Background: The activity-based costing system allows organizations to estimate the exact cost of their services based on the consumed resources, which in turn translates into increased efficiency of healthcare organizations.
Objectives: The current study aimed to estimate the cost of ultrasound and CT scan services using the activity based costing (ABC) method.
Methods: Following a descriptive-applied design, the total cost of the most commonly used ultrasound and CT scan services in Imam Khomeini Hospital of Ahvaz was calculated using the ABC method. Data were collected using special forms and a list of services’ costs. To estimate the costs for different hospital sectors, first, the principles of determining cost proportion per service were set, and then using the direct cost approach, costs were estimated.
Results: The highest and lowest differences from government-approved medical tariffs were related to the facial (523,000 Rials) and lung (133,000 Rials) CT scans, respectively. Also, except for abdominal and pelvic CT scans, the estimated cost of services was higher than the tariffs. The highest and lowest share of costs were related to the depreciation of capital equipment (1,174,490,000 Rials) and energy consumed by activity centers (952,000 Rials), respectively.
Conclusions: For most of the investigated services, the total cost was significantly higher than the approved tariffs. To make medical tariffs more realistic and to continuously improve the provision of healthcare services, it is necessary to use costing techniques like ABC.

Background: Chemotherapy-induced neutropenia is one of the risk factors for infection in patients undergoing chemotherapy (due to the weakened immune system). Febrile neutropenia (FN) may be the sole indicator of an underlying infection in these patients.
Objectives: Since infection is associated with an increased risk of mortality in patients undergoing chemotherapy, the present study aimed to assess the incidence of FN in neutropenic cancer patients admitted to an oncology ward.
Methods: This retrospective, descriptive, and cross-sectional study was conducted on 52 patients (selected using the census method) with signs of infection (i.e., FN) hospitalized in Ghazi Tabatabai Hospital in Tabriz, Iran, within 2018 - 2020. The data were collected by a researchermade form and analyzed using descriptive statistics (e.g., frequency, percentage, and mean) and chi-square in SPSS software (version 20). The significance level was considered less than 0.05.
Results: The absolute neutrophil count was less than 500 cells/ml in 15.38% of the patients (n = 8). Infection was the cause of FN in 69.23% of the subjects (n = 36). An unknown factor was the cause of infection in 30.77% of the cases. The incidence of all types of infections (i.e., perianal abscess, sepsis, oral infection, cutaneous infection, gastrointestinal infection, pharyngitis, pneumonia, and urinary tract infection) was higher in patients undergoing chemotherapy than that reported for those not receiving chemotherapy.
Conclusions:The results of this study suggested that cancer patients undergoing chemotherapy should be aware of infection signs; accordingly, they can visit treatment centers in case of the first symptoms of infection to prevent progression of infection and reduce mortality rates.

Background: Power outage risk is one of the serious risks that could be eliminated by supplying electricity through the emergency power system installed in a hospital, such as diesel generators and uninterruptible power supplies (UPSs).
Objectives: The present study aimed to investigate the observance of safety and maintenance standards of emergency power diesel generators in the hospitals of Tabriz.
Methods: This descriptive-analytical research was cross-sectionally performed in 18 hospitals of Tabriz in 2014. The data collection tools included a questionnaire and a checklist prepared according to the national standards and consisted of 87 questions in 15 categories. Data were analyzed using SPSS version 19.
Results: The average rates of observance of safety and maintenance standards of diesel generators in 111-question standards and 87-question standards were equal to 61.4 and 52.8%, respectively. Regarding the observance of the 19 standards, “ventilation” and “daily visits” standards with 28.94 and 96.24, respectively, had the lowest and highest degrees of observance in hospitals. There was a significant direct association between observing the standards defined for diesel generators with the number of hospital beds (P = 0.01) and the total capacity of emergency power generation by generators (P = 0.05).
Conclusions: The results of the present study indicate a low level of safety and maintenance for the emergency power systems of hospitals. These scores are not considered favorable for a system called “emergency”, and if the necessary interventions are not made in this regard, in the event of natural disasters and human errors, hospitals will face numerous problems.

Background: As fast and accurate techniques, advanced medical imaging technologies (AMIT) allow healthcare professionals to better diagnose and treat various health conditions, which translates into higher use of non-invasive operational procedures. Objectives: The current study intended to investigate the effect of inpatient use of MRI and CT scan on the inpatient mortality and length of stay (LOS) in Tehran general university hospitals.
Methods: Data were collected from all general university hospitals in Tehran in 2017. A multiple linear regression model was constructed for each combination of technology and outcomes (i.e., mortality and LOS), and all models were controlled for patients’ demographic and clinical characteristics and structural profile of hospitals. In calculating hospital standardized mortality ratio (HSMR) for each of 72 diagnosis groups related to death, a binary logistic regression model was fitted with predictors including LOS, admission type, comorbidity level, sex, and age.
Results: The use of CT varied from 0.39 to 149.35, and MRI from 0.24 to 80.23 exams per 100 discharges. The HSMR ranged from 76.8% to 146%, and the average length of stay (ALOS) was 3 - 8.46 days. MRI and CT had no significant effect on the HSMR and ALOS. 

Conclusions:Further use of AMIT was not linked with improved efficiency and quality but was associated with better resource management in healthcare organizations. Effective management of the AMIT use requires clear rules and regulations with assertive commitment, in addition to establishing clinical guidelines with the support of insurance companies.

Background: Human factor has currently become the source of change in organizations. The evaluation of human performance is a practical issue in human resources management and the best way to obtain information for organizational decision-making.
Objectives: The current study aimed to monitor the performance of health caregivers in the eastern health center of Ahvaz, Iran, in the self-care program.
Methods: This cross-sectional descriptive study was conducted on 72 health caregivers in 20 affiliated and 31 non-affiliated health posts in the eastern health center of Ahvaz in 2018. The census sampling method and ministerial checklist were the tools of assessment for the performance measurement of the health caregivers. The checklist consisted of two parts for personal information and technical performance evaluation. The data were analyzed using the t-test and analysis of variance in SPSS software (version 22).
Results: All the participants were female health caregivers. The results showed that there was notanysignificantdifferencebetweenthestudy dimensions with the participants’fieldofstudy (P = 0.798;F = 0.226), academic degree (P value =0.957; t = 0.003), age (P = 0.419; F = 0.955), and work experience (P-value = 0.537; F = 0.627). The health caregiversofthe eastern Ahvaz health center of Ahvaz scored 767.35 out of the total 1,000, indicating that their performance was generally at an acceptable level.
Conclusions: The findings of this study can assist the managers and experts of the health sector in evaluating the performance of health caregivers in their self-care program. For the enhancement of the performance of health caregivers, not only health ambassadors should be identified and trained, but also the dimension of organizational self-care should be reinforced.

Background: Chronic diseases confront the patients with questions about the meaning and purpose of life. This study aimed to determine the relationship between spiritual health and stress, depression, and anxiety in hemodialysis patients of Birjand Special Diseases Center in 2019.

Methods: In this descriptive-analytical cross-sectional study, using the census method, all dialysis patients referred to Birjand Special Diseases Center, Iran, were enrolled. A three-part questionnaire was used to collect information in this study. The first part deals with patient demographic information (age, gender, marital status, degree, occupation, duration of dialysis per week, and medical history), the second part includes the DASS21 standard questionnaire and the third part includes the Ellison-Palutzian spiritual health standard questionnaire. Data analysis was performed by the Mann-Whitney, ANOVA and Pearson correlation coefficient.

Results: In this study, 119 hemodialysis patients were studied, of which 77 (64.7%) were male. The mean depression, anxiety and stress of the participants in the study were 18.8 ± 7.52, 16.43 ± 7.13 and 19.36 ± 8.31, respectively. The mean spiritual health of the patients studied was 82.37 ± 12.12. The results showed that there was a significant (P<0.05) inverse relationship between spiritual health and depression, anxiety and stress in the patients studied.

Conclusion: The findings showed patients with higher spiritual health scores experienced less anxiety, stress and depression. So that, more focus should be on improving the spiritual health of hemodialysis patients by medical staff in the process of admitting and dealing with them in hospitals and medical centers.

Background: Due to the health sector’s serious mission in maintaining the health and care of the community, the quality of provided health services is of particular prominence.
Objectives: This study aims to assess the quality of services in health centers in western suburbs of Ahvaz by examining the gap between expectations and perceptions.
Methods: This was a cross-sectional study and conducted in 2018. The sample size included 291 people visiting health centers in western suburbs of Ahvaz. The data were collected through the SERVQUAL standard questionnaire for assessing the quality. This questionnaire assesses five dimensions of the quality of the provided services. These five dimensions include tangible factors, reliability, responsiveness, assurance, and empathy. Pearson correlation coefficient test was used to investigate the relationship between the variables. Independent t-test was used to compare the means. Data analysis was performed through SPSS version 22.
Results: Overall, 89.55% of the subjects were female. In all the five dimensions of quality, there was a significant difference between the ideal status and the observed status (P < 0.001). The lowest gap was related to empathy (r = 0.25), and the highest gap was reported for tangible factors (r = -0.99). There was a significant positive correlation between each of the dimensions of expectations and the same dimension in the perceptions section (P < 0.001).
Conclusions: Expectations in all the dimensions, except for empathy, were higher than perceptions, and health centers were far from ideal. Among these dimensions, expectations and perceptions in the area of reliability were higher than in other cases, and the mean scores were at a higher level. In the area of increasing the quality of care in health centers in suburbs of Ahvaz, some measures should be taken to promote the quality.

Background: Spouse abuse is a major human problem in various communities, which not only has legal aspects but also considerably affects family as the primary social institution.
Objectives: The aim of this study was to determine the relationship between spouse abuse and obsessive-compulsive disorder (OCD) and identify the predictors of domestic violence in women visiting comprehensive urban health services centers in Birjand, Iran.
Methods: In this descriptive-analytical study, 475 women visiting comprehensive urban health services centers in Birjand were selected via the cluster sampling method. Data was collected using a demographics form, Samuee’s Standard Spouse Abuse Scale, and Rabie’s Behavioral Measurement Scale for obsessive-compulsive disorder. The collected data was entered into SPSS 16 and analyzed using MannWhitney, Kruskal Wallis, and Spearman non-parametric tests. The level of significance was set at α = 5%.
Results:The mean scores of OCD and domestic violence in the studied women were 9.7 ± 5.1 and 77.1 ± 27.9, respectively. Of all the participants, 86.5% had experienced mild violence, 9.3% moderate violence, and 4.2% severe spousal violence. Moreover, 42.9% of women were suffering from OCD. The mean score of violence was significantly higher in addicted women, women with OCD, and women with unemployed, loweducated, or addicted spouses (P < 0.05). Furthermore, women who had a history of family conflict or parental conflict were significantly influenced by violent, high-risk, and arrogant behaviors of the spouse. The mean score of violence was significantly correlated with some components of OCD, age of women and their spouses, and duration of marriage (P < 0.05). Obsessive compulsive disorder was determined as a good predictor of violence against women (P < 0.05).
Conclusions: It seems that numerous psychological problems of women, such as anxiety and OCD, can be attributed to family violence. On the other hand, anxiety and OCD can increase the level of incompatibility in women and make them more vulnerable to violence. Therefore, the identification of cases of violence and spouse abuse and the timely detection and treatment of OCD in women can ensure the physical, emotional, and psychological security of women in a family, and thereby contribute to the stability of the family and community and reduce social harms.

Background: Hospitals are considered as the most central and resource-consuming units in the healthcare system. They use from 50 to 80% of public expenditures. As hospitals become more efficient, the better the allocated resources in health sector will be used.
Objectives: The aim of this study was to assess hospitals’ efficiency in South Khorasan using the Pabon Lasso model.
Methods: In this quasi-experimental and time-series study, we investigated the efficacy of South Khorasan hospitals during 2010 - 2018 (before and after the implementation of the health reform plan). All public hospitals in South Khorasan province were enrolled. Data including bed occupancy rate (BER), bed turnover (BT), and patient length of stay (LOS) were collected from hospitals in summer 2018 and analyzed using SPSS, version 21.
Results: The means of the Pabon Lasso performance indicators for eight years were 74.4% for bed occupancy rate, 89.9 times for be turnover, and 3.01 days for the length of stay. The coefficient of occupancy index after the implementation of the health reform plan was 5.7% higher than before, the bed turnover index increased 4.1 times, and the average length of stay increased by 0.08 day. On average, 35% of the hospitals were located in region 1, while 38% in region 2, 21% in Region 3, and 6% in Region 4 in the Pabon Lasso Diagram.
Conclusions: Only 21% of the hospitals were in the region 3 of the Pabon Lasso Diagram, which is the desirable region for the efficiency of hospitals. This situation is not desirable and acceptable for hospitals. To increase productivity, interventions are required, and health planners and authorities need to apply economic tools for the improvement of this situation.

Context: Rheumatoid arthritis (RA) is a chronic progressive systemic inflammatory condition, which affects mainly the joint synovial and does not have a definitive treatment. Data was collected using the American College of Rheumatology (ACR) score, and different levels of improvement were shown as ACR20, ACR50, and ACR70. The aim of this study was to compare the effectiveness of combination of leflunomide and methotrexate (LEF + MTX) to etanercept (ETN).
Methods: This systematic review was performed to evaluate the effectiveness of LEF + MTX in comparison with ETN. Electronic databases, including cochrane, PubMed, Scopus, and CRD, were searched up to December 2015. Quality assessment was conducted by the Jadad scale and the Cochrane Collaboration’s tools. Meta-analysis was conducted for effective outcomes of the included studies. Effectiveness was measured by ACR. This review was updated up to January 2019.
Results: Overall, 2780 eligible articles were retrieved, five of which were eligible for inclusion. Effectiveness outcomes showed an improvement in ACR criteria. Differences in the improvement of ACR70, ACR50, and ACR20 criteria in LEF + MTX groups compared to placebo groups were reported 0.78%, 20%, and 27%, respectively, and these differences compared to ETN groups were respectively 0.003%, 21.93%, and 32%.
Conclusions: Combination of leflunomide and methotrexate is effective, and it can be used as before biomedical medications such as etanercept, as it is more cost-effective.