Developing a responsive model to societal needs in medical education

BACKGROUND

Responsiveness is relevant in the context of treatment and the provision of medical services. However, if we delve deeper into the subject, we must establish and develop responsiveness within the medical sciences education system. This study aims to identify the dimensions that significantly impact responsiveness in the medical education system based on a comprehensive review and expert opinions in healthcare.

METHODS

The present research is descriptive-analytical in terms of its objective and follows a mixed-method approach. This study was conducted in three stages. Initially, we utilized relevant keywords related to education in databases, such as Web of Science, Scopus, ScienceDirect, OVID, CINHAL, EBSCO, Google Scholar, Iranmedex, SID, and Irandoc. Subsequently, in the expert panel session stage, the factors influencing responsiveness were identified in the comprehensive review stage, and with this thematic background, they were conceptualized. Finally, the Confirmatory Factor Analysis (CFA) technique was employed to coherently examine the relationships between variables and present the final model.

RESULTS

We obtained 32 articles from the comprehensive review of studies. Four components in planning, implementation, monitoring and evaluation, and intersectoral cooperation were identified based on expert panel opinions. Based on the standardized coefficients, the components of research-based educational planning, community-oriented education evaluation indicators, and utilization of modern educational methods are statistically significant.

CONCLUSION

The establishment and development of responsiveness in the medical sciences education system involve training specialized and responsive human resources through innovative educational methods that have sufficient familiarity with the multidimensional concepts of health and how to achieve them. This approach allows for practical and responsible steps toward training competent and committed physicians in line with the needs of society. On the other hand, responsiveness in the medical sciences education system can be improved by enhancing research-based educational planning and developing community-oriented evaluation indicators that can assess the number of revised educational programs based on societal needs. Therefore, understanding the critical elements in revising medical education programs, which play the most significant role in addressing societal needs and responding to changing disease patterns and new health priorities, is both a necessity and an important priority.

What rate of Iranian women perform Pap smear test? Results from a meta-analysis

In this study, an attempt was made to estimate the aggregated proportion of Pap smear test uptake among women in Iran from 2012 to 2022 using meta-analysis. The data collection process involved reviewing records registered in databases between January 1, 2012, and September 11, 2022. The final data was analyzed using random effects models, and potential heterogeneity was assessed using the I2 index. To examine publication bias, Egger's test and Funnel Plot were employed. Sensitivity analysis, specifically single study exclusion Meta-analysis, was conducted to assess the influence of each individual study on the aggregated percentage of Pap smear test uptake. A total of 28,754 women were included across the 33 articles analyzed. The pooled percentage of Pap smear test uptake for both one-time and regular screenings was found to be 46.52% (95% CI: 40.91 to 52.14) and 17.80% (95% CI: 12.42 to 23.18), respectively. No significant evidence of publication bias was detected, although the influence of smaller studies was confirmed. Sensitivity analysis indicated that the overall rate of Pap smear test uptake was not highly sensitive to the results of individual studies. The findings emphasize the low rate of regular Pap smear testing among Iranian women and suggest that tailored interventions considering cultural and geographical factors specific to different provinces in Iran could help increase the utilization of this screening service.

Are behavioral economics interventions effective in increasing colorectal cancer screening uptake: A systematic review of evidence and meta-analysis?

Various interventions have been investigated to improve the uptake of colorectal cancer screening. In this paper, the authors have attempted to provide a pooled estimate of the effect size of the BE interventions running a systematic review based meta-analysis. In this study, all the published literatures between 2000 and 2022 have been reviewed. Searches were performed in PubMed, Scopus and Cochrane databases. The main outcome was the demanding the one of the colorectal cancer screening tests. The quality assessment was done by two people so that each person evaluated the studies separately and independently based on the individual participant data the modified Jadad scale. Pooled effect size (odds ratio) was estimated using random effects model at 95% confidence interval. Galbraith, Forrest and Funnel plots were used in data analysis. Publication bias was also investigated through Egger's test. All the analysis was done in STATA 15. From the initial 1966 records, 38 were included in the final analysis in which 72612 cases and 71493 controls have been studied. About 72% have been conducted in the USA. The heterogeneity of the studies was high based on the variation in OR (I2 = 94.6%, heterogeneity X2 = 670.01 (d.f. = 36), p < 0.01). The random effect pooled odds ratio (POR) of behavioral economics (BE) interventions was calculated as 1.26 (95% CI: 1.26 to 1.43). The bias coefficient is noteworthy (3.15) and statistically significant (p< 0.01). According to the results of this meta-analysis, health policy and decision makers can improve the efficiency and cost effectiveness of policies to control this type of cancer by using various behavioral economics interventions. It's noteworthy that due to the impossibility of categorizing behavioral economics interventions; we could not perform by group analysis.

What is the uptake rate of breast self-examination in Iranian women? Estimation based on systematic review and meta-analysis

BACKGROUND

Breast self-examination is a simple, painless, confidential and inexpensive screening method for early diagnosis that does not require specialized tools and equipment. In this study, we have estimated the pooled percentage of breast self-examination (BSE) in Iranian women.

METHODS

All the published literatures between 2012 and 2022 have been reviewed. Searches were performed in PubMed, Web of Science, ProQuest, Science Direct, Google Scholar, Scientific Information and Magiran databases. The effect size was the pooled percentage of breast self-examination (BSE). In order to check the heterogeneity, the estimation of the I2 index and extraction of the Galbraith plot were used, and the drivers of heterogeneity have been identified through meta-regression and estimates were made based on subgroups. All the analysis was done in STATA 15.

RESULTS

From the initial 294 records, 38 were included in the final analysis in which 9960 women have been studied. The heterogeneity of the studies was high based on the variation in OR (I2 = 98.4%, heterogeneity X2 = 2278.21 (d.f. = 37), p < 0.01). The pooled rate of BSE based on fixed and random methods was obtained as 15.46 (95% CI: 14.83 to 16.09) and 24.74 (95% CI: 19.62 to 29.86) percent, respectively. The highest pooled percentage BSE (39.41%, 95% CI: 30.98 to 47.83) was obtained from studies that investigated the action phase in the Trans theoretical model. The pooled percentage obtained from the studies conducted in the central regions of Iran was higher than other cities (27.47%, 95% CI: 17.38 to 37.55).

CONCLUSION

The result from our analysis determined that performing breast self-examination in Iranian women is low. Health policy makers can increase the rate of breast self-examination in Iran by implementing basic educational programs in schools and encouraging and justifying women in social health centers.

Socioeconomic Inequalities in Cancer Incidence: A Comparative Investigation Based on Population of Iranian Provinces

Cancer is the second important cause of death worldwide. Cancer is one of the top health priorities in Iran. We aimed to study the socio-economic inequality of cancer incidence in Iran provinces. We conducted this cross-sectional study using provincial data. We obtained the required data from the statistical yearbook report, the Statistics Center Report and the National Cancer Registration Program Report of Iran's Ministry of Health and Medical Education (MoHME) for 2018. Socio-economic inequality of cancer incidence was analyzed by estimating the concentration index and extracting the concentration curve. Statistical analyzes were performed using STATA 14. Our findings revealed that cancer incidence was unequally distributed in terms of the socio-economic status in Iranian provinces. Cancer incidence is slightly concentrated in the provinces with higher than average literacy, per capita income and insurance coverage and household size below average. The concentration of cancer incidence has been to the detriment of the provinces that have a slightly better ranking in terms of the socio-economic index. The employment rate did not significantly affect cancer's distribution burden. We recommend policymakers facilitate early cancer detection by providing insurance coverage for screening services, payment exemptions, and public awareness.

Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background

Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets.

Methods

The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B.

Findings

In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [–5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [–5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000.

Interpretation

The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination.

Funding

Bill & Melinda Gates Foundation.

Developing decision model for the outsourcing of medical service delivery in the public hospitals

BACKGROUND

The decision to outsource an activity is one of the most complex organizational decisions. This decision is also influenced by several factors and components. In order to facilitate and optimize it, for the first time in this study, a decision model for outsourcing medical service delivery in public hospitals has been developed.

METHODS

We conducted this cross-sectional study in 3 stages: 1) We identified the factors affecting the outsourcing decisions, 2) an expert panel identified the influential factors. After standardization, we distributed 220 questionnaires among university staff managers and heads, nursing managers, and managers of the research units, and 3) Structural Equation Model applied to evaluate the relationship between the variables on AMOS22, at 0.05 significant level.

RESULTS

Findings indicated the optimal level of all fit indices. The path coefficient between all identified factors with the outsourcing decision was positive (t > 1.96). Factors ranging from the most effective to least effective included monitoring and control, service type, human resource, economic and financial, executive capability, external environment, and terms and conditions.

CONCLUSION

The proposed model provides unit evaluation to make the appropriate decision on outsourcing or non-outsourcing. Control and monitoring were the most determining factors. We recommend performing monitoring continuously as a guide and deterrent to error. We also recommend continuous monitoring and control over the quality of outsourced units and stakeholder satisfaction.

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults.

METHODS

Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults.

FINDINGS

There were 1·19 million (95% UI 1·11-1·28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5-65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8-57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9-15·6] per 100 000 person-years) and middle SDI (13·6 [12·6-14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9-25·2) DALYs to the global burden of disease, of which 2·7% (1·9-3·6) came from YLDs and 97·3% (96·4-98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally.

INTERPRETATION

Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts.

FUNDING

Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute.

Social distance capacity to control the COVID-19 pandemic: A systematic review on time series analysis

BACKGROUND

Reducing interpersonal contact has been one of the least expensive and most widely used COVID-19 control strategies.

OBJECTIVE

This systematic review has been conducted with the aim of identifying social distancing strategies and policies and their impact on the COVID-19 pandemic.

METHODS

In order to compile this systematic review, Google Scholar, PubMed, Scopus, Web of Science, Science Direct, Magiran, SID, and Irandoc databases were searched from the COVID-19 outbreak until March 2021. Keywords included "social", "physical", "distance", "outbreak", "incidence", "prevalence", "spread", "new case", "death*", "mortality*", "morbidity*" , "covid-19", "coronavirus", "sars-cov-2" and "time series*". The articles were qualitatively evaluated by two researchers using the STROBE tool. Finally, the study data were divided into three conceptual categories by three researchers, who then agreed on one category. The practical suggestions were also categorized in the same way.

RESULTS

The policies and strategies adopted to implement social distancing were included in five categories of restrictions, prohibitions, closures, incentives, and punishments. Transportation and travel restrictions, crowded places and schools closure, use of telecommunications and virtual communications, and financial and psychological support to society members were the main policies in this area.

CONCLUSION

Rapid and complete vaccination of all people around the world is out of reach, therefore social distancing and the implementation of physical restraints, especially in crowded and densely populated environments, should be done extensively until COVID-19 is eradicated.

Implicit racial bias among medical graduates and students by an IAT measure: a systematic review and meta-analysis

INTRODUCTION

Racial implicit bias is an unconscious response and behavior that affects interpersonal interactions and clinical decision-making.

AIMS

We attempted to meta-analyze the scores of implicit association test (IAT) to estimate pooled quantity of implicit racial bias among medical graduates and students METHODS: As far as we know, our study is the first systematic-based meta-analysis estimating the pooled score of implicit racial bias among physicians and medical students. Keywords were searched in Scopus, Web of Science, Google Scholar, PubMed, Science Direct, Cochrane, MEDLINE, Wiley online library, and ProQuest databases from 2011 since 2021. The IAT's pooled score estimates through a fixed-effect meta-analysis using STATA 15. Also, I² statistic was used to determine heterogeneity across the articles.

RESULTS

Out of 1177 articles, 29 studies entered to analysis. The pooled score of IAT among physicians and medical students was 0.28 (95% CI 0.13 to 0.43) and 0.35 (95% CI 0.03 to 0.67), respectively. The racial bias score of physician ranged from -0.12 to 0.62. While score of implicit association test for medical student ranged from -0.01 to 1.29.

CONCLUSION

Our meta-analysis revealed that there was an implicit anti-black attitude among physicians and medical students, but the size of this implicit racial bias was small. Although the level of racial bias in physicians and medical students was low, it could be reduced to the lowest level through informative programs and training in ways to control implicit attitudes.

Front-line staff's perspective on patient safety culture in Iranian medical centers: A systematic review and meta-analysis

BACKGROUND

The prerequisite for promoting safety culture is to assess the existing safety culture level of institutes, because safety precautions without appropriate evaluation increase costs and unforeseen risks.

OBJECTIVE

This study aimed to systematically review the status of patient safety culture from the perspective of clinical personnel at Iranian hospitals through a meta-analysis of studies using the Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire.

METHODS

The present systematic review and meta-analysis was conducted in 2018. Data were gathered by searching Google Scholar, Scopus, PubMed, and Web of Science databases up to November 2018. Search keywords were "patient", "safety", "culture", "healthcare", "hospital", "medical center", "HSOPSC tool", and "Iran". The search protocol was limited to 10 years. To estimate the PSC score, computer software CMA:2 (Comprehensive Meta-Analysis) was used. The presence of heterogeneity across the studies was assessed with the I2 statistic. A forest plot was used to report the results. Publication bias was assessed through a funnel plot.

RESULTS

The meta-analysis of studies showed that the PSC score based on the random effect model was 52.7% (95% CI: 50.2%-55.2%), (Q = 522.3, df = 54, P < 0.05, I2 = 89.6). A mean of 12 dimensions of HSOPSC showed that the "Teamwork within units" dimension had the highest PSC score (67.2%) and "Non-punitive response to error" had the lowest score (40.4%).

CONCLUSIONS

Managers and policymakers should be directed towards non-punitive responses to errors and persuade staff to report errors and execute the approach to learn from mistakes. Also, a periodic government evaluation of the patient safety culture will help further its sustainable development.

Predicting Inpatient Length of Stay in Iranian Hospital: Conceptualization and Validation

Objective:

The length of stay is an important indicator of hospital performance and efficiency. Regarding the importance of the length of stay, this study aimed to design a structural model of the inpatients’ length of stay in the educational and therapeutic health care facilities of Iran in order to identify the influencing dimensions.

Methods:

The present study was an analytical and applied study. The face validity of the data gathering tool was investigated by the expert judgment and the construct validity was examined by using the exploratory factor analysis. In order to verify the reliability of the tool, the internal consistency was also trialed by using the Cronbach’s alpha. For ranking the influencing dimensions and factors and also in order to examine the causal relationships between the variables in a coherent manner and presenting the final model, the structural equation modeling technique was used in AMOS software at a significant level of 0.05.

Results:

The mentioned structural model consists of 4 dimensions and 29 factors influencing the length of stay of hospitalized patients. The independent variables are based on priority and importance as follows: patients’ conditions, the underlying factors, the clinical staff performance, and hospitals’ service delivery, which were examined by second-order factor analysis in order to study the relationship between them and the inpatients’ length of stay.

Conclusion:

Considering the importance of each one of the proposed dimensions from the point of view of service providers in some therapeutic centers of the country by paying attention to the role of each one of them in preventing prolonged hospitalization can be essential in the effectiveness of the treatment and cost reduction.

Make Intelligent of Gastric Cancer Diagnosis Error in Qazvin's Medical Centers: Using Data Mining Method

Objective: Gastric cancer is one of the most common types of cancers, which will result in irreparable harm in the case of misdiagnosis or late diagnosis. The purpose of this study is to investigate the capability of data mining techniques and disease risk factor characteristics to predict and diagnose the gastric cancer. Methods: In this retrospective descriptive-analytic study, we selected 405 samples from two groups of patient and healthy participants. A total of 11 characteristics and risk factors were examined. we used four Machine learning methods, Include support vector machine (SVM), decision tree (DT), naive Bayesian model, and k nearest neighborhood (KNN) to classify the patients with gastric cancer. The evaluation criteria to investigate the model on the database of patients with gastric cancer included Recall, Precision, F-score, and Accuracy. Data was analyzed using MATLAB® software, version 3.2 (Mathworks Inc., Natick, MA, USA). Results: Based on the results achieved from the evaluation of four methods, the accuracy rates of SVM, DT, naive Bayesian model, and KNN algorithms were 90.08, 87.89, 87.60, and 87.60 percent, respectively. The findings showed that the highest level of F-Score was related to the SVM (91.99); whereas, the lowest rate was associated with the KNN algorithm (87.17). Conclusion: According to the findings, the SVM algorithm showed the best results in classification of Test samples. So, this intelligent system can be used as a physician assistant in medical education hospitals, where the diagnosis processes are performed by medical students.

Organizational commitment, job satisfaction, organizational justice and self-efficacy among nurses

Background & Aim: Nursing shortage is a growing global challenge in healthcare organizations. Promoting nurses’ organizational commitment may help alleviate nursing shortage. This study sought to evaluate the relationships between organizational commitment, job satisfaction, organizational justice, and self-efficacy among nurses.   Materials & Methods: This cross-sectional study was conducted on 401 Iranian nurses randomly selected through two-stage cluster sampling. Data were collected using self-administered questionnaires and analyzed using the SPSS (v.17.0) and the Amos (v.17.0) software. Results: The goodness of fit indices were as the following: χ2/df=2.76 (P<0.001), GFI=0.93; AGFI=0.87, NFI=0.96, RMSEA=0.068, and CFI=0.95. Organizational commitment had significant positive relationships with self-efficacy (β3=0.28, P<0.001) and job satisfaction (γ3=0.73, P<0.001), while organizational justice had significant positive relationship with job satisfaction (γ2=0.89, P<0.001). Moreover, job satisfaction had a mediating role in the relationship of organizational justice with organizational commitment. Conclusion: Hospital managers can promote nurses’ organizational commitment through employing strategies to enhance their perceived organizational justice and thereby, improving their job satisfaction.

Factors Affecting Use of Telemedicine and Telesurgery in Cancer Care (TTCC) among Specialist Physicians

Background: Considering the increasing incidence of different cancers, use of modern technologies such as TTCC can make a dramatic change in treatment of these diseases. So, if the evolution strategy conflicts with the organizational culture, national culture, and organizational structure of experts in this field, resistance will rise. Objective: The purpose of this study was to determine the effective factors on the use of TTCC in hospitals affiliated to Tehran University of Medical Sciences using the AHP model. Materials and Methods: This current descriptive study was carried out in 2018 on specialist physicians from five hospitals of Tehran University of Medical Sciences. The data gathering tool was a questionnaire consisting of two sections; demographic items and 27 effective factors influencing the implementation of TTCC technology, which was evaluated for validity and reliability. Data analysis was performed using analytical hierarchy process with expert choice and for empirical illustration are used to discuss the use of covariance-based SEM versus smart PLS software. Results: Based on AHP comparisons in the studied factors, the highest priority was the Cultural factor. In other words, commitment of senior executives to support the provision of a new technology with a weight of 0.327. The lowest priority, however, was related to support diverse approaches, innovation, creativeness, and acceptance of new ideas with a weight of 0.038. In regard with technical and organizational factors, out-of-hospital access to the intranet network and support provided by the doctors, with the weight of 0.221 and 0.205 in order, acquired the highest rates. Conclusion: Considering the high prevalence of cancer in Iran and the necessity of using new technologies in its treatment and by addressing the specialists’ views and opinions in this field, organizational and national culture in the application of TTCC technology should be promoted. This target can be hit through acceptance, change in attitude, and successful use of TTCC technology by medical professionals.

Role of Organizational Climate in Job Involvement: A Way to Develop the Organizational Commitment of Nursing Staff

Employees are the most valuable assets of an organization; therefore, it is very important to understand their behavior. In this regard, the present study was carried out in order to examine the effect of organizational climate on job involvement among nurses working in the teaching hospitals of Qazvin Province, Iran. The present descriptive analytical study was done in 2017. To randomly select a specific proportion of nurses from each of Qazvin teaching hospitals, stratified sampling was used. In total, 340 nurses were selected. Data were collected using 3 questionnaires: Halpin and Kraft Organizational Climate Questionnaire, Job Involvement Questionnaire (Kanungo), and Allen and Myer Organizational Commitment Questionnaire. For data analysis, confirmatory factor analysis and structural equation modeling were used applying AMOS-24 software. The results of path analysis showed the effect of organizational climate on the nurses’ job involvement. Moreover, organizational climate influenced organizational commitment through the mediation of job involvement. According to values obtained for degree of freedom based on chi-square, goodness-of-fit index, root mean square error of approximation, and comparative fit index were in the defined range; therefore, the validity of the conceptual model was approved. Based on the results of the present study, managers of health organizations can achieve their goals by understanding the organizational climate of the hospitals and its effect on the employees’ job involvement and discovering strategies needed for organizational commitment improvement.

Role of transformational leadership on employee productivity of teaching hospitals: using structural equation modeling

BACKGROUND

In today's transforming world, increased productivity and efficient use of existing facilities are practically beyond a choice and become a necessity. In this line, attention to change and transformation is one of the affecting factors on the growth of productivity in organizations, especially in hospitals.

AIM

To examine the effect of transformational leadership on the productivity of employees in teaching hospitals affiliated to Iran University of Medical Sciences.

METHODS

This cross-sectional study was conducted on 254 participants from educational and medical centers affiliated to Iran University of Medical Sciences (Tehran, Iran) in 2016. The standard questionnaires of Bass & Avolio and of Hersi & Goldsmith were used to respectively assess transformational leadership and level of productivity. The research assumptions were tested in a significance level of 0.05 by applying descriptive statistics and structural equations modeling (SEM) using SPSS 19 and Amos 24.

RESULTS

Results of the fitting indicators of the assessing model after amending includes Chi-square two to degrees of freedom of 2.756, CFI indicator 0.95, IFI indicator 0.92, Root mean square error of approximation (RMSEA) indicator 0.10. These results indicate that the assessing model is well fitting after the amendment. Also, analysis of the model's assumptions and the final model of the research reveals the effect of transformational leadership on employees' productivity with a significance level of 0.83 (p=0.001).

CONCLUSION

This research indicates that the more the leadership and decision-making style in hospitals lean towards transformational mode, the more positive outcomes it brings among employees and the organization due to increased productivity. Therefore, it is essential to pay focused attention to training/educational programs in organizations to create and encourage transformational leadership behaviors which hopefully lead to more productive employees.

The structure of the pharmaceutical market in Iran using concentration indices

Background and objective

The efficiency and function of the pharmaceutical sector, as a vital portion of the health system, have a significant effect on intermediate and final indices of health. In this research, the structure of the pharmaceutical market in Iran was examined through the calculation of concentration indices in 2011.

Methods

In this cross-sectional study, the needed data was gathered from the Food and Drug Administration in the year 2011. Data were analyzed using SPSS software version 20 and Microsoft Office Excel software. Finally, two common measures of market concentration, the Concentration Ratio and the Herfindahl-Hirschman Index, were calculated.

Results

The largest and the smallest shares of the industry were 5.57% and 0.01%, respectively. The average industry share was 1.09%. The share range was calculated to be 5.56%. The Herfindahl-Hirschman Index was 248.5, which indicates a very low concentration of the pharmaceutical market in Iran. Also, based on the Concentration Ratio of 4 companies (18.39%), the concentration of the pharmaceutical market has been too low.

Conclusion

The pharmaceutical market in Iran has a very low concentration and it does not have an exclusive mode in terms of market structure. Therefore, it can be attributed to the competitive model. The policy makers in this area can use this characteristic as a leverage to improve efficiency, fairness, revenue and health indices.

Survey of Cancer Patient Safety Culture: A Comparison of Chemotherapy and Oncology Departments of Teaching Hospitals of Tehran

Background: Patient safety culture plays an important role in healthcare systems, especially in chemotherapy and oncology departments (CODs), and its assessment can help to improve quality of services and hospital care. Objective: This study aimed to evaluate and compare items and dimensions of patient safety culture in the CODs of selected teaching hospitals of Iran and Tehran University of Medical Sciences. Materials and Methods: This descriptive-analytical crosssectional survey was conducted during a six-month period on 270 people from chemotherapy and oncology departments selected through a cluster sampling method. All participants answered the standard questionnaire for “Hospital Survey of Patient Safety Culture” (HSOPSC). Statistical analyses were performed using SPSS/18 software. Results: The average score for patient safety culture was three for the majority of the studied CODs. Statistically significant differences were observed for supervisor actions, teamwork within various units, feedback and communications about errors, and the level of hospital management support. (p<0.05). Relationships between studied hospitals and patient safety culture were not statistically significant (p>0.05). Conclusion: Our results showed that the overall status of patient safety culture is not good in the studied CODs. In particular, teamwork across different units and organizational learning with continuous improvement were the only two properly operating items among 12 dimensions of patient safety culture. Therefore, systematic interventions are strongly required to promote communication.

Factors affecting length of stay in teaching hospitals of a middle-income country

Introduction

The length of stay (LOS) in hospitals is a widely used and important criteria for evaluating hospital performance. The aim of this study was to determine factors affecting LOS in teaching hospitals of Qazvin Providence.

Methods

In this cross-sectional study, patients’ health records were randomly selected from archives in teaching hospitals of Qazvin in 2013. Data were collected through a data entry form and were analyzed using Kolmogorov–Smirnov, Kruskal–Wallis, and Mann–Whitney U tests at the significant level of 0.05.

Results

The mean of hospital LOS was 5.45 ± 6.14 days. Age, employment, marital status, history of previous admission, patient condition at discharge, method of payment, and type of treatment had an impact on LOS (p<0.05). Other factors, including gender, place of residence, and type of admission, did not affect LOS.

Conclusion

Because hospitals consume a perceptible part of resources in a health system, controlled and optimized use of its resources help to save a lot. Therefore, this study showed many clinical and nonclinical factors affect LOS in evaluating these factors, which may reduce inappropriate hospital stays and decrease costs.

THE RELATIONSHIP BETWEEN ORGANIZATIONAL JUSTICE AND TURNOVER INTENTION OF HOSPITAL NURSES IN IRAN

Background:

Despite advances in science and technology, human resources are of the major capital for organizations. Workforce retention is required to improve organizational efficiencies.

Objective:

Therefore, in this study, the relationship between organizational justice (as one of the most influential factors) and turnover intention was investigated.

Methods:

This descriptive-analytic study was done in the Comprehensive Jame Women’s Hospital of Tehran in 2015. The statistical sample consisted of 135 nursing staff members. The data were collected using a questionnaire of Beugre’s organizational justice and analyzed by the use of Spearman’s and Anova statistical tests.

Results:

Averages of organizational justice was obtained to be 68.85 ± 7.67 . Among different sorts of organizational justice, the highest average score of 75.24 ± 16.68 was achieved relevant to interactional justice. A significant relationship was observed between organizational justice (r = -0.36), interactional justice (r = -0.38), and procedural justice (r = -0.36) and turnover intention, but no relation was found between turnover intention and systemic and distributive justice. Furthermore, there was no relationship between demographic variables, organizational justice, and turnover intention.

Conclusion:

Considering the prominent role of organizational justice in the personnel’s intention to stay or leave and due to the high costs of recruiting and training new staff, managers should pay especial attention to justice and provide their employees’ satisfaction and stability in their organizations by creating a positive mindset in them.

Psychometric properties of the Persian version of the "Hospital Ethical Climate Survey"

In order to improve the ethical climate in health care organizations, it is important to apply a valid measure. This study aimed to investigate the psychometric properties of the Persian version of the Hospital Ethical Climate Survey (HECS) and to assess nurses' perceptions of the ethical climate in teaching hospitals of Iran. A cross-sectional study of randomly selected nurses (n = 187) was conducted in three teaching general hospitals of Tehran, capital of Iran. Olson's Hospital Ethical Climate Survey (HECS), a self-administered questionnaire, was used to assess the nurses' perceptions of the hospital ethical climate. Descriptive statistics, confirmatory factor analysis (CFA), internal consistency, and correlation were used to analyze the data. CFA showed acceptable model fit: an standardized root mean square residual (SRMR) of 0.064, an non-normalized fit index (NNFI) of 0.96, a comparative fit index (CFI) of 0.96, and an root mean square error of approximation (RMSEA) of 0.075. The Cronbach's alpha values were acceptable and ranging from 0.69 to 0.85. The overall Cronbach's alpha coefficient was 0.94. The factor loadings for all ethical climate items were between 0.50 and 0.80, which revealed good structure of the Persian version of the HECS. Survey findings showed that the "managers" subscale had the highest score and the subscale of "doctors" had the lowest score. This study shows that the Persian version of the HECS is a valid and reliable instrument for measuring nurses' perceptions of the ethical climate in hospitals of Iran.

Comparing the perspectives of managers and employees of teaching hospitals about job motivation

Recognition of career motivators and understanding of managers and employees in prioritizing them, in order to plan incentives for this understanding, can play an important role in increasing productivity and creating harmony between the goals of the organization and staff. This study was done to survey the importance of career motivating factors from perspective of employees and managers in educational hospitals of Iran. In this study 269 from a total of 1843 employees of educational hospitals in Qazvin province of Iran were selected through Quota-Random sampling and studied along with all 49 Managers. Lawrence Lindale questionnaire with 10 factors where used in order to determine motivational priorities. The results indicated that among the 10 studied motivational factors, from employees' viewpoint; "Good wages", "Good Working Conditions" and "Job Security" have the greatest roles in motivating employees. In the context of perspective agreement amongst employees and managers, the results showed 20 percent agreement. In this study, results of "Independent T" test showed a significant difference in comparison, between prioritizing employees' view and prediction of managers in the factors of "Job Security" (p = 0/031) and "Interesting Work" (p = 0/001). With respect to increase disagreement in the views of managers and employees as compared to previous studies, Managers need to pay more attention to cognition of motivational factors and make their viewpoints closer to actual motivational need of their employees. Attention to this fact can be a great help to the growth and productivity of the organization, making the organizational and individual goals closer and also keeping managers safe from execution of constant and undue motivational patterns.

Outpatient waiting time in health services and teaching hospitals: a case study in Iran

Background:

One of the most important indexes of the health care quality is patient’s satisfaction and it takes place only when there is a process based on management. One of these processes in the health care organizations is the appropriate management of the waiting time process. The aim of this study is the systematic analyzing of the outpatient waiting time.

Methods:

This descriptive cross sectional study conducted in 2011 is an applicable study performed in the educational and health care hospitals of one of the medical universities located in the north west of Iran. Since the distributions of outpatients in all the months were equal, sampling stage was used. 160 outpatients were studied and the data was analyzed by using SPSS software.

Results:

Results of the study showed that the waiting time for the outpatients of ophthalmology clinic with an average of 245 minutes for each patient allocated the maximum time among the other clinics for itself. Orthopedic clinic had the minimal waiting time including an average of 77 minutes per patient. The total average waiting time for each patient in the educational hospitals under this study was about 161 minutes.

Conclusion:

by applying some models, we can reduce the waiting time especially in the realm of time and space before the admission to the examination room. Utilizing the models including the one before admission, electronic visit systems via internet, a process model, six sigma model, queuing theory model and FIFO model, are the components of the intervention that reduces the outpatient waiting time.