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Masoud Ferdosi,1 Reza Rezayatmand,2 Yasamin Molavi Taleghani3 1Health Management and Economics Research Center, Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran; 2Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; 3Department of Health Services Management, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, IranCorrespondence: Yasamin Molavi TaleghaniIsfahan University of Medical Sciences, School of Management and Medical Informatics, Health Management and Economics Research Center, Hezar Jarib Street, Second Floor, Isfahan, IranTel +98 912 7233347Email yasamin_molavi1987@yahoo.comBackground: This study attempted to present a framework and appropriate techniques for implementing risk management (RM) in executive levels of healthcare organizations (HCOs) and grasping new future research opportunities in this field.Methods: A scoping review was conducted of all English language studies, from January 2000 to October 2018 in the main bibliographic databases. Review selection and characterization were performed by two independent reviewers using pretested forms.Results: Following a keyword search and an assessment of fit for this review, 37 studies were analyzed. Based on the findings and considering the ISO31000 model, a comprehensive yet simple framework of risk management is developed for the executive levels of HCOs. It includes five main phases: establishing the context, risk assessment, risk treatment, monitoring and review, and communication and consultation. A set of tools and techniques were also suggested for use at each phase. Also, the status of risk management in the executive levels of HCOs was determined based on the proposed framework.Conclusion: The framework can be used as a training tool to guide in effective risk assessment as well as a tool to assess non-clinical risks of healthcare organizations. Managers of healthcare organizations who seek to ensure high quality should use a range of risk management methods and tools in their organizations, based on their need, and not assume that each tool is comprehensive.Keywords: organization risk management, scoping review, risk analysis, health care, executive levels

This study was carried out to identify the phytoconstituents in ethyl acetate fraction of flower extract of Indian laburnum (Cassia fistula L.) and to enlist their bioactivities as reported in the literature. For this purpose, dry flowers of the selected plant species were extracted in methanol and the ethyl acetate soluble compounds of this extract were separated using separating funnel technique. The isolated ethyl acetate fraction was analyzed by GC-MS that indicated the presence of 39 phytoconstituents. Among these, 2-butenal, 2-ethyl- (21.12%), decane (9.13%) and 1-decanol, 2-hexyl- (8.09%) were identified as principal constituents. Four compounds namely cyclohexanone, 2,3-dimethyl- (4.45%), benzene, 1-ethyl-3-methyl- (3.18%), phenol, 4-propyl- (3.24%), and heptadecane (3.89%) were ranked as moderately abundant. Less abundant compounds included mesitylene (2.81%), nonane, 4-methyl- (2.79%), nonane, 3-methyl- (2.74%), nonadecane (2.66%), naphthalene (2.13%), tetratetracontane (2.05%), trifluoroacetoxy hexadecane (2.01%), octane, 2,5-dimethyl- (1.88%), nonane, 2-methyl- (1.75%), octane, 2,6-dimethyl- (1.66%), decane, 2,5,6-trimethyl- (1.71%), hexacosane (1.61%), heptadecane, 2,6,10,14-tetramethyl- (1.38%), benzene, 1,2,3-trimethyl- (1.38%), benzofuran, 2,3-dihydro- (1.34%), benzene, nitro- (1.24%), 17-pentatriacontene (1.31%), hexadecane (1.29%), pentadecane (1.46%), 5-octadecene, (E)- (1.13%), tetradecane (1.03%), and oxalic acid, allyl hexadecyl ester (1.01%). The remaining 9 compounds were present as the least abundant compounds with peak areas 1%. Literature showed that among the identified compounds, some possess antimicrobial, antioxidant, anti-inflammatory and anticancer properties. [ABSTRACT FROM AUTHOR]

Macrophomina phaseolina and Sclerotium rolfsii are the two important soil-borne phytopathogens causing diseases in hundreds of plant species. In search of alternatives to synthetic fungicides, the present study was carried out to investigate the antifungal activity of methanolic extract of flowers of Cassia fistula L. against these two highly destructive plant pathogens. The extract was prepared by soaking 200 g shade dried flowers of the test plant species in 1000 ml of methanol for two weeks, followed by filtration and evaporation on a rotary evaporator. Bioassays carried out with 1.562, 3.125, 6.250, 12.500, 25.000, and 50.000 mg/ml concentrations of the extract exhibited 2-36% and 31-56% reduction in biomass of M. phaseolinaand S. rolfsii, respectively. The extract was partitioned with n-hexane followed by chloroform and the later fraction was analyzed by GC-MS that showed presence of 37 compounds. Hexacosane (16.06%) followed by heptacosane (10.94%) and benzene, 1,2,3-trimethyl-(8.12%) were recognized as the principal components of chloroform fraction. Compounds namely heptadecane (7.15%), benzene, 4-ethyl-1,2-dimethyl- (4.60%), benzene, 1,2,3,4-tetramethyl- (3.93%), benzene, 2-ethyl-1,4-dimethyl- (3.88%), aniline, N-methyl- (3.68%) and naphthalene (3.08%) were ranked as moderately abundant. Some of the identified compounds are known to possess antifungal activities against various fungal species and could be responsible for antifungal activity of the flower extract against M. phaseolina and S. rolfsii in the present study. This study also concluded that S. rolfsii was more susceptible to the flower extract than M. phaseolina. [ABSTRACT FROM AUTHOR]

In this paper, the effect of solutioning and various aging heat treatment processes on the microstructure, the hardness and electrochemical properties of a duplex stainless steel (DSS) were studied. The evaluation of the microstructure and phase compositions were carried out by the optical microscopy (OM) and the X-ray diffraction (XRD). Electrochemical behavior of specimens were evaluated by both potentiodynamic polarization and electrochemical impedance spectra (EIS) tests at 25 and 60 °C. The obtained results showed that the solutioning heat treatment increased corrosion rates with respect to the blank specimen. The aging process at 490 °C for 20 hrs increased the volume percent of the carbide phase to the highest value (25.1%) which resulted in an increase in the hardness value up to 170 VHN. The specimen which was aged at 540 °C for 10 h with the Cr7C3 size of 22.8 µm, exhibited the higher corrosion resistance at both temperatures of 25 and 60 °C with respect to other aged specimens. In addition, the temperature of 60 °C promoted the anodic reactions in 3.5 wt.% NaCl solution which decreased impedance modulus values significantly. Consequently, the carbide size was more effective parameter than the carbide content in predicting electrochemical behavior of such alloys. [ABSTRACT FROM AUTHOR]

Celosia argentea var. cristata is an edible plant mainly cultivated as an ornament for its spectacular flowering and is highly appreciated by horticulturists for its originality, unique appearance of flower and better vase life. Utilisation of plant growth regulator [salicylic acid (SA)] and mineral nutrition [zinc (Zn)] is a sustainable approach to ameliorate crop health and yield. A field experiment was performed on a randomised complete block design with 12 treatments in 36 blocks to investigate the effectiveness of the combined application of SA (50 ppm and 100 ppm) and Zn (ZnSO4: 0.5 ppm, 1.5 ppm and 2.5 ppm) as well as when each one is applied separately on vegetative, reproductive, physiochemical attributes in C. argentea var. cristata. Results analysed through Tukey's honestly significant difference (HSD) test, biplot and heat map indicated a significantly greater improvement up to 2.5 folds in the growth attributes when plants received foliar application of 100 ppm of SA combined with 2.5 ppm of Zn as compared to control group. All treatments modified the physiobiochemical responses of plants by lowering catalase (CAT) activity significantly, and enhancing photosynthetic pigments, total protein content and peroxidase (POX) and polyphenol oxidase (PPO) activities as compared to the control group. It was concluded that foliar application of SA (100 ppm) + Zn (2.5 ppm) at pre-flowering stage could be applied to obtain better growth and flower quality in cockscomb.

The Turnpike problem aims to reconstruct a set of one-dimensional points from their unordered pairwise distances. Turnpike arises in biological applications such as molecular structure determination, genomic sequencing, tandem mass spectrometry, and molecular error-correcting codes. Under noisy observation of the distances, the Turnpike problem is NP-hard and can take exponential time and space to solve when using traditional algorithms. To address this, we reframe the noisy Turnpike problem through the lens of optimization, seeking to simultaneously find the unknown point set and a permutation that maximizes similarity to the input distances. Our core contribution is a suite of algorithms that robustly solve this new objective. This includes a bilevel optimization framework that can efficiently solve Turnpike instances with up to 100,000 points. We show that this framework can be extended to scenarios with domain-specific constraints that include duplicated, missing, and partially labeled distances. Using these, we also extend our algorithms to work for points distributed on a circle (the Beltway problem). For small-scale applications that require global optimality, we formulate an integer linear program (ILP) that (i) accepts an objective from a generic family of convex functions and (ii) uses an extended formulation to reduce the number of binary variables. On synthetic and real partial digest data, our bilevel algorithms achieved state-of-the-art scalability across challenging scenarios with performance that matches or exceeds competing baselines. On small-scale instances, our ILP efficiently recovered ground-truth assignments and produced reconstructions that match or exceed our alternating algorithms. Our implementations are available at https://github.com/Kingsford-Group/turnpikesolvermm.

Background: Among different tools, accreditation is widely used worldwide to improve the quality and safety of hospital services. In Iran, as in many other countries, the same accreditation standards apply to all hospitals, regardless of their size and type of activity. This has given rise to many problems for hospitals., Materials and Methods: We will conduct this study in three phases: In the first phase, relevant individuals are interviewed to identify challenges caused to hospitals by applying the same standards for all types of hospitals and clarify issues that could be removed or changed in small hospitals. In the second phase, a scoping review is conducted on the literature about accreditation models worldwide. The first and second phases are conducted simultaneously, and a new accreditation model for Iran hospitals is derived by combining their results. In the final phase, using the Delphi technique, the obtained model and accreditation modules are verified during Delphi rounds., Discussion: A more appropriate accreditation model that matches the characteristics of the target hospitals could be the output of this study. It is expected that the model could improve the process of evaluating the quality of hospital services through the accreditation tool., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

The quality of emergency services is one of the indicators describing the health status of countries. Moreover, the specialization of services and targeted response to any accident or disease has been the priority of pre-hospital emergency operations in some leading countries. This study aimed to compare the special services provided in the emergency department of several selected countries. This was a comparative study that was done in Isfahan in 2022. Data were collected by reviewing the literature provided by libraries and emergency websites of selected countries. We selected countries based on the accessibility of information in two groups of developed countries and countries with the same income and population as Iran including Germany, France, The United States, Australia, Britain, Malaysia, and Turkey. Data were classified and compared based on staff, vehicles, and specialized services. Emergency staffs in most countries were of different skill and training levels. Ambulances varied in equipment types in various land, air, and sea forms and dimensions. Developed countries had more modern ambulances and equipment. France and Germany were operating more especially. Specialized teams are dispatched only in the United States and Germany. Existing studies have shown the adequacy and effectiveness of these teams in reducing complications and mortality and improving the prognosis of patients. The use of specialized teams appropriate to each emergency based on the specific and targeted response is effective in improving the prognosis of patients. The results of this study are suggested to beneficiaries to improve the quality of emergency care and reduce complications and potential causalities., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Most patients with diabetes will present to hospital for a reason not directly related to their diabetes. When a person with diabetes is not cared for properly, hospitalization can become complicated and lead to worse consequences for the patient. In fact, it is important to know how to manage a diabetic patient while in hospital. Therefore, a special organization is needed in hospitals for adaptation to chronic diseases such as diabetes. This study intends to help hospital adaptation to the special needs of diabetic patients by identifying patterns of care delivery in selected countries. This comparative study was performed in 2021. The data collection was conducted by searching in PubMed, Web of Knowledge, Scopus, Science Direct, Springer, Proquest, and also the websites of the selected countries hospitals. Based on the sampling method, three countries, Turkey, United Kingdom, and the United States, were selected from the countries with eligibility. However, during the study, according to the good practices about special diabetic care of countries such as Australia and Denmark, they were also examined. In this review study, we organized and compared the effective measures taken in selected countries in relation to the management of these patients in the hospital, focusing on the dimensions of service package, human resource, process, structure, equipment/technology, and information system required by diabetic patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 International Journal of Preventive Medicine.)

Background: It is essential to identify the necessary competencies of hospital CEOs in order to improve the quality and efficiency of services they provide. Expert leadership skills and competencies can have a significant impact on the success of an organization, benefiting both patients and staff. This study aimed to assess the competencies and training needs of hospital CEOs in Iran public hospitals., Methods: We conducted this cross-sectional analytical study through a self-assessment questionnaire, which was a web-based platform developed by the WHO country office in Iran, between July 2018 and September 2018. The questionnaire was completed by 180 hospital CEOs and included a core set of 81 items based on Assessing the Competency of Hospital CEO. These items were categorized into five superordinate categories: leadership, personality and quality of individual behavior, knowledge and business skills, social responsibility, and healthcare environment. In addition, we conducted focus groups with 30 hospital CEOs, supervisor assessments with 10 hospital managers, and interviews with 10 supervisors., Results: Of the 180 questionnaires distributed, 78% were returned, and most respondents were medical specialists. The need for leadership competencies such as individual behavior skills and change management received the highest priority. Most respondents required training in management skills, including financial management, governance, strategic thinking, quality improvement, and disaster management., Conclusion: Providing needs-based education is crucial, especially in developing countries. In this study, leadership and strategic thinking were found to be the most needed competencies among hospital CEOs in Iran. These findings serve as reference points for developing countries with similar backgrounds and healthcare environments as Iran., (© 2023. BioMed Central Ltd., part of Springer Nature.)

In this study, polypropylene nonwoven was coated with chitosan after being activated by oxygen/argon low-pressure plasma. The chitosan-treated sample (PP-Ch) was coated with TiO 2 nanoparticles by a pad-dry method. Silver nanoparticles were in situ synthesized on the chitosan-TiO 2 -coated sample by a chemical reduction method. The morphology of each of the samples mentioned above was evaluated by FESEM. The efficiency of each sample in the removal of C.I. Acid Brown 248 from aqueous media was evaluated. The PP-Ch sample removed 90% of the dye at pH=3. Coating the PP-Ch sample with TiO 2 and silver nanoparticles improved the dye removal efficiency under UV irradiation., (© TÜBİTAK.)

Background: One of the crises facing human beings is coronavirus disease. This disease was identified in December 2019 in Wuhan, China. With the death of two patients with respiratory complications in Qom Hospital on February 20, 1998, and the confirmation of their positive test, the arrival of COVID-19 disease in Iran was officially confirmed and Khorshid Medical Center as the main reception the Medical Center for patients with COVID-19 from August 3, 2010. The purpose of this study is to document the experiences of Khorshid Training Center in coronavirus crisis management to improve crisis management knowledge., Materials and Methods: This research was conducted qualitatively with grounded theory method in the period from March 1998 to the end of May 1999. The study population was Khorshid Educational and Medical Center. Sampling was done purposefully among medical staff, support, and hospital officials. The number of samples with the mentioned conditions reached 44 people. Data were collected using a semi-structured questionnaire and analyzed in the style of grounded theory in the style of Strauss and Corbin., Results: Data collected after sorting, analysis, conceptual analysis; they were coded and categorized into four groups of challenges, weaknesses, strengths, and actions based on the specific objectives of the research in 5 natures, reorganization, accident control system, medical equipment and supplies, human resources, and clinical approaches., Conclusion: According to the points classified in the challenges and weaknesses, it was found that the hospital has faced several problems in corona crisis management. The management team, taking advantage of strengths in various areas, has taken effective measures to improve corona crisis management. It has led to the provision of appropriate services to the patients of the Medical Center., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Education and Health Promotion.)

Background: There is no specific tool for measuring the professional resilience of emergency nurses. Therefore, the present study aimed to design and psychometrically evaluate a new tool named the emergency nurses' professional resilience tool., Method: This mixed-method sequential exploratory study was conducted in two phases: (1) item generation using literature review and evaluation of the results of a qualitative study and (2) psychometric evaluation of the developed scale. The face, content, and construct validity (exploratory and confirmatory factor analysis), reliability (internal consistency, relative, and absolute), and accountability were assessed in the population of Iranian nurses (N = 465) during March 2019-June 2020., Results: The tool designed for assessing the professional resilience of Iranian nurses included 37 items. The average scale content validity index (S-CVI/Ave) was equal to 0.94. The exploratory factor analysis revealed five factors, including professional competencies, emotional-cognitive characteristics, external support, in addition to behavioral and cognitive strategies, and explained 75.59% of the whole variance. Cronbach's alpha and intraclass correlation were 0.915 and 0.888, respectively. Construct validity for five factors was established with acceptable model fit indices [Chi-square/df = 1336.56/619, p < .001]; [Comparative Fit Index [CFI] = 0.96]; [Non-Normed Fit Index [NNFI] = 0.96]; [Root Mean Square Error of Approximation (RMSEA) = 0.074 and 90 Percent Confidence Interval = (0.069; 0.080)]; and [SRMR = 0.095]., Conclusions: According to the findings of the current study, the emergency nurses' professional resilience tool can be used by healthcare managers as a valid and reliable scale to evaluate the professional resilience of nurses to designate them as nurses working in emergency and disaster situations., Competing Interests: The authors have declared that no competing interests exist.

Aim: We aimed to describe the epidemiological and clinical characteristics of Iranian patients with COVID-19., Methods: In this single-center and retrospective study, patients with confirmed COVID-19 infections were enrolled. Univariate and multivariate logistic regression methods were used to explore the risk factors associated with outcomes., Results: Of 179 patients with confirmed COVID-19 infection, 12 remained hospitalized at the end of the study and 167 were included in the final analysis. Of these, 153 (91.6%) were discharged and 14 (8.38%) died in hospital. Approximately half (50.9%) of patients suffered from a comorbidity, with diabetes or coronary heart disease being the most common in 20 patients. The most common symptoms on admission were fever, dyspnea, and cough. The mean durations from first symptoms to hospital admission was 8.64 ± 4.14 days, whereas the mean hospitalization time to discharge or death was 5.19 ± 2.42 and 4.35 ± 2.70 days, respectively. There was a significantly higher age in non-survivor patients compared with survivor patients. Multivariate regression showed increasing odds ratio (OR) of in-hospital death associated with respiratory rates >20 breaths/min (OR: 5.14, 95% CI: 1.19-22.15, p = 0.028) and blood urea nitrogen (BUN) >19 mg/dL (OR: 4.54, 95% CI: 1.30-15.85, p = 0.017) on admission. In addition, higher respiratory rate was associated with continuous fever (OR: 4.08, 95% CI: 1.18-14.08, p = 0.026) and other clinical symptoms (OR: 3.52, 95% CI: 1.05-11.87, p = 0.04)., Conclusion: The potential risk factors including high respiratory rate and BUN levels could help to identify COVID-19 patients with poor prognosis at an early stage in the Iranian population.

This article attempts to fill part of the research void created by the premature cancellation of the Ontario Basic Income Pilot (OBIP), reporting the results of former Ontario Works and Ontario Disability Support Program service users who received basic income in the Hamilton region through a comparison of their experiences related to physical and mental health, food and housing security, financial security, and social and family relations. It shows that basic income led to improvements on a variety of indicators, proving transformational for some. The evidence suggests that when compared to existing income support systems, a basic income modeled similar to OBIP can significantly improve recipients' lives, while at the same time providing a more humane approach to service delivery., (© 2020 Canadian Sociological Association/La Société canadienne de sociologie.)

Context and Aims: The country development can be promoted through applying policies of the resistance economy in the health system and universities. Therefore, this paper aimed to provide a scientific analysis of resistance economy policies and providing a roadmap for their implementation in the field of health care of Isfahan University of Medical Sciences., Materials and Methods: This is a qualitative study. The basis, general purposes, and strategies of the resistance economy were extracted from the review of the policy of the resistance economy with a political research approach. Then, effective programs and indicators to achieve the goals of the resistance economy were proposed by holding 10 sessions of a centralized group discussion. Finally, the implementation of the resistance economy in the deputies of the University of Medical Sciences was approved by these programs and indicators along with other components and Delphi questionnaire to 30 experts. Framework analysis and descriptive statistics were used to analyze the data from the group discussion and the Delphi stage, respectively., Results: Implementation of general policies of resistance economy in the field of health and treatment of Isfahan University of Medical Sciences with eight thematic bases, 39 goals, 54 strategies, and 98 programs and indicators were approved by experts. The eight areas of people-centered, economic growth, economic justice, support for internal services, economic flexibility, economic stability, economic influence, and economic health were identified as the thematic bases of communicative policies of the resistance economy in the field of health., Conclusion: The implementation of resistance economy policies entails planning in the long run, culture-building, appreciating the resistance economy in health issues, cooperation, and synergy among different institutions, restructuring the education system at different levels of the health system, and entrepreneurship training., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Education and Health Promotion.)

Background: Iranian health system underwent a series of reforms entitled Health Transformation Plan (HTP) in 2014. The plan started with packages that have imposed financial burden and increased expenditure in the health system. This study aimed to identify strategies and solutions to reduce expenditures in HTP in Iran. Methods: To conduct this qualitative study, the researchers held 15 semi-structured interviews with prominent experts in the research arena in 2018. Content analysis was used to analyze the data using MAXQDA 10 software. Results: Data collection yielded 9 main topics, including purchase and provision medicine, prescription, purchase and use of equipment, diagnostic medical services, referral system, human resources, physical space, payment system, and modifying and increasing base salaries. Conclusion: In Iran's health system, some aspects of HTP wasted resources, eg, the waste of resources in the service delivery system; thus, policymakers should consider proper strategies to control the costs based on the nature of their implementation.

Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking. Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described. Results: The followings were done to accomplish the goals of each step: collecting experts' viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation). Conclusion: In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran's health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework.

Background: Methodology of Failure Mode and Effects Analysis (FMEA) is known as an important risk assessment tool and accreditation requirement by many organizations. For prioritizing failures, the index of "risk priority number (RPN)" is used, especially for its ease and subjective evaluations of occurrence, the severity and the detectability of each failure. In this study, we have tried to apply FMEA model more compatible with health-care systems by redefining RPN index to be closer to reality., Methods: We used a quantitative and qualitative approach in this research. In the qualitative domain, focused groups discussion was used to collect data. A quantitative approach was used to calculate RPN score., Results: We have studied patient's journey in surgery ward from holding area to the operating room. The highest priority failures determined based on (1) defining inclusion criteria as severity of incident (clinical effect, claim consequence, waste of time and financial loss), occurrence of incident (time - unit occurrence and degree of exposure to risk) and preventability (degree of preventability and defensive barriers) then, (2) risks priority criteria quantified by using RPN index (361 for the highest rate failure). The ability of improved RPN scores reassessed by root cause analysis showed some variations., Conclusions: We concluded that standard criteria should be developed inconsistent with clinical linguistic and special scientific fields. Therefore, cooperation and partnership of technical and clinical groups are necessary to modify these models., Competing Interests: There are no conflicts of interest.

Background: The rapid rise in noncommunicable diseases (NCDs) is one of the main health challenges affecting the global development in the present era. This raising challenge is a major threat to countries' socioeconomic development as well as millions of people health., Methods: It was a retrospective study with analysis of reported death in Isfahan Province during a 5-year period from 2007 to 2011. Required data were collected from statistics provided by Deputy of Health in Kashan and Isfahan Universities of Medical Sciences in 2012. Excel software was used for data analysis., Results: During this period, the cardiovascular events, cancers and tumors, unintentional injuries, respiratory diseases, and prenatal mortality were the main reasons of mortality in Isfahan Province. The overall rate of cardiovascular events rose 5.10% in the 5-years of the study observation, and Khor - Biabanak was on the top of the list; while in cancer rating Khor - Biabanak, Golpayegan, and Khansar both stood at the outset (per 1,000 people). For injuries, the highest rate belonged to Golpayegan, Tiran-Kervan, and Chadegan. Meanwhile, for mental illnesses, the highest rate was observed in Khomeini Shahr. Moreover, the highest maternal and fetal mortality was reported in Fereydunshahr, Khor - Biabanak and Mobarakeh., Conclusions: Given the sharp rise of NCD, programs by health care system should be directed toward lifestyle modification while a proper framework should be determined to deal with these kinds of disease. Furthermore, optimal allocation of resources based on needs can provide better facilities for different cities.

Introduction: In the new approach, all health care providers have been obligated to maintain and improve the quality and have been accountable for it. One of the ways is the implementation of clinical governance (CG). More accurate understanding of its challenges can help to improve its performance., Aims: In this study, barriers of CG implementation are investigated from the perspective of the hospitals involved. Besides, some solutions are suggested based on stakeholders' opinions., Materials and Methods: This study used combined method (qualitative content analysis and questionnaire) in hospitals affiliated to Isfahan University of Medical Sciences in 2014. First, experts, and stakeholders talked about CG implementation obstacles in a semi-structured interview. Interviews were confirmed by the interviewee (double check). After analyzing the interviews using reduction coding the questionnaire was drawn up. The questionnaire "validity was confirmed by Cronbach's alpha (0/891)" and its reliability was obtained using experts confirmation. Data analyzing was performed using SPSS (18) software., Results: According to results staffing and management factors were the main obstacles. After them, were factors related to organizational culture, infrastructure elements, information, sociocultural and then process factors. The learning barriers were in final rank. Thirty-four solutions was proposed by experts and divided into subset of eight major barriers. Most solutions were offered on modifying processes and minimal solutions about modifying of organizational culture, sociocultural, and educational factors., Conclusion: Removing the obstacles, especially management and human resource factors can be effective by facilitating and accelerating CG. Furthermore, use of experts and stakeholders opinions can help to remove CG barriers.

Introduction: Policy makers and decision makers must identify the stakeholders in medical tourism, who will be affected by and/or affect this industry, and determine their status for partnership. The aim of this study was to identify the main stakeholders in Isfahan's medical tourism, analyze them, and provide strategies for developing this industry., Materials and Methods: A qualitative study was conducted in 2011. At first, the key stakeholders in medical tourism were identified in accordance with the experts' idea and literature review. Then we interviewed the key stakeholders. Data analysis was conducted using the stakeholders' analyses, which helped in developing strategies., Results: The result showed that the key stakeholders were made up of nine groups. They included the provincial governance of Isfahan, the Cultural Heritage and Tourism Organization of Isfahan, the Chamber of Commerce, the Medical Council, the Isfahan University of Medical Sciences, health service providers, tourism services providers, investors, and the Tosea Saderat Bank. The rate of knowledge of the Cultural Heritage and Tourism Organization of Isfahan, clinic and international relationship of Isfahan University of Medical Sciences from government policy about medical tourism were very much. Private Hospitals, the Medical Council, investors, and the University of Medical Sciences had great power. Private hospitals, clinics, the Cultural Heritage and Tourism Organization of Isfahan, and the University of Medical Sciences were in the supporter position. The effected strategies were the included strategies, focused on increasing power; increasing support, and on maintaining the position., Conclusion: There are different stakeholders in the medical tourism industry. Thus, policy makers can plan, make a policy and decision, and use effective strategies to develop medical tourism by designing a medical tourism stakeholders' network, a medical tourism provincial council, and clarify the roles and responsibilities of stakeholders.

Introduction: Medical wastes are among hazardous wastes and their disposal requires special methods prior to landfilling. Medical wastes are divided into infected and non-infected wastes and the infected wastes require treatment. Incineration is one of the oldest methods for treatment of medical wastes, but their usage have faced wide objections due to emission of hazardous gases such as CO2 and CO as well as Carcinogenic gases such as Dioxins and Furans which are generated as a result of incomplete combustion of compositions like PVCs. Autoclave is one the newest methods of medical wastes treatment which works based on wet disinfection., Methods: The statistical population in this descriptive, comparative study includes hospitals located in Isfahan city and the sample hospitals were selected randomly. To environmentally evaluate the Autoclave method, TST (time, steam, temperature) and Spore tests were used. Also, samples were made from incinerator's stack gases and their analyses results were compared with WHO standards., Findings: TST and spore tests results were negative in all cases indicating the success of treatment process. The comparison of incinerator's stack gases with WHO standards showed the high concentration of CO in some samples indicating the incomplete combustion. Also, the incineration efficiency in some cases was less than 99.5 percent, which is the efficiency criterion according to the administrative regulations of wastes management law of Iran. No needle stick was observed in Autoclave method during the compaction of bags containing wastes, and the handlers were facing no danger in this respect. The comparison of costs indicated that despite higher capital investment for purchasing autoclave, its current costs (e.g. maintenance, etc) are much less than the incineration method., Discussion: Totally, due to inappropriate operation of incinerators and lack of air pollution control devices, the use of incinerators doesn't seem rational anymore. Yet, despite the inefficiency of autoclaves in treatment of bulky wastes such as Anatomical wastes, their usage seems logic considering the very low amounts of such wastes. Also, considering the amount of generated wastes in Isfahan hospitals, a combination of centralized and non-centralized autoclaves is recommended for treatment of infected wastes. Mobile autoclaves may also be considered according to technical and economical conditions. It must not be forgotten that the priority must be given to the establishment of waste management systems particularly to personnel training to produce less wastes and to well separate them.

Background: Hospitals need to focus on their core activities, thus outsourcing of services may be effective in some instances. However, monitoring and supervision is a vital mechanism to preserving and enhancing the quality of outsourced services, and to identify the benefits and losses occurred. The purpose of this study is evaluation of nursing services outsourced in a general hospital from different point of views., Methods: This is a descriptive and applied study done by case study (before and after) method. Outsourcing nursing services of clinical wards (ENT and Neurosurgery) of Kashani Hospital in 2011 has been studied. We extracted data from a handmade questionnaire about internal customer's satisfaction and semi-structured interviews with officials, and also survey of financial and administrative documents and records related to the topic., Results: The findings indicate an increased number of graduated nurses per bed to fulfill the main objective of outsourcing in this case. But achieving this objective is accompanied with remarkable increased costs per bed after outsourcing. Besides, we noticed minor changes in internal customer satisfaction rate., Conclusion: While outsourcing should bring about staff and patients' satisfaction and increase the efficiency and effectiveness, outsourcing nursing workforce singly, leaded to a loss of efficiency. Therefore, the applied outsourcing has not met the productivity for the hospital.

Conflict of Interest: none declared., Introduction: Employees' job satisfaction and commitment depends upon the leadership style of managers. This study clarifies further the relationships between leadership behaviors of managers and two employees' work-related attitudes-job satisfaction and organizational at public hospitals in Iran. A better understanding of these issues and their relationships can pinpoint better strategies for recruiting, promotion, and training of future hospital managers and employees, particularly in Iran but perhaps in other societies as well., Methods: This cross-sectional study was conducted using self-administered questionnaires distributed among 814 hospital employees and managers through a stratified random sampling., Results and Discussion: The dominant leadership style of hospital managers was participative style. Hospital employees were moderately satisfied with their jobs and committed to their organization. Salaries, benefits, promotion, contingent rewards, interpersonal relationships and working conditions were the best predictors of job satisfaction among hospitals employees. Leadership, job satisfaction and commitment were closely interrelated. The leadership behavior of managers explained 28% and 20% of the variations in job satisfaction and organizational commitment respectively., Conclusion: This study clarifies the causal relations of job satisfaction and commitment, and highlights the crucial role of leadership in employees' job satisfaction and commitment. Nevertheless, participative management is not always a good leadership style. Managers should select the best leadership style according to the organizational culture and employees' organizational maturity.

Introduction: The purpose of this study was to investigate the impact of top management turnover on Strategic Collaborative Quality Management (SCQM) implementation in healthcare organizations. The role of top management turnover in the process and impact of the SCQM model was investigated using a case study of a public hospital., Methods: Both qualitative and quantitative methods were used for data collection., Results and Discussion: Top management turnover is a major threat to the long-term success of the SCQM intervention and makes it very difficult to sustain its benefits. Successful quality management implementation needs supportive and committed leadership and management. Top management stability encourages long-term planning and commitment to pursuing long-term objectives., Conclusion: This paper has highlighted the critical role of top management stability during the course of quality management implementation.

Introduction: Behavioral science experts believe that all entities capable of stimulating a person can be addictive; and whenever a habit changes into an obligation, it can be considered as an addiction. Researchers also believe that there are a number of similarities as well as some differences between drug addiction and behavioral addiction diagnostic symptoms. The purpose of this study is to consider different approaches in this field., Methods: This is a descriptive research using content analysis method. First, differences and similarities of various perspectives on addiction and addiction behavior in different substances were obtained, thereafter, the data was coded and categorized, subjects were discussed and major issues were extracted., Results: Behavioral addiction such as internet addiction is similar to drug addiction except that in the former, the individual is not addicted to a substance but the behavior or the feeling brought about by the relevant action. In addition, the physical signs of drug addiction, are absent in behavioral addiction. Others have stated that behaviorally addicted individuals have certain symptoms and will undergo the same consequences brought about by addiction to alcohol and drugs as well as other obsessive behaviors., Conclusion: Similar to substance abuse prevention, programs aimed at addicted individuals and specialized training can educate adolescents about the warning signs of online addiction, in order to assist the early detection of this disorder. For prevention of behavioral addiction (such as internet addiction) authorities, cultural institutions and parents should monitor the use of internet and teach to the adolescent and children, the useful and appropriate methods of internet use.

Objectives: Infected hospital wastes are among hazardous wastes, and special treatment methods are needed for their disposal. Having information about present status of medical waste management systems is of great importance in finding weak, and for future planning. Such studies have not been done for most of the hospitals in Iran., Methods: This paper reports the results of a study on the present status of medical waste management in Isfahan hospitals. A ten page researcher made questionnaire was used to collect data in terms of collection, transportation, segregation, treatment and disposal. For assessment of autoclaves, standard tests including TST (Time, Steam, and Temperature) strip test and spore tests were used. Samples were made of stack gases of incinerators. Quantity and composition of hospital wastes in Isfahan were also measured manually., Results: Of all wastes in selected hospitals, 40% were infected wastes (1.59 kg/day/bed), which is 15 to 20% higher than World Health Organization (WHO) standards. TST and Spore test results were negative in all samples. Stack gases analysis showed high concentration of CO in some samples. Besides, the combustion efficiency in some samples is less than 99.5%, which is the standard criterion in Iran., Conclusions: This study may create awareness regarding the magnitude of the problem of waste management in hospitals of Isfahan and may stimulate interests for systematic control efforts for hospital waste disposal. Hospital waste management cannot succeed without documented plans, certain equipment, defined staff trainings, and periodic evaluations.

Background: This study aimed to investigate the impact of internet addiction on some psychiatric symptoms among university students., Methods: This cross-sectional study was conducted among 250 students selected via quota sampling from universities in Isfahan, Iran. Participants completed demographic questionnaire, Young Diagnostic Questionnaire, Internet Addiction Test and Symptom Checklist-90-Revision (SCL-90-R). Finally, the means of psychiatric symptoms of internet addicted and non-addicted subjects were compared. Also, t-test and multivariate analysis of covariance were used through SPSS(16) software for data analysis., Results: The mean±standard deviation (SD) of psychiatric symptoms such as somatization, obsessive-compulsive disorder, interpersonal sensitivity, depression, anxiety, aggression (hostility), phobic anxiety, paranoid ideation and psychoticism in the addicted group were 11.27 ± 6.66, 14.05 ± 7.91, 10.5 ± 6.20, 15.61 ± 8.88, 10.77 ± 5.52, 6.77 ± 4.88, 6.05 ± 4.47, 7.61 ± 4.28, and 9.66 ± 6.87, respectively, and in the non-addicted group were 6.99 ± 6.42, 7.49 ± 5.23, 5.46 ± 4.95, 9.27 ± 7.92, 6.35 ± 6.69, 3.57 ± 3.35, 2.41 ± 2.79, 5.47 ± 4.1, and 5.29 ± 4.95, respectively. There were significant differences between the means of psychiatric symptoms in all SCL-90-R subscales and Global Severity Index, Positive Symptom Distress Index, Positive Symptom Total in the addicted and non-addicted individuals (P<0.05). Also, internet addiction (with controlling sex variable) seemed to affect psychiatric symptoms., Conclusion: Psychiatrists and psychologists involved in the field of mental health need to be well informed about mental problems due to internet addiction, such as anxiety, depression, aggression, and job and educational dissatisfaction.