مجله پیاورد سلامت
سال شانزدهم شماره 5 (آذر و دی 1401)

Background and Ami: 

Identifying the genotype of blood groups in different communities will give the decision makers of the health system to take the necessary measures to prevent and identify the possible side effects of blood transfusion, including the production of alloantibodies. Duffy blood group has increased the possibility of alloantibody production in beta-thalassemia major patients who regularly need blood transfusion due to different types of genotype with different prevalence. However, no study has been conducted regarding the frequency of Duffy blood group distribution in beta-thalassemia Kurd patients dependent on blood transfusion.

This case-control study was conducted on 100 patients with beta thalassemia major, as case group and 50 healthy individuals, as control group, in Bostan Clinic, Kermanshah University of Medical Sciences. After collecting peripheral blood samples from people participating in the study, DNA was extracted from peripheral blood mononuclear cells. Then, using PCR-RFLP and electrophoresis, Duffy genotypes including FYA/A, FYB/B and FYA/B were identified.

The results of Chi-square test showed that in the patient group, there is no statistically significant difference between the two genders in terms of the frequency of distribution of Duffy genotypes (P=0.588). On the other hand, in the healthy group too, there was no statistically significant difference between the two sexes in terms of the frequency of distribution of Duffy genotypes (P=0.707). According to nominal regression results, although the distribution ratio rate (95% confidence interval) of FYA/FYA and FYB/FYB genotypes as compared to FYA/FYB genotype (reference category) in the patient group as compared to healthy people was 2.42 (0.7 to 8.34) and 0.76 (0.36 to 1.64) respectively, but there was no statistically significant difference between the case and control groups in terms of the distribution frequency of these genotypes (P<0.05).

The frequency distribution of Duffy genotypes in beta-thalassemia major patients is similar to that of healthy people, and there is no relationship between the distribution of Duffy genotypes and beta-thalassemia disease. FYB genotype has the highest frequency in both case and control groups

Evaluation of hospital environments with reliable and valid tools is considered to be one of the essential prerequisites for continuous improvement of the hospital learning environment. The present study aimed to translate and evaluate psychometric properties of the short version of the PHEEM questionnaire among the residents of Tehran University of Medical Sciences residents. 

This was a psychometric evaluation study. After translation and back translation, the questionnaire was provided to 18 experts. The content validity was qualitatively checked using the coefficients of content validity ratio (CVR), content validity index (CVI), and face validity. Then, the revised questionnaire was distributed among 20 residents. Face validity was evaluated by qualitative method and cognitive interview to check the questionnaire items in terms of difficulty level, appropriateness, and ambiguity. The test-retest method checked initial reliability by redistributing the questionnaire to the same residents with an interval of two weeks. In order to determine construct validity, the modified questionnaire was distributed among 548 medical residents from 24 specialized fields. The sample was selected using the convenience sampling method. Then the data were analyzed using exploratory and confirmatory factor analysis. Internal consistency was calculated using Cronbach’s alpha.

The questionnaire’s content validity ratio (CVR) and content validity index (CVI) were 0.93 and 0.88, respectively. Based on the results of face validity, some minor changes were made to the vocabulary of most items, and item 12 was wholly changed. The ICC coefficient was more than 0.90 in all dimensions. In the exploratory factor analysis using the principal component method (PCA), the Kaiser-Meyer-Elkin value was 0.83. Bartlett’s test of sphericity was statistically significant (P<0.001), which confirms the functionality of the correlation matrix. The Cronbach’s alpha coefficient of the questionnaire was 0.83, which indicates the internal consistency of the questionnaire items. 

According to the results, the PHEEM short-version questionnaire has good reliability and validity (face, content, and structure) among medical residents. Therefore, this measure can be used to evaluate residents’ perceptions regarding the quality of the educational environment of hospitals.

this study aims investigating the effect of the physician's presence on the error of recording surgical codes by surgical assistants and the resulting financial effects in Rasoul Akram hospital.

The present study was a descriptive-analytical and prospective study that was performed by collecting data in the hospital and reviewing the documents from Jun to March 2022. Therefore, in order to compare the deductions according to the presence or absence of the doctor, an expert was stationed in the operating room to enter the information in special forms, and thus the types of deductions for each of the mentioned situations were identified. T-test was used for analysis between the two groups (presence and absence of physician) and data were analyzed using Excel and SPSS software.

Three hundred and one records were reviewed during the presence of the physician and 300 cases during the absence of the physician based on Cochran sampling formula. The percent difference between hidden deductions in the presence and absence of the physician was not significant (P-value=0.078). However, the difference between the obvious deductions in the presence and absence of the physicians was significant (P-value=0.024). The difference in obvious deduction costs was significant in the presence or absence of a physician (P-value<0.001). But, the difference in hidden fraction costs in the presence or absence of physicians, was not significant (P-value=0.435).

The presence or absence of a surgeon has an effect on the amount of errors in the registration of surgical codes by the surgeon’s assistant and, as a result, this matter affects the percentage and costs of surgical deductions, especially in the obvious deductions. Therefore, planning for the presence of the surgeon in cases where the error of registering the codes by the surgeon’s assistant leads to obvious deductions, can help to more accurate documentation and, as a result, fewer deductions are accrued.

Effective monitoring and evaluation of human resources in countries require an agreed set of indicators and measurement tools. Due to the existence of different payment mechanisms, this study aimed to identify performance evaluation indicators in hospitals affiliated with the Tehran University of Medical Sciences.

A qualitative phenomenological study was conducted in 2022. Data were collected using semi-structured interviews, purposive sampling, and participation of 23 members of the Senior executives and financial team of hospitals affiliated to Tehran University of Medical Sciences and analyzed by content analysis method using MAXQDA-10 software.

Twenty-three experts participated in this research, 78.2% were men and 21.7% were women, and a total of 526 final codes were identified and according to the balanced scorecard management tool in 4 main themes of finance, customers, internal processes, and growth and Development. Also 8 sub-themes of resource efficiency with 86%, medical tourism with 52%, professional ethics with 65%, satisfaction with 78%, accreditation with 48%, diagnosis and treatment with 78%, education with 56% and The research was categorized with 78%.

The provision of optimal medical services requires managers to be aware of the performance of subordinate personnel, which makes it possible to choose the appropriate criteria, develop performance evaluation systems and conduct correct evaluation, informing Doctors regarding the indicators considered for more accurate evaluation are among the suggestions that can be a solution to the existing problems. Another important point considering the limited available resources is the role of doctors in the field of health tourism to which attention will lead to an increase in financial resources.

Surgical site infection (SSI) is one of the most common health-care associated infections. Using proper antiseptic solutions for preoperative surgical site skin preparation (skin prep) is one of the methods to reduce SSIs. The purpose of this study was to compare the effect of preoperative surgical site skin preparation with povidone-iodine and chlorhexidine-gluconate on the rate of SSI in laparotomy patients.

A total of 70 Laparotomy surgery patients who referred to Firoozgar hospital in Tehran from May to September of 2021 were included in this clinical trial. Patients were randomly allocated into two groups which were treated with povidone-iodine(PVI) or chlorhexidine-gluconate (CHG) for surgical site skin prep. Skin prep was done with standard rotational method in two steps by the researcher for each group by using of PVI and CHG. SSI incidence was assessed by a researcher-made check list and also over post-surgical follow up visits by the surgeon. We used Fischer’s exact test, t-test, Chi-square and Cochrane’s Q-test to analyze the collected data.

SSI was seen in five patients (14.29%) of PVI group and one patient (2.86%) of CHG group. Although the SSI incidence in PVI group was 5.54 times more than CHG group, still the difference wasn’t statistically significant (P=0.198). Comparing the incidence of SSI’s in 24 hours after surgery (0%) and 30 days after surgery (8.57%) in both groups revealed that using these antiseptics for skin prep was effective in preventing SSI (P<0.001). SSI incidence was also associated with two days of patient’s hospital admission time (P=0.001).

The result of this study revealed that the occurrence of SSI in PVI group was 5.54 times more than CHG group. However, the difference was not statistically significant. So both of these antiseptics can be used for surgical site skin prep.

The participation of doctors and clinical leadership in organizational strategies to improve quality performance is a necessary precondition for providing safe and high-quality care, and since improving the quality of health care services and increasing the participation of doctors in accreditation is very necessary, the present study was conducted with the aim of explaining the obstacles of doctors' participation in the accreditation programs of Iranian hospitals with a qualitative approach.

In this study, using the snowball sampling method, interviews were conducted with 11 managers, 9 doctors and 8 officials and experts in the field of quality management (a total of 28 people) in the field of hospital accreditation. Interviewees were selected through purposive snowball sampling. To collect data, unstructured and semi-structured in-depth interviews were conducted. The obtained data were analyzed using the conceptual framework method in ATLAS.ti.

The results of this research extracted 3 main issues including cultural, organizational and behavioral factors. Also, this research found 12 sub-themes and 57 items. Subtopics in the cultural area were motivation, patient demand, mutual trust, and evaluation system. The organizational field included seven sub-topics, including high workload, understanding the role of the quality management unit, unrealistic accreditation, the nature of accreditation, empowering doctors in the field of quality, effective communication, and limited resources. Subthemes in the behavioural dimension were role ambiguity and uncertainty about how to participate in the accreditation program. The most repeated challenges in the interviews were expressed in the field of effective communication and the least in the field of role ambiguity.

Physicians' participation in accreditation programs can be increased through culture building and proper training in accreditation activities in the medical community. By revising the categories of activities performed in the hospital by doctors and including a specific time to perform activities to improve quality and accreditation and create a balance between the quantity and quality of services provided in the hospital, it is possible to increase the participation of doctors in the accreditation program.

  With the outbreak of the COVID-19 pandemic, the performance of hospitals were affected, and changes were made in the utilization of hospital services. Analyzing hospital performance data during the COVID-19 pandemic can provide insights into service utilization patterns and care outcomes for managers and policymakers. This study was conducted to investigate the impact of COVID-19 on selected outcome indicators in the hospitals of Shahid Beheshti University of Medical Sciences, Tehran.

 This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital's intelligent management system. The data were analyzed using R software's interrupted time series analysis method.

 The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05).

 Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic's beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic.

Surgical smoke (SS), is caused by the use of high temperature devices such as electrocautery, laser and ultrasonic scalpel, which are used for cutting and coagulation of tissue during surgery, is considered as a serious threat to the health of operating room (OR) personnel. Various studies have identified the workplace safety climate as one of the main causes of the occurrence or prevention of occupational hazards. This study was conducted with the aim of Perceived Safety Climate (PSC) in ORs and its relationship with the awareness of the OR staff about the SS hazards.

This cross-sectional study was conducted from April 2021 to July 2022 in the ORs of 26 public hospitals affiliated to Tabriz University of Medical Sciences. In this research, 396 surgical and anesthesia technologists were included in the study by stratified random sampling. Data were collected using a demographic questionnaire, PSC questionnaire and awareness about the hazards of SS questionnaire and analyzed using SPSS software

The knowledge of the OR staff regarding the hazards of surgical smoke was evaluated at a moderate level with a mean and standard deviation of 9.82±4.32 (range 0 to 21). The average knowledge score of surgical technologists (11.1±4.56) regarding the hazards of surgical smoke was significantly higher than the average score of anesthesia technologists (8.75±4.1)(P=0.02). The PSC in the OR was evaluated at moderate level with a mean and standard deviation of 62.15±11.1 (range 19 to 95). The results of linear regression analysis showed that the effect of PSC in increasing the awareness of OR staff about the hazards of SS was significant (P=0.001). By increasing one score to the total score of the PSC, the awareness score increases by 0.201.

The safety climate of the OR can predict the awareness of the hazards of SS among OR staff. It is recommended to adopt strategies such as educating personnel about the hazards of SS and how to prevent it, creating a suitable supportive environment for personnel, and providing suitable protective facilities to prevent OR staff from being exposed to SS.