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Abstract 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

Introduction and purpose: In order to have more effective programs and social interventions controlling the burden of diseases, it is necessary for policy makers to have valid evidence about the role of socioeconomic determinants. The present study aimed to provide empirical evidence about the relationship of socioeconomic inequalities and the availability of resources with the burden of diseases among the provinces of the country in 2019. Methods: This descriptive and analytical research was carried out using the provincial data of 2019. The required provincial data were extracted from the Statistical Yearbook Report and the Household Income Expenditure Report of the Statistics Center and the data related to adjusted years with disability and early death (DALI) from the 2019 disease burden estimates. DALY's inequality was investigated by estimating the concentration index and extracting the concentration curve at a 95% confidence interval. The analyses were carried out in the Stata software (version 15). Results: In 2019, the average per capita DALY was 18.33±3.98. The average socio-economic index and resource availability index for 31 provinces were obtained at 0.37±0.21 and 0.64±0.20, respectively. Considering the difference in the available resources (covariate), there was a statistically significant difference between the socio-economic quartiles in terms of the distribution of per capita DALY (P

Background: Critical thinking is the ability to ask appropriate questions and gather relevant information. It enables rational judgment and problem-solving for physicians and nurses. For the first time, this study examined two major groups of caregivers at the patient's bedside in terms of the relationship between critical thinking and self-efficacy. Methods: This was a descriptive-analytical and cross-sectional study conducted in 2021. The sample was taken from QUMS’s nursing and medical students through stratified random method. It was performed using structural equation method (n=377). Data collection tools included: demographic information, Ricketts critical thinking questionnaire, and GSE-17 questionnaire. Finally, data were analyzed through the correlation coefficient and multiple regression tests using SPSS22 software at a significance level of 0.05. Results: Results indicated that the model established at this step demonstrates good fitness. In this model χ2 = 1919.91, df = 89, χ2 / df = 2.14, RMSEA = 0.05, NFI = 0.63, GFI = 0. 77 and CFI = 0. 76. The structural equation model's standard estimation coefficients show that all the existing paths are at a significant level (CTH: CRV 0.96, CTH: COM 0.94, CTH: SFE -0.61; P-value< 0.05). Finally, the regression analysis showed an inverse effect of critical thinking on self – efficacy. Conclusion: The study showed that critical thinking had a direct effect on self-efficacy. In addition, these two features have a significant effect on increasing the efficiency and making the right clinical decisions in medical and nursing groups. Therefore, upgrading these skills by updating curriculum will ultimately improve healthcare outcomes provided by these two specific groups.

Background: Medical equipment maintenance plays an important role in improving the equipment's function, increasing its effectiveness and efficiency, providing continuous health services, and improving the quality of services. This study is conducted to investigate the factors affecting medical equipment maintenance management. Methods: The present study was a qualitative investigation based on content analysis that was conducted in 2021. Data collection method was an open ended interview. The interviewees included all medical equipment operators and technicians of educational and medical centers affiliated with Qazvin University of Medical Sciences. The semi-structured interview guide was used as a data collection tool. Qualitative data obtained from interviews were analyzed by the content analysis method. The obtained coded were classified into dimensions and components using MAXQDA Software12 . Results: According to the findings, categories of time constraints, access to information, instructions and programs, type and number of equipment, financial constraints, user, patients, training programs, and equipment repair agencies were the most important factors affecting medical equipment maintenance management. Conclusion: Observing purchasing standards and guaranteed equipment, training all the staff involved, developing and explaining instructions and programs are essential for optimal equipment maintenance. These measurements will reduce the cost of repairing. g medical equipment and the need to purchase equipment; improve equipment, service quality performance, patient and user safety; and increase the device life.

Background: Nowadays, since many health care organizations are facing a crisis of declining productivity and labor force stagnation, productivity can be improved through identifying and strengthening the components affecting the labor force productivity and performance. Thus, the present study was aimed at determining the effect of intellectual capital on innovative performance with the mediating role of health staff’s empowerment in Qazvin University of Medical Sciences. Methods: This is a descriptive-analytical cross-sectional study carried out in 2021. Three hundred and four staff of the Health Department and Health Networks participated in the research by the available sampling method. The Bontis questionnaire was employed for measuring the intellectual capital, the Spritzer questionnaire for measuring staff’s empowerment, and the Huang and Li questionnaire for measuring innovative performance. Moreover, for preliminary data analysis, SPSS25 Software was used as well as AMOS software for structural equation modeling at a significance level of 0.050 %. Results: The results of the path coefficient among the model variables on each path, corresponding to the research hypotheses, are positive, revealing a positive relationship among the research variables. The path coefficient of the direct relationship between intellectual capital and innovative performance was equal to 0.767 (P-value < 0.001). Moreover, the relationship between intellectual capital and empowerment was equal to 0.306, and between empowerment and innovative performance was equal to 0.153, both of which were significant (p < 0.001). Furthermore, indices of fit including NFI = 0.652, RMSEA = 0.064, GFI = 0.710, and CFI = 0.769 exhibited a relatively good fit of the final model. Conclusion: Given the direct relationship between model variables, the University of Medical Sciences’ managers and health officials should provide the bed for improving the capacity of human resources and innovative performance through developing intellectual capital besides creating a platform to play an effective role in the organization. Accordingly, effective and innovative performance based on responding to the human resources’ changing needs in all sectors may be imagined.

Aim & Background: Cost management is the most important factor affecting the economic performance of the hospital. Good management of costs in the short term stabilizes and balances the operating balance of the hospital and secures the hospital in terms of liquidity. Also, good management of costs in the long term makes the hospital financially stable. According to the mentioned cases and increasing hospital costs, the present study was conducted with the aim of identifying and investigating the factors, drivers and obstacles to improve cost management. Methods & Materials: This systematic review was conducted in 2020. Data was collected through searching keywords in Google scholar, PubMed, Scopus, Web of Science, Science direct, Magiran, SID and Irandoc databases from 2007 to 2020. The classification of the results of the studies was done by the researchers. Results: All the components identified and extracted from the articles were divided into four dimensions (increasing factors, prerequisites, obstacles and solutions) to improve hospital cost management. Conclusion: Reviewing the results of each study showed the importance of each component in managing, improving and controlling hospital costs. In this regard, policy makers at decision-making level and managers at executive level should pay attention to the components and dimensions affecting the control and improvement of hospital costs according to the structure, process and expected consequences, and then decide on their implementation.

Background: Hospital management style can affect various aspects of hospital performance. One of these aspects is the level of market orientation of the hospital. Therefore, the present study attempts to answer whether management style makes a difference in the degree market orientation of hospitals or not. Methods: This research is a descriptive-analytical and cross-sectional study conducted in 2020. About 420 people were selected by stratified sampling out of the six medical centers' staff in Qazvin, Iran. A total of 411 people (97.86 %) completed the questionnaires. The collected data were analyzed using STATA15 and SPSS16 software. Robust regression analysis was used to estimate the role of management style in the level of market orientation of hospitals. Mean variables were analyzed using one-way analysis of variance and post hoc test. Results: The score range of the variables was from 1 to 5. Autocratic and delegating styles obtained the highest average (3.22 ± 0.54) and the lowest average (2.87 ± 0.70), respectively. Among the dimensions of market orientation, customer orientation had the highest average (3.32 ± 0.84), while competitor orientation obtained the lowest average (2.80 ± 0.86). The average score of market orientation was 2.88 ± 0.65. A statistically significant difference between hospitals was observed in terms of participative and delegating styles (P-value < 0.05). In addition to market orientation, there was a statistically significant difference between hospitals (P-value < 0.05). The regression coefficient between the level of the hospital market orientation and the participative and delegating styles was 0.10 and 0.09 , respectively (P-value < 0.05). In contrast, the regression coefficient between autocratic style and level of market orientation was estimated to be -0.76. Conclusion: It can be concluded that managers should use more participatory and delegating styles to increase the market orientation of the studied hospitals.

Abstract 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.

Introduction: Management is one of the most important factors that can affect the performance of an organization such as hospital. Therefore, identifying the management style used in hospitals can be useful empirical evidence to solve many hospital problems. In this study, the management styles used in the educational-medical centers of Qazvin University of Medical Sciences have been studied and determined. Methods: In this descriptive-analytical study, a sample of 411 people was selected using random sampling method from a population of 2265 employees working in university hospitals in Qazvin. The required data were collected using a valid Clark management style questionnaire and through employee perception survey. Finally, the obtained information was analyzed in the space of STATA 15 and SPSS 16 software. Results: Individuals reported the highest frequency (42%) for autocratic style items and the lowest frequency (25%) for delegating style items. Autocratic style had the highest total mean (3.22 of 5) and delegating style had the lowest total mean (2.87 of 5). Apart from autocratic style, there was a significant difference between hospitals in terms of the use of participative and delegating styles (p

Background: In addition to providing effective and equitable services to low-income groups, teaching hospitals must obtain a significant share of the demand of high-income groups in order to have a balanced and positive operational performance. The aim of this study was to investigate the market orientation of teaching and medical hospitals in Qazvin. Materials & Methods: This descriptive-analytical study was conducted at teaching and medical hospitals of Qazvin University of Medical Sciences in a cross-sectional manner in 2020. Data were collected in a one-month period through a questionnaire survey. The study population was the total staff working in 6 hospitals of this university who were selected using quota-random sampling method. The required data were obtained by collecting 411 market orientation questionnaires (Ahmad and Eqbal 2013) and were analyzed in SPSS 16 software. One-way analysis of variance with 95% confidence interval was used to compare the means. Results: The market orientation of all studied hospitals was 2.88 out of 5. Also, customer orientation had the highest average (3.32 out of 5) and paying attention to competitors had the lowest average (2.80 out of 5). The mean for dimension of coordination between tasks was 2.86 out of 5. Apart from paying attention to competitors, there was a statistically significant difference in terms of market orientation, customer orientation and coordination between tasks(P

Background: A significant amount of revenues and deductions exist in the hospitals each year. This study aimed to determine the number of deductions applied and identify its causes. Furthermore, we aimed to provide management strategies to reduce these deductions in Shafa Takestan hospital. Methods: This applied and interventional study was conducted with a cross-sectional design. The data collection tool was a checklist from the previous studies. Data were analyzed using descriptive statistics such as mean, percentage, and standard deviation as well as analytical statistics of the Wilcoxon test. Results: Before the intervention, among 405 non-global inpatient cases, about 323 (80 %) contained subtractions. After the intervention, among 555 non-global hospital admissions, about 264 (47 %) included deductions. Most deductions were related to health services insurance (75.38 %). Concerning each hospital ward, most deductions were related to surgery ward (38 %). Before and after the intervention, service deductions were included in 5.59 % and 4.57 %, respectively. Conclusion: Therefore, medical personnel should pay more attention to documenting patientschr('39') records and minimizing documentation errors. Moreover, to reduce patient record deductions, the health care staff should be familiarized with proper documentation procedures by conducting training sessions.

Background: In health economics, policymakers need to be aware of the individuals' sensitivity and reaction to change effective factors on the healthcare services demand. This study aimed to estimate the healthcare demand function and extract the price, income, and educational elasticity in Iran. Methods: A panel of macro data was used to estimate the demand function. The data included provincial average of the nominal values of Iranian household healthcare and education expenditure, provincial average of their nominal income, and Consumer Price Index values of the healthcare services from 31 provinces during 7 years (2011 to 2017). This information was obtained from the annual Household Budget Survey Reports and no sampling was performed in this research. The dependent variable was the actual amount of demand for health care services. Robust pre-estimation tests and a robust standard error panel regression were run to estimate the demand function in Stata 15. Results: All variables were stationary at the first-order differential (P-value < 0.01). All four variables were co-integrated (P-value < 0.01). The cross-sectional and fixed effects existed for each province (P-value < 0.01). Income and educational expenditure had a positive association with healthcare demand. Price elasticity of demand was -0.897 (P-value < 0.01), income elasticity was 0.491 (P-value < 0.1), and elasticity of education expenditure was 0.486 (P-value < 0.01). Noteworthy, 1 % increase was observed in the household incomes and their educational expenditure increased the demand for health care services by about 0.49 % and 0.48 %, respectively. Conclusion: Healthcare services have been low elastic to price and education expenditure and have also been the essential commodity in the household budget in Iranian households. Later, the price and income coefficients were consistent with the health investment model, but coefficient of the education expenditure was not matched with predictions of the health investment model.

Background: Self-efficacy and spiritual beliefs can be considered as strong motives for improving the quality of working. Due to the different job description and environment than other service sectors, medical centers need to pay attention to these factors. So, the present study is aimed at identifying the effect of spiritual intelligence components on self-efficacy among operational staff of Qazvin medical centers. Methods: The present research is a descriptive-analytical and cross-sectional study conducted in 2019. About 238 people were selected by stratified sampling out of the medical centers staff in Qazvin, Iran. Spiritual intelligence was measured by King’s questionnaire including four dimensions, and self-efficacy was measured by Sherer’s questionnaires including three dimensions. Primary data analysis was done by Pearson’s correlation test in SPSS20 software, and path analysis was done by structural equation modeling in AMOS software with the significance level of 0.05. Results: There was a significant direct relationship between all dimensions of self-efficacy and spiritual intelligence except persistence in the face of adversity and consciousness expansion (P-value ˂ 0.01). All the relationships were significant in path analysis of the final model. Also, the fit indices including NFI = 0.901, RMSEA = 0.055, GFI = 0.923, and CFI = 0.913 suggest the good fitness of the final model. Conclusion: The managers of the studied hospitals can promote self-efficacy in clinical staff and improve their performance and behavior in service provision by psychological enrichment of the staff and raising their spiritual intelligence.

Background and Aim: Analysis of functions enables organizations to identify their special capabilities and weak points accurately and thus they can enhance capabilities and reduce impacts of threats and obstacles through such analysis. The main goal of this work is investigation of status of Weisbord Model's variables (6 variables) as functional dimensions of management in hospitals of Tehran University of Medical Sciences. Materials and Methods: This was a descriptive - analytical study. The study population consisted of 384 staffs from hospitals of Tehran University of Medical Sciences. Standardized questionnaire for organization recognition was used for data collection. Descriptive statistics (frequency distribution, frequency percentage) and inferential statistics (Pearson correlation coefficient and significance level) were used for statistical analysis and data analysis was run using SPSS software. Results: The results showed that there is a significant difference (p=0.0001) in hospitals in terms of the internal situation. Internal situation of all hospitals in the study was evaluated as favorable condition by obtaining 94.5 score out of 125. Among the hospitals, Hashemi-Nejad Hospital with highest score (113) showed the better condition and Rasoul Hospital had the lowest score (87) and lower condition as compared to other hospitals. Conclusion: Necessity of systematic perspective in designing and development of fair compensation mechanism with presence of representatives of employees is an action which can considerably influence improvement of current situation in the hospitals and facilitates achieving predetermined goals of the organization