Learner satisfaction with synchronous and asynchronous virtual learning systems during the COVID-19 pandemic in Tehran university of medical sciences: a comparative analysis

BACKGROUND

The need for electronic learning and its systems, especially during specific circumstances and crises, is crucial and fundamental for users in universities. However, what is even more important is the awareness and familiarity of learners with different systems and their appropriate use in e-learning. Therefore, the present study was conducted to determine the satisfaction of learners with synchronous and asynchronous electronic learning systems during the COVID-19 period at Tehran University of Medical Sciences.

METHODS

The present study was a descriptive-analytical study conducted cross-sectionally from the first semester of 2019-2020 academic year until the end of the second semester of 2021-2022 academic year, coinciding with the COVID-19 pandemic. The sample size was determined to be 370 students and 650 staff members using the Krejcie and Morgan table. The face validity and reliability of the research tool, which was a researcher-made questionnaire, was confirmed. Considering a response rate of 75%, 280 completed questionnaires were received from students, and 500 completed questionnaires were collected from employees. For data analysis, absolute and relative frequencies, as well as independent t-test, analysis of variance (ANOVA), and Post Hoc tests in the SPSS software were utilized.

RESULTS

During the COVID-19 pandemic, both students and staff members at Tehran University of Medical Sciences showed a relatively decreasing level of satisfaction with electronic learning. There was a significant difference in satisfaction between these two groups of learners regarding electronic learning (P = 0/031). Learners were relatively more satisfied with the offline system called "Navid" compared to online learning systems. Among the online systems, the highest level of satisfaction was observed with the Skype platform.

CONCLUSION

Although learners expressed relative satisfaction with electronic learning during the COVID-19 period, it is necessary to strengthen infrastructure and provide support services, technical assistance, and continuous updates for electronic learning platforms. This can contribute to more effective and efficient utilization of electronic learning, especially during particular circumstances and crises, or in hybrid models combining online and face to face education and training.

The role of taxation measures in the management of harmful products, services, and practices in Iran: a qualitative study

BACKGROUND AND AIM

Levying a tax on harmful products, services, and practices can affect consumer choices, effectively preventing diseases and reducing health care costs. The goal of this study was to investigate the role of taxation as a powerful financial tool in the management of harmful products, services, and practices to maintain and improve public health and preserve the financial sustainability of the health care system.

MATERIALS AND METHODS

This qualitative study was conducted in 2020-2021. In order to collect information for this study, semi-structured interviews were conducted. Using purposive and snowball sampling methods, 38 managers, policymakers, economists, and key experts were interviewed. Data were analyzed using the content analysis method. The transcribed interviews were further imported into MAXQDA for classification, and relevant codes were extracted.

FINDINGS

In this study, 6 main themes and 19 subthemes were labeled. The main themes included 1) objectives, effects, and requirements of the taxation of harmful products, services, and practices, 2) definition, instances, elasticity, and grading of harmful products, services, and practices, 3) Problems in controlling harmful products, services, and practices, 4) controlling harmful products, services, and practices, 5) traffic violations and accidents, and social harms, and 6) tax revenue use and the share of health care. The effects of taxing harmful products include reduced access to these products, reduced demand for harmful products, and the promotion of public health.

CONCLUSION

Harmful products, services, and practices have major health and financial implications for individuals, families, and society. To improve public health, the demand for these products and services can be controlled through taxation measures to push consumers toward less harmful alternatives.

Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project

BACKGROUND

SASHA, which stands for "evidence-informed health policy-making (EIHP)" in Persian, is a national project to draw a roadmap for strengthening EIHP in Iran. As a part of SASHA, this research aimed to develop evidence-based and context-aware policy options for increasing the capacity of decision-makers to apply EIHP in Iran.

METHODS

This was a qualitative study, which was informed by a literature review of pull efforts' capacity building programs. Based on the review, we developed policy options and validated them through an expert panel that involved twelve experts. Data were analyzed using a content analysis method.

RESULTS

We extracted data from 11 articles. The objectives of capacity building programs were: single-skill development, personal/professional development, and organizational development. According to these objectives, the contents and training methods of the programs vary. Capacity building programs have shown positive impacts on individual knowledge/attitudes to use EIHP. However, the impacts of programs at the organizational or the health system level remain under-researched. We followed several threads from the literature review through to the expert panel that included training the management team, instead of training managers, training for problem-solving skills, and designing tailored programs. Barriers of capacity building for EIHP regard the context of the health system (weak accountability and the widespread conflict of interest) and healthcare organizational structures (decision support systems, knowledge management infrastructures, and lack of management team). Experts suggested interventions on the barriers, particularly on resolving the conflict of interests before launching new programs. A proposed framework to increase the capacity of health policy-makers incorporates strategies at three levels: capacity building program, organizational structure, and health system context.

CONCLUSION

To prepare the context of Iranian healthcare organizations for capacity building programs, the conflict of interests needs to be resolved, decision-makers should be made more accountable, and healthcare organizations need to provide more knowledge management infrastructures and decision support systems.

Explaining specific taxes management and use in the health sector: a qualitative study

Background and aim

Being the major source of revenue and essential economic tool for policymakers to improve public health, taxes contribute to government spending on the development of health care facilities and services. Given the financial challenges facing the health sector together with the public health issues that affect each society, placing specific taxes on some goods, services, and activities can be effective in this regard. The study aims to explain the various dimensions of specific taxes in the health sector and management of these resources in order to achieve the health system goals.

Materials and methods

This study with a qualitative research design was conducted using semi-structured interviews with open-ended questions in 2020–2021. In total, 38 managers, policymakers, economists, key experts, and other individuals, as informants, were interviewed. Purposive and snowball with maximum variation was also employed. As well, content analysis was utilized to shed light on the data. The transcribed interviews were further imported into MAXQDA for extracting and classifying the relevant codes.

Findings

In this study, 5 main themes and 23 subthemes were labeled. The main themes accordingly included “Objectives and Conditions of Specific Health Taxes”, “Earmarked Taxes”, “Taxes on Goods and Measures of Harmful to Health”, “Value-Added Taxes”, and “Green Taxes”.

Discussion and conclusion

Considering the specific taxes in the health sector, i.e., taxes on goods and measures of harmful to health, value-added taxes, and green taxes, all taxation and pricing policies need to take account of the effects as well as the advantages and disadvantages of types of taxes, a country’s economic structure, the conditions of industries and manufacturing enterprises, cultural aspects in society, and peoples’ socioeconomic status.

Expression of miRNA1, miRNA133, miRNA191, and miRNA24, as Good Biomarkers, in Non-Small Cell Lung Cancer Using Real-Time PCR Method

Background:

Lung cancer has recently shown the highest incidence among all cancers. microRNAs (miRNAs) are the molecules playing a role in regulating gene expression and contributing to many pathogenic mechanisms. Therefore, these molecules could be used as biomarkers for the detection, anticipation, and treatment of cancer. With this in mind, we decided to investigate and compare the expression of miR-1, miR-133, miR-191, and miR-24 and also the expression differences in these four RNA molecules between lung cancer patients and the controls.

Methods:

A total of 50 patients with lung cancer participated in this study. In addition, 50 healthy blood samples were selected as the control group. Real-time PCR determined the expression levels of miRNA. The RNAs extracted from the patients’ white blood cells were initially synthesized, and then cDNA was extracted. Finally, the synthesized cDNA was amplified using real-time PCR, and its expression was compared with the control group.

Results:

The result indicated a low expression level of miR-1 and miR-133, and a high expression level of miR-191 and miR-24 in the blood of patients with lung cancer compared to the healthy subjects.

Conclusion:

Our findings revealed that miR-1, miR-133, miR-191, and miR-24 are oncogenes, and their expression could result in cancer. It appears that a therapy to overexpress miR-1 and miR-133 and downexpress miR-191 and miR-24 could contribute to the treatment of lung cancer.

The relationship between managers' ideal intelligence as a hybrid model and employees' organizational commitment: a case study in Tehran University of Medical Sciences

High ideal hybrid intelligence of managers is among the factors that can improve employees’ organizational commitment. Therefore, this study aimed to determine the relationship between managers’ ideal hybrid intelligence and employees’ organizational commitment in the Vice Chancellors’ Headquarters of Tehran University of Medical Sciences. This was a descriptive-analytical and cross-sectional study conducted in 2017 - 2018. The research sample size consisted of 86 senior and middle-level managers selected through census method, as well as 181 employees, selected using the Kerjecie and Morgan table. The research tool was an ideal hybrid intelligence questionnaire consisting of 102 questions on cultural, moral and spiritual intelligence, and also Meyer and Allens’ organizational commitment questionnaire including 24 questions. Face validity and reliability of each questionnaire were confirmed by an expert panel and Chronbach’s alpha method. The data were analyzed by SPSS software, and descriptive results were shown through mean and standard deviation, and analytical results by inferential tests. The results showed that the ideal hybrid intelligence of the Vice Chancellors’ Headquarters managers and employees’ organizational commitment were at a desirable level. Also, there was a significant correlation between cultural, moral and spiritual intelligence as constituents of the ideal hybrid intelligence of managers and employees’ organizational commitment. We found that ideal hybrid intelligence may affect employees’ organizational commitment, but it should be mentioned that other forms of intelligence may also affect organizational commitment.

A phenomenological study on barriers of adherence to medical advice among type 2 diabetic patients

BACKGROUND

More than three decades of research and study for overcoming the problem of "non-acceptance/non-compliance" of patients has neither resolved nor reduced the severity of this problem. This phenomenological study aimed to identify barriers of adherence to medical advice among type 2 diabetic patients.

METHODS

This study was a qualitative research using phenomenology approach, and the data were analyzed using content analysis approach. Participants were 69 type 2 diabetic patients covered by the diabetes unit of West and East Community Health Centers of Ahvaz, Iran. The views and attitudes of patients about the barriers of adherence to medical advice were elicited by conducting 20-45 min sessions of semi-structured interviews. Data analysis was performed following Colaizzi's seven-step method.

RESULTS

Barriers of adherence to medical advice were classified into systemic and individual barriers. Individual barriers included 11 codes and 5 categories, and systemic barriers contained within 5 codes and 3 categories. Physiologic and physical factors, financial problems, occupational factors, attitudinal problems and lack of knowledge, and social and family problems were identified as individual barriers. Systemic barriers included inadequate publicizing and limited notification, inadequate equipment and facilities, and poor inter-sectional coordination.

CONCLUSIONS

Generally, problems stated by diabetic patients at the individual level can partly be solved by training patients and the people around them. However, as for the systemic problems, it seems that solving the barriers of adherence to medical advice requires coordination with other organizations as well as intersection coordination. Overall, these problems require not only comprehensive health service efforts, but also the support of policymakers to resolve barriers at infrastructure level.

Developing an Evaluation Model for Maternity Care: A Mixed-Method Study from Iran

Background:

Maternity care is an integral part of primary health care (PHC) systems worldwide. This study aimed to develop a new model for evaluating the maternity health program (MHP) in Iran.

Methods:

In this mixed-methods study, first, the challenges of MHP were surveyed through systematic review and expert interviews. Next, to identify the existing shortcomings in MHP evaluation system, the SWOT technique, cross-sectional study and comparative analyses were used. Finally, the Delphi technique was used to reach consensus on developed evaluation standards.

Results:

The final developed evaluation model contains five dimensions including reproductive health/family planning, maternity health, health records, evaluation, and resources management. Overall, this model has 32 standards and 289 measures. The scores obtained for the sum of the measures in two importance and applicability criteria were 8.24 and 7.85, which these scores are estimated to be equal to 91.55 and 87.22 percent of the highest possible scores, respectively.

Conclusion:

Considering the comprehensiveness of the obtained model, it is hoped that it could lead to performance improvement of the PHC centers in the area of maternity health.

Barriers to reporting clinical errors in operating theatres and intensive care units of a university hospital: a qualitative study

BACKGROUND

Clinical errors are one of the challenges of health care in different countries, and obtaining accurate statistics regarding clinical errors in most countries is a difficult process which varies from one study to another. The current study was conducted to identify barriers to reporting clinical errors in the operating theatre and the intensive care unit of a university hospital.

METHODS

This qualitative study was conducted in the operating theatre and intensive care unit of a university hospital. Data collection was conducted through semi-structured interviews with health care staff, senior doctors, and surgical assistants. Data analysis was carried out through listening to the recorded interviews and developing transcripts of the interviews. Meaning units were identified and codified based on the type of discussion. Then, codes which had a common concept were grouped under one category. Finally, the codes and designated categories were analysed, discussed and confirmed by a panel of four experts of qualitative content analysis, and the main existing problems were identified and derived.

RESULTS

Barriers to reporting clinical errors were extracted in two themes: individual problems and organizational problems. Individual problems included 4 categories and 12 codes and organizational problems included 6 categories and 17 codes. The results showed that in the majority of cases, nurses expressed their desire to change the current prevailing attitudes in the workplace while doctors expected the officials to implement reform policies regarding clinical errors in university hospitals.

CONCLUSION

In order to alleviate the barriers to reporting clinical errors, both individual and organizational problems should be addressed and resolved. At an individual level, training nursing and medical teams on error recognition is recommended. In order to solve organizational problems, on the other hand, the process of reporting clinical errors should be improved as far as the nursing team is concerned, but when it comes to the medical team, addressing legal loopholes should be given full consideration.

Organizational behaviour management in clinical laboratory: A literature review

BACKGROUND

The clinical laboratories require organizational behavior management approach that creates a balance between directors' expectations and staffs' needs in this field. This study was aimed to explain the role of organizational behavior management in clinical laboratories and suggest mechanisms for its implementation in these organizations.

MATERIALS AND METHODS

In this research, using several Persian and English databases by keywords consist of the clinical laboratory, organizational behavior management, and staff diversity. Three hundred and fifty four references from 1990 to 2020 were studied, and 72 references, including abstracts and full papers utilized for this research, and excluded papers presented at conferences, seminars, and dissertations. Using MESH strategy and Pico's instruction.

RESULTS

The results of studies revealed staffs' individual differences in all aspects, including early and secondary dimensions may influenced the style of leadership implemented in clinical laboratories, "job-personality compatibility theory," job satisfaction and job commitment of staffs work in clinical laboratories and the way the directors and managers can develop the job loyalty and improve the organizational productivity in these organizations.

CONCLUSION

It is suggested a conceptual model for understanding and assessing the different organizational behaviors of clinical laboratories staffs based on communication skills, staffs' interaction, and socio-political, economic, and cultural elements, which should be more developed in future using the other similar studies.

The Relationship Between Distribution of Human Resources Distribution and Performance Indicators of Hospitals Before and After Implementation of Health System Evolution Plan in Iran

The implementation of the Health System Evolution Plan has resulted in an increase in the rate of patient’s referral to hospitals of medical universities, and thus, hospitals’ performance indicators. The aim of the present study is to investigate the changes in hospital indicators after the implementation of the Health System Evolution Plan and the relationship between this plan and distribution of human resources in hospitals of Tehran University of Medical Sciences. This was a descriptive-analytical and cross-sectional study. The research population consisted of information about human resources and performance indicators before and after the implementation of the Health System Evolution Plan in the hospitals. The research tool was a data collection form. The collected data were analyzed in SPSS software, and analytical results were obtained using the Pearson correlation test and Two Sample t-test. The results showed that there was a significant relationship between hospitals performance indicators and the distribution of human resources after the implementation of the Health System Evolution Plan. In fact, this plan has increased the deficit of nursing and paraclinical staff. In addition, the results showed as hospitals’ performance indicators have increased, more human resources has been recruited in these hospitals. The success of Implementation of Health System Evolution Plan and development of general hospitals indicators need comprehensive. Planning for retainment of all groups of health workers and paying attention to appropriate distribution of physicians, nurses, and paraclinical staff in public hospitals and finally a comprehensive review of human resources standards by the Iranian Ministry of Health. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(8):510-517.

Competencies Gap in Hospital Management in Tehran, Iran: A Cross-sectional Survey

Competent managers are essential to the efficient, effective and responsive of hospitals. This study aims to determine the competencies gaps in hospital management. This cross-sectional survey was carried out using a self-administered questionnaire among 127 hospital managers in the Iran. The questionnaire included 61 items and 11 dimensions. Participants were completed on a five-point scale ranging the level of importance that each proposed competency had in their job and to indicate their proficiency in each skill. Managers felt most competent in terms of legal and ethical issues, health delivery, planning, change management. People management, leadership and strategic management and problem-solving were rated as being most important for the efficient and effective management of hospitals. The gaps were highest for people management (–0.97), leadership and strategic management (–0.82) and problem-solving (–0.80). The least skill gaps were in the areas of legal and ethical issues (–0.31), health service delivery (–0.32) and change management (–0.43). The findings of this study reflect the reality of the management in Iran and the needs of managers and will be helpful in the conceptualization, design and delivery of hospital management programmes aimed at improving current and future management and management capacity in the hospital in Iran.

Three Markers in Cancerous and Healthy Cells of Patients with Non-Small-Cell Lung Carcinoma (NSCLC)

Introduction: Lung cancer is the most common cause of cancer-related death among males and females. The diagnosis of lung cancer is of great importance for clinical considerations and follow-up treatment. This study aimed to examine the expression of CEA, LUNX, and CK19 biomarkers in the cancerous and healthy tissues of patients suffering from NSCLC. Methods: In this study, 30 patients with NSCLCs referring to Masih Daneshvari Hospital in Tehran were voluntarily selected prior to taking any treatment. A tissue sample from the center and a sample of healthy tissues close to the cancerous masses were prepared by a specialist in the bronchoscopy sector and tested using real-time RT-PCR. Results: Positive CEA mRNA was observed in cancerous tissues in the center of tumors of 25 out of 30 cases. In the healthy tissue group, the same was found in 10 out of 30 cases (P<0.001). The markers CK19 and LUNX mRNAs showed to be positive in cancerous samples in the center of tumors of 15 and 22 out of 30 cases, and in the healthy tissue group, the expression was observed in 5 and 4 out of 30 cases, respectively(P<0.001). Conclusion: This study confirms that the aformentioed markers are the ones with a relatively appropriate sensitivity and specificity for the diagnosis of lung cancer.

Evaluation of service quality from patients' viewpoint

Background

Measuring patients’ perception from health service quality as an important element in the assessment of service quality has attracted much attention in recent years. Therefore, this study was conducted to find out how the patients evaluated service quality of clinics at teaching hospitals affiliated with Tehran University of Medical Sciences in Iran.

Methods

This cross-sectional study was conducted in Tehran in 2017 and 400 patients were randomly selected from four hospitals. Data were collected using a questionnaire, the validity and reliability of which were confirmed in previous study. In order to analyze the data, T-test, ANOVA, and Pearson correlation coefficient were calculated using SPSS 23.

Results

The results indicated that among eight dimensions of health service quality, the patients were more satisfied with physician consultation, services costs and admission process. The highest and lowest mean scores were related to physician consultation (Mean = 4.17), and waiting time (Mean = 2.64), in that order. The total mean score of service quality was 3.73 (± 0.51) out of 5. Outpatient services were assessed as good, moderate and weak by 57.5, 40 and 2.5% of the patients, respectively. There was a significant relationship between the positive perception of service quality and reason for admission, source of recommendation, gender, education level, health status, and waiting time in the clinics (p <  0.05).

Conclusion

The majority of the patients had a positive experience with visiting clinics and perceived service provision as good. In fact, patients’ perceptions of physician consultation, provision of information to patients and the environment of delivering services, are the most important determinants of service quality in clinics.

Design a Fuzzy Rule-based Expert System to Aid Earlier Diagnosis of Gastric Cancer

INTRODUCTION

Screening and health check-up programs are most important sanitary priorities, that should be undertaken to control dangerous diseases such as gastric cancer that affected by different factors. More than 50% of gastric cancer diagnoses are made during the advanced stage. Currently, there is no systematic approach for early diagnosis of gastric cancer.

OBJECTIVE

to develop a fuzzy expert system that can identify gastric cancer risk levels in individuals.

METHODS

This system was implemented in MATLAB software, Mamdani inference technique applied to simulate reasoning of experts in the field, a total of 67 fuzzy rules extracted as a rule-base based on medical expert's opinion.

RESULTS

50 case scenarios were used to evaluate the system, the information of case reports is given to the system to find risk level of each case report then obtained results were compared with expert's diagnosis. Results revealed that sensitivity was 92.1% and the specificity was 83.1%.

CONCLUSIONS

The results show that is possible to develop a system that can identify High risk individuals for gastric cancer. The system can lead to earlier diagnosis, this may facilitate early treatment and reduce gastric cancer mortality rate.

A Study of the Readiness of Hospitals for Implementation of High Reliability Organizations Model in Tehran University of Medical Sciences

Creating a safe of health care system requires the establishment of High Reliability Organizations (HROs), which reduces errors, and increases the level of safety in hospitals. This model focuses on improving reliability through higher process design, building a culture of accreditation, and leveraging human factors. The present study intends to determine the readiness of hospitals for the establishment of HROs model in Tehran University of Medical Sciences from the viewpoint of managers of these hospitals. This is a descriptive-analytical study carried out in 2013-2014. The research population consists of 105 senior and middle managers of 15 hospitals of Tehran University of Medical Sciences. The data collection tool was a 55-question researcher-made questionnaire, included six elements of HROs to assess the level of readiness for establishing HROS model from managers' point of view. The validity of the questionnaire was calculated through the content validity method using 10 experts in the area of hospitals' accreditation, and its reliability was calculated through test-retest method with a correlation coefficient of 0.90. The response rate was 90 percent. The Likert scale was used for the questions, and data analysis was conducted through SPSS version 21 Descriptive statistics was presented via tables and normal distributions of data and means. Analytical methods, including t-test, Mann-Whitney, Spearman, and Kruskal-Wallis, were used for presenting inferential statistics. The study showed that from the viewpoint of senior and middle managers of the hospitals considered in this study, these hospitals are indeed ready for acceptance and establishment of HROs model. A significant relationship was showed between HROs model and its elements with demographic details of managers like their age, work experience, management experience, and level of management. Although the studied hospitals, as viewed by their managers, are capable of attaining the goals of HROs, it seems there are a lot of challenges in this way. Therefore, it is suggested that a detailed audit is conducted among hospitals' current status regarding different characteristics of HROs, and workshops are held for medical and non-medical employees and managers of hospitals as an influencing factor; and a re-assessment process afterward, can help moving the hospitals from their current position towards an HROs culture.

Innovation Network Development Model in Telemedicine: A Change in Participation

Objectives

This paper introduces a telemedicine innovation network and reports its implementation in Tehran University of Medical Sciences. The required conditions for the development of future projects in the field of telemedicine are also discussed; such projects should be based on the common needs and opportunities in the areas of healthcare, education, and technology.

Methods

The development of the telemedicine innovation network in Tehran University of Medical Sciences was carried out in two phases: identifying the beneficiaries of telemedicine, and codification of the innovation network memorandum; and brainstorming of three workgroup members, and completion and clustering ideas. The present study employed a qualitative survey by using brain storming method. Thus, the ideas of the innovation network members were gathered, and by using Freeplane software, all of them were clustered and innovation projects were defined.

Results

In the services workgroup, 87 and 25 ideas were confirmed in phase 1 and phase 2, respectively. In the education workgroup, 8 new programs in the areas of telemedicine, tele-education and teleconsultation were codified. In the technology workgroup, 101 and 11 ideas were registered in phase 1 and phase 2, respectively.

Conclusions

Today, innovation is considered a major infrastructural element of any change or progress. Thus, the successful implementation of a telemedicine project not only needs funding, human resources, and full equipment. It also requires the use of innovation models to cover several different aspects of change and progress. The results of the study can provide a basis for the implementation of future telemedicine projects using new participatory, creative, and innovative models.

Designing an electronic personal health record for professional Iranian athletes

Background:

By providing sports organizations with electronic records and instruments that can be accessed at any time or place, specialized care can be offered to athletes regardless of injury location, and this makes the follow-up from first aid through to full recovery more efficient.

Objectives:

The aim of this study was to develop an electronic personal health record for professional Iranian athletes.

Patients and Methods:

First, a comparative study was carried out on the types of professional athletes’existing handheld and electronic health information management systems currently being used in Iran and leading countries in the field of sports medicine including; Australia, Canada and the United States. Then a checklist was developed containing a minimum dataset of professional athletes’ personal health records and distributed to the people involved, who consisted of 50 specialists in sports medicine and health information management, using the Delphi method. Through the use of data obtained from this survey, a basic paper model of professional athletes' personal health record was constructed and then an electronic model was created accordingly.

Results:

Access to information in the electronic record was through a web-based, portal system. The capabilities of this system included: access to information at any time and location, increased interaction between the medical team, comprehensive reporting and effective management of injuries, flexibility and interaction with financial, radiology and laboratory information systems.

Conclusions:

It is suggested that a framework should be created to promote athletes’ medical knowledge and provide the education necessary to manage their information. This would lead to improved data quality and ultimately promote the health of community athletes.

Frequency of beta-thalassemia or beta-hemoglobinopathy carriers simultaneously affected with alpha-thalassemia in Iran

BACKGROUND

Beta-thalassemias are prevalent heritable single gene disorders affecting the quantity of the hemoglobin molecule. Rarely, a co-inheritance of these impairments with alpha-thalassemia and/or a hemoglobinopathy occurs and makes an important double heterozygote or homozygous state. Thus finding these cases is essential for genetic counseling. The present study aimed to identify the prevalence of coexistent alpha-thalassemia mutations, hemoglobinopathies, and beta-thalassemia determinants.

METHODS

This descriptive study was performed on 5760 patients. We used complete blood cell count, Hb electrophoresis, and HbA2 measurement for thalassemia carrier identification. Increased HbA2 (> or = 3.5%) is the standard diagnostic marker for beta-thalassemia, while normal HbA2 with low MCH and MCV can indicate an alpha-thalassemia carrier or atypical beta-thalassemia minor. Individuals with MCV < 80 fL, MCH < 27 pg, and hemoglobin < or = 15.3 g/dL in men or < or = 14 g/dL in women, were candidates for molecular thalassemia investigations. Patients with abnormal hemoglobin varieties in hemoglobin electrophoresis were referred to a genetics laboratory for hemoglobinopathy detection.

RESULTS

141 subjects out of 5760 were affected by alpha and beta-thalassemia or a beta-hemoglobinopathy simultaneously, including: 13 (11.1%) fetuses, 55 (38.2%) male cases, and 73 (50.7%) females. Among these 141 alpha-thalassemia patients, 92 cases (65.24%) were beta-thalassemia carriers and 3 (2.12%) were beta-thalassemia major, 43(30.49%) had beta-hemoglobinopathies, and 3 cases (2.12%) had co-inherited beta-thalassemia and variant hemoglobins. 31 beta-gene mutations were observed in this population, the most common being HbS Cd6 (A > T) (24%). These thalassemia determinants account for about 46% of all detected mutations. As for alpha-gene mutations, -3.7 detection was the most prevalent.

CONCLUSIONS

The relatively high prevalence of co-inherited alpha-thalassemia and hemoglobinopathies among beta-thalassemia carriers indicates the importance of molecular analysis to diagnose these double heterozygous or sole homozygous cases for prenatal diagnostic purposes and putting forth strategies to prevent more complicated and dangerous combinations.

Quantum leadership: the implication for Iranian nursing leaders

Quantum organizations are referred where stakeholders know how to access the infinite potential of the quantum field. Viewing healthcare organizations from perspective of quantum theory suggest new approaches into management techniques for effective and efficient delivery of healthcare services. This research is aimed to determine the quantum skills, quantum leadership characteristics and functions of Tehran University of Medical Sciences hospitals' nursing administrators. A cross-sectional, descriptive and analytical study was conducted among 25 nursing administrators of Tehran University of Medical Sciences (TUMS) hospitals, Tehran, Iran. The research tool for data collection was a self-constructed questionnaire that measured the quantum skills, quantum leadership characteristics and functions of TUMS hospitals' nursing administrators. The validity of questionnaire was confirmed by 5 management science experts and its reliability was performed by using test-retest method yielded a Cronbach's alpha coefficient of 0.90. Data were collected and analyzed by SPSS software and t-test statistical methods. The results of this research showed that all respondents had desired quantum skills (75.71±5.98), quantum leadership characteristics (82.01±6.77), and quantum leadership functions (78.57±6.28) and total quantum leadership (78.76±4.50). Also, passing management training courses of the respondents was significantly correlated with their quantum leadership. Iranian healthcare organizations require quantum leadership that provides an important resource to advance Iranian nursing leadership to the organizational excellence. We hope Iranian hospitals' nursing leaders who have quantum skills potentially, present a highly developed sense of self and the ability to improve nursing care outcomes in these hospitals.

Organizational behavior of employees of Tehran University of Medical Sciences

Organizational behaviors are commonly acknowledged as fundamentals of organizational life that strongly influence both formal and informal organizational processes, interpersonal relationships, work environments, and pay and promotion policies. The current study aims to investigate political behavior tendencies among employees of Tehran University of Medical Sciences (TUMS). This cross-sectional, descriptive and analytical study was conducted on 810 TUMS employees at the headquarters of the Tehran University of Medical Sciences, Iran during 2010-2011. The research tool for data collection was a researcher-tailored questionnaire on political behaviors. The validity of the questionnaire was confirmed by seven management professors, and its reliability was tested by a pilot study using test-retest method which yielded a Cronbach's alpha coefficient of 0.71. The respondents were asked to fill the questionnaire and express their perceptions and tendencies to engage in organizational behaviors. The collected data was read to and analyzed by IBM SPSS environment and correlation analytical methods. Overall, 729 respondents filled and returned the questionnaire yielding a response rate of 90%. Most of the respondents indicated that they had no tendency to engage in political behavior. Moreover, we found that there was a significant correlation between sex, higher education degrees, tenure and the employees' tendency to engage in political behavior. The participants were not overtly political because of their personal belief, ethical values, and personal characters. Non-political and overtly political employees are both prejudicial for all organizations. Therefore, it seems that the medium rate of good political behavior is vital and prevalent in Iranian organizations.

Organizational citizenship behavior among Iranian nurses

BACKGROUND

Organizational Citizenship Behavior (OCB) is defined as "individual behavior that is discretionary, not directly or explicitly recognized by the formal reward system, and that in the aggregate, promotes the effective functioning of organization". OCB, enhance job satisfaction among nursing employees. According to several findings, nurses' OCB have a positive and significant influence on job satisfaction. This research is aimed to study OCB among Iranian nurses.

METHODS

A cross-sectional, descriptive and analytical study was conducted among 510 nurses working in 15 teaching hospitals in Tehran, Iran to be selected by stratified random sampling. The respondents were asked to complete Netemeyer's organizational citizenship behavior questionnaire that encompassed four dimensions of OCB including Sportsmanship, Civil Virtue, Conscientiousness, Altruism and selected each item of OCB dimensions and identified their attitudes about OCB items were observed in hospitals of Tehran. The data was analyzed by T-test, ANOVA and Pearson statistical methods.

RESULTS

The results of this research showed that most of the nurses who studied in this study, had OCB behaviors. Also, we found that there was significant correlation between Iranian nurses' marriage status, qualifications and gender with sportsmanship, altruism and civic virtue.

CONCLUSION

This research demonstrates the existence of OCB among Iranian nurses that are essential in developing patient - oriented behavior. The results can be used to develop further nursing management strategies for enhancement of OCB. Finally, the present study indicates new possibilities for future researches such as analysis and comparison of OCB between different hospitals and how nursing policy-makers can enhance these behaviors in Iranian hospitals.

Life Change Units (LCU) rating as stressors in Iranian hospitals' nurses

Healthcare workers suffer from work-related or occupational stress. This can lead to severe distress, burnout or physical illness, and finally to decrease quality of work life and services provision. Nurses must be aware of retential stressors, because they add to the cumulative effect of other stressful events. Holmes and Rahe both found a relationship between life change unit as stressors and health changes. This research reported here aims to measure the life change units as stressors among Iranian Hospitals Nurses by LCU rating. A cross - sectional, descriptive and analytical study was conducted among 389 nurses working in 15 teaching hospitals in Tehran, Iran. The respondents were asked to select each of 54 events that cause stress ranked in order of their life change units developed by Holmes and Rahe as stress scale. Before beginning the main study, the reliability and coincidental validity was performed. All data were analyzed using SPSS for windows version 18, t-test, Anova statistical methods. Approximately, half of the nurses associated major mortgage, foreclosure of mortgage or loan. More than 50% of the Iranian nurses had 150-300 and more than 300 LCU rating which had the chance to expose to extremely serious risk to health.Iranian hospitals nurses suffer from stress that caused by Life Change Units organizational factors such as change in the financial state, change in the work environment and major mortgage. We recommend to Iranian nursing policy-makers to choose strategies to help nurses' cope effectively with workplace stressors. Nursing managers and / or nursing management should develop strategies to address and improve the quality of working conditions for nurses in the hospitals. Providing educational and career prospects can contribute to decrease nurses' occupational stress level, the maintaining their work ability.

The Implementation of the Sharia Law in Medical Practice: A Balance between Medical Ethics and Patients Rights

As medical ethics indisputably needs to consider patients' religious beliefs and spiritual ideas, one can suggest that hospitals are responsible for not only patients' rights and dignity, but also for her/his religious concerns and expectations. The current study is designed shed some light on the patients' view of the implementation of religious law in Iranian hospitals, specifically, the right of patients to be visited and delivered health services by professionals from the same sex. This protocol is proposed by the Ministry of Health and Medical Education of the Islamic Republic of Iran as a response to the increasing demand for implementation of the religious law by Iranian patients. This research is a cross-sectional study which was conducted at four teaching general hospitals in Tehran, Iran. The data was collected by the means of a questionnaire distributed to 120 women who were admitted to different wards of the hospitals. These women were asked to express their opinion of the implementation the Same Sex Health Care Delivery (SSHCD) system in Iranian hospitals. All analyses were performed with the use of SPSS software, version 16.0. The results indicate that half of the hospitalized women believed that being visited by a physician from the same gender is necessary who advocated the implementation of SSHCD in a clinical setting; and most of their husbands preferred their wives to be visited exclusively by female physicians. This study highlights the view of the Iranian patients towards the issue and urges the Ministry of Health and Medical Education of the Islamic Republic of Iran to accelerate the implementation of this law. SSHCD is what the majority of Iranian patients prefer, and, considering patients' rights and the medical ethics, it should be implemented by Iranian policy makers.

Hospitals pharmacy quality assurance system assessment in tehran university of medical sciences, iran

BACKGROUND

Health system pharmacies, like other health care professional, practice under a number of mandated standards. Basic concepts of quality assurance (QA) standards should be applied to hospital pharmacy practice. The survey reported here is to assess QA system implementation and its standard indicators observation in Tehran University of Medical Sciences (TUMS) hospitals' pharmacies in 2007 - 2008.

METHODS

A cross - sectional, descriptive analytical survey was accomplished. First, a checklist within the framework of QA standard indicators was made to assess TUMS hospitals pharmacies practice. Collected data was saved by Excel software for recording and analyzed by SPSS version-15. Observation rate of QA standard indicators was classified by inappropriate, relatively appropriate, and appropriate.

RESULTS

Characteristics of TUMS hospitals pharmacists organizational structure, size, equipment, safety facility and drug requirement were studied by QA standard indicators.

CONCLUSION

Many of QA standard indicators are observed and implemented in TUMS hospitals pharmacies, but several of these standards are not observed too. It is appropriate that all TUMS hospitals pharmacies are required to advance the profession, often with the same goal of increasing involvement in direct patient care.

The study of life change unit as stressor agents among Tehran University of Medical Sciences Hospitals' employees

Life crises as stressor agents can disrupt the best stress management regime. Different life crises have different impacts. A standard scale to rate change and its related stress impact has been developed commonly referred to as LCU (life change unit) rating. This allocates a number of life crisis units or life change units (LCUs) to different event and then evaluates them and takes action accordingly. This idea behind this approach of is to rundown the LCU table, totaling the LCUs for life crisis that have occurred in the previous one year. A cross-sectional, descriptive and analytical study was conducted among 900 Tehran University of Medical Sciences (TUMS) employees by a Holms and Rahe LCU questionnaire at 15 hospitals. The respondents were asked to determine their demographic information, list of stress symptoms which suffered from these diseases in the previous one year and finally, responded to 45 Life Change Unit as stressful life events and the value of each in "stress units" which occurred in the previous one year. The results showed that there is significant correlation between the employees LCU rating by sex, educational degree and size of hospital. Also we found that there are significant correlations between the employees stress symptoms with their LCU rating. Totally, 40% of the employees have less than 150 LCU rating (normal range) and 60% of them have 150-300 or more than 300 LCU rating (abnormal range). In conclusion most of TUMS hospitals' employees who had stress symptoms have more LCU rating. One third of these employees are not in danger of suffering the illness effect, while two third of them are in danger.

Color blindness defect and medical laboratory technologists: unnoticed problems and the care for screening

Color-blindness is the inability to perceive differences between some color that other people can distinguish. Using a literature search, the results indicate the prevalence of color vision deficiency in the medical profession and its on medical skills. Medical laboratory technicians and technologists employees should also screen for color blindness. This research aimed to study color blindness prevalence among Hospitals' Clinical Laboratories' Employees and Students in Tehran University of Medical Sciences (TUMS). A cross-sectional descriptive and analytical study was conducted among 633 TUMS Clinical Laboratory Sciences' Students and Hospitals' Clinical Laboratories' Employees to detect color-blindness problems by Ishihara Test. The tests were first screened with certain pictures, then compared to the Ishihara criteria to be possible color defective were tested further with other plates to determine color - blindness defects. The data was saved using with SPSS software and analyzed by statistical methods. This is the first study to determine the prevalence of color - blindness in Clinical Laboratory Sciences' Students and Employees. 2.4% of TUMS Medical Laboratory Sciences Students and Hospitals' Clinical Laboratories' Employees are color-blind. There is significant correlation between color-blindness and sex and age. But the results showed that there is not significant correlation between color-blindness defect and exposure to chemical agents, type of job, trauma and surgery history, history of familial defect and race. It would be a wide range of difficulties by color blinded students and employees in their practice of laboratory diagnosis and techniques with a potentially of errors. We suggest color blindness as a medical conditions should restrict employment choices for medical laboratory technicians and technologists job in Iran.