Hospital Practices and Research

Abstract Background: Effective inventory management and control have been associated with numerous benefits for healthcare institutions, including improved organizational performance and enhanced competitive advantage.
Objectives: This study aimed to investigate the practices, impacts, and challenges of inventory management and control in two public hospitals in Ghana.
Methods: A qualitative phenomenological approach was adopted in this study. Thirty participants—comprising procurement managers, officers, storekeepers, and other relevant administrative staff—were selected through purposive and convenience sampling. Data were collected using in-depth interviews and focus group discussions. Thematic content analysis served as the primary analytical technique, complemented by interpretative phenomenological analysis to deepen the understanding of participants' lived experiences.
Results: Participants reported key inventory control practices such as First-In-First-Out (FIFO), Last-In-First-Out (LIFO), and First-Expiry-First-Out (FEFO). Positive outcomes identified included improved availability of medical supplies, reduced waste and cost, and enhanced patient safety. However, challenges included limited financial resources, delays in supplies, and instances of mismanagement or misuse of stock by healthcare staff.
Conclusion: The study recommends enhanced collaboration among healthcare stakeholders to address persistent inventory management challenges. It further encourages policymakers and hospital administrators to invest in inventory systems and staff capacity-building to strengthen overall healthcare delivery.

Abstract Background: Chronic kidney disease is a health problem in today’s world and hemodialysis is an alternative method for patients with chronic renal failure. Preparing provincial and national information on the situation of patients can play a significant role in improving the quality of services provided to patients undergoing hemodialysis.
Objective: This study aimed to investigate the characteristics of patients on dialysis in hemodialysis centers in Isfahan and some other centers (up to 30 km distant).
Methods: This cross-sectional study was conducted on 1,024 patients on dialysis in 13 dialysis centers in the early part of 2013. Studied variables were collected using a researcher-made questionnaire with Cronbach's alpha coefficient of 0.86. Data was analyzed using descriptive statistics and Chi-square test by SPSS version 22 software.
Results: The results of 1024 patients undergoing hemodialysis includes the following: 60% (610 people) were male with a mean age of 54±17.67 years, and 92% (867 patients) had a private house. The family history of hemodialysis was positive in 24% (229 patients). In this study, 38% of patients (365 patients) were illiterate and the most common cause of kidney disease was diabetes in 42% (436) of the patients. Vascular access was venous-arterial fistula in 52% (519 people) with a mean hemodialysis of 52 months. Chronic renal failure was estimated at 300 per one million inhabitants in Isfahan Province (based on the last census in 2011 with the population estimated at 4,815,863 persons).
Conclusion: Majority of the studied population variables was somewhat similar to the studies conducted in other provinces; the only major difference was the most common cause of chronic renal failure leading to dialysis.

Abstract Background: Dissociation is a symptom that can be related to traumatic childhood events. Dissociation in some cases is categorized in a distinct subgroup from other psychiatric disorders.
Objective: The purpose of this study was to investigate the prevalence of dissociative experiences in patients who have attempted suicide and who have referred to an emergency psychiatric center.
Methods: This was a cross-sectional epidemiological study in which dissociative experiences were evaluated in 98 patients who referred to Ibn Sina and Hafez hospitals after attempting suicide. In addition to determining the prevalence of these experiences, the relation between the symptoms and variables such as sex, age, marital status, education and suicide risk was determined.
Results: There was a significant difference in the level of disappointment between married and single patients (P = 0.047). The mean disappointment score for the overall population was 11.92, which is in the normal range. There was no significant relationship between the dissociation score and level of disappointment (P = 0.933). The prevalence of dissociative experiences was found to decrease as the age of the patients increased (P = 0.006). There was no significant difference between the rate of suicide as reflected in the measurement of disappointment and dissociative symptoms. There was no significant relationship between DES score and other variables.
Conclusion: One cause of psychological pressure in deciding to attempt suicide is family conflict. Many individuals who attempt suicide did not have a thought-out desire to take their lives, but attempted it impulsively in response to a periodic stressor.

Abstract Background: Child abuse is defined as any act or omission which causes physical or psychological harassment and lasting effects on children. Injuries resulting from child abuse are widespread, and this trauma can lead to psychological problems in adulthood.
Objective: The aim of this study was to investigate the correlation between a history of child abuse and suicide attempts.
Methods: In this case-control and retrospective study, patients admitted in 2016 to the toxicity emergency center in Yazd city, Iran, with symptoms of attempted suicide and patients of other conditions were recruited. Participants in the control and case groups were matched for age, gender, marital status, and place of residence. Each patient was given a questionnaire to collect information on demographics, history of suicide attempt or suicide in other members of the family, and history of child abuse (self-report scale) which investigated five aspects of childhood abuse (sexual, physical, neglect, lack of nutrition, and emotional neglect).
Results: The chi-square test and t test were used in the analysis. Mean severity rates of physical, sexual, neglect, nutrition, and emotional child abuse were 8.49, 6.42, 10.4, 6.43, and 9.62, respectively, for the case group and 7.89, 5.52, 7.88, 5.92, and 8.52, respectively, for the control group.
Conclusion: Statistical analysis revealed that except for nutritional abuse cases, the incidence rates of all other aspects of child abuse were significantly higher among cases than in the control group. The results of this study showed that a history of child abuse, especially sexual and emotional types, are correlated with the incidence of attempted suicide.

Abstract Background: Hospitals, the main providers of healthcare services, are costly centers which account for about 80% of the health sector budget and have a huge share of resources.
Objective: This study aimed to analyze the economic performance of selected military hospitals in Tehran using hospital indicators and inpatient bed-day costs.
Methods: This descriptive, cross-sectional, retrospective study conducted in hospitals affiliated with a military medical university. Data was collected with forms completed by referring to the hospitals’ finance and accounting, medical records, staffing, and logistics departments. The extracted data converted to hospital indicators using the appropriate formulas and analyzed using Excel and SPSS software with the T-test.
Results: The average bed occupancy rate (BOR) was 71%, the average length of stay (ALOS) was 2.5 days, the average bed turnover (BT) was 31 times, and the average bed turnover interval (BTI) was one day. The comparison of means of all the above-mentioned indicators other than BOR with the national standards was statistically significant (P < 0.05). Inpatient bed-day costs with and without capital costs were calculated to be 3 312 353 IRR and 12 253 775 IRR, respectively.
Conclusion: Higher BOR and BT and lower ALOS and BTI indicators were appropriate compared with the national standards, but the cost performance was not appropriate. An unreasonable increase in inpatient bed-day cost revealed that there were unused beds and that hospitals had no monitoring systems for revenues and expenditures. Therefore, serious attention must be given to the scientific criteria and principles of health economics to improve resource productivity.

Abstract Background: The issues of patient safety and healthcare quality have become increasingly important around the world since the 1990s. Many hospitals manage to reduce the number of adverse events (AEs) that can threaten patient safety in healthcare organizations. Assessing the existing patient safety culture gives hospital management a clear vision of an organization’s strengths and weaknesses. The Safety Attitudes Questionnaire, with its good psychometric properties and great internal consistency, has been used extensively to assess the patient safety culture in healthcare organizations.
Objective: Physicians and nurses form the core staff of each organization. With different demographic variables, they might perceive patient safety culture differently. This study purposed to identify critical demographic variables from the viewpoints of physicians and nurses that significantly influence the patient safety culture in a regional teaching hospital in Taiwan.
Methods: Linear regression with forward selection was employed in this study to focus on all physicians and nurses using results of a 2015 internal survey in the case hospital. Ten demographic variables were the independent variables, and seven dimensions of the Chinese version of the Safety Attitudes Questionnaire were dependent variables.
Results: Four out of 10 demographic variables had significant impacts on 6 out of 7 dimensions (with the exception of emotional exhaustion) from the Safety Attitudes Questionnaire. “Supervisor/manager” and “experience in position” followed by “age” were viewed by physicians and nurses as the most critical variables affecting the patient safety culture in this regional teaching hospital in Taiwan.
Conclusion: Assessing an organization’s current patient safety culture provides a significant value to improving patient safety. This study revealed that “supervisor/manager” and “experience in position” are the 2 most important demographic variables influencing the patient safety culture. Hospital management should take heed of the suggestions of staff members regarding these characteristics to continuously enhance their patient safety culture.

Abstract Background: Person-organization fit is an effective factor for recruiting, selection, and retention of human resources in organizations.
Objective: This study examined the correlation between person-organization fit and performance indicators used in healthcare in the hospitals affiliated with Qazvin University of Medical Sciences (QUMS).
Methods: This descriptive cross-sectional study was conducted in 2014. A total of 324 employees were randomly selected from among the study population comprising the staff of teaching hospitals affiliated with QUMS. The sample size was distributed between the hospitals using the class-ratio method. Data were collected using person-organization fit (Scroggins) questionnaires, and their validity and reliability were evaluated. Data analysis was done using Spearman-Pearson correlation, chi-square, and Kruskal-Wallis tests.
Results: In terms of values fit, personality fit, and skills, knowledge, and ability fit, hospital C ranked first among the hospitals tested with average ratings of 175.99, 195.53, 199.49, respectively. Significant relationships were found between person-organization fit and patients admitted per bed, median duration of patient stay, and crude mortality rate. No significant relationships were found between person-organization fit and the performance indicators of bed circulation and bed occupancy rate (p ≤ 0.05).
Conclusion: In order to show an association between person-organization fit and the performance indicators, more efficient use of resources and improved efficiency is suggested. Policymakers must pay more attention to person-organization fit during recruitment, selection, and assignment of staff.

Abstract Background: Tuberculous, parapneumonic and traumatic loculated pleural-effusions pose therapeutic challenges due to resultant pleural-thickening and compromised lung-function for life. Tuberculosis is widely prevalent in developing countries, necessitating appropriate, effective, and economical treatment for loculated pleural-effusion to reduce the burden and sequelae.
Objective: An uncontrolled and blind before-after intervention study to determine the effectiveness of intrapleural fibrinolytic therapy (IPFT) using urokinase in loculated pleural effusions was conducted at a tertiary-care respiratory center after obtaining approval and written informed consent.
Methods: Fifty-one patients with loculated pleural effusion were administered with repeated cycles of three doses of 1 Lakh IU of urokinase intrapleurally until complete drainage of pleural fluid. Pre- and post-IPFT clinical and radiological responses were compared using removal of fluid, ultrasound, and chest radiography were compared. The Kolmogorov-Smirnov test and paired t test with significance at a P value less than 0.05 were applied to test statistically significant differences in proportions and means, respectively.
Results: Tuberculosis was the most common etiology leading to loculated pleural effusion (80%), and 82.4% of tuberculosis patients required at least two cycles of IPFT. Complete resolution in chest radiograph after IPFT was observed in 80.4% of patients. Chest pain (13.7%) and fever (9.8%) were the most common undesired effects associated with IPFT. A statistically significant reduction in mean intrapleural fluid levels pre- and post-IPFT from 184±81 ml to 67±52 ml was observed.
Conclusion: IPFT with urokinase is an effective treatment modality in patients with post-tubercular loculated pleural effusions. IPFT has minimal and tolerable undesired effects and prevents sequelae such as pleural thickening and consequent compromise of respiratory function.

Abstract Background: Ankylosing spondylitis (AS) is a chronic, progressive, and disabling disease among rheumatological diseases.
Objectives: Current study aimed to investigate the Time lag between the onset of symptoms and final diagnosis of AS, and also identify the factors that contribute to that delay in Sulaymaniyah province.
Methods: In this cross-sectional study, 104 (AS) patients who satisfied the modified New York 1984 criteria were enlisted. The time lag was defined as the diagnosis delay (DD) between the appearance of the first symptoms and the correct diagnosis of AS. Spearman correlation analysis was used to detect correlations between variables.
Results: The higher percentage of variables with DD ≥ 6 years were urban 32 (74.4%), housewife 15(34.9%), had no family history 42 (97.7%), with high diploma 33 (76.7%), and positive HLAB27 31 (72.1%), the first specialist consulted orthopedics 21(48.8%) then GP 6 (14.9). Moreover, the higher percentage of variables with DD < 6 years were diagnosis years between 2000 to 2020, rural 55 (90.2), 39 (63.9%) respectively, higher education 47 (77%), employee and worker 22 (36.1%), positive family history 44 (72.1%), positive human leukocyte antigen (HLAB27-61) (100%), inflammatory back pain 47 (77%), rheumatologist 29 (47.5%). The average year’s DD is 6.48. A statistically significant positive correlation was detected between the DD and age, age at diagnosis but, a negative correlation was found between the DD time and, age at symptom onset.
Conclusion: The Time lag between the onset of symptoms of AS and the final diagnosis in Sulaymaniyah was 6.48 years. (HLA-B27), age, age at diagnosis, education level, occupation, 1st specialist, 1st symptom at onset of disease and family history are the factors that affect delayed diagnosis in Sulaymaniyah patients with AS.

Abstract Background: Prostate cancer screening is more commonly utilized by highly educated people. As shown by marginalization-related diminished returns (MDRs), the effects of socioeconomic status (SES) such as education on the health outcomes are considerably smaller for ethnic minorities than for Whites. The role of MDRs as a source of ethnic health disparities is, however, still unknown.
Objectives: The current study had two aims: first, to explore the association between years of schooling and having taken a prostate-specific antigen (PSA) test among men in the US, and second, to explore ethnic differences in this association.
Methods: This study was a secondary analysis of data from the National Health Interview Survey (NHIS-2015). The data of 5,053 men aged 55 years or older who were either Latino, non-Latino, African–American, or White were analyzed. Years of schooling was the independent variable. The dependent variable was taking a PSA test sometime during one’s lifetime. Age, region, and employment were the control variables. Ethnicity was the focal moderating variable. Binary logistic regression was used for data analysis.
Results: A higher number of years of schooling was associated with higher odds of having taken a PSA test, net of all confounders. Ethnicity showed a significant statistical interaction with years of schooling on having taken a PSA test. This interaction was suggestive of a smaller slope for Latino men than non-Latino men. White and African American men did not show differential effects of years of schooling on having taken a PSA test.
Conclusion: Similar to the MDRs patterns in other domains, non-Latino White men show more health gain from their years of schooling than Latino men. Highly educated Latino men still need programs to encourage their use of prostate cancer screening.

Abstract Background: Due to the expansion of addiction treatment clinics and the costs that these clinics incur on the government and the families of addicts, monitoring the performance of these clinics and the need to pay attention to the principles of management, efficiency, and effectiveness is essential.
Objectives: The present study was conducted to identify the factors affecting the management of addiction treatment clinics.
Methods: The present study is a descriptive-applied and cross-sectional study conducted in 2019. Experts and academic experts have been considered as the research community, and 18 people were selected as the research sample by the purposeful snowball method. Data collection tools were the review of relevant national and international documents as well as semi-structured exploratory interviews. Finally, after collecting information from the interview sections and reviewing the sources, the data foundation and coding methods (open, axial, and selective) were used to classify the data.
Results: The findings of the study showed that the effective factors in the management of addiction treatment clinics are dimensions such as organization, planning, control, guidance as well as leadership and treatment management.
Conclusion: According to the findings of this study, it can be concluded that the effective factors in the management of addiction treatment clinics can be a good basis to evaluate managers so that the policies and programs of the organization can be upgraded, modified, and reviewed.

Abstract Background: Foodservice is an important issue in hospital settings, and patients’ levels of satisfaction are often indicated by consumption and plate waste.
Objective: The current study compared patient satisfaction in hospital areas and other factors and determined the relationship between patient satisfaction and plate waste.
Methods: This quantitative research was performed in four East Malaysian public hospitals. Patients at these hospitals were asked to complete a questionnaire which had three parts: A) general information, B) patient satisfaction questionnaire (Acute Care Hospital Foodservice Patient Satisfaction Questionnaire), and C) plate waste scale (Comstock 6-point scale).
Results: A total of 189 patients participated. The results indicated that overall, 53.3%, 29.3%, 14.1%, 2.7%, and 0.5% of respondents rated the hospital foodservice as okay, good, poor, very good, and very poor, respectively. Average plate waste was 35% for all hospitals, and only 11% of patients finished all the food served. Satisfaction with hospital food differed according to the catering system (in-house and outsourced). However, the results also indicated that satisfaction with hospital foodservice was not significantly related to food wastage (r=-0.018, n=189, P=0.809).
Conclusion: Various factors in hospital foodservice, especially food quality, should be improved to motivate patients to consume hospital food.

Abstract Background: Outsourcing in healthcare is a cost-effective strategy that reduces costs and increases service quality. Managers must attempt to outsource healthcare services using scientific methods.
Objective: This study is a strategic analysis of the outsourcing of health services in one specialty and subspecialty hospital in Tehran.
Methods: This mixed method study (quantitative-qualitative) was performed in 2014 at one of the biggest specialty hospitals in Tehran. Data was collected through interviews, focus discussion groups (FDG), and the internal and external factors evaluation matrix. The study population comprised managers and directors of the hospital. Data was analyzed using Excel 2010 software and SWOT analysis.
Results: The final scores for internal and external factors were 2.16 and 2.68, respectively, indicating the hospital had a conservative strategic position for choosing outsourcing strategies.
Conclusion: Since this hospital had a conservative strategic position in outsourcing, managers were able to change their outsourcing strategy while considering its advantages and disadvantages and determining the type of services to be outsourced.

Abstract Background: A professional is an individual who prefers a profession, is specially qualified in its technical aspects, and makes a living with the profession.
Objective: This research was conducted to determine the professional values of nurses and the factors affecting them.
Methods: This descriptive research evaluated a sample of 97 nurses working in a private hospital in Ankara, Turkey. Data was collected using the demographic form and professional values scale (PVS).
Results: Among the nurses in the study sample, 43% had a graduate degree, 84.5% were staff nurses, and 37.2% were surgery, obstetrics, and cardiovascular surgery nurses. The mean score of professional values of nurses in this study was determined to be 4.20 ± 0.55. It was determined that professional values of nurses in the 34-year and older group, including male nurses, those usually working the day shift, those who chose the profession, those with memberships in associations, and those who participated in scientific meetings/seminars, had higher scores for professional values, but this finding was statistically insignificant (P > 0.05).
Conclusion: The professional values of nurses was found to be above the middle level. In this light, it can be recommended, especially to managers, that training on professional values should be planned for nurses. It is also recommended that nurses receive undergraduate education and other comprehensive studies. In order to achieved a desired position in nursing, nurses must update regularly their scientific knowledge, participate in scientific meetings/seminars, and become members of professional associations.

Abstract Background: Knowledge and attitude are the main indicators of awareness about the use of artificial sweeteners.
Objectives: This study aimed to evaluate the knowledge, attitude, and practices (KAPs) of patients with type 2 diabetes mellitus (T2DM) in relation to the consumption of low-calorie artificial sweeteners.
Methods: In this descriptive-analytical study, 400 diabetic patients admitted to the diabetes clinic of Bu-Ali hospital in Zahedan were selected by the census method. After recording the demographic characteristics, we assessed participants’ knowledge and attitude through a researcher-made questionnaire. Also, the subjects’ practices were evaluated based on their nutritional behaviors. The answers were marked as good, moderate, and poor.
Results: The knowledge and attitude of the study population were 39% and 34.8%, respectively at the ‘poor’ level, 58% and 58.3% at the ‘moderate’ level, and 3% and 7% at the ‘good’ level. There was a significant relationship between patients’ knowledge, attitude and their demographic indicators (p <0.001). Moreover, 8% of patients reported side effects after taking artificial sweeteners, and 20.2% of patients used artificial sweeteners in their pure form beside food.
Conclusion: The findings showed that half of the diabetic patients had moderate knowledge and attitude concerning the consumption of artificial sweeteners. They had limited information about low-calorie sweeteners, which affected their nutritional behaviors so that almost half of the subjects did not consume any sweeteners. It has been suggested that appropriate educational programs be designed and implemented to overcome this information gap.

Abstract Background: Patients’ waiting time for healthcare services is identified as one of the key measurements of an effective health system. This factor has an important role in patients’ satisfaction as well. One factor that is related to the waiting time is patients’ punctuality.
Objectives: the objective of this study was assessing the effect of patients’ and physicians’ punctuality on outpatients’ waiting time.
Methods: This was a cross-sectional study. The study population was outpatients that were admitted in clinics of a general non-educational hospital. 3500 samples were selected from all clinics. The sampling method was stratified randomized method. Samples were included after taking the informed consent. Data gathered by check lists that recorded the patients work flow at the clinic and the time of arrival to and departure of each station.
Results: About 34% of patients had appointment that 98.5% of them were unpunctual. The correlation of patient unpunctuality (positive and negative) and their waiting time indicated that these variables had positive correlation (P<0.001). Assessing the correlation of physicians’ punctuality and patients’ waiting time indicated that these variables also had positive correlation (P<0.001).
Conclusion: Appointment systems are very useful in controlling patients waiting time. This study identified that patient’s unpunctuality will increase patients waiting time. By the way negative punctuality will affect waiting time more that positive punctuality. Other important findings of this study were revealing the relation of physicians’ unpunctuality and patients’ waiting time. Punctuality of patients and providers are very important in the performance of appointment system in outpatient settings.

Abstract Background: Due to the importance of disinfectant and sterilization of dental instruments, in total, 14%–28% of dentists, 13% of assistants, and 17% of healthcare workers (HCWs) have been subjected to the hepatitis B virus (HBV), and more than 200 healthcare providers (HCPs) pass away annually in the United States from HBV infection catched from their work place.
Objective: This study examined the effects of glutaraldehyde 2% on Bacillus subtilis spores in the Surgery and Microbiology Department of the Dental Branch of Islamic Azad University.
Methods: This experimental research evaluated a total of 58 samples, one called first evidence (pure glutaraldehyde not exposed to spore suspension), one called second evidence (spore suspension not exposed to glutaraldehyde), and 40 samples including a suspension with a normal turbidity of 1×108 CFU/mL according to 0.5 McFarland with exposure to glutaraldehyde 2%. Experiments were done in time intervals of 10, 15, 20, 25, 30, 40, and 60 minutes with 8 repeats. In all times, a B. subtilis spore suspension was used as evidence and also as a case.
Results: This research was done on 58 samples. The results showed that in the 10th minute there were 102 colonies, 18.6 ± 3.4 in the 15th minute, 6.2 ± 1.4 in the 20th minute, 2.1 ± 0.8 in the 25th minute, and no colonies after 30 minutes. In an overall observation, it was seen that there were more colonies in the first 10 minutes, and from 15 to 20 minutes, this amount significantly decreased; after 30 minutes in each 8 repeats, the growth of colonies had stopped completely, while in the evidence samples, B. subtilis spores grew.
Conclusion: It seems that the density of 2% glutaraldehyde in 30 minutes time was enough to destroy the spores of B. subtilis.

Abstract Background: With regard to the particularly high prevalence, cost, and number of disabilities associated with diabetes, increasing patients’ knowledge and skills for managing the disease can help minimize the risks of complications.
Objective: The present study aimed to design and evaluate a mobile-based application with which patients with type 2 diabetes can increase their knowledge of and skills for managing their disease.
Methods: The current developmental-applied study was conducted in 2016 in a library and used a 2-step sectional format. The research population comprised 15 physicians and endocrinologists working in medical centers associated with Tehran University of Medical Sciences and 20 physicians and patients. Based on the library study, a checklist was designed and then distributed among participants. Their responses were analyzed using SPSS software version 20.
Results: The data was divided into 4 main sections: identity information (patient demographics), clinical information, education curriculum related to diabetes management, and program requirements for diabetes management, which consisted of 52 subsets. The evaluation of the system by doctors and patients showed that the system has high capabilities.
Conclusion: Mobile-based programs can help diabetics control blood glucose levels, reduce diabetes complications, and promote overall health.

Abstract Background: For decades, static stretching has been the standard benchmark for training programs, because it has been shown to increase flexibility compared with other methods of stretching.
Objective: The current study investigated and compared the effects of active dynamic stretching and passive static stretching on hamstring tightness.
Methods: For this experiment, 64 female students were enrolled and randomly assigned to active dynamic or passive static stretching groups (n = 32 each). The first and second experimental groups were trained with repetitive dynamic stretching and static stretching exercises, respectively. Exercises were performed 10 times per limb, 3 times per day, 5 days per week for 4 weeks. Hamstring muscle length measurements were repeated in weeks 2 and 4. Statistical analysis of the results was performed by t-test and repeated measures ANOVA using SPSS 15.
Results: Both experimental groups showed significant improvements in the active knee extension range of motion during the intervention (P < 0.001). However, active stretching showed better results and had a greater effect on range of motion in comparison with static stretching.
Conclusion: Active dynamic training can be considered a suitable method for increasing the flexibility of the hamstring muscle and, consequently, reducing the complications and problems associated with hamstring tightness.

Abstract Background: One way to improve the performance of hospitals, the largest resource-consuming units in the healthcare sector, is to continuously evaluate their performance.
Objective: The current study assessed the performance of hospitals affiliated with the Kurdistan University of Medical Sciences using data envelopment analysis (DEA).
Methods: This retrospective descriptive-analytic study used DEA to assess efficiency types (technical, managerial, and scale) in hospitals of the Kurdistan University of Medical Sciences (n = 12) in the years 2007 to 2011. The number of active beds, nurses, physicians (general and specialist), and other staff were inputs; inpatient admission and occupied bed days were outputs. Stata version 12 was used for data analysis.
Results: The mean technical, scale, and managerial efficiency values were 0.85, 0.89, and 0.95, respectively. The highest and lowest slack inputs were nurses and active beds, respectively.
Conclusion: The findings indicate that Kurdistan hospitals were less than appropriately efficient during the studied period. They also suggest that there is a capacity of about 15% for enhancing output in hospitals (compared with the most efficient studied hospitals) without increasing costs or inputs.

Abstract Background: Hospitals are the most important and largest providers of health services in the health system.
Objectives: This study aimed to examine hospital managers’ attitudes toward health promotion policies at a teaching hospital in Tehran, Iran.
Methods: This research was a descriptive-analytical study. The study population consisted of 75 senior and middle managers of a teaching hospital in Tehran, Iran in 2018. Sampling was conducted through a census. The study instrument was a researcher-made questionnaire assessing managers’ attitudes toward health promotion. The questionnaire was validated. Data were collected and then analyzed using SPSS 20 software.
Results: Total score of health promotion policies was estimated to be 84.5 ± 10.6 out of 100. The highest scores of the components associated with health promotion policies were 94.9 ± 9.34 and 93.8 ± 10.36 of 100 belonging to “Awareness of hospital staff of health promotion policies” and “Enjoyment of a written health promotion policy” items, respectively; while the lowest score was 75.4 ± 20.68 out of 100 belonging to “Informing patients, their companions, and staff about factors associated with the disease whose health is supported by the hospital”. The highest score of components associated with health promotion activities was 94.1 ± 9.74 out of 100 belonging to “Increasing patients’ trust by providing health promotion services” item and the lowest was 72.2 ± 19.4 out of 100 belonging to “Assessment of patient’s needs for health promotion” item.
Conclusion: Hospital managers’ attitudes score was high toward health promotion policies and activities, but there are still problems with health promotion activities, the most important of which is a therapeutic-centered perspective.

Abstract Background: A green hospital is a hospital that improves people's health by continuously reducing environmental consequences and eliminating its harmful effects. Therefore, in recent years, the concept of "green hospital" has been created due to sustainable development with the aim of controlling costs and protecting the environment.
Objectives: The purpose of this study was to determine and compare the level of compliance with the standards of green hospitals in teaching hospitals in Yazd.
Methods: This descriptive-applied study was conducted in 2022. A standard checklist was used to collect data. This checklist included 11 areas and 96 questions. For data analysis, frequency and percentage were used in SPSS26 software.
Results: The level of compliance with the standards of green hospital was 75.88%, the highest score was related to Shahid Dr. Rahnamon Hospital (80.55%) and the lowest score was related to Shohadai Mehrab Hospital (70.13%). The waste water management variable was obtained with 61.3% as a priority for improvement, and the highest score was obtained in the area of hazardous consumables (90.73%).
Conclusion: It seems that the teaching hospitals of Yazd had an average status in the field of environmental protection and controlling costs and pollution as well. Therefore, in order to comply with the standards of green hospital, a comprehensive planning is required regarding the 11 studied areas, so that in addition to focusing on their strengths and improving them, also covering the weaknesses and bringing them to an acceptable level is recommended.

Abstract Background: Human rights, which are very important for the health system and hospital accreditation requirements, include the issue of patient rights in hospitals. Artificial Intelligence (AI) is one of the advanced technologies in this industry, which aims to improve the standard of medical services for patients.
Objectives: This study was conducted with the aim of improving the enhancing patient's rights criteria in hospital accreditation standard by using AI (case study: selected hospitals in Zahedan county), which examines the factors affecting patient rights and the benefits of using AI.
Methods: According to the subject and purpose, the research approach is cross-sectional and descriptive, which was conducted in several hospitals in Zahedan in 2023. Experts in this field were given a questionnaire to complete as part of this study. Then the most important effects in this field were ranked.
Results: Experts ranked the factors of better disease diagnosis, prevention and prediction, advanced treatment methods, and easier access to medical data as the most important factors. The findings of this study indicate that if AI is used in selected hospitals of Zahedan, the rights of patients will be consistent with international validation criteria.
Conclusion: The factors covered in this study are necessary for the successful integration of AI in the health system, as well as following the guidelines that apply to any other intelligent system, including technical training and considering organizational, managerial and economic aspects. In order to intelligently adapt these systems, stakeholders in the health sector must use these components.

Abstract Background: Cutaneous leishmaniasis (CL) is one of the most significant parasitic diseases in Iran and other endemic regions. Existing standard treatments face challenges, including drug toxicity, difficulty in administration, and parasite resistance.
Objectives: In this study, nano chitosan based on dendrimers (NChi), which has antibacterial and antiparasitic effects, was used to target Leishmania major in vitro.
Methods: NChi was synthesized first. Fourier transform infrared spectroscopy (FTIR) and dynamic light scattering (DLS) were used to confirm the synthesis and measure the size, while scanning electron microscopy (SEM) was employed to examine the nanostructure's morphology. After assessing the cytotoxicity of the NChi on the macrophage cell line, the antileishmanial effects of NChi were evaluated after 24 and 48 hours. Finally, the data were statistically analyzed using the ANOVA test in SPSS software.
Results: The results demonstrated that NChi, with a size of 128.5 nm, is suitable for drug delivery. FTIR analysis confirmed the successful synthesis of the nanostructure by indicating the attachment of chitosan to the dendrimer. The MTT assay on macrophage cells showed no cytotoxicity of the synthesized nanocomposite at the applied concentration. Moreover, after 48 hours, the NChi exhibited significant antileishmanial activity, achieving 100% growth inhibition at a concentration of 40 µg/ml.
Conclusion: This study highlights NChi as a more effective alternative to conventional chitosan for leishmaniasis due to its optimal size, stability, and potent anti-promastigote activity, positioning it as a promising substitute for chemical drugs like glucantime.

Abstract Background: Major Depressive Disorder (MDD) often presents with cognitive deficits, including impairments in attention and short-term memory, which can significantly impact patients' quality of life.
Objectives: This study investigated the effectiveness of repetitive Transcranial Magnetic Stimulation (rTMS) on attention and short-term memory in patients with MDD.
Methods: This study adopted a quasi-experimental, pretest-posttest control group design, conducted in Yazd, Iran, during 2023. A convenience sample of thirty patients, aged 20-50 years, diagnosed with MDD, was recruited and subsequently randomized into either an intervention or a control group (n=15 per group). All participants received antidepressant medication (SSRI); however, the intervention group also underwent ten sessions of 5Hz rTMS at an intensity of 120% of the motor threshold, targeting the left dorsolateral prefrontal cortex (DLPFC), while the control group received sham rTMS. Cognitive function, specifically attention and short-term memory, was evaluated using the Wechsler Memory Scale. Statistical analysis was performed using SPSS-27, with analysis of covariance (ANCOVA) employed to assess treatment effects.
Results: Participants in the study included 30 individuals with MDD (male and female), with a mean age of 43.65 ± 6.49 years. The findings indicated that rTMS yielded statistically significant changes in attentional and short-term memory performance among these patients (P<0.01). This outcome demonstrates a beneficial impact of rTMS on cognitive domains affected by MDD, providing empirical evidence for its potential therapeutic role.
Conclusion: This study demonstrates that rTMS targeting the DLPFC significantly enhances attention and short-term memory in MDD patients. Consequently, these results suggest rTMS as a valuable adjunctive therapy for mitigating cognitive deficits associated with MDD through its neuromodulatory effects, offering a potential strategy to improve patients' daily functioning and overall quality of life.