness, capacity adaptation, crisis service continuity, rehabilitation and adaptation to post-crisis conditions. The results of factor analysis showed that the highest factors in each of these dimensions were as follows: identification of the main processes of threats and accidents in the hospital (0.82), hospital in the wider community program (0.90), identifying and managing key skills of employees (0.88), prioritization and maintaining basic performance (0.84), and extra emergency space, resources and staff (0.81).

Military hospitals should provide special measures to increase capacity adaptation in crises by reviewing their current mission and operations. Military hospitals should be able to practice and provide post-accident rehabilitation services to increase resilience.

The issue of special needs patients and their support and the importance of the quality of insurance services provided to these patients is one of the components that has attracted the attention of many communities in recent years. Therefore, this study was conducted to determine the relationship between the quality of insurance services and the quality of life of these patients.

This cross-sectional study was conducted in 2019. Two-hundred sixty-two specific need patients in 6 groups of diseases (malignancies, dialysis, hemophilia, kidney transplantation, MS and thalassemia) and covered by health insurance of the Armed Forces were enrolled by census method. The assessment tools included a researcher-made questionnaire on the quality of insurance services with 5 dimensions (financial protection, insurance coverage, support package, accountability, process and administrative services) and the standard questionnaire SF36. Quantitative data analysis was performed using a structural equation model based on the partial least squares approach with Smart-PLS3 software.

The results showed that the quality of insurance services had a significant positive relationship with patientschr('39') quality of life (β=0.23, p<0.001). Other results showed that the financial protection factor had the most significant effect on the physical quality of life (p<0.001) and insurance coverage had a significant positive effect on both physical and mental quality of life (p<0.001).

Patients who have good health insurance services will also enjoy a good quality of life and hope to improve and continue to live longer than others.

Hospital bed productivity is crucial for efficient management. In this study, the capacity of hospital beds in Al-Zahra Hospital in Isfahan was evaluated using an innovative indicator.

 The present study was performed by a descriptive method in 2018. Using the statistical data of Al-Zahra Hospital, field survey, review of the official license of the hospital and putting in the proposed indicator of this study, hospital bed productivity for the whole hospital and three randomly selected wards (gastrointestinal ward, neonatal surgery ward and heart-dermatology-endocrine-post CCU ward) was calculated and analyzed.

The overall hospital bed productivity was 50.7%. The indicator was estimated for the gastrointestinal ward 68.9%, neonatal surgery ward 24.9%, and for the heart-dermatology-endocrine-post CCU ward 70.9%. The effect of the active bed on the formula was investigated which caused some beds to exit from the activity cycle. The problem of bed occupancy rate in terms of patient admission and patient distribution in wards and the negative effect of the average length of stay in the formula was also examined for systematic and individual causes.

The proposed formula presented in this study will help managers to increase hospital productivity by measuring the extent of existing capacity utilization and identifying the reasons for not using the maximum capacity to achieve optimal utilization capacity.

Healthcare networks in industrial areas are the main pillars of preventing and coping with chemical accidents and crises, which are of great importance in improving their level of resilience. In order to achieve this goal, it is necessary to apply a precise method for assessing and empowering these centers. The purpose of this study was to provide a resiliency pattern for these centers in accidents and chemical crises.

The present research is a combined study (quantitative - qualitative) study of the applied type. In the first phase, the indicators of resilience assessment were extracted from internal and international literature and confirmed by content validity. Then, in the next phase, the questionnaire was designed and computed based on the extracted indicators and was approved by the experts. Finally, by designing quantitative criteria for analyzing the results of healthcare networks assessment in disasters and crises, a model for assessment and empowerment of the health system in disasters and crises was presented.

Based on the literature review and the methodology, 12 indicators were extracted for assessing healthcare networks in chemical accidents and crises. Content validity (CVI = 0.85 and CVR = 1) of all indicators was confirmed, then using the questionnaire on the weight of each indicator was identified in the score of the total score (100 points). The quantification methods of the 12 indicators developed by the expert group were confirmed. Finally, an evaluation and capability model for these networks were developed.

According to the results, the pattern of healthcare networkschr('39') resilience in chemical disasters and crises was divided into three stages before, during and after the crisis in 12 indicators of chemical hazards, structure status, documentation analysis, capacity and facilities, training, exercises, human capital, management systems, crisis management, communications, accident analysis, and audit and monitoring with relevant sub-groups.

Respect for patientschr('39') privacy is especially important in the emergency department. The present study was conducted to determine the relationship between the moral intelligence of emergency personnel with the level of respect for patient privacy in the emergency departments of hospitals affiliated to Zanjan University of Medical Sciences, Iran.

In this cross-sectional study, 154 patients and 77 emergency department staff participated by convenience sampling method. Demographic, moral intelligence and patient privacy questionnaires were used to collect data. Data were analyses by SPSS software version 16.

The mean age of employees was 34.04±7.6 years (range 24-54 years old), and the mean age of patients was 38.8±13.4 years (range of 18-76 years old). Employeeschr('39') moral intelligence was 76.96±8.42 and was in a good category. Also, the level of respect for patient privacy in the emergency departments was 85.63±13.88 and was in the moderate category. There was a significant and inverse relationship between employees’ moral intelligence with patientschr('39') physical privacy (r=-0.226) (p=0.048).

Considering the moderate level of respect to patient privacy in the emergency departments in the present study, it seems that in addition to the lack of staff information in this regard, the factors affecting it needs to be studied and paid special attention.