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   2013| April-June  | Volume 1 | Issue 2  
    Online since March 4, 2014

 
 
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REVIEW ARTICLE
Metanarrative review: Current status and opportunities for public health research
Sanjeev Davey, Anuradha Davey, Jaivir Singh
April-June 2013, 1(2):59-63
DOI:10.4103/2347-9019.128111  
Metanarrative review (MNR) is a new way of doing systematic review (SR), for topics which are differently conceptualized and studied by different types of researchers in public health system research. The key aim of this paper is to explore current status and opportunities of MNRs for public health research. A SR on the key search word: "Metanarrative review for Public health research" was done from key indexed journals abstracting databases (PubMed, Cochrane, BioMed Central, and Google Scholar, etc.,) in all forms including e-journals till 31 st August 2013 since last 30 years. A total of 33 articles met the inclusion criteria, both types of studies showing its good role and no utility, were included. Major criteria of impact, effectiveness, and evaluation of MNR in health system research globally were taken in search. Studies from both developed and developing world were included including conferences data, research reports, and data from books, on role of MNR in health system research were taken (excluding thesis data) to draw final conclusions. MNR is a type of SR based on a MNR approach, suggested by Greenhalgh et al., (2005). It is a systematic' review rather than a traditional expert-driven literature review and it ensures a rigorous and extensive treatment of the literature in public health research. MNR has a great ability to show heterogeneous topic areas in public health system research by opening up the contrasting and complementary paths in which public health researchers have studied the same topic.
  4,824 408 3
ORIGINAL ARTICLES
Risk management status of anaesthesia equipment using standards of Emergency Care Research Institute
Arefeh Mousavi, Saeed Asefzadeh, Ahmad Reza Raeisi
April-June 2013, 1(2):72-77
DOI:10.4103/2347-9019.128117  
Context: Anaesthesia equipment failure can lead to incidents during anaesthesia and surgeries. A comprehensive system for risk management of anaesthesia equipment is necessary. Aims: Identify risks related to anaesthesia equipment, identify deficiencies and problems, provide solutions, planning and prevention from adverse event due to anaesthesia equipment in teaching hospitals in Iran. Settings and Design: Collected data were analysed in six dimensions. Then, the statistical comparisons between hospitals were done. Subjects and Methods: A descriptive-analytic study was designed. Instrument for data collection was a standard structured checklist that had been developed by Emergency Care Research Institute (ECRI). Checklists were filled onsite through direct observation and interviews with anaesthesia personnel in 46 operating rooms. Statistical Analysis: To statistical analysis one-way analysis of variance was used. SPSS statistical program, version 16, was used for performance all statistical analyses. P < 0.05 were defined as the level of statistically significance. Results: Descriptive statistics in this study indicated that total mean score of risk management status of anaesthesia equipment was 2.52 from the scale of 3. In the studied operating rooms, 69% complied with pre-determined standards, 14% needed improvement and 17% had no compliance. Routine check and alarm control were at good level. Maintenance, training, evaluation and monitoring and availability were at medium level. Conclusions: The risk management status of anaesthesia equipments in the studied hospitals are in good condition. The best means for prevention of adverse event-related anaesthesia equipment is using a viable and effective risk management programme. Development of programme in alarm control, maintenance, routine check, training and evaluation and monitoring of anaesthesia equipment is necessary strategy for this subject.
  4,109 325 -
Using failure modes and effects analysis techniques in assessment of medical records errors in Qadir hospital, Shiraz in 2012-2013
Hamed Rahimi, Erfan Kharazmi, Tahereh Shafeghat
April-June 2013, 1(2):92-98
DOI:10.4103/2347-9019.128122  
Introduction: Failure modes and effects analysis (FMEA) is a preventive method to improve and increase system safety. Using this technique, four selected process errors were identified, evaluated, prioritized and analyzed, in medical records section in Qadir hospital in Shiraz. Materials and Methods: This is an applied descriptive study in which using FEMA in medical records section were identified and analyzed. The included steps are: Processes selection, drawing processes flowcharts, determination of failure modes and effects by brainstorming, prioritization of failure modes, determination of root causes of failure modes using Eindhoven classification model. Results: Using FEMA methodology, we found that 41 failure modes in 4 selected processes. Totally, 13 failure modes with risk priority number ≥100 were identified as "non-acceptable risk" and their root causes were classified according to Eindhoven Classification model. Conclusion: By emphasizing on preventive approach and team work, FMEA technique can enhance staff precision and attract their attention to their possible professional weaknesses in recording medical errors and prevent their failure.
  3,768 294 1
Capabilities of infertility tourism in Isfahan: A qualitative study 1
Alireza Jabbari, Zahra Agharahimi, Sheida Hosseini, Farnoosh Safari
April-June 2013, 1(2):99-104
DOI:10.4103/2347-9019.128123  
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.
  3,393 286 3
Balanced Scorecard method: The success factor in achieving medical tourism objectives in hospitals
Somayeh Hessam, Shaghayegh Vahdat, Zohreh Seidmoradi
April-June 2013, 1(2):115-123
DOI:10.4103/2347-9019.128129  
Introduction: In the medical tourism industry, which is considered to be one of the branches of health tourism, understanding the component of medical tourism in healthcare centers and their evaluation in this area, especially with multilateral and multi-dimensional tools such as balanced scorecard (BSC) can be a solution for growth and improvement of performance in the health centers, care quality, and economic growth of the country. This research has been conducted aiming to create a BSC in order to determine factors which affect medical tourism in healthcare centers. Review method: Thisresearch isdescriptive in nature, conducted in 2012-2013 in an application form. The statistical population consists of clients, hospital managers, and university faculty members involved in strategic planning, managers of medical tourism and executive managers of Isfahan University of Medical Sciences. Since Delphi technique has been used in data collection, only 15-20 people were selected as sample models. In the present study the sampling method based on purpose was used. The research tool comprised a check list, which was given to the sample models and collected after its finalization. In order to ensure the results of the Delphi method and analyze the data obtained from the opinions of the decision-making group, operations research techniques (group decision-making method) has been used. Results: BSC method includes four perspectives, customer, learning and growth, internal processes and financial. The customer perspective includes two main measures customer loyalty and customer needs; the internal processes perspective includes four main measures, space and equipment, health indicators, excellence and referral system; the learning and growth perspectives includes three main measures, human resources, information and corporate culture; and the financial perspective includes two main sub measures, profit and service costs. Conclusion: The BSC method proposes four perspectives- customer, internal processes, learning and growth, and financial-in order to review an organization such as a hospital. Measures obtained in this way have significant universality to them, so that in comparison with other similar methods more measures will be reviewed and studiedin order to determine factors affecting health tourism.
  3,396 267 1
Crisis management competencies and their relation to self-efficiency of managers in the organizations related to disasters
Mohammad H Yarmohammadian, Maryam Fooladvand, Abbas Haghshenas, Golrokh Atighechian, Azadeh Alavi
April-June 2013, 1(2):64-67
DOI:10.4103/2347-9019.128113  
Aims: The present study aims at evaluating crisis management competencies and their relation among the managers of the major organizations dealing with disasters and tragedies in Isfahan, Iran. Materials and Methods: This was a cross-sectional descriptive survey. The population, which consisted of all the managers and experts in the mentioned organizations, were randomly selected and estimated to be 186 persons using the formula for sample size determination. The materials used were two researcher-made questionnaires, one regarding the managers' competency and the other on their self-efficacy, which were divided to three parts. The first part focused on the demographic characteristics, the second on assessing the managers' competency that included 32 questions, and the third on their self-efficacy in critical conditions. The validity of the questionnaires was confirmed by the key experts and officials in the field, and their reliability values were also determined using Cronbach's alpha, which were 94% for the competency and 97% for the self-efficacy questionnaire. To analyze the data, both descriptive (frequency, percentage, and mean) and inferential [t-test, analysis of variance (ANOVA), and factor analysis] statistics were used. Results: Data analysis revealed 53.4% of the subjects were females and 46.6% were males. Most managers were 34-43 years old. Those with degrees lower than BA were the least in number, and those holding BA formed the majority. Those studying management in various trends also formed a major part of the sample. Regarding the sample managers' background in management, the least amount of experience was 6 months and the highest was 26 years. Factor analysis of competency and self-efficacy also identified the managers' most important technical, cognitive, behavioral, and underlying characteristics. Conclusions: This study revealed the effects that each of the technical, cognitive, behavioral, and underlying characteristics have on managers in critical conditions, and showed their demographic characteristics (age, gender, education, amount of experience) also influence their competency and self-efficacy. Finally, it was found there is a statistically significant positive correlation between the managers' competency and self-efficacy: The more the managers' competency is, the more their self-efficacy is, and vice versa.
  3,189 344 -
Evaluation of the chemical and microbial quality of bottled water distributed during disasters
Mansooreh Dehghani, Hassan Hashemi, Mojtaba Karamimanesh
April-June 2013, 1(2):68-71
DOI:10.4103/2347-9019.128114  
Aims: Since during natural disaster all infrastructures such as water distribution system are damaged, access to safe drinking water is one of the first priorities following a disaster. The main aim of this study was to determine the chemical and microbial quality of bottled water distributed during disaster and compare them with National Iranian Standards. Materials and Methods: The microbial parameters (total coliform, fecal coliform) and chemical parameters (total hardness, calcium, magnesium, nitrate, nitrite, iron and fluoride) were determined according to standard methods. Results: The results showed that there were no microbial contaminations in any of the six different brands of mineral water. The total coliform and fecal coliform in all of the samples was not found. However, for the chemical composition, the concentration of the studied compounds was lower than standard. The amount of fluoride in all water samples was lower than 0.5 ppm. The hardness of six brands of bottled water in Fars was relatively high (121-180) and there was no iron in any of the samples. Conclusions: According to the results, though there was no microbial and chemical contamination in the studied bottled waters, the amount of fluoride in all water samples was lower than 0.5 ppm that may cause dental caries. Chemical quantities measured in this study were different from the amount listed on the label on bottled water. Therefore, the administrators need more control on labeling bottled water.
  3,136 248 -
Urban trauma centers locating using coverage supply-demand model
Nasser Pourmoallem, Seyed Ehsan Jafari Nasab, Amir Reza Barshan
April-June 2013, 1(2):85-91
DOI:10.4103/2347-9019.128120  
Introduction: Nowadays the factors of the considerable number of the human death are traffic accident, wars, and work incidents. The researches show that most of these deaths happen among the youth in their most productive period of life and result in many disability adjusted life years. Methodology: One of the ways of reducing these injuries is producing a medical system which increases the probability of the saving of severely injured persons. According to available scientific clues, trauma system can be a good solution to control the injuries. This system is an organized and coordinated effort which provides the injured persons with complete medical care in a given geographical region. It is also integrated with local medical systems. This system can decrease the measure of preventable deaths to 50% and the measure of all incidental death to 15-20%. One of the important matters in providing medical emergency services is the location of these facilities in cities so that more people can access them in standard time. Trauma center is an equipped hospital which is known as the heart of trauma system. The aim of this research is the selection of optimum location of some trauma centers with different levels as emergency medical services (EMS) facilities, out of some candidate location in Kerman city. In this paper, maximal covering location problem (MCLP) model from the available EMS location models, was used. Findings and Conclusion: The results of using trauma system and trauma center locating in Kerman city was not comparable with the present situation in which there is just one emergency services center in a hospital with low equipment and limited coverage. If a level-I trauma center is established in Kerman, 87% of demands of EMS will be covered, and if two level-II trauma centers are established, 98% of EMS will be covered. While the present coverage of demands by Kerman EMS center is less than 30%.
  3,053 234 -
Estimation of standard and quality of health indices for provinces by totally fuzzy analysis 1
Arashk Masaeli, Hossein Sadeghi, Ali Ghanbari, Mohammad Reza Vaez Mahdavi, Marzieh Javadi
April-June 2013, 1(2):109-114
DOI:10.4103/2347-9019.128126  
Introduction: With the expansion of new indexes in the area of health, calculation of these indexes has been welcomed by the intellectuals of this area. The present study determines the standard and quality of health in the provinces of Iran. Materials and Methods: The present analytical descriptive survey has used fuzzy logic to calculate the indexes of standard and quality of health, which is very similar to the relative and ambiguous concept of the standard and quality of health. The targeted community is also the provinces and the year of survey is 2007. Results: The calculations show that Chaharmahal and Bakhtiari, Tehran and Semnan have the highest ranks in terms of the standard of health and Chahrmahal and Bakhtiari, Yazd and Mazandaran have the highest ranks in terms of the quality of health; however, Northern Khorasan, Gilan and Sistan and Baluchestan are the critical provinces in terms of the standard of health and Kurdistan, Tehran and Sistan and Baluchestan are the critical ones in terms of the quality of health. Conclusions: The findings of Pearson's correlation coefficient show that there is a meaningful relationship between the indexes of human development and standard of health at the level of 0.005 as well as between the indexes of standard and quality of health at the level of ten percent; whereas no relationship exists between income per capita and the quality and standard of health which seems that in provinces level it is logical.
  2,771 226 -
Assistants' awareness of teleconsultation in Isfahan AL-Zahra hospital
Nahid Tavakoli, Asghar Ehteshami, Zohreh Savadkoohi, Shirin Sheivan
April-June 2013, 1(2):105-108
DOI:10.4103/2347-9019.128125  
Introduction: The use of health information transmitted by communication tool to provide health, medical care or patient education aimed at improving the patient's condition is named "teleconsultation". Simply put teleconsultations uses communication and information technology to facilitate access to medical specialists and aims to increase the quality and reduce the cost of health care through exchange of medical informations. The aim of this project is to investigate the knowledge of residents about teleconsultation. Materials and Methods: This was an applied and descriptive study in which the residents of Isfahan's Alzahra hospital were taken as the population study. The cluster random sampling was carried out using Morgan table to determine 146 persons. The data collection tool was made by the researchers and its validity and reliability were proofed using content validity and Cronbach's alpha (r = 80.1), respectively. Data were analyzed by using SPSS. Result: Residents' knowledge about the existent technologies of teleconsulting was 62.5 percent and about the benefits of this technology was 60.5 percent, and the limitations was 67.5 percent. The mean of resident's knowledge was 62.7. Conclusion: Most of the resident's knowledge was in regard to teleconsultations restrictions and the lowest knowledge in relation to the existent teleconsultation technologies. Residents were fairly good estimate of the total amount. Residents still need training to learn more about this technology and also to create the appropriate infrastructure, such as increased bandwidth of the internet and promote the culture of users can be appropriated.
  2,633 209 -
Study of complying with principles of burn diagnosis recording and coding in Imam Musa Kazim hospital according to the ICD-10 instructions
Sakineh Saghaeiannejad, Asghar Ehteshami, Mahtab Kasaei, Sedigheh Shokrani
April-June 2013, 1(2):78-84
DOI:10.4103/2347-9019.128118  
Introduction: Coding of disease makes it possible to recover data in the medical records for a diversity of medical, managerial, financial and research objectives. The correct coding of disease and medical interventions greatly helps to effective planning for prevention of injuries, especially burns. Therefore, in this study we aimed to determine the extent of complying with the principles of diagnosis recording and coding of inpatient burn cases in Imam Musa Kazim Hospital. Materials and Methods: This is an applied study with a cross-sectional descriptive method in which sampling was done from skin burn cases from October 2010 to September 2011 in Imam Musa Kazim Hospital using Morgan table, and 300 cases were studied. A researcher made questionnaire was used to collect data made up of two sub-questionnaires to evaluate the principles of diagnosis recording (with 21 components), and to evaluate the accuracy of diagnostic codes (with 15 components), respectively. Reliability and validity of questionnaires were confirmed by professors of the Department of Health Management and Information Technology at Isfahan University of Medical Sciences. The researchers studied 300 cases, and analysed obtained data using descriptive statistics (indices of central tendency and dispersion) and the Pearson correlation co-efficient and SPSS software version 20. Results: Findings showed that the overall compliance of the principles of burn diagnosis recordings is 78.27%, and the overall accuracy of codes assigned to burn diagnosis and related measures is 74.17%. No significant relation was observed between these two variables (r = −0.024, sig = −0.673). Conclusion: The principles of diagnosis recording and the burn coding are well complied. However, since there is no significant relation between the overall compliance of the principles of burn diagnoses and the accuracy of related coding, an improvement in the documentation of burn diagnoses and coding requires empowerment of both physicians and coding staff.
  2,591 248 -
LETTER TO THE EDITOR
Uttarakhand disaster: Is it natural or man-made?
Harshal Tukaram Pandve, Balkrishna S Lanjewar
April-June 2013, 1(2):124-124
DOI:10.4103/2347-9019.128132  
  2,031 202 -
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