One of the ways for preventing diseases is the transfer of health information by educating the patients and encouraging them to search for related information. Knowledge of patient information seeking behavior can provide health and health information experts with valuable information used to improve the patients' health. Although due to the abundance of health information, it is easily possible to prevent some chronic diseases, many people lose their lives or suffer serious complications from these diseases due to lack of knowledge about prevention methods. Therefore informing people about the progress of these diseases and useful prevention methods is of outmost importance. Investigating the patients' information seeking behavior and identifying their information seeking patterns can provide us with useful strategies for effective transfer of information to the patients, thus improving the patients' self-management and prevent progression of their disease. The aim of the current study is to introduce models and theories related to information seeking behavior of patients.

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Context: In crises, a lot of casualties and victims are referred to hospitals to receive health care services. Appropriate reaction to crises necessitates hospital readiness for such conditions. So, each hospital should have previously designed action plan for confronting the crises. Aims: This study aimed to determine the hospital disaster preparedness in Tehran and identify lessons learned on disaster and mass casualty management system. Settings and Design: A mixed qualitative and quantitative approach in hospital settings. Methods and Material: This descriptive- sectional study was performed in the 2013-2014. The 21 selected hospitals of Tehran comprised the study populations that were purposively selected. The Mass Casualty Disaster Plan Checklist was used for data collection. Also a part of data was gathered by focus group meetings with who were experienced. Statistical Analysis Used: The data analysis was performed using the IBM SPSS version 15 and ANOVA and Tukey tests. Results: The results showed that weakness of management and communications, structural problems, facility deficiencies, in appropriate organization of human resources, and budget inadequacy, were among the most important problems of hospitals in crisis. Conclusions: Hospital emergency incidence commanding systems is a standard system that can be used by all hospitals both in national and local levels. Using this system in hospitals, along with the systematic arrangement of human resources and exact distribution of managerial duties and developing a commanding unity can improve crisis management in hospitals.

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Primary healthcare is a vital strategy which remains the backbone of health service delivery. Primary healthcare is the day-to-day care needed to protect, maintain, or restore our health. For most people, it is both their first point of contact with the healthcare system and their most frequently used health service. In India concept of primary healthcare was laid down by the recommendations of Bhore Committee (1946). In last 6 decades of independence, we have seen much improvement in primary healthcare services, infrastructure, and related healthcare indices of the country. Still many challenges are ahead to achieve health for all. There is a need to review primary healthcare in the country to know our strengths and weaknesses to face the challenges in the future. This review article discusses the evolution of primary healthcare system in India over period of time. It also focuses on the challenge for primary healthcare system in current scenario and in future. A search strategy involved a detailed literature review on the subject of primary healthcare system in India. Indexed and non-indexed journals, websites of important organizations, and national programs in the field were identified and searched for key words. The most relevant publications were reviewed in detail and included in the present review.

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Quality in primary health care services is a key component in reducing all-cause mortality and disability cases. Quality in primary health care services is associated with adequacy of the features of primary health care and provision of preventive and promotive services. The purpose of the current study is to summarise the quality of primary health care in Uttar Pradesh (UP) and to identify important barriers that hamper quality service achievement. This review study was carried out in the year 2014 by searching Science Direct, PubMed and JSTOR, official reports and books. The search was conducted using the keywords primary health care, quality of primary health care, health indicators and barriers in health care delivery along with the term Uttar Pradesh and India. Studies were included if they address these pre-defined aspects of primary health care and published after the introduction of National Rural Health Mission in India. Therefore, studies, conducted before 2005 and not covered the aspects of primary health care are excluded from this review study. A total of 27 articles met the inclusion criteria out of 176 searched studies. The study results indicate that the quality of primary health care services is abysmally poor in primary health care setting of UP. The state has some of the deplorable health outcomes among the Indian states as consequences of poor quality in health care services. There are numerous barriers that impede quality services achievement and service utilisation.

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Background: Natural disasters are extreme geographical fragmentations with a high severity which can have catastrophic economic, social, and environmental impacts. Damage to the infrastructure can severely impede economic activity. Iran is a country which is highly susceptible to natural disasters and because of the unpredictable nature of the disasters, it is essential to be prepared for them. Objectives: The present study aimed to investigate the status of disaster preparedness in the hospitals of Shiraz, Iran. Materials and Methods: The present descriptive, cross-sectional study was conducted in nine government and six private hospitals of Shiraz, Iran. The study data were collected using a self-administered checklist through observation and interview. The checklist included 220 yes/no questions in 10 domains of emergency (30 questions), admission (24 questions), evacuation and transfer (30 questions), traffic (15 questions), communication (16 questions), security (17 questions), education (17 questions), support (28 questions), human workforce (21 questions), and leadership and management (22 items). Scores 0 and 1 were given to "No" and "Yes" choices, respectively. The validity and reliability of the checklist was confirmed in this study. Then, the data were analyzed through the Statistical Package for Social Sciences (SPSS) software (version 16). Results: Overall, the relative mean of disaster preparedness in the study hospitals was 62.3%. The highest and the lowest scores of the disaster preparedness were related to emergency and evacuation and transfer domains, respectively. Conclusion: Although the disaster preparedness in the study hospitals was good, they were not well prepared in some domains, such as evacuation and transfer, traffic, communication, and security; therefore, plans are needed to be developed in these regards.

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Aims: The management of leachate has become to one of the main focuses for the environment management. The aim of this study was a complementary treatment of leachate using sequencing batch reactor (SBR). Materials and Methods: A bioreactor was fed by effluent with 70-1360 mg/L chemical oxygen demand (COD) concentration. The values of pH and dissolved oxygen (DO) were monitored routinely. However, analysis of 5-days biochemical oxygen demand (BOD ₅ ), COD, and total suspended solid (TSS) was done in feed and effluent whenever the system reached steady state twice a week for 280 days. Results: The pH values in the influent were 7.4-8.16 that increased slightly up to 8 in the effluent. COD removal efficiency increased in bioreactor with time in all experiments up to 70%. The removal efficiency was 40-80% depending on the feeding values. TSS concentration in influent was ranged between 100 and 1860 mg/L that was decreased to 30-398 mg/L in the bioreactor effluent. In most cases, TSS values were below the standard limit. Conclusions: The acceptable performance of the SBR under different conditions suggests the promising capability of a full-scale, on-site SBR as efficient and versatile treatment system in handling the fluctuating nature of both the quantity and quality of composting leachate.

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Context: Improving patient safety in health systems is one of the main priorities in healthcare systems, for this reason clinical risk management in organizations has become increasingly significant. Although several tools have been developed for clinical risk management, each has its own limitations. Aims: This study aims to develop a comprehensive tool that can complete the limitations of each risk assessment and management tools with the advantage of other tools. Settings and Design: Procedure was determined in two main stages included development of an initial model during meetings with the professors and literature review, then implementation and verification of final model. Subjects and Methods: This study is a quantitative − qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment of the two parts of the fourth phase and seven phases of the research was conducted. Purposive and stratification sampling of various responsible teams for the selected process was conducted in the operating room. Final model verified in eight phases through application of activity breakdown structure, failure mode and effects analysis (FMEA), healthcare risk priority number (RPN), root cause analysis (RCA), FT, and Eindhoven Classification model (ECM) tools. This model has been conducted typically on patients admitted in a day-clinic ward of a public hospital for surgery in October 2012 to June. Statistical Analysis Used: Qualitative data analysis was done through content analysis and quantitative analysis done through checklist and edited RPN tables. Results: After verification the final model in eight-step, patient's admission process for surgery was developed by focus discussion group (FDG) members in five main phases. Then with adopted methodology of FMEA, 85 failure modes along with its causes, effects, and preventive capabilities was set in the tables. Developed tables to calculate RPN index contain three criteria for severity, two criteria for probability, and two criteria for preventability. Tree failure modes were above determined significant risk limitation (RPN > 250). After a 3-month period, patient's misidentification incidents were the most frequent reported events. Each RPN criterion of misidentification events compared and found that various RPN number for tree misidentification reported events could be determine against predicted score in previous phase. Identified root causes through fault tree categorized with ECM. Wrong side surgery event was selected by focus discussion group to purpose improvement action. The most important causes were lack of planning for number and priority of surgical procedures. After prioritization of the suggested interventions, computerized registration system in health information system (HIS) was adopted to prepare the action plan in the final phase. Conclusion: Complexity of health care industry requires risk managers to have a multifaceted vision. Therefore, applying only one of retrospective or prospective tools for risk management does not work and each organization must provide conditions for potential application of these methods in its organization. The results of this study showed that the integrated clinical risk management model can be used in hospitals as an efficient tool in order to improve clinical governance.

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Introduction: Hospitals are the most important treatment centers in case of occurrence of disasters. Therefore, ensuring the maintenance the structural and functional security of hospitals in critical conditions is a necessary issue. Creating safe hospitals cause the creation of assessment instruments such as risk assessment. Risk identification as the first step in enhancing preparedness of hospitals for disasters and trying in creating vital factors such as trained personnel, safe and accessible equipment. Doing assessments continuously can provide information necessary for enhancing the system. Methodology: The present study is a descriptive-analytical one conducted using a cross-sectional design in 2015 in Social Security Hospitals in Isfahan Province. To investigate the risk assessment, the Hospital Safety Index Standard Questionnaire was used. It was developed into two sections of general information of hospitals and in the second section; it includes 145 indices in structural, functional, and nonstructural fields. To complete the questionnaire, in each hospital, questionnaires were completed via observation and interviewing the owners of the process. The weighting method was based on the hospital safety index from 0 to 2. Data were analyzed using Excel software. Results: Investigating the results of safety in the three hospitals indicated that hospital 1 with about 64% has the highest level of preparedness and hospital 3 with about 62% has the lowest level of preparedness. In general, the three hospitals were at level B in terms of safety. Conclusion: The results obtained from the safety hospital index in the studied hospitals indicated that the safety level in the tree hospitals is at the moderate level. Although the state of them is not critical, they need planning and conducting measures necessary for improving safety levels, and these hospitals require necessary short-term measures for reducing damages.

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Medical errors have become an increasing public concern among policy-makers, healthcare providers and experts. Medical errors in the U.S. hospitals and healthcare institutions are the third leading cause of death and almost 98,000 people annually lose their lives in this way. According to healthcare and health industry leaders, using information technology enhances patient safety by preventing medical errors, assessment errors and surveillance system with rapid response and reduces the risk of harm created after the fact. In this paper, medical errors are investigated, the role of information technology in reducing and preventing medical errors is investigated, and recommendations are presented regarding the use of information technology for prevention and reduction of medical errors in healthcare institutions. Scientific databases and electronic journal citations were searched to identify articles that discussed the role of health information technology in reducing preventable medical errors and improving patient safety. We used reference tracking and citation methods and searched by following keywords: Information technology, medical errors, computerized provider order entry (CPOE), and clinical decision support system (CDSS). A total of 33 related articles were included in this study from the 609 articles initially obtained from the searches. Nature of medical errors occurring in healthcare organizations includes medication prescribing, treatment, procedures, diagnostic and administrative errors. Among systems and techniques that are used to prevent and reduce medical errors, CPOE, CDSS, EHR (Electronic Health Record), BCMA (Barcode Medication Administration) and RFID (Radio Frequency Identification) are well known. Studies show that in reducing errors, and improving quality of care, CPOE, CDSS and EHR are more effective than other technologies. The integration of CPOE with CDSS, also likely leads to a further reduction of medical errors. CPOE covers all three healthcare quality problems (low use, misuse and overuse). Furthermore, EHR increases the effectiveness of healthcare and reduces medical errors through reminders, alerts and internal intelligent capabilities.

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The frequent occurrence of damaging natural and technological hazards clearly demonstrates the urgent need of study of multi-hazards vulnerability assessment methods to effectively reduce the impact of multi hazards in the built envirenment. This study presents the Multi Hazard Casualty Model (MHCM). Two types of hazards will be assessed, namely earthquake and fire following earthquake. Our objective in this paper is to present the casualty model, to analyse the applicability of casualty model for the assessment of multi-hazards vulnerability of building and human with a GIS-based Analysis. Methods used in this paper are based on theoretical approach and documentation. The approach used for casualty model is based on semi-quantitative and quantitative analysis. The analytical vulnerability model use building damage and consequential triggering hazard (e. g. fire) for the evaluation of human casualties. An attempt to develop casualty model based on interactions among hazards and/or domino effects. To this task is to correlate second hazard casualties directly with triggering hazard. The focus is on indicating hazard relations to understand how potential hazards of various degrees and magnitudes might result in MHCM. It incorporated considerations for multiple and cumulative hazards occurrences into the overall assessment framework and methodology. Triggering (domino) effects, and building vulnerability are two major factors that can lead to effected casualties in MHCM. The model is implicated with data collected in a part of Shiraz City. The casualty model shows that structural failure is the primary cause of earthquake built environment casualties and that physical damage potential should be the foundation of estimation fire followind earthquake casualty. Other factors should also be integrated. In the present study has been done to present the casualty model and to analyse the applicability of casualty model for the assessment of multi-hazards vulnerability of building and human.

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Introduction: The awareness of using chemical, biological, and nuclear agents in everyday industrial and nonindustrial incidents has increased recently; release of these materials can be accidental or intentional. Since hospitals are the forefronts of confronting chemical, biological, radiological, and nuclear (CBRN) incidents, the goal of the present research was to provide a generic protocol for CBRN incidents through a comparative review of CBRN protocols and guidelines of different countries and reviewing various books, handbooks, and papers. Methods: The integrative approach or research synthesis was adopted in this study. First a simple narrative review of programs, books, handbooks, and papers about response to CBRN incidents in different countries was carried out. Then the most important and functional information was discussed in the form of a generic protocol in focus group sessions and subsequently confirmed. Results: Findings indicated that most of the countries had various protocols, guidelines, and handbooks for hazardous materials or CBRN incidents. The final outcome of the research synthesis was a 50 page generic protocol whose main topics included introduction, definition and classification of CBRN agents, four major phases of incident and disaster management cycle, hospital response management plan, equipment, and recommended supplies and antidotes for decontamination (radiological/nuclear, chemical, biological); each of these also had subtopics. Conclusion: In the majority of international protocols, guidelines, handbooks and also international and Iranian books and papers, there is an emphasis on the importance of incident command system, determining the safety degree of decontamination zones, maps of decontamination zones, decontamination process, triage classifications, personal protective equipment, and supplies and antidotes for decontamination; these are the least requirements for such incidents and also consistent with the provided generic protocol.

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Background: Nowadays, medical tourism and attracting foreign patients has been seriously considered by the ministry of health. Healthcare industry has faced the emergence of a global competition in the context of medical tourism. Shiraz is considered as a medical tourism hub in the South of Iran, even among the Persian Gulf states. The aim of this research was a study of medical tourism profile in Shiraz. Methods: In this cross-sectional study, 200 medical tourists referred to Shiraz selected hospital that were selected randomly entered the study within 6 months in 2012-2013. A valid and reliable questionnaire in English and Arabic languages was completed by medical tourists the collected data were analyzed using the software SPSS, version 15. Result: The results showed that most of them (50.5%) were form Oman, and they used operational ophthalmology services (45%) delivered in selected hospitals in Shiraz. Furthermore, most of their information sources about the services in the selected hospital were by medical tourism mediators or the translators (23%). Conclusion: Shiraz has a valuable competitive advantage including international popular and proficient specialists and physicians. Since Omanis patients were the largest number of foreign patients and hence this country has the potential to be one of the choices of the target market of medical tourism. Managing and using suitable informational sources and training and teaching translators capability in high communication skills and using experiences of traditional mediators, can develop the industry of tourism and attract tourist from different countries.

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Context: Patient's safety is the core part of healthcare service providing process and hence improving safety culture in hygienic care system plays a critical role in eliminating or reducing mistakes and generally improving the hygienic care quality. Aims: This study aims at evaluating the viewpoint of nurses working at selected hospitals of Isfahan toward patient's safety culture in 2013. Subjects and Methods: This study is a descriptive-analytical research. Sample community consists of 50 nurses of three selected hospitals in Isfahan and sampling method was chosen to be of stratified kind. Data gathering Questionnaire has been the patient safety culture evaluation questionnaire of the Agency of Healthcare Research and Quality of America (AHRQ). This questionnaire consisted of 44 questions categorized into 14 dimension, 10 dimension of patient safety and 4 dimension of consequences of patient safety culture. Statistical Analysis Used: Analysis of data from descriptive statistics has been conducted using SPSS version 18 software. Results: The amount of positive scores in 10 dimensions of safety culture and 4 dimension of safety culture consequences and almost in every factor of them was at acceptable level. The average of positive scores in 10 dimension of patient safety culture have been 73%, 83%, and 78% for charity, private, and public hospital respectively (feedback and communication about the errors) and lowest (teamwork in part) has the most points won have. Conclusion: Each organization can indeed improve the patient safety by knowing its weaknesses and strengths. For example in this research, hospitals must attention to feedback and communication about error and hospital management support form patient safety.

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Context: In the hospital environment, Acinetobacter baumannii (A. baumannii) can colonize the respiratory, urinary, gastrointestinal tract and wounds of the patients and can cause infections in burn, trauma, mechanically ventilated and immunocompromised patients. It shows a special predilection for the ICU. The most alarming problems encountered during this period are the organism's ability to accumulate diverse mechanisms of resistance and the emergence of strains that are resistant to all commercially available antimicrobials coupled with the lack of new antimicrobial agents. Aims: To study the resistance pattern of multidrug resistant (MDR) Acinetobacter spp. in ICU. Settings and Design: This is a 6-month retrospective study conducted in the Microbiology department. Materials and Methods: The present study was carried out in the Microbiology department of a tertiary care hospital and teaching institute. During the study period (Jan-June 2013), 370 samples were collected aseptically and processed immediately following collection. Growth was identified by observing the colony characteristics on the blood agar and MacConkey agar plates and biochemical reaction using standard microbiological methods. The bacterial isolates were subjected to antibiotic susceptibility testing by standard Kirby Bauer Disc Diffusion methods. Statistical Analysis Used: No. Results: Out of 370 samples, 83 (22.4%) samples were found to be positive for Acinetobacter spp. Among the 83 Acinetobacter isolates, 29 (34.9%) extended spectrum beta-lactamase (ESBL) and 8 (9.6%) were carbapenemase producers and 3 were MDR. Conclusions: Emergence of MDR Acinetobacter strains alarms us to take care of risk factors like irrational prescription of higher antibiotics, prolonged stay in ICU and use of mechanical ventilation. However, polymixin B and tigicycline are effective to treat infection caused by MDR Acinetobacter.

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Objectives: To survey the attitudes, awareness, and practice of evidence based medicine (EBM), and to determine the barriers that influence application of EBM in therapeutic process among clinical residents in Iran. Materials and Methods: A cross sectional survey was conducted during September to December 2012 at the teaching hospitals of Tehran University of Medical Sciences among 79 clinical residents from different medical specialties. A valid and reliable questionnaire consisted of five sections and 27 statements were used in this research. Most respondents (90%) completed the questionnaires voluntarily and anonymously. We inserted the data into Microsoft Excel 2007. Data were analyzed using Statistical Package for Social Sciences (SPSS) 16.0 software. We applied Spearman and Mann-Whitney test for correlation between variables. Results: Knowledge of residents about EBM is low and their attitude towards EBM was positive, but their knowledge and skills in regard with the evidence based medical information resources were mostly limited to Google Scholar. Lack of enough time to practice EBM and unperfect access to data bases were the main barriers. There was no significant correlation between residency grade and familiarity and use of electronic EBM resources (Spearman, P = 0.138). Conclusions: It is essential to improve their knowledge, skills, and capabilities to practice EBM. They can conduct EBM that should reduce medical errors and faulty diagnoses. Integration of training approaches like journal clubs or workshops with clinical practice is suggested.

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Introduction: Several constraining rules on infertility treatment in many countries lead to providing market in infertility treatments as one of the developing medical tourism markets. Further, many patients travel abroad to receive the services with lower costs. The present study attempts to identify Isfahan capabilities of infertility tourism. Materials and Methods: The present study is a qualitative research. The subjects participated were a group of 11 gynecologists working in the centers providing infertility treatment in Isfahan, who were chosen purposefully. To gather the data, they were given a semi-structured questionnaire and to analyze them, content analysis was performed. Findings: Total of 3 themes and 13 sub-themes were identified: Two sub-themes were stated as "the nature of foreign patients' demand" namely "Iranian citizens abroad" and "patients in neighboring countries". "Factors underlying therapeutic journey" includes "skilled gynecologists", "human resources professionals in fertility treatment" (16 persons), "cost advantage", "environmental features" and "ethnic and cultural advantage in Persian Gulf countries" which, in participants' point of view, all show Isfahan capabilities to succeed in infertility tourism. The third theme, "factors underlying medical tourism development", includes "basic tourism infrastructure enhancement", "infertility hospitals and clinics development", "inter-sectoral collaboration at the macro level", "inter-sectoral collaboration at the operational level", "marketing and information" and "census and registry system". Conclusion: Noting the capabilities of medical sector and low costs of infertility services in Isfahan, we can conclude that policy-making and comprehensive planning to remove the challenges at macro and operational level can make Iran more actively successful in the field.

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Aims: The main purpose of this study was to make an initial assessment on the possibility of anaerobic treatment of an extremely high strength leachate streams generated at Isfahan composting plant. Materials and Methods: In this interventional study, the pretreated composting leachate was fed intermittently to a anaerobic sequencing batch reactor (ASBR) at increasing steps of 6 g chemical oxygen demand (COD)/l.day (hydraulic retention time [HRT] =23 h), 33 g COD/l.day (HRT = 18 h), and finally 36.5 g COD/l.day (HRT = 12 h) for about 10 months. Reactor performance was investigated by measuring pH, total suspended solids (TSS), electrical conductivity, biogas production, COD, and TSS removal twice a week. Results: In pretreated composting leachate, biochemical oxygen demand 5/COD ratio was ranged 0.64-0.8. The pH value in ASBR was between 7.47 and 8.15 without any pH adjustment throughout the study. Conclusion: Although in loading rate of 11 g/l.day, most of the pollutants were decreased significantly, but aerobic process is required to ensure achieving national standard values for discharge in receiving waters.

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Context: Prenatal screening for antibodies to TORCH infectious agents is an important tool for diagnosis. Primary infections with TORCH in pregnant women can lead to serious complications that are initially unapparent or asymptomatic or mild infection in the mother but can cause much more serious consequences in the fetus. Aims: The aim of the study was to determine the seroprevalance of TORCH. Settings and Design: This is the 6-month prospective study conducted in central lab of Microbiology department at Sri Aurobindo Institute of Medical Science (SAIMS), Medical college and PG Institute, Indore. Subjects and Methods: Present study was carried out in the serology lab of Microbiology department in a tertiary care hospital and teaching institute; during the study period (July-Dec 2013), total 64 sample were collected for detection of TORCH seroprevalance (Toxoplasma, Rubella, Cytomegalovirus, CMV, Herpes simplex virus, HSV) by the commercially available TORCH ELISA kit following the manufactures instruction. Statistical analysis used: No. Results: Out of 64, tested by TORCH ELISA, 35 (54.68%) were positive for IgG in single infection [Rubella-15, toxoplasma-6, CMV-10, HSV-4] and 28 (43.75%) were positive for IgM [Rubella-4, toxoplasma-19, CMV-5]. In majority of the cases, 82.8% co-infection by TORCH agents were observed in our set-up. Conclusions: Serological screening is contributed to the prevention of congenital infections due to TORCH agent. Therefore, all the antenatal cases should be routinely screened for the TORCH infections, for carrying out early interventions to prevent fetal loss.

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Introduction: Journey to treat certain diseases or performing surgery in medical centers in another country is called medical tourism. This new industry to earn millions of dollars annually participating countries. Due to differences in hospital quality and cost effective services across the world they are attracting medical tourists. This study aimed to assess the level of preparedness of hospitals in Mashhad was to attract medical tourists in 2013. Materials and Methods: This cross-sectional study in four hospitals in Mashhad which attracts medical tourists (Imam Reza, Ghaem, Doctor Shaikh and Taleghani) was conducted in 2013. Data were collected using a researcher-made Checklist (22 questions), the field observations and interviews with hospital staff. Data using descriptive statistics (mean, standard deviation, and percent) and the Pearson correlation coefficient was also tested. Results: Most preparedness in attracting medical tourists among hospitals was 63.5% and minimum level was 46.75%. Most preparedness related to medical equipment and geographic conditions (87%) and the least amount of preparation on the website (20%). Pearson correlation between the level of preparedness of hospitals and numbers of foreign patients was not significant. Conclusion: In accordance with the regulations of the Ministry of Health hospitals were been in relative preparedness in attracting medical tourists. Hospitals should invest more on their strengths and unique abilities as they introduce their services; their role has become more prominent in this market. It can also be modified on the basis of the comprehensive plan, staff training and improvement of processes to produce the desired result.

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Introduction: Hospital, as one of the most important departments providing health services needs to regard safety principles due to its especial conditions. This study was conducted to assess safety in the hospitals affiliated to Isfahan University of Medical Sciences. Materials and Methods: This Cross-sectional and descriptive study was conducted in four hospitals affiliated to Isfahan University of Medical Sciences. Data collection instruments consist of the checklist and questionnaire which were completed through observation, the monitoring of documents and interview with the officials of different sectors. These equipments were designed and used in according to Australia`s safety Management Standards. In addition, the amounts of Cronbach's alpha for the checklist and questionnaire were 0.74 and 0.77 respectively. Hospitals safety condition was classified to very appropriate, appropriate, moderate, weak and very weak categories, according to the levels achieved by safety management standards. The study's results were analyzed by SPSS through ANOVA statistical test. Results: The averages and standard deviations of safety management scores of A, B, C and D hospitals were 62.5 ± 7.09, 49.08 ± 9.15, 60.01 ± 9.46 and 60.3 ± 5.76, respectively. The highest levels achieved by safety management standards were found in management, leadership and organization standards with 68.87 average score and also the least ones could be seen in the standard of the plan assuring quality with 36.09 average score. Conclusions: The condition of safety management in studied hospitals was mostly at the average level and in some cases was evaluated lower than expected. Since regarding the safety principles in hospitals are very necessary and crucial, they must be reconstructed and considered in the hospitals' policies and management rules.

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Introduction: Disaster occurs almost daily in the world and increases the issue of it because of high volume of population, industrialization, and acts of terrorism; my country is one of the most unexpected event areas of the world. Healthcare systems encounter special challenges in disaster management, that they include triage and treatment a large number victims and also victims' information management. To ensure correct way of documentation of victims as introduction information management and effective triage and treatment, useful medical record are necessary, because medical record usually used for patients are too complicated and ineffective to use in case of emergency. Objectives: The objective of this research is design the disaster-victim medical record to document and triage easily for victims in disaster. Materials and Methods: This research is an applied study and has been performed as descriptive study. Source of information is libraries and accepted articles in indexed journals. During survey of corresponding organizations about disaster in Isfahan and absence of a medical record for documentation of victims, researchers identified the organizations of disaster in the world and then gathered necessary data elements for medical record in disaster. Then necessary parameters for the medical record extracted from American and European models. Results: According to situation and standards of Iran, a proper and final pattern designed with assisting management and medical emergencies center in Isfahan province. Discussion: Medical record in disaster relief operations must be simple and useful; medical record used in hospitals is not effective. The proposed model is simple and proper form for documentation of victims and easy reference for accessing clinical, administrative, and statistics information in disaster.

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Context: Toxoplasma gondii, the causative agent of toxoplasmosis can cause significant morbidity and mortality in the developing fetus if the mother acquires acute infection during pregnancy. Transmission rate to the fetus increases from 15-65% with increasing gestational age. However, the severity of congenital disease decreases with increasing gestational age. Aims: To study the seroprevalance of Toxoplasma gondii in central India. Subjects and Methods: A total of 68 pregnant women between gestational age of 24-36 weeks were included in this prospective study during July to December 2013. All were attended at the antenatal clinic of Department of Obstetrics and Gynecology and most of them belonged to rural areas. Samples were collected and antibodies for Toxoplasma gondii were detected by using commercial ELISA kit from Calbiotech Inc, USA. Results: In our study, 14 (20.58%) out of 68 pregnant women were positive for toxoplasma IgG antibodies and 19 (27.94%) out of 68 were positive for IgM antibodies. However, only two i.e. 2.94% were both IgM and IgG positive. Acute infection during pregnancy was diagnosed if IgM positivity is there. Conclusions: Our study recommended that pregnant women should be screened and educated concerning the risk factors that contribute to toxoplasma infections and the importance of taking preventive measures.

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Introduction: Clinical risk management and medical errors have become a basic part in every hospital management. The critical complexity that controls the conditions of very ill patients in some specialized units like the operating room may increase the number of errors in providing healthcare services. Using failure mode and effect analysis (FMEA) method, the present study attempts to identify, assess and provide appropriate actions to control, reduce and eliminate the potential risks in the operating room in Feiz hospital in 2012. Materials and Methods: The present study is a qualitative research conducted in 2012 through direct observation, interview with the officials and authorities in the operating room, and available document review. The participants include the authorities in hospital units and those aware of processes in the operating room. To collect the data, the standard worksheet of the FMEA technique was used. Findings: Based on the authorities' point of view, eight main actions were selected to analyze the potential errors. The finding suggested that 35 failure modes were identified in the operating rooms at the Feiz hospital in Isfahan from among which seven potential failure modes were related to injection and transfusion, four to prechecking the apparatuses, 14 to the cares before and during the surgery, four to the cares after the surgery, one to the sterilization of the apparatuses, three to admitting the patients in the operating room, one to checking the blood glucose, and one to checking the doctors' instructions and prescriptions. Discussion: Based on the results presented, the following priorities were found to eliminate or reduce the identified errors: teaching the Haemovigilance system and an identification guideline of the patient to the personnel, full awareness of drugs and their possible side effects, teaching fluid therapy, controlling the operation of the apparatuses, teaching the health processes and controlling infection, and so on. Hospitals can easily provide a list of the required specific errors reported in the centers and introduce some approaches to deliver the services and enhance their quality, by performing a simple comprehensive technique and analysis, like the one presented in this study in all units.

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Background: Intestinal parasitic infections are important public health problems, especially in the developing countries like India. The prevalence of different parasitic diseases depends upon social, environmental, and economic factors. Aim: To evaluate the year-wise, gender-wise, and age-wise prevalence of intestinal parasites among the patients visiting a tertiary care hospital located in central India. Materials and Methods: The present study was conducted in the microbiology section of central laboratory located in our hospital. All the stool samples received in the laboratory were macroscopically and microscopically examined. The parasite prevalence data collected from June 2007 to May 2012 was evaluated retrospectively. Results: Out of the total 7,215 samples evaluated, 1,004 (13.9%) samples were found to be positive for least one parasite. A total of 969 (13.4%) samples had protozoan parasite and 35 (0.4%) samples had helminthes. Among these, the 670 (9.2%) samples had a single parasite, 278 (3.8%) had dual infection, 51 (0.7%) had triple, and 5 (0.07%) had quadruple infection. Discussion: The parasite prevalence gradually declined from the year 2007 (17.5%) to 2012 (11.7%). The rate of infection was found to be high in males (15.6%) as compared to females (12%) as influenced by day to day activity. More of the infected patients were found to be among age groups 21-30 years as affected by food habits and higher exposure of young adults to contaminated environments. Conclusions: The prevalence of intestinal parasitic infections has though declined year after year due to increased awareness, improved health and sanitary practices, and availability of potable water in our place; still negative reports can be increased by personal implementation of these practices by every individual from rural as well as from urban areas.

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The concept of medical social work had emerged towards the end of the eighteenth century, and has gradually become an integral element in the practice of medicine. It is executed with the help of Medical Social Worker (MSW) - a paramedical worker who has been trained in the social case work and art of interviewing. The aim of this manuscript is to describe the role of MSW in establishing a linkage between the healthcare system and the members of the community. The MSW is a pivotal member of the health team for any public health initiative whose success is based on community engagement and participation. Recognizing the importance of medical social worker in healthcare system, they are now considered as an essential part of the health care along with doctors and other allied health professionals in the analysis and correction of the social and emotional factors, eventually leading to ill health. They are also increasingly being relied upon for supplying information that is of fundamental importance in reaching the correct diagnosis and management of the patients' health. To conclude, the MSW plays a decisive role in helping sick people - individual-by- individual, both through the best use of the patient's capabilities and community resources and thus eventually assists in the strengthening of the healthcare delivery system of the entire nation.

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