Developing a Medical Tourism Marketing Model by a Meta-Synthesis Method

Background: Today, medical and health tourism is one of the most promising sectors in the tourism industry in the world, which has led the organizations involved ,and the countries interested in developing tourism ,to focus their attention on this aspect of the tourism industry and plan for it. Hence, the aim of this study was to design the marketing model of medical tourism using meta-synthesis method. Methods: The present study was designed as a meta-synthesis research in several stages for East Azerbaijan Province, Iran. Accordingly, after identifying the categories, concepts and marketing codes of medical tourism and evaluating its validity and reliability, the initial conceptual model of the research was formed. Out of 100 retrieved studies, 8 studies completely related to the purpose of the study were included in final analysis. In order to present the marketing model of medical tourism, the qualitative research method of meta-synthesis,s Sandlowski and Barroso (2006) was used. Results: The conceptual model in the present study consists of 5 dimensions, 10 components and 40 indicators which can show the marketing model of medical tourism. 5 main dimensions included; quality of medical and tourism services, price of medical and tourism services, development of tourism and medicine, medical and tourism facilities and equipment, and information and communication technology. Conclusion: The results of the research show that the dimensions, components and indicators extracted from the meta-synthesis method are approved by the panel of experts. The findings provide a new model and perspective on how to market medical tourism for the Iranian tourism industry, which will help managers, planners and policy makers of the healthcare system.

Prevalence of Psychological Disorders in Patients with COVID-19 Syndrome

The coronavirus 2019 first broke out on December 17, 2019 in Wuhan, China, and on March 11, 2020, it was announced as a worldwide pandemic by the World Health Organization. Despite nutritious diets and promising vaccines, health tips such as wearing a mask, social distancing, home quarantine, and not traveling are still the best ways to control the spread of COVID-19.While the widespread prevalence of COVID-19, severe restrictions, lack of definitive treatment, and the high infection and mortality rates have led to cognitive psychological disorders among the general population of the world. One of the epidemic consequences of COVID-19 syndrome in people who have defeated the coronavirus was psychological disorders. Considering the role of mental health in boosting the immune system, improving the effectiveness of the COVID-19 vaccine and accelerating the treatment process of patients, it is suggested that in the post-COVID era, more attention be paid to the psychological health of the community.

Career Development in Nursing: Identifying the Career Anchors of Nurses at Shiraz University of Medical Sciences

Background: Nurses are the largest providers of care services in the health care system who play an important role in the community health by providing health care. Therefore, maintaining and developing them is an integral part of human resource management in the health system. Considering that one of the tools for career development is determining job anchors, this study was conducted in 2020 to identify the career anchors of nurses from Shiraz University of Medical Sciences in order to develop their career path. Methods: This cross-sectional study was performed on 268 nurses working in hospitals and educational centers of Shiraz University of Medical Sciences who were selected by convenience sampling. Data were collected using the standard Schein questionnaire and analyzed by independent t-test and ANOVA in SPSS 23 software. Results: Among career anchors, service and dedication (24.74 ± 1.72) had the highest, and managerial competence (16.35 ± 2.32) had the lowest mean score. Furthermore, the average entrepreneurial creativity in women was significantly higher than men (p = 0.04). And in men, the average of pure challenges was significantly higher than women (p = 0.04). In addition, people with undergraduate degree showed a greater tendency to technical/functional competence (p = 0.02). Clinical nurses were more likely to become managers (p = 0.04), and corporate nurses were more inclined to have a lifestyle anchor (p = 0.04). Conclusion: Regarding service and dedication anchor, which had the highest average score among the interviewed nurses, individuals are motivated by pursuing valuable goals and meeting the needs of others. Whilest managerial competencies were not the priority of the studied nurses. Therefore, the opportunity for promotion in nurses is not just focused on reaching a managerial position. Therefore, it is suggested that the management of human resources in university define the career path of people based on their anchors and specific interests to people in terms of mental and mental health for creating a favorable atmosphere and better performance.

Identifying the Factors Affecting the Incidence of Medication Errors of Nurses in Teaching Hospitals of Shiraz University of Medical Sciences

Background: Medication errors are one of the major causes of injury to patients while receiving medical care. This study aimed to investigate the effective causes of medication errors in nurses in educational hospitals affiliated with Shiraz University of Medical Sciences. Methods: This descriptive-analytical and cross-sectional study was conducted in 2020 on 340 nurses from 10 educational hospitals affiliated to Shiraz University of Medical Sciences. The data collection tool was a questionnaire. Data were analyzed using t-test, ANOVA and Pearson correlation coefficient were analyzed using SPSS23 software . Results: According to the results, human factors have been the most important factor in the occurrence of medication errors. The most important causes of medication errors with respect to human, managerial and environmental factors include fatigue due to overwork (3.13 ± 1.16), method of supervision (3.06 ± 0.98) ,and heavy workload (3.00 ± 1.19), respectively. There was a statistically significant relationship between human factors and age (p = 0.024), gender (p = 0.013), employment relationship (p = 0.016), and marital status (p = 0.027), and between management factors and employment relationship (p = 0.034) and the number of patients under observation (p = 0.011). Conclusion: Considering the most important causes of medication errors, including fatigue due to overload, supervision methods, and heavy workload, using strategies to reduce fatigue due to workload, such as balancing nurses' work shifts and also holding workshops on supervision methods is recommended in order to improve the level of managerial competencies of nurses.

A Proposed Model for Dental Services Management in Iran

Background: Oral health is an integral part of general health and one of the necessities of a good life. Having a healthy mouth and teeth requires individual care, the development and implementation of community-based intervention programs, and professional care. The purpose of this study was to design a model for the management of dental services in Iran. Methods: This was an applied research in terms of purpose, descriptive in terms of implementation method, and a survey research in terms of descriptive typology. The statistical population included dental experts. To conduct the study among policy makers, planners, managers, university professors and the staff of the dental services, dental experts were chosen using purposive non-probability sampling for in-depth interviews based on grounded theory method to collect indicators of dental services management for providing a suitable selection model. To reach theoretical saturation, the text of the interviews was analyzed, phrase by phrase and sentence by sentence, through constant comparative analysis. For analysis, the grounded theory method was used, and the collected data were coded in 3 steps. In order to assess the validity of the research regarding interviews, the participants' feedback and the opinions of colleagues were used. To ensure the reliability of the interviews, 2 methods of test-retest and double coding were used. In this study, Delphi method was used in designing the model. Results: According to the obtained model, 29 factors were effective in managing dental services. The obtained indicators were included in the Delphi survey. During the Delphi stages, consensus was reached on 29 indicators which were classified into 5 dimensions (components) including planning, organizing, mobilizing of resources and facilities, guiding, monitoring and controlling. Conclusion: The results of the study showed that a 5-component model is suitable for the management of dental services in Iran, and health planners and policy makers can use it to improve the delivery of dental services.

Comparison of Gross Domestic Product Forecasts before and after the Covid-19

The International Monetary Fund (IMF) and the World Bank (WB) publish annual reports on the world economic outlook. This study compared the Gross Domestic Product (GDP) of different countries by these 2 institutions, before and after the Covid-19 pandemic. The countries were selected from the 6 regions of Africa, the Americas, the Eastern Mediterranean, Europe, Southeast Asia, and the Western Ocean. In order to be able to compare these countries, WB reports were selected as a model and then the corresponding economic data were extracted from the IMF.

Identifying Factors Affecting Sustainability Reporting of Pharmaceutical Companies: Application of Delphi and Analytic Network Process based on Fuzzy DEMATEL

Background: Today, one of the most important concerns in the pharmaceutical industry is achieving sustainability, and the pharmaceutical industry is recognized as a leading sector in corporate sustainability reporting. The purpose of this study was to identify, extract, prioritize and analyze the social factors and corporate characteristics which are effective in the sustainability reporting of Iranian pharmaceutical companies. Methods: This was a cross-sectional study conducted in autumn 2020. The expertise and availability principles were used for sampling, and the snowball sampling method was used for sample selection. In order to identify and extract effective social factors and corporate characteristics, the method of content analysis and the study's review of literature have been used. The survey was conducted on 40 experts in the field of research using a researcher-made questionnaire. In order to purify the effective factors, Delphi method and the Analytic Network Process method based on Fuzzy DEMATEL were used. Results: In terms of a strong interaction, the criterion for university-industry collaborations came first, and the criterion for sustainable innovation and cooperation with other companies came next. In this study, profitability, research and development intensity and the financial leverage were considered to be weak causal variables and sustainability reporting, an effect variable. Conclusion: The results showed that Iranian pharmaceutical companies, in order to achieve the goals of sustainable development, should emphasize the continuous and regular presentation of annual sustainability reporting, and in this regard, key factors such as the criteria of university-industry collaborations, sustainable innovation and cooperation with other companies should be considered critical priorities.

The Effect of Implementing Health Promotion Hospitals' Plan on the Awareness of Cardiac Patients Admitted to Selected Educational Hospitals in Yazd

Background: Health promotion includes the concepts of health education, disease prevention and rehabilitation services. Accordingly, the implementation of standards and indicators of health promotion in hospitals is necessary to ensure the quality of the services provided. Therefore, this study was conducted to investigate the effect of implementing a health promotion hospital plan on the awareness of hospitalized cardiac patients in selected educational hospitals in Yazd. Methods: This was an interventional study, which was performed on 62 cardiac patients referred to 2 selected educational hospitals of Yazd University of Medical Sciences. 31 patients from Afshar Hospital (the case group), and 31 patients from Shahid Sadoughi Hospital (the control group) were selected by purposive sampling method. In the case group, in addition to the routine trainings, the subjects received face to face and group educational interventions based on the Health Belief Model and the Guidelines to the American Cardiovascular and Pulmonary Rehabilitation Association for 3 months, and were finally given an educational package. The samples in the control group also underwent routine training. Data analysis was performed using a questionnaire based on Health Belief Model, before the educational intervention and 3 months after, using SPSS 23 software, Chi-square and independent t-tests. Results: Awareness scores in the case and control groups before the intervention were 7.90 ± 4.01 and 10.67 ± 5.31, and after the intervention were 21 ± 1.61 and 11.54 ± 5.31 respectively, and a significant difference was seen in the scores of the post-intervention group (p < 0.001). Conclusion: The implementation of the health promotion hospital plan can be effective in increasing the awareness and improving the performance of cardiac patients. Therefore, it is recommended for hospitals to move towards health promotion.

Measuring Technical Efficiency of Hospitals affiliated with Shahrekord University of Medical Sciences, Using a Combination Method Data Envelopment Analysis (DEA) – Principle Component Analysis (PCA)

Background: Measuring the efficiency of hospitals due to the high proportion of budget allocated to them on the one hand, and the need to ensure the best practices regarding the use of scarce resources on the other hand, is of particular importance. The purpose of this study is to evaluate the technical efficiency of the affiliated hospitals of Shahrekord University of Medical Sciences by using a combination of Principal Component Analysis and (PCA) & Data Envelopment Analysis (DEA). Methods: This was an analytical and cross-sectional study measuring the technical efficiency of all 8 hospitals affiliated to Shahrekord University of Medical Sciences. The required information was collected from the medical records unit of each hospital. For better differentiation between efficient and inefficient units, and the increase of research accuracy and further differentiation between hospitals in terms of efficiency, at first, 17 indicators were selected to assess and adjust these parameters to 3 components proportional to the number of the hospitals by using PCA and SPSS 16 software. After doing the PCA, 7 studied input variables became 7 principal components among which the first input component reflecting the 83 % of scattering data was selected as principal input component, and for being more influenced by human resource variables, it was named as a human resource index. Furthermore, among the output variables, the first 2 output components, which represented 76% of the variance of the data, were selected as the 2 principal components of the output for the study, which were mostly affected by these variables, respectively, the number of admissions and length of stay. Then, the modified input and output components were entered into the software Windeap 2.1 and the technical efficiency of hospitals and their rank were calculated by assuming constant and variable efficiency with respect to the scale. In order to evaluate the effect of using the combined method instead of the conventional method of efficiency measurement, the results of the PCA - DEA method were compared with the results of the conventional DEA method. Results: The result of DEA on the selected components showed the capacity to upgrade the Technical Efficiency (TE) of hospitals is 15 % (TE: 0.852). Moreover, out of 8 hospitals, 1 hospital was increasing return to scale, 3 decreasing returns to scale and 4 constant returns to scale. The technical efficiency of 3 hospitals was 1 (TE = 1), 2 hospitals had the technical efficiency between 0.80 to 1 (1 > TE > 0.80) and that in 3 hospitals was less than 0.80 (TE < 0.80). The scale efficiency for 50 % of hospitals and the management efficiency for 62/5 % of them were equal 1. Conclusion: The average of total technical efficiency, management efficiency and scale efficiency were calculated to be 0.999, 1 and 0.999, respectively based on the usual comprehensive analysis method; while using the combined method, the average total technical efficiency, management efficiency and scale efficiency were 0.852, 0.947 and 0.902 respectively. The results confirm that the use of PCA method, due to its important role in reducing alignments, increases research accuracy and better differentiates between hospitals in terms of efficiency.

A Comparison of Effectiveness of Compassion-Focused Therapy (CFT) and Mindfulness-Based Stress Reduction (MBSR) on Psychological Flexibility of HIV Patients in Imam Khomeini Hospital

Background: HIV patients are exposed to many psychological problems, including psychological inflexibility. It seems that psychological interventions can be effective to improve the psychological state of these patients. Therefore, in this study, we aimed to compare the effectiveness of interventions with 2 methods of Compassion-Focused Therapy (CFT) and Mindfulness-Based Stress Reduction (MBSR) program on psychological flexibility of HIV patients in Imam Khomeini Hospital. Methods: The present study was a descriptive-analytical study that was performed as an intervention in the period from May to January in 2020 on 54 HIV patients referred to Voluntary Counseling and Testing (VCT) center of Imam Khomeini Hospital Complex. The samples of the study mode were selected by available sampling and randomly divided in 3 groups of 18 people based on CFT, MBSR session and the control group. Each treatment was presented to 2 experimental groups for 10 sessions per week and the control group was placed on a waiting lists. Patients' psychological flexibility was assessed by the Acceptance and Action Questionnaire- II "AAQ-II" in 3 stages: pre-test, post-test and follow-up. SPSS 23 software and analysis of covariance, bonferoni test and one-way analysis of variance were used to analyze the data. Results: The results showed that CFT and MBSR were effective on increasing psychological flexibility of HIV patients (p < 0.01). Comparison of the effectiveness of the 2 therapies showed that CFT caused a further increase on increasing psychological flexibility (p < 0.01). Changes in follow-up 3 months after treatment also remained stable (p < 0.01). Conclusion: Findings of the study show that the use of therapies in this study can be effective in planning psychological interventions to promote and improve mental health in HIV patients.