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Introduction: Optimum management of medical equipment in hospital settings has tremendous effects on decreasing costs and providing desired health and treatment services. This research has been undertaken to design a medical equipment management model for public hospitals of Iran. Materials and Methods: In this adaptive research, medical equipment management among United States of America, United Kingdom, Germany, Canada, Australia, Sweden and Italy, which have successful experiences and determined patterns for medical equipment management, are assessed with respect to 6 dimensions as structure, purchase, control, maintenance, training and distribution and according to the shared strategies in the mentioned countries, a model was designed for Iran's public hospitals. This model was validated using expert's survey in DELFI method. Results: In all of the studied countries, the medical equipment engineering unit is established for effective management of medical equipments and in direction with the main purpose of ensuring safety and improving patient care, clinical engineers are being trained. Trainings are designed according to international federation course plan for clinical engineers “which are combination of necessary engineering and managing courses for activities of hospital medical equipment management”. Under study issues include: precise need assessment for medical devices, balancing, use of life span expenditure, stock management, location finding, and needed physical space prediction, selection and purchase committee establishment, entering controls plus reception test, performance and safety control, activities documentation, using computerized systems for preventive maintenance and semi-centered distribution, are among necessary processes in the medical equipment management cycle of under studied countries' hospitals. Conclusion: Management and medical equipment engineering unit establishment in hospitals, selection and purchase committee formation, continuous equipment performance control during calibration process, equipment preventive maintenance according to workforce training schedule, training needed experts, and with respect to the topics of international federation courses for clinical engineering training in universities, will improve medical equipment efficiency in hospitals.

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Background: Medical equipment improvement and tremendous expenditure is allocated costs annually, so that optimum and proper maintenance management of equipment would have outstanding effects on health and treatment of medical training and research economies of the country. Present research was implemented aiming to examine effect of the medical equipment maintenance management systems on the hospital setting expenditures. Methods and Materials: In an interventional research, the model of medical equipment maintenance management system implemented in Imam Khomeini Hospital was examined precisely and based on appropriate software for Vali-e-Asr Hospital was designed. According to the model for all available medical instruments in Vali-e-Asr hospital with usage of more than 5 years (240 medical equipment) all costs were recorded in 2006 and compared with previous year (2005). Results: There wasn't any training for medical equipment operators and for its implementation necessity on 21.7% of equipment in the installation and start up phase with for 83.7% of equipments the operator was not fixed using of medical equipment maintenance management system, the repair events decreased from 78 events in 2005 to 58 events in 2006. Vali-e-Asr hospital recorded costs for maintenance and repair of medical equipment in 2006 was 801765375 Rials(Iran)which decreased to 513212912 Rials (Iran) according to accurate calculation of costs and auditing by medical equipment engineer and shows 36% saving in expenditures by medical equipment maintenance management system. Conclusion: Medical equipment computer–based maintenance, management system implementation and also using of medical engineers potentialities in hospital are necessary.

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Background: Hospitals need performance evaluation systems for development and competition in order to evaluate the effectiveness and efficiency of their plans, processes and human resources. The objective of this research is to design an evaluation system at hospitals through the use of the Balanced Scorecard. Methods and Materials: In this comparative study, the selected countries consisted of Australia, USA, Canada and New Zealand, and 34 public hospitals of Iran which were applying strategic planning. Performance evaluations were examined in terms of 6 aspects including mission, vision, strategies, perspectives, objectives and measures .A pattern was designed for performance evaluation of public hospitals in Iran and was validated using experts’ survey of DELFI method. Results: All countries had mission and vision as important aspects of their performance evaluation model while health effectiveness promotion was the most important strategy. High quality health services, resource development, innovation and guaranty in continuous services were other strategies. Perspectives of Balanced Scorecard included customer, internal processes, learning and development of staff and financial affairs. All of the countries had objectives and measures for each of the perspectives. Iranian hospitals had mission, vision, strategies and objectives but for them perspectives had not been defined and measures were not congruent with strategies and objectives. In the model, 4 perspectives were determined to describe hospital strategies and to use competition benefits as well. Conclusion: Applying measures of 4 perspectives including "Patients and Community", "Internal process and Productivity", "Growth and innovation" and "financial aspects" to doevaluation of Iranian public hospitals collates their performance, improves productivity of their resources and enhances patients and community satisfaction.

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Background: Recognition of mortality-related factors in Intensive Care Units (ICUs) could increase efficiency and effectiveness of these units. This research determined the relationship between the physical structure, human resources and their relevance to mortality rate in Intensive Care Units. Methods and Materials: In this cross-sectional study, all ICUs of hospitals in Markazi province were considered. Data gathering tools were resource (human, physical and training) questionnaires and checklists which their reliability and validity were accepted by Monitoring and Validation Center of Ministry of Health. Mortality rate after 24 hours of admition was also determined in relation to hospital resources and activities. Data were analyzed with descriptive statistics, Spearman and Kruskal-Wallis tests. Results: Total score of human, physical and training resources in hospitals of Markazi Province is 55 percent of the country standard score. Mortality ratio after 24 hours of admission, to all patients (released and deceased patients) was highest in Vali-e-Asr hospital (25%) and lowest in Saveh Shahid Chamran Hospital (5%). There wasn’t significant difference in this ratio among hospitals. There were no significant difference between obtained scores of each resource (human, physical and training) among University, Social Insurance and Qods (private) hospitals with respect to mortality rate 24 hours of admission. Conclusion: Human, physical and training resources have not direct effect on decreasing mortality rate after 24 hours of admission but can create necessary conditions for providing higher quality services.

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Abstract Background: Necessary to making constant revisions in the continuous education programs and updating the physicians’ knowledge in accord to the needs of society seems to be essential. The present study was conducted to conformity of continuous educational programs’ content of radiology department with needs of Continuous medical education learners, Markazi province, 2008. Materials and Methods: In this cross- sectional study, in 2008, the opinions of 40 physicians falling under continuous medical education (CME) were collected through a questionnaire on a Likert scale in more than 30 instructional topics. Before educational program performance, priorities in education were assessed and after performance, rate of coverage and requirements conformity with content was determined. Results: The most educational need was indication of chest x-Ray with mean of 4.21 and the less need was wrist MRI with mean of 2.42. After program performance, the greatest conformity of needs with educational content was indication of mammography (mean= 83.1) and wrist and shoulder MRI (mean=53.2) which was the least required. Though, there was a general correlation between need and content coverage in both areas of graph indication order and interpretation, but was not base on priority needs. There was significant relationship between physicians needs with educational needs (p<0.001). But about gender and work experience was not significant relationship. Conclusion: Lake of complete coverage of needs base on educational priority of CMS learners will seek greater attention and emphasis or scientific secretary and lecturer on needs in special educational objectives frame for accelerating of continuous education effectiveness.

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Background: Myopia is the most common refractive defect and degenerative myopia is one of the five causes of blindness in the world. The aim of this study is to examine degenerative myopia and its related risk factors. Materials and Methods: In this cross-sectional study, the data was collected through a questionnaire along with the auto-refraction apparatus, which was utilized for determining the myopic degree. The inclusion criteria for this study were the age above the 10, myopia or astigmatic myopia, apparent media (in fonduscopic examination), and the absence of age related retinal defect. Results: A total 65 patients participated in this study 51% of whom had degenerative myopia. Choroid neovascularization was observed in 17.65% of the subjects. There was a significant difference in the relationship between hypertension(r=28%), diabetes mellitus (r =22%) and glaucoma, and degenerative myopia however, this difference was not observed between cataract and myopia. The correlation coefficients between hypertension and diabetes mellitus, and degenerative myopia were 28% and 22%, respectively. This correlation was very low in the case of glaucoma. The greatest correlation existed between the myopic crescent and hypertension (r=0.295%). In all of the cases, the correlation coefficient between diabetes mellitus and all the myopic complications was positive but below 40%. Conclusion: The majority of the patients had degenerative myopia. Hypertension and diabetes mellitus were the most common co-existing diseases. Noticing the correlation coefficient existing between hypertension and myopia, the need for controlling hypertension and diabetes mellitus for preventing retinal complications is emphasized. Also, for preventing the adverse effects of degenerative myopia in retinal defects, controlling glaucoma is suggested.

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Background: Two of the most common complaints of patients who refer red to ophthalmology clinic are headache and asthenopia which are induced or intensified by exodeviation. This study was conducted to determine the relationship between exodeviation and headache or asthenopia. Materials and Methods: In this cross-sectional study, the sampling method, was screening of patients who referred to ophthalmology clinic with headache and asthenopia in 2006. Inclusion criteria were age above three, rejection of other causes of headache and asthenopia. Also, patients with organic headaches such as tumor were eliminated from the study. A questionnaire was provided for the patients and Cover-uncover test was also conducted for determining the existence of exotropia. Results: Of 206 patients, participating in this study, 90.77% had exotropia and the majority of them were female. The most common symptom in these patients was headache. A direct relationship was observed between both headache and asthenopia with exodeviation. Exodeviation also had a direct relationship with gender. Conclusion: Noticing the direct relationship between headache and asthenopia with exodeviation in patients referring with such complaints, exodeviation examinations must be done in order to prescribe surgical or non surgical treatments asneeded.

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Background: Job satisfaction is regarded as an individual's opinion of his or her job. Noticing the key role of hospital personnel in giving health services to patients, this study was designed to determine job satisfaction of hospital personnel in Arak. Materials and Methods: This cross-sectional study was carried out on 702 hospital personnel through simple sampling method. The means of gathering data were demographic and Herzberg's job satisfaction questionnaires. Job satisfaction was categorized in three levels. Results: Results in eight domains showed that most personnel's satisfaction of job environment (%75.2), relationship with co-workers (%49), salary and benefits(%75.1), job position(%60.5), job security (%64.6), supervision(%64),management policy(%59.2)and personal life relations (%65.7)were at average levels. Overall, %82.2 of the personnel had an average satisfaction with their jobs. The greatest level of satisfaction was with relationship with co-workers and the lowest level of satisfaction was related to job difficulty benefits, establishment of justice and fairness, discrimination and lack of facilities. X2 statistical test revealed significant differences amolay sex, level of education, type of employment, type of job and work shift. Conclusion: Overall, Job satisfaction in this study was at an average level. Increasing salaries, job difficulty benefits, on time payment and providing welfare facilities are essential for the improvement of job satisfaction in this group.

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Background: Leukemia, due to its widespread prevalence, high mortality rate, high treatment expenses, and long hospital stay, influences the families and their children to a great extent. This study was done to explore the experiences of parents whose children suffer from leukemia. Materials and Methods: Using qualitative research approach with applying content analysis method, 22 participants were interviewed in two teaching hospitals during 2 months. The study started by purposive sampling and continued by a theoretical one till data saturation. The obtained data were constantly analyzed through content analysis method. Results: Data analysis showed that “finding no solution in life, having a lot of problems, errors in treatment, concealing the illness, faith in God, parents’ devotion, hospital facilities, and consistency were the level 3 codes of parents’ experiences and “parents’ reaching a dead-end in life” was the main theme or core category of this study. Conclusion: Using a qualitative approach for exploring the experiences of parents with a child suffering from blood cancer helped recognize them more profoundly than quantitative methods. On the other hand, “parents’ reaching a dead-end in life” as the theme shows the importance of attention to parents’ problems. Using these experiences can increase hope among parents and help conduct the treatment more effectively.

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Background: Endophthalmitis is the most important complication after cataract surgery which its incidence can lead to severe loss of vision or even loss of vision therefore, methods of prevention are very important. This study investigated the influence of vancomycin consumption during cataract surgery on prevention of endophthalmitis.

Materials and Methods: In this experimental study, the study population included patients of cataract surgery that were admitted to Amir Kabir Hospital. The patients were randomly assigned to two groups: with and without receiveing vancomycin in serum. Demographic characteristics of the patients before surgery and incidence of endophthalmitis with the examination until two weeks after surgery were recorded. To compare the frequency (incidence) of infection, endophthalmitis in two groups, Fisher's exact test and X2 test were used.

Results: Of the 1281 patients, 539 were administered vancomycin in serum. The examination after two weeks indicated that 3 (0.23%) patients developed endophthalmitis. Of these, 2 (0.16%) patients belonged to the group without vancomycin and 1(0.07%) patient belonged to the group receiving vancomycin. Fisher's exact test did not show any significant differences between the groups receiving vancomycin and the control group in the prevalence of endophthalmitis.

Conclusion: Although the relative frequency of endophthalmitis in patients without receiving vancomycin was further than control group, the difference was not statistically significant. Thus, adding a drop of vancomycine was not effective in prevention of endophthalmitis and the causes should be sought in other cases.

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Background: According to the organizational intelligence to increase access of the knowledge in organizations and can to create competitive advantage in order to improve efficiency & effectiveness in organization, but that are affected by the structural dimensions of centralization, formalization, complexity (which reflects the characteristics of the internal organizations). This study aimed to investigate the relationship between organizational structure & organizational intelligence in Arak Medical University affiliated teaching hospital was performed.

Materials and Methods: In this study, the research community was comprised official staff that have high school diploma, working in hospitals that were selected for this study by sample stratified random studied. Tool for data collection, was questionnaire Robbins organizational structure and standardized questionnaire Alberkht about organizational intelligence. After confirming the validity and reliability of questionnaires, these were distributed between colleagues in teaching hospitals and then were collected. Using data collected from 16 SPSS software testing was analyzed by Spearman correlation coefficient.

Results: From 87 respondents, most of them have had a bachelor's degree and about 52 people who (74%) had experience about five years. The results were shown of the significant correlation between the organizational structure &intelligence in teaching hospital (r=-0.612 and p=0.001). The relationship between the complexity of organizational with organizational intelligence was not significant (r=0.157 and p=0.53), but by two other organizational dimension of structures (i.e., degree of formalization, centralization) with organizational intelligence was obtained significant respectively (r=-0.693 and p=0.001) and (r=-0.711 and p=0.001).

Conclusion: Based on findings from this research, teaching hospitals must be review current situation about organizational structural dimensions particular through decreasing centralization, formalization, to provide necessary field for developing and implementation of organizational intelligence

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Background: According to the toxoplasmic retinochoroiditis leading to loss of central vision, corneal opacity, tearing, photophobia, and is, therefore early treatment is very important. This study aimed to evaluate the efficacy of intravitreal injection of toxoplasmic retinochoroditis clindamycin in comparison with conventional therapy (oral drug) was performed.

Materials and Methods: In this clinical trial, target population was all patients with the toxoplasmic retinochoroiditis referred to clinics in ophthalmology Arak city, that stratified randomly into two groups, interventional group “A” was received treatment with intravitreal injection clindamaycin " and control group “B” was received standard oral treatment (Pyrimethamine and sulfadiazine and clindamaycin). Tool for data gathering was questionnaires and medical records of patients in which visual acuity based on the Senllene Chart and retinal thickness with use tomography layers of the retina (OCT). Results of measurement were recorded by specialist retina before and after intervention (weekly and monthly until complete resolution of lesions in retina) during one year. The data entered into the SPSS 16 software and after matching age &sex of patients, was final analysis the using descriptive and inferential tests such as t-test was performed.

Results: Of the 26 patients with toxoplasmic retinochoroditis, 16 (61.5%), urban and number 10 (38.5%) were rural. The average improvement in visual acuity between the two groups in mean time to lesion healing (A) and (B) was different. The visual acuity in before and after treatment (separation of treatment) was significant difference in both groups (p<0.05). Also central macular thickness (in patients with toxoplasmic retinochoroditis) between before and after treatment in each group was different (p= 0.001), but the changes mean central macular thickness (in cases of toxoplasmic retinochoroditis) There was no significant difference between treatments (p=0.452).

Conclusion: Although any two methods of treatment are effective, but intravitreal injection clindamaycin method due to shorter lesion healing time and increase higher visual acuity, is better than the alternative similar way .

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Background: Nasolacrimal duct obstruction as a common problem causes bothersome social and physical symptoms such as euphoria, acute and chronic dacryocystitis attacks, pain, pruritus and erythm of eye. Although, there is no consensus about available therapeutic methods. So the aim of this study is to investigate and compare the effect and complications of endoscopic dacryocystorhinstomy and patients' preferences in two common surgical methods for settling nasolacrimal duct obstruction.

Materials and Methods: In this clinical trial study, 220 patients with nasolacrimal duct obstruction were randomly divided into two groups and underwent external and endoscopic dacryocystorhinostomy surgery. Finally, patients were compared with a view to echymosis and tearing after operation and the time of surgery and bleeding during operation. The patients data were analysed by Chi-square test and using SPSS-16 software.

Results: Our results show significant difference between two groups in post-operative echymosis, post-operative bleeding and the time of surgery (p=0.000). There was no significant difference in post-operative tearing between two groups (p=0.418).

Conclusion: According to the results of our study, the use of endoscopic dacryocystorhinostomy is remarkably better than external dacryocystorhinostomy Therefore, with regard to the most of patients' tendency to endoscopic surgery, surgeons should achieve more experience in this method.

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Abstract

Background: Today, the role of word of mouth (WOM) in making decision particularly in service sector became important. Thus, this study aimed to investigate the effect of word of mouth on pregnant woman decision-making behavior to join the Royan Cord Blood Bank.

Materials and Methods: The research is operational and has a causal nature. The population of study was 790 pregnant women enrolled in Royan Cord Blood Bank in Arak city that 294 subjects were selected by available non-random sampling method. To collect data, questionnaire instrument was used. Data were analyzed according to Structural Equations Modeling (SEM) by LISREL (version 8.54) software.

Results: The results of the study revealed that the effect of communication medium on personal information source and word of mouth was significant and positive. In addition, opinion leaders had a significant and positive influence on personal information source and word of mouth and also, the significant and negative effect of opinion leaders on perceived risk was seen. Personal information source had a significant and positive effect on decision-making. However, social structure didn't have any effect on word of mouth. Likewise, word of mouth didn't influence decision-making.

Conclusion: According to the findings of the research, it seems that paying attention to the prerequisites and conditions making a suitable bed for creating effective word of mouth and expanding it to making decision for joining the Royan Cord Blood Bank is very necessary.

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Introduction: Quality of life is one of the most influential issues that can encourage a person to continue a happy and healthy life. On the other hand, spiritual health is one of the dimensions of health and a sense of harmonious connection between oneself, others, nature, and beyond, and leads to understanding the ultimate purpose and meaning in life. The purpose is to determine the relationship between spiritual health and quality of life in university students in Arak. The results of this study can be used to formulate strategic plans improve spiritual health and the quality of students' lives.
Methods: First, the population of each university in Arak city was measured, and taking into account their population and establishing a ratio between the sample size of the study and the population of each university, people who had the characteristics of entering the study were included in the study. The sample size was 400 people and was conducted on students who have been studying at the university for at least six months. After obtaining the consent of the participants, the researchers filled out the questionnaire through interviews with the students. The questionnaires included two instruments: a spiritual health questionnaire and a quality of life questionnaire with 36 questions.
Results: No significant relationship was observed between spiritual health and demographic variables. Likewise, spiritual health had no statistically significant relationship with demographic variables. The analysis of the study data showed that there is a positive correlation between the quality of life and spiritual health of students. (P < 0.05).
Conclusions: According to the horoscope results, there is a relationship between the quality of life and the spiritual health of the students of Arak universities. By improving the quality of students' lives, we can increase their spiritual health, and even by increasing their spiritual health, we can witness the improvement of students' quality of life.

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Introduction: One of the clinical manifestations of coronavirus is neurological symptoms. However, due to the emergence of this virus, little information is available about its symptoms. Therefore, this study aimed to evaluate the prevalence of neurological symptoms in patients with coronavirus at hospitals in Arak.
Methods: In this study, all patients hospitalized with COVID-19 in two hospitals in Arak who were willing to participate were selected by census. The questionnaires consisted of two parts: demographic information and the prevalence and severity of neurological symptoms, which were completed by interviews with patients.
Results: 208 patients with a mean age of 60.5±14.1 years participated in the study. Of the 20 neurological symptoms studied, only two (tingling around the mouth and cranial nerve palsy) were absent in patients. The most common neurological symptoms in patients were headache (82.5%), fatigue (81%) and muscle pain (74.9%), respectively. Also, according to the visual scale, participants reported the highest severity for headache (average: 7.5), followed by fatigue (average: 7.03), and muscle weakness (average: 6.9).
Conclusions: The results showed that the most common neurological symptoms in patients with coronary heart disease include headache, fatigue, and muscle pain and the most severe neurological symptoms in these patients are headache, fatigue, and muscle weakness. According to the findings of this study, these results can be used to diagnose patients and follow them up.