Vol 4, No 4 (2020)


  • XML | PDF | downloads: 264 | views: 262

    Introduction: Activity-based costing system allows organizations to identify the actual cost of their services in terms of related consumed resources as well as increase efficiency of health service organizations. The purpose of this study was to determine the cost of Sonography and CT scan services by Activity-based costing method.

    Method: In this descriptive-applied study, the cost of 8 common Sonography and CT scan services was calculated using activity-based costing method at Imam Khomeini Hospital in Ahvaz. Data collection tools were lists and forms related to the direct and indirect cost lists of sonography and CT scan services and other related activity centers. To estimate the share of other departments in the studied services, first the shares of costs were determined, then attributable costs were calculated.

    Results: The highest and lowest deviations from the tariff were related to facial CT scan service (523,000 Rials) and lung CT scan (133,000 Rials) compared to the tariff in 2015, respectively. Also, the actual cost of all ultrasound and CT scan services, except for abdominal and pelvic CT scans, was higher than the government-approved tariff. The highest share of expenses was related to the depreciation cost of capital equipment (1,174,490,000 Rials) and the lowest share was related to the energy cost of consumables of activity centers (952,000 Rials).  

    Conclusion: The cost of most of the Sonography and CT scan services studied is more than the price set in the government-approved tariff table and has significant deviations. Extensive use of costing techniques such as (ABC) is essential to make tariffs more realistic and to continuously improve service delivery.

  • XML | PDF | downloads: 170 | views: 140

    Background and Objective: Chemotherapy‐induced neutropenia is one of the risk factors for infection in patients undergoing chemotherapy (due to weakened immune system). Febrile neutropenia (FN) may be the sole indicator of an underlying infection in these patients. Since infection is associated with an increased risk of mortality in patients undergoing chemotherapy, the study aimed to assess the incidence of FN in neutropenic cancer patients admitted to the oncology ward.

    Materials and Methods: This was a descriptive, cross-sectional study involving 52 patients (selected using census method) with signs of infection (FN) hospitalized in Ghazi Tabatabai Hospital (Tabriz University of Medical Sciences) in 2018-20. The participants consisted of 52 neutropenic cancer patients who developed FN and were admitted to the oncology ward of Ghazi Tabatabai Hospital in 2018-20. Collected data was written down in specific forms and analyzed using descriptive (frequency, percentage, and mean) and inferential statistics with SPSS v.20. Significance level was less than 0.05.

    Results: Absolute neutrophil count (ANC) was less than 500 cells/ml in 15.38% of the patients (8 patients). Infection was the cause of FN in 69.23% of the patients (36 patients). An unknown factor was the cause of infection in 30.77% of the cases. The incidence of all types of infections (perianal abscess, sepsis, oral infection, cutaneous infection, gastrointestinal infection, pharyngitis, pneumonia, and urinary tract infection) was higher in patients undergoing chemotherapy than those not receiving  chemotherapy.

    Conclusion: Infection is one of the main causes of FN in cancer patients admitted to the oncology ward.

  • XML | PDF | downloads: 168 | views: 245

    Introduction: The risk of power outages is a serious risk that in needed situations the emergency power supply system employs in a hospital, such as diesel generators and UPSs can be used. The purpose of this study is to investigate the safety and maintenance standards of emergency power generators of diesel generators in Tabriz hospitals.

    This is a descriptive analytic cross-sectional study which was done in 2015 in 18 hospitals of Tabriz. Data collected with a checklist which was created based on national standards. This checklist included 87 items which were categorized in 15 groups. Data were analyzed using SPSS v.19.

    Results: Average compliance with the safety and maintenance standards of the diesel generator in the standards of 111 questions and the standards of 87 questions were 61.4% and 52.8% respectively. In terms of compliance with the 19 standards, the "ventilation" standards and the "daily visit" standards were the lowest and highest in hospitals, respectively, with 28.94 and 96.24, respectively. There was a significant direct relation between compliance with the standards for diesel generator with hospital bed (P value = 0.01) and total power generation capacity by generators (P value = 0.05)

    Conclusion: The results of this study indicate a low level of safety and maintenance for emergency systems in hospitals. These scores are not suitable for a system called "Emergency", and if there are no interventions in this area; hospitals will face many problems in the event of natural disasters and human error.

  • XML | PDF | downloads: 82 | views: 116


    Background: Advanced medical imaging technologies (AMIT) are greatly associated with the pace, accuracy and ability of physicians to better diagnose and treat various diseases, and boost the possible potential of non-invasive operational procedures. Accordingly, this study aims to investigate inpatient use of MRI and CT and the effect of their use on inpatient mortality and length of stay (LOS) in Tehran general university hospitals.

    Methods: The study gathered its data from all general university hospitals in Tehran in 2017. Analysis unit was hospital. Multiple linear Regression model was constructed for each combination of technology and outcomes (mortality and LOS), and all models were Controlled for patients’ demographic and clinical characteristics and structural characteristics of hospital. In calculating Hospital standardized mortality ratio (HSMR) for each of seventy two 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 percent to 146 percent and, the average length of stay (ALOS) from 3 to 8.46 days. The use of MRI and CT had no significant effect on the HSMR and ALOS in the studied hospitals.

    Conclusions: Further use of AMIT has not improved efficiency and quality in health care. This research indirectly assessed the appropriateness of MRI and CT services in the studied hospitals, and it is possible that inappropriate and unnecessary use of these services affected the results. Better management of the use of AMIT requires clear rules and regulations with assertive commitment, in addition to establishing clinical guidelines with the support of insurance companies.





  • XML | PDF | downloads: 91 | views: 88

    Introduction: Human factor has, nowadays, become the source of change in organizations. The evaluation of human performance is a practical issue in human resources management and is the best way to obtain information for organizational decision-making. The purpose of this research is to monitoring the performance of health caregivers of health center, in east Ahvaz, in their self-care program.

    Method: To this end, this cross-sectional descriptive study was conducted on 72 health caregiver in 20 affiliated and 31 non-affiliated health bases in 2018. Census sampling method and ministerial checklist for the performance measurement of health caregivers were the tools of assessment. The checklist consisted of two parts for personal information and technical performance evaluation. Data were analyzed using T-independent test and ANOVA in SPSS22.

    Results: all participants were female health caregivers. The results showed that there was not any significant difference between the participants’ field of study (P=0.798; F=0.226), academic degree (P=0.957; t=0.003), age (P=0.419; F=0.955) and work history (P=0.537; F=0.627). The health caregivers of eastern Ahvaz health clinic scored 767.35 out the total 1000 indicating that their performance was generally at an acceptable level. 

    Conclusion: The findings of this research can assist the managers and experts of health sector to evaluate the performance of health caregivers in their self-care program. In order to enhance the performance of health caregivers, not only should health ambassadors be identified and trained but also the dimension of organizational self-care must be reinforced. 

  • XML | PDF | downloads: 166 | views: 156

    Background and Objectives: 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 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.

  • XML | PDF | downloads: 110 | views: 116


    Introduction: Due to health sector’s serious mission in maintaining the health and care of the community, the quality of provided health services has a particular importance. The aim of this study is to assess the quality of services in health centers in suburbs of West Ahvaz by examining the gap between expectations and perceptions.

     Method: This study was a descriptive-analytical and cross-sectional study that was conducted in 2018 on 291 clients of health centers in the suburbs of West Ahvaz. The data were collected through SERVQUAL standard questionnaire for assessing the quality. 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 SPSS22 software.

    Results: 89.55% the subjects were female and 10.45% were male. In all five dimensions of quality, there was a significant difference between the ideal status and the observed status (p-value <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 direct and significant relationship between each of the dimensions of expectations and same dimension in the perceptions section (p-value <0.001). 

    Conclusion: Expectations in all 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 other cases and the mean scores were at a higher level. In the area of increasing the quality of care in health centers in the suburbs of Ahvaz, some measures should be taken to increase the quality.

    Keywords: Quality, Health Care, Health Center, Ahvaz.


  • XML | PDF | downloads: 1755 | views: 733


    Spouse abuse is a major human problem in many communities, which not only has legal aspects but also considerably affects family as the primary social institution. The aim of this study was to determine the relationship between spouse abuse, obsessive-compulsive disorder (OCD), and predictors of domestic violence in women referring to comprehensive urban health services centers in Birjand.


    In this descriptive-analytical study, 475 women referring to comprehensive urban health services centers in Birjand were selected via cluster sampling method. Data were collected using a demographics form, Samuee’s standard Spouse Abuse Scale and Rabie’s Behavioral Measurement Scale for Obsessive-Compulsive Disorder. The collected data were entered into SPSS 16 software and analyzed using Mann-Whitney, Kruskal Wallis, and Spearman non-parametric tests. The level of significance was set at α = 5%.


    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, low-educated, 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 spouse. The mean score of violence was significantly correlated with some components of OCD, age of women and their spouse, and duration of marriage (P <0.05). OCD was determined as a good predictor of violence against women (P <0.05).


    It seems that many psychological problems of women such as anxiety and OCD can be attributed to unpleasant consequences of 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 as well as 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.

  • XML | PDF | downloads: 109 | views: 159

    Background and Objectives: Hospitals are the largest and most costly operating units of health systems and their share of current public expenditures in the health sector is between 50 to 80 percent. Higher hospital's efficiency will result in better use of the allocated resources in health sector. The aim of this study was to evaluate the efficiency of hospitals in South Khorasan using the Pabon Lasso model.

    Materials and Methods: This is a quasi-experimental and time-series study that investigates the efficacy of South Khorasan hospitals during 2010-2018 (before and after health reform plan). All public hospitals in South Khorasan province were enrolled in the study. Data (bed occupancy rate, bed turnover and patient length of stay) were collected from hospitals in summer 1397 and analyzed using SPSS version 21 software.

    Results: The average of the Pabon Lasso performance indicators for 8 years was 74.4% bed occupancy rate, 89.9 times the bed turnover and 3.01 days the average of length of stay. The coefficient of occupancy index after 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 hospitals were in region 1, 38% in region 2, 21% in region 3 and finally 6% were in 4th region in the Pabon Lasso Diagram.

    Conclusion: Just 21% of the hospitals were in the region 3 of the Pabon Lasso Diagram- which is the desirable region for effectiveness efficiency of hospitals-. This is not an acceptable statistics for hospitals and requires the intervention of health practitioners and policymakers.

Review Article

  • XML | PDF | downloads: 75 | views: 77

    Background and AimRheumatoid arthritis (RA) is a chronic and progressive systemic inflammatory condition, which affects mainly the joint synovial. There is not any definite treatment. The Object of this study was comparison effectiveness of combination leflunomide and Methotrexate to Etanercept.

    Material and Method

    A systematic review was performed to evaluate the Effectiveness of LEF + MTX in comparison with ETN. Electronic databases, including Cochrane, Pub Med, Scopus, and CRD were searched up to December 2015. Quality assessment was conducted by the Jadad score and The Cochrane Collaboration’s tools. Meta-analysis was calculated for effective outcomes in the included studies. Effectiveness was measured by ACR. This review was updated up to January 2019.



    2780 eligible articles were found in the search. Finally, five studies were eligible for inclusion. Effectiveness outcome showed an improvement in ACR criteria. The difference of improvement in ACR70 , ACR50,  ACR20  criteria in LEF + MTX group in compared with placebo were reported 78 / 0 % , 20 % , 27% and of ETN respectively were 0.003 % , 21.93 % , 32% .



    Combination of Leflunomide with Methotrexate was effective and it would be an effective combination which can be used before biomedical medication regarding their cost