Analysis of vaginal delivery promotion package in the National Health System Reform Plan in Iran: a qualitative study

Background: The Vaginal Delivery Promotion Package was a part of the National Health System Reform Plan in Iran, which was implemented to reduce the rate of cesarean sections. The aim of the present study was to examine the views of the beneficiaries on the implementation of the promotion of natural vaginal delivery in the hospitals affiliated to Tehran University of Medical Sciences.  Methods: A qualitative study conducted in 2016 using semi-structured interviews for data collection. The sampling method was purposeful with maximum variation of the beneficiaries. After doing 35 interviews, the data reached a saturation point. Data analysis was done through content analysis method using MAXQDA 10 software.   Results: The package beneficiaries believed that it was successful in achieving its goal to reduce cesarean sections. Their perspectives were classified into two categories (strengths and weaknesses), eight themes (package design, achieving the goals, education and persuasion, package comprehensiveness, monitoring, infrastructures, plan implementation, and service quality), and 24 sub-themes. The most important weaknesses of this package were the payments and supervisions.  Conclusion: Officials and policymakers can improve the package by continuous monitoring, providing necessary feedback to the staff, and modifying the payments. Besides, paying attention to midwives and health workers, the first contact point for pregnant mothers with service providers, can increase the effectiveness of this package

Patrick-Murray Administration Issues South Coast Rail Executive Order and Awards Technical Assistance

BACKGROUND:The migration of healthcare specialists from developing countries has increased in recent years. This has caused a rapid reduction in the access to and quality of healthcare services in such countries. The aim of this study is to evaluate the factors affecting the migration of specialist human resources in Iran's healthcare system. METHODS:This is a qualitative study, which was carried out through semi-structured interviews between 2015 and 2016. For sampling, purposive sampling method with maximum variation sampling was used. Further, data saturation was observed by conducting 21 interviews, and data analysis was performed using the MAXQDA10 content analysis software. RESULTS:Factors affecting the migration of specialists were classified into five key themes, including structural, occupational, personal, socio-political and economic factors. These themes consisted of 12 categories and 50 subcategories. The most important factors affecting the migration of our study population were structural issues, occupational problems, and personal concerns. CONCLUSION:Identification of factors influencing migration is the first step to prevent the migration of specialist human resources. Implementing the recommendations proposed in this study would assist to prevent migration of medical professionals

Relationship between Quality of Work Life of Medical Staff and Quality of Patient Care

Background: Nowadays, quality of patient care is one of the major and important concerns of health care delivery which is extremely dependent on the medical staff. Objectives: The purpose of this study was to investigate the relationship between Quality of Work Life (QWL) and quality of patient care. Methods: This study was a descriptive-analytic study based on correlation which was conducted in the educational hospitals of Kermanshah. A total of 320 medical staffs were selected for the study. Quality of Work Life and Quality of Patient Care questionnaires were used to collect the data. For data analysis, descriptive statistics, person correlation coefficient, t-test and multivariate regression were used by using SPSS16 Results: Data analysis showed that the Quality of Work Life of medical staffs was in a medium level. Our findings indicate that there is a significant, negative relationship between stress at work and quality of patient care (P-value=0.001 & r=-0.247) and there is a significant, positive relationship between control & job satisfaction and quality of patient care (P-value=0.001 & r=0.217). Results of multivariate regression analysis showed that stress at work net account for 6% of the variance of the quality of patient care. Conclusion: Focusing on improving the working conditions of medical staffs can be incredibly useful in increasing the quality of health care

Public COVID-19 vaccination acceptance: A narrative review of correlated factors

Following the discovery of the first instances of COVID-19 in nations and the subsequent announcement of a “pandemic” by WHO, worldwide efforts to identify efficient methods to combat COVID-19 began. One of the most effective solutions is to carry out widespread vaccination against the virus. Despite this, some members of the community refuse to be vaccinated. The present paper reviews the potential causes and factors correlating with people's hesitation to receive COVID-19 vaccines. This article is a narrative review paper. We searched PubMed, Scopus, and Web of Science databases using COVID-19, Vaccine, Acceptance, and Hesitancy keywords. Qualitative content analysis was performed and associated predictors with public vaccination acceptance were identified. According to the study,  hesitation in receiving COVID-19 vaccines, regardless of the countries, is significant among females, lower ages, lower education level, doubt about efficacy, and concerns about the safety of the vaccines, history of not receiving vaccines, especially the influenza vaccine, distrust of regional or national health officials, low level of health literacy and lack of information, fear of side effects and other complications, doubt of pharmaceutical companies and fear of lobbying, presence of chronic underlying diseases and comorbidities, lower socioeconomic status and racial or religious minorities. According to the results, several factors can influence individuals' uncertainty about COVID-19 vaccines. Given the importance of vaccinating the majority of the community to achieve mass immunity, healthcare systems should consider the vaccine acceptance rate to be a vital and substantial factor.Keywords: COVID-19; Vaccination Refusal; Review

Content and citation analysis of Lorestan University of Medical Sciences Journal during 2011-2015

Background: Considering the importance of content and citation analysis in understanding the needs and improving journals’ scientific quality, the objective of the present study was to content and citation analysis of published articles in Lorestan University of Medical Sciences Journal (Yafte) during 2011 to 2015. Materials and Methods: This study is a prospective longitudinal study conducted in 2016. Published articles during 2011 to 2015 were studied. Data were collected by a researcher-made checklist and analyzed by SPSS version 21 and descriptive statistics. Results: Results showed that 95.8 percent of the articles were original and most of organizational affiliations of authors were related to Lorestan University of Medical Sciences (53.8). Over the past five years, 262 articles have been published in the Yafte Journal, half-life of resources were 8.38 years and the highest number of articles were published in the years 2013 and 2012. Conclusion: Considering the results of this study, it is suggested that the journal authorities should take necessary steps to balance organizational affiliations of published articles. It is also suggested that authors should be encouraged to use newer sources by setting some restrictions. &nbsp

The Sources of Work Stress among Nurses in Private Hospitals in Shiraz, 2016

Introduction: Since there are few studies on stress experienced by nursing staff in private hospitals, this study aimed to determine the sources of job stress among nurses in private hospitals in southwest of Iran. Method: In a cross-sectional design, nurses in private hospitals in Shiraz were investigated; about 160 nurses were selected by single-stage cluster sampling as the study samples in three selected hospitals. A standard questionnaire on the sources of job stress was used for data collection. The data were analyzed through SPSS, version 21, using Mann-Whitney and Kruskal-Wallis tests. The level of significance was considered as 0.05. Results: Five important causes of stress among nurses were low income, lack of job security, work-home interface, lack of enough time for work, and exposure with unsuitable physical situation. There were significant associations between the source of stress and having persons with chronic disease in family and concurrent education and work (P = 0.021, X2= 426.5 and P = 0.022, X2 = 717.5, respectively). Conclusion: The sources of job stress should be considered for effective working of the hospital. Attention to nurses’ salary and job security reduces job stress

A Review of Studies Conducted to Evaluate the Preparedness of Medical Centers Against the Potential Risks of Natural Disasters in Iran

INTRODUCTION ... [1, 2]. Iran is one of the 10 most prosperous countries in the world due to its extent, geographical location, and climatic diversity [3]. In 2015, the Islamic Republic of Iran ranked ninth in the world in terms of the number of deaths due to disasters with 319,000 deaths, most of which were due to earthquakes and floods [4]. ... [5, 6]. In the event of an unexpected disaster, hospitals are considered to be the most important centers for victims of accidents [1] and their effective and timely medical care services can play a vital and decisive role in reducing mortality and rescuing victims [7]. Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has set specific standards for the preparation of hospitals, unfortunately, many hospitals do not follow these standards [6]. ... [8, 9]. In a review study conducted by Bazyar et al. in 2020, the results showed that the readiness of Iranian hospitals is 53%, which is at the average level [10]. Also, the results of a study in Iran show that the low level of disaster readiness in hospitals in the western and southern regions of the country is more noticeable [11]. AIM(S) The purpose of this study was to review the readiness of medical centers against the potential risks of natural disasters in Iran RESEARCH TYPE The present study is a review study. RESEARCH SOCIETY, PLACE AND TIME All articles resulting from studies conducted in Iran, using the checklist of ten domains of Hojjat et al. [12] and reporting the readiness of hospitals were reviewed. SAMPLING METHOD AND NUMBER Four databases including Google Scholar, PubMed, Scopus, and Web of Science, and four Iranian databases including SID, Magiran, Civil, and Irandoc were examined. Keywords such as hospital, disaster, earthquake, flood, readiness, natural disaster, Iran, were used to access the resources. The resources list (Reference of Reference) of the articles was also reviewed to identify other related studies. Published sources in Persian and English were studied and the study period was limited from 2008 to 2019. USED DEVICES & MATERIALS The quality of the articles was evaluated based on the STROBE checklist and the poor quality articles (including one article) were removed from the study and other studies entered the content analysis level. The most important difference between the present study and other review studies conducted in Iran (concerning the readiness of hospitals against potential disaster risks) is that only studies were reviewed that used a common checklist of the Hojjat et al. in this questionnaire, the readiness status based on the obtained percentage is respectively 0-19 very poor readiness, 20-39 poor, 59-40 moderate, 60-79 good and 80-100 very good. FINDING BY TEXT Among 17 published articles, one article was excluded due to poor quality and finally, 16 articles were entered for final analysis. Among the studies selected for the final analysis, two studies were conducted throughout the country, two in Tehran, three in the west, three in the east, five in the south, and one in the northwest. In total, 118 hospitals were studied that 41 state hospitals, 17 military hospitals, 8 private hospitals, and three of them were social security hospitals. The type of possession of other hospitals (49 hospitals) was not mentioned in the studies (Table 1). The highest level of readiness was related to Kermanshah hospitals with 75% readiness and the lowest level was related to Bandar Abbas hospitals with 38.6% readiness (Table 2). In general, the readiness of the studied hospitals with a score of 52.18% was at an average level. The lowest level was related to the acceptance with a score of 37.98% and the highest level was related to the support with a score of 62.31% (Table 3). MAIN COMPARISON TO THE SIMILAR STUDIES Based on the findings, the level of general readiness of the studied hospitals against disasters was assessed at a moderate level (52.18%). In line with the results of the present study, the results of the study of Asefzadeh et al. (2016) have shown that the overall readiness of hospitals in all three dimensions of structural, non-structural, and functional is moderate [25]. The results of the study by Djajali et al. (2013) show that all Swedish hospitals are at a high level of readiness; while Iranian hospitals are at an average level [26]. ... [27]. According to the studies compared with the present study, it was found that hospitals in developed countries such as Sweden, England, Lithuania, and Luxembourg were more prepared than Iranian hospitals. The present study showed that the level of readiness of the studied hospitals was poor (37.98%) in terms of admission. The results of this study are consistent with the study of Bazyar et al. [10], which was performed on 36 studies with the research community of 181 hospitals in Iran. Also, the results of a review study conducted by Rezaei et al. (2018) to assess the readiness of 1,047 hospitals in 50 countries using the WHO guideline, show that hospital readiness for disasters in the area of triage is poor (16.28%) [28]. Therefore, hospital admissions in Iran, like many other countries, do not have the appropriate level of disaster readiness. In the study of Kazemzadeh et al., the readiness of emergency departments of 51 Iranian hospitals in the face of disasters has been assessed at a moderate to the high level, which is in line with the present study [29]. One of the reasons why the emergency department is more prepared than other departments may be related to the nature of the emergency department's work. ... [30]. LIMITATIONS In assessing the readiness of hospitals for emergencies, many variables are involved, including time, geographical conditions, type of accident, the hospital’s involvement in the crisis, and the number of clients, which make comparisons difficult. The research team also did not have information about the people who completed the checklists in the hospitals, and the views or tastes of different people may have influenced the scoring. SUGGESTIONS To identify weaknesses and strengthen all aspects related to hospital readiness, a disaster response maneuver should be held at least once a year under the supervision of the Ministry of Health. Maneuvering helps hospitals improve their capacity through practice. It is also suggested to use international standards such as WHO standards to improve the level of disaster readiness of Iranian hospitals and to accredit hospitals through international institutions. It is also recommended to conduct supplementary research on the most important problems of hospital admissions during disasters. The role of the military in all aspects of disasters, especially security, can complement the actions of hospitals. It is suggested that researchers study the coordination and interactions between hospitals and the military and examine the strengths and weaknesses, threats and opportunities of these interactions. CONCLUSIONS The readiness of Iranian hospitals is average. Also, the readiness of the studied hospitals was poor in terms of admission and moderate in terms of emergency, transfer and evacuation, traffic, communications, safety, human resources, as well as management and command. In terms of education and support, the level of readiness of the studied hospitals is good. ACKNOWLEDGMENTS This study was conducted with the support of the Deputy of Research and Technology of Lorestan University of Medical Sciences in the form of a research project number IR.LUMS.REC.1399.154. Thus, the mentioned deputy is appreciated and thanked. CONFLICT OF INTEREST The authors state that there is no conflict of interest in the present study. FUNDING SOURCES This study was conducted with the financial support of the Deputy of Research and Technology of Lorestan University of Medical Sciences

Factors influencing the adoption of health information technologies: a systematic review

Introduction: The successful implementation of health information technologies requires investigating the factors affecting the acceptance and use of them. The aim of this study was to determine the most important factors affecting the adoption of health information technologies by doing a systematic review on the factors affecting the acceptance of health information technology. Methods: This systematic review was conducted by searching the major databases, such as Google Scholar, Emerald, Science Direct, Web of Science, Pubmed, and Scopus. We used various keywords, such as adoption, use, acceptance of IT in medicine, hospitals, and IT theories in health services, and we also searched on the basis of several important technologies, such as Electronic Health Records (HER), Electronic Patient Records (EPR), Electronic Medical Records (EMR), Computerized Physician Order Entry (CPOE), Hospital Information System (HIS), Picture Archiving and Communication System (PACS), and others in the 2004-2014 period. Results: The technology acceptance model (TAM) is the most important model used to identify the factors influencing the adoption of information technologies in the health system; also, the unified theory of acceptance and use of technology (UTAUT) model has had a lot of applications in recent years in the health system. Ease of use, usefulness, social impact, facilitating conditions, attitudes and behavior of users are effective in the adoption of health information technologies. Conclusion: By considering various factors, including ease of use, usefulness, and social impact, the rate of the adoption of health information technology can be increased

Designing a medical tourism website: a qualitative study

Informing plays a prominent role in attracting medical tourists. The enjoyment of proper medical information systems is one of the most important tools for the attraction of medical tourists. Iran's ability in designing and implementing information networks has remained largely unknown. The current study aimed to explore information needs for designing a medical tourism website.This qualitative study was conducted in 2015 for designing Hospital Medical-Tourism Website (HMTW). A purposive sampling method was used and data were gathered using a semi-structured questionnaire. Totally, 12 faculty members and experts in the field of medical tourism were interviewed. Data were analyzed using the MAXQDA10 software.Totally 41 sub-themes and 10 themes were identified. The themes included the introduction of hospital, general guide for patients, tourism information, information related to physicians in hospital, costs, treatment follow-up, online hospital appointment scheduling in website, statistics and news of hospital medical tourism, photo gallery and contacts. Among the themes, the participants highly emphasized four themes including costs (100%), tourism information (91.6%), information related to physicians in hospital, (83.3%) and treatment follow-up (83.3%).This profitable industry can be developed through considering information requirements for hospital medical tourism website

Study of Functional Vulnerability Status of Tehran Hospitals in Dealing With Natural Disasters

Introduction: At the time of disasters, hospitals are considered as one of the most important facilities which should provide emergency services continuously. The purpose of this study was to determine the functional vulnerability of Tehran hospitals in dealing with natural disasters. Methods: This cross-sectional study was conducted in educational hospitals of Tehran University of Medical Science (TUMS), in 2013. Of all 26 hospitals, 12 hospitals were selected through single-stage cluster sampling, including six general (Shariati, Amiralam, Sina, Imam, Hazrat Rasoul, Baharlou) and six specialized (Bahrami, Hazrat-e Aliasghar, Shahid rajaie, Roozbeh, Moheb yas, Children Medical Center) hospitals. Data were collected using World Health Organization (WHO) checklist for functional indicators of safe hospitals, recommended for countries with similar climates. Data were collected through interviews with members of hospital crisis committees and direct observations. Data analysis was carried out using SPSS version 18 using descriptive statistics and Fisher's exact test. Results: Fifty percent of hospitals in the study, in terms of functional vulnerability status, were in satisfactory\ud condition with low level of vulnerability, 41.7% were in the moderate level and 8.3% were in a non-satisfactory condition with high levels of vulnerability. The results of Fisher's exact test showed that there wasn't a significant correlation between functional vulnerability and hospitals lifespan (p=0.99) and type of specialty (p=0.99). Conclusion: As this study, assesses hospitals' main weaknesses in terms of procedures, strategies, plans, human resources, monitoring and evaluation, it is essential that each of these areas be reviewed by hospital managers separately, in order to take significant actions to eliminate their weaknesses