Iranian System Research Articles

Eco-efficiency analysis of selected tropical fruit production systems in Iran

Eco-efficiency analysis of selected tropical fruit production systems in Iran

Estimating the Future of Electronic Health Information System in Society

Background: The health information system provides an integrated platform and an information connection between the actors of the health system regardless of temporal and spatial limitations. Objective This study aims to investigate the factors affecting the development of electronic health record (EHR) system and predict the future of this system in Iran. Methods: In this descriptive study, identification of the main factors for the development of HER and designing the future scenarios of this system was done using a questionnaire completed by 33 managers and experts of information technology in hospitals and medical universities in Guilan and Qazvin provinces of Iran. Data were analyzed in SPSS v. 22 and Expert Choice v. 11 applications. Results: Three dimensions and six criteria were determined to explain the HER development. Dimensions included: information content, information architecture, and information security. The criteria were: Manpower, hardware and software infrastructure, speed of access to health services, operating costs, not dependent on the internet, and comprehensiveness. Moreover, eight scaled scenarios were determined for the future of the EHR system. Conclusion: It is necessary to pay attention to information content, architecture, and security in development of the HER system in Iran.

Irrational prescription of surfactant replacement therapy in neonatal respiratory distress.

PurposeRespiratory distress is known as one of the leading causes of neonatal death. In recent decades, surfactant therapy has revolutionized respiratory failure. Since the implementation of the health system reform plan as well as the allocation of new financial resources for health system in Iran, the rate of irrational prescription has increased and prescription of surfactant for neonates, has raised unexpectedly, which is thought to be due to irrational prescriptions partly. The present study aimed to determine the rate of irrational prescription of surfactant for neonates with respiratory distress.MethodsThis research was a cross-sectional descriptive study, which was conducted retrospectively. In the current study, determining the rate of irrational prescription was done in terms of the surfactant prescription guideline. Finally, the medical data of 846 neonates who underwent surfactant therapy in Iran in 2018, were extracted from the information system of the Ministry of Health and the neonatal medical records.ResultsThe results show that drug selection index, dose index, and time index were irrational for 14.30%, 27.42%, and 1.06% of neonates, respectively. Moreover, the total index of drug prescription, which is a combination of the above-mentioned three components, was found to be irrational for 31.47% of neonates.ConclusionsThe results of the present study are considered as a warning to providers and decision makers in the field of neonatal health to reduce irrational prescriptions of surfactant for neonates. This study suggests the use of educational interventions in order to reduce irrational prescriptions due to drug selection as well as the use of computer alert approaches in order to reduce irrational prescriptions due to wrong dose.

Designing and validating the organizational mentoring evaluation model in the higher education system in Iran

Designing and validating the organizational mentoring evaluation model in the higher education system in Iran

Challenges of the organizational structure of county health network in Iran: findings from a qualitative study

BackgroundPrimary healthcare with the right structure is the base for any highly efficient healthcare system to achieve better health outcomes at the lowest cost. Challenges of this system, including structural weaknesses, are one of the factors of inefficiency. Therefore, the purpose of this study was to identify challenges of the organizational structure of county health network in Iran.MethodsAn exploratory qualitative face-to-face semi-structured interviews were carried out with 21 key informants including experts and managers in Ahvaz-Iran. Purposive sampling method with maximum diversity were used. Interviews were recorded digitally and transcribed verbatim. Interview transcripts were analyzed based on a thematic analysis approach via NVivo-11.ResultsIn analysis of the interviews, after removing the duplicate codes and merging similar items, finally 6 main challenges and 56 sub-themes were obtained. The themes of structural challenges included formalization, complexity, centralization, culture, environment, and resources.ConclusionsBased on the present situation, the challenges in the current organizational structure and a change in the goals and strategies of the healthcare system in Iran, the appropriate structure needs to be designed and implemented at different levels in accordance with the goals and strategies. The separation and independence of health centers management and hospitals (treatment) in the county can provide a basis for understanding the challenges to the provision of health services.

Legitimation of governments by renaming of everyday things and places: a comparison of the Pahlavi and Islamic Republic in Iran

ABSTRACT Political systems employ a variety of resources to acquire legitimacy and support from society. Any changes in the political system and sources of legitimacy can fundamentally alter the social world and the sign system, and even lay the foundations for identity conflict. Since the collapse of the Pahlavi dynasty and the establishment of the Islamic Republic government, Iran has experienced such a trend. Therefore, the Pahlavi dynasty and the Islamic Republic government can be considered the most important periods of civilization and identity conflict in contemporary Iran. The present study aims to apply semiotics to examine the naming process as one of the elements of the sign system in the legitimacy of the Pahlavi and the Islamic Republic of Iran governments. The findings show that the changes in the naming process during the Pahlavi and the Islamic Republic governments represent a shift in the source of legitimacy from ancient Iran to the Islamic period, which has been reflected in the names of individuals, places, coins, and commemorative medals. The change of political system has also intensified the identity and ideology conflicts in the sign systems of Iran.

Iranian’s attitudes toward law-abidingness in administration system in Iran

According to international statistics and domestic research, the rate of law-abidingness in Iran is low. The purpose of this article is to measure the degree of law-abidingness in the administrative system. The results show that in general, the mediation effect for three mediation variables in the path model is significant except the relationship between political satisfaction, necessity of organizational rules, and law-abidingness. There is mediation effect between political satisfaction, trust, and law-abidingness, which is positive. There is a positive significant relationship between political satisfaction, success priority of material preference system, and law-abidingness. The relationship between nepotism, trust, and law-abidingness is negative.

Establishing a minimum data set for suicide and attempted suicide registry system in Iran

BackgroundSuicidal behavior is a major cause of mortality and disability worldwide. Accurate and consistent collection of data on suicide, suicide ideation, and suicide attempts presents many challenges for public health practitioners, policymakers, and researchers. This study aimed to establish a minimum data set (MDS) for integrating data across suicide registries and other data sources.MethodsThe MDS proposed in this study was developed in two-stepwise stages. First, an extensive literature review was performed in order to identify the potential data items. Then, we conducted a two-round Delphi stage to reach a consensus among experts regarding essential data items and a supplementary one-round Delphi stage for validating the content of the final MDS by calculating the individual item content validity index (CVI) and content validity ratio (CVR) and using other statistical tests.ResultsAfter the literature review, 189 data items were extracted and sent to a panel of experts in the form of a questionnaire. In the Delphi stage and CVI calculation, 55 and 10 experts participated in kappa and CVR calculation, respectively. Finally, the MDS of the suicide registry was finalized with 84 data elements that were classified into four categories, including patient profile, socio-economic status, clinical and psychopathological status, and suicide circumstances.ConclusionsThe suicide MDS can become a standardized and consistent infrastructure for meaningful evaluations, reporting, and benchmarking of suicidal behaviors across regions and countries. We hope this MDS will facilitate epidemiological surveys and support policymakers by providing higher quality data capture to guide clinical practice and improve patient-centered outcomes.

Drug-related Death low Registration in Iran: A Mixed Method Approach for Causes, Recommendations to Solve This Problem and Geographical Evaluation of an Intervention.

The death registration is conducted by different systems in Iran. The drug-related death registration is exclusively conducted by Ministry of Health and Medical Education (MOHME) and Legal Medicine Organization (LMO). This study investigates the causes of undercounting drug-related deaths (DRDs) in Iran, provides recommendations for addressing this issue, and provides a geographical evaluation of the integrity and quality of drug-related mortality registration (2014-2017). This is a mix-method study. In part1, individual targeted interviews were conducted with 12 experts in death registration in MOHME and LMO to collect data on the causes of low registration in Iran and provide recommendations for resolving the issue. Part2 of the study involved an intervention in the form of a memorandum of understanding on reduction of low-registrations. This memorandum was signed to transfer information about the corpses between the MOHME and LMO. First, the number of DRDs (2014- 2017) was examined using capture-recapture method and, then, we calculated and compared the rate of pre-intervention (2014-2016) and post-intervention (2017) under-registration to assess whether this memorandum of understanding had been effective in reduction of under-registrations. In part1, according to the participants, the causes of undercounting DRDs in LMO and MOHME were arranged and categorized into 4 categories: weak administration system, physician and personnel training problems, system constraints, and client-related problems. Also, some suggestions were presented to help resolving the problem of undercounting; these suggestions concern the administrative system, technology, and educational domains. In part 2, about half of the provinces in Iran had a positive performance in reducing the undercount. At the macro level, the memorandum of understanding between the two organizations responsible for registering deaths was effective. However, increasing the quality of data registrations requires monitoring at the micro and organizational levels to lead to a positive performance in reducing death under-registration in all provinces.

Explaining the rise and fall of the photovoltaic technological innovation system in Iran

AbstractDespite the importance of the transnational dimensions of TISs in developing countries, the number of case studies on the subject remains limited. The process of developing PV solar systems in Iran as a developing country has gone through different phases since 1991. The evolution of this process has been influenced by macro financial and political factors. This study aims to present a historical analysis of the formation and application of PV solar TIS in Iran to identify the innovation motors driving each stage of the process. Based on various changes in application models, PV technological innovation in Iran has been categorized into four phases: 1. Initiating (1991 to 2005), 2. Rising (2006–2012), 3. Fostering (2012–2017), and 4. Falling (2017 onwards). The historical analysis revealed that transnational factors have been overlooked in Iran, and the country has been deprived of its advantages to develop a suitable TIS. Furthermore, through literature review, expert interviews, and thematic analysis, several strategies were established to promote transnational, including transfer and emulation of foreign technologies, international cooperative research programs, investment in joint operations, cooperative agreements, access to foreign markets, access to international investment, and submission to international laws and regimes.

The Process of Establishing and Managing a Laboratory Diagnostic Network in the COVID-19 Pandemic in Iran

The COVID-19 pandemic caused by the newly emerged coronavirus was first detected in China in December 2019 and rapidly spread worldwide. The rapid spread of the disease urged all countries involved, in accordance with their capacities, take the necessary measures to diagnose and manage the disease. The first patient was diagnosed with COVID-19 in Iran in February 2020. Considering the significant role of the laboratory services in detection and management of the disease, planning and programming to provide access to these services was considered as a top priority for healthcare system in Iran. Adopting all existing laboratory capacities and providing necessary infrastructures for expanding COVID-19 laboratory diagnostics, resulted in the establishment of a nationwide network of COVID-19 molecular diagnostic laboratories within the shortest possible time. In addition to expanding the capacity of laboratory services, improving the laboratory network’s performance have been taken into serious consideration. Despite the strict sanctions, the COVID-19 molecular diagnostic laboratories scaled up to more than 430 laboratories currently (September 2021), mostly are operating in the private sector. With considerable efforts, COVID-19 molecular laboratory network was established to provide nationwide diagnostic services. Considering the capacity for the SARS-CoV-2 Rapid Antigen test, we can now perform more than 100,000 COVID-19 diagnostic tests per day. However, due to the ongoing pandemic and in accordance with the requirements of the health system, it is necessary to plan and carry out more COVID-19 diagnostic tests. This study aimed to introduce the process of establishing the COVID-19 laboratory diagnostic network to manage the COVID-19 pandemic in Iran.

Marriage, Parentage and Child Registration in Iran: Legal Status of Children of Unmarried Parents

In the contemporary legal system in Iran, child registration is closely tied to Islamic marriage. The Civil Registration Law foresees a process for registering a child born to Islamically married parents. This raises the question of what happens to children whose parents are not married. This paper uses literature review and content analysis methods and focuses on the Iranian law, press and media pieces, Shi’i rulings, and academic literature on child ‘legitimacy’ and the unregistered child phenomenon to answer this question. I explore the relationship between Iran’s marriage and parentage law and the child registration process. The paper discusses the consequences of rendering children legally ‘illegitimate’ for children’s rights. The conclusion addresses the potential in the Shi’i school of Islam to improve religious rulings and, consequently, the possibility of changing discriminatory laws regarding the rights of children born to unmarried parents.

Insurance and Improving Its Strategic Purchase in Iran.

As in most countries, patients, health care providers, and insurance organizations are key components of the health care system in Iran. High rates of growth and development in today's financial markets, have made the insurance industry with its unique calculations and models, a prominent player in this specialized economic sector.

Analysis of Students’ Desired and Fulfilled Expectations from the Future of Academic Studies: Educational Effectiveness for Prosperous Life

Universities and higher education institutions (HEIs) aim to provide the maximum support for the community. Hence, to obtain the optimum results, the educational policies must be in alignment with the societies’ needs and prerequisites. The present research investigated the undergraduates’ expectations of studying at university and the fulfillment of those expectations prior and after being accepted into the university. 600 first-year undergraduates were selected based on cluster sampling from 2783 first-year undergraduates at Allameh Tabataba’i University, Iran. The data were gathered through deep interviews and cross-sectional survey. We emphasize that the centralized educational system in Iran works as a speed bump to obtain the goals and ambitions as portrayed in the HEIs’ mottos. The findings remind the educational policy-makers that success does not happen in a vacuum; rather, it is a collaborative joint practice among all members of the HE sector. The novelty of the research is its applicability to those centralized systems of policy-making worldwide specifically with engagement of students which adds to the literature and can urge the authorities of the HE sector to modify their earlier policies in the short run; and work toward decentralized system of educational leadership as the main panacea in the long run.

The Effect of Prospective Payment Systems on Health Care Providers' Behavior: A Case Study of Global Surgeries Payment System in Iran.

Background: Global payment system is a kind of case-based payment system which pays for 60 commonly surgical operations by the average cost for each specified surgery case in Iran. The aim of the study was to determine the effect of this payment system on the number of services provided for each global surgical case versus fee-for-service (FFS) for the same operation. Methods: This is a retrospective study based on data from a large referral teaching hospital in Iran in the period of 2012-2015. Information related to 46 surgeries was performed which both global and FFS documents were gathered (N=7672). Statistical analysis was done on variables including Length of stay (LOS), Blood test (BT), Radiology (RA) and a mixed variable named VC (visit and consult number). Data were analyzed by a zero-inflated negative binomial regression model using STATA 11. Results: Descriptive analysis showed the mean of each service was significantly (p<0.001) higher in the FFS document’s group rather than the global payment group. Regression estimates showed the amounts of each service including LOS, BT, RA and VC were significantly (p<0.001) higher in FFS surgery than global documents for the 15 selected surgery. LOS and BT have shown a significantly higher amount in 100% of surgeries for FFS above global document. Same as for Radiology test and VC variables, there were significantly higher amounts in 93% of surgeries for FFS above global hospital documents. Conclusion: The findings can reinforce the presence of a relationship between providing more clinical services in FFS document form and providers’ incentives to adjust profits against their Costs. The significantly higher service provision in FFS documents can be controlled with a prospective global payment mechanism.

Developing a Risk Reduction Support System for Health System in Iran: A Case Study in Blood Supply Chain Management.

Health systems are recognised as playing a potentially important role in many risk management strategies; however, there is strong evidence that health systems themselves have been the victims of unanticipated risks and have lost their functionality in providing reliable services. Existing risk identification and assessment tools in the health sector, particularly in the blood supply chain, address and evaluate risks without taking into account their interdependence and a holistic perspective. As a result, the aim of this paper is to develop a new systemic framework based on a semi-quantitative risk assessment approach to measure supply chain risks, which will be implemented through a case study on the Iranian BSC. This paper identifies and assesses supply chain risks (SCRs) by employing a novel systemic process known as SSM-SNA-ISM (SSI). First, the supply chain and its risks are identified using Soft Systems Methodology (SSM). Then, given the large number of risks, the second stage uses Social Network Analysis (SNA) to identify the relationships between the risks and select the most important ones. In the third stage, risk levelling is performed with a more in-depth analysis of the selected risks and the application of Interpretive Structural Modelling (ISM), and further analysis is performed using the Cross-Impact Matrix Multiplication Applied to Classification (MICMAC). The study found that by using the new proposed approach, taking into account risk relationships, and taking a holistic view, various supply chain risks could be assessed more effectively, especially when the number of risks is large. The findings also revealed that resolving the root risks of the blood supply chain frequently necessitates management skills. This paper contributes to the literature on supply chain risk management in two ways: First, a novel systemic approach to identifying and evaluating risks is proposed. This process offers a fresh perspective on supply chain risk modelling by utilising systems thinking tools. Second, by identifying Iranian BSC risks and identifying special risks.

Investigation of a composite two-phase hedging rule policy for a multi reservoir system using streamflow forecast

Long-term changes in reservoir inflow due to climate changes and human interference violate the assumptions of hydrologic stationarity especially in the reservoir design. Utilization of uncertain prediction into a reservoir operating rule curves somehow reflects the challenges that imposed by nonstationary conditions. This study proposes a hedging based policy incorporated forecast term to manage release decisions in two separate phases. Hedging is applied firstly regarding to reservoir water level similar to conventional hedging rules and secondary according to an extra simulation in the near future. To determine the time interval of future effects, an exterior optimization model is introduced to handle the trade-off between forecast uncertainty and future information which imposed by forecast horizon. Future inflows are forecasted introducing a model including a wrapper-based feature selection method and AdaBoost.RT as a learning algorithm. The results of applying the model to a real six reservoir system in IRAN showed that incorporating future inflows into the real time decisions significantly improves the total squared relative deficit about 20% and 10% compared to conventional hedging rule curve (CHRC) and standard operation policy as objective function. Also having a glance at the near future reduces the vulnerability of the system about 5% and 27% respectively against CHRC and SOP. The results also showed that, although the SOP reaches to a best reliability of satisfying water demands in total system as 31% and 27% better than CHRC and the proposed two-phase policy, but the number of intensified failures was higher than two others which somehow influences on volume-based indices like vulnerability.

Response capability of hospitals to an incident caused by mass gatherings in southeast Iran

Background and ObjectivesHospitals are expected to provide a safe environment for patients, visitors, and employees during emergencies and disasters, as well as provide health care to disaster survivors. The aim of this study was to evaluate the response capability of hospitals to an incident caused by mass gatherings (MG) in Kerman province. MethodsThis cross-sectional study was performed among hospitals of Kerman city in 2021. To collect data, the adjusted emergency response checklist-WHO (2011) was utilized with 90 questions prepared in nine domains. Data analysis was carried out using SPSS version 20 with descriptive tests. ResultsIn this incident, 438 people were injured and 61 killed (31 women and 30 men). Of the 438 injured taken to hospitals, 193 were treated on an outpatient basis, 146 were hospitalized and 99 were treated at Advanced Medical Post (AMP) and mobile hospital in the scene. Results showed a moderate response level of hospitals to an incidence (151.50±18.28). Among the components of hospitals' response to incidence, the command and control component had the highest mean score (159.16 ± 22.39) while the surge capacity component had the lowest mean score (129.78 ± 25.21). ConclusionOur hospitals faced new challenges in this incident; therefore, policymakers and executives managers of the health system in Iran should develop a comprehensive strategic plan to promote hospitals’ preparedness for suitable and timely response to MG incidences and improve risk perception of mass gathering participants and hospitals personnel through training and implementing discussion and operation–based exercises.

Developing the required data set for the integration of breast cancer registry systems in Iran

BackgroundBreast cancer is a major public health concern due to its increasing incidence and mortality rates. A large volume of data is generated from different healthcare settings with inconsistent and heterogeneous data frameworks. There is an increasing demand to integrate breast cancer data between various information systems to answer specific research questions and future clinical trials. Thus, this study aimed to develop a minimum data set (MDS) for integrating breast cancer registry systems as a prerequisite for multi-center data exchange and research cooperation. MethodsThe proposed MDS was developed using a multi-stage process. First, a systematic search was performed in scientific databases. Available data sets and registries related to breast cancer were also reviewed until data saturation. Then, a two-round Delphi survey was performed to reach an agreement on the primary data items. Finally, an additional Delphi stage was carried out to validate the content of the final MDS by calculating the individual item content validity index (CVI), overall scale CVI (S-CVI), and face validity. ResultsAfter the literature review, the primary data set for breast cancer including 309 data items was identified. After the Delphi phase and calculation of I-CVI, S-CVI, and face validity, the breast cancer MDS was finalized with 14 classes and 205 data items. ConclusionsThis agreed-upon MDS enables accurate, consistent, and comparable inter-organizational data collection between breast cancer care centers. This data homogeneity enhances the analytic power and depth of variables, thereby contributing to multicenter, large-scale, and more generalizable epidemiological and predictive studies on breast cancer.

Assessment of Hearing Loss in Two-Year Follow-up Study of Neonates with Congenital Cytomegalovirus Infection

ObjectivesCongenital Cytomegalovirus (cCMV) infection constitutes the main cause of sensory neural hearing loss (SNHL) worldwide. The rate of Cytomegalovirus (CMV)-induced SNHL is not well documented in developing countries, such as Iran. Therefore, this prospective follow-up study aimed to evaluate this rate among neonates with cCMV infection in Iran.Materials & MethodsNeonates with cCMV infection admitted to neonatal intensive care units and neonates with CMV infection identified in two other prospective screening studies in Tehran, Iran, were enrolled in this study. Audiological assessments, including otoacoustic emission and auditory brainstem response tests, were performed for all the cases. Antiviral therapy was administered for the newborns in case of having severe symptoms.ResultsA total of 22 neonates with cCMV infection were entered into the study, of whom 8 and 14 subjects had symptomatic and asymptomatic cCMV infection, respectively. In total, 3 of 22 newborns had SNHL (13.6%; 95% CI: 2.8-39.8), 2 of 8 cases with symptomatic cCMV infection (25.0%; 95% CI: 3-90) and 1 of 14 cases with asymptomatic cCMV infection (7.1%; 95% CI: 0.1-39). No association was observed between SNHL and CMV-related risk factors in newborns.ConclusionThe findings of this study revealed that the rate of cCMV-induced SNHL is high among neonates born in Tehran. The severe sequelae of cCMV infection indicate the need for screening for CMV infection at birth to reduce the risk of CMV complications and the financial load of treatment imposed on healthcare and treatment systems in Iran.