A systematic review of assisted and third-party reproduction guidelines regarding management and care of donors.

BACKGROUND: Gamete and embryo donors face complex challenges affecting their health and quality of life. Healthcare providers need access to well-structured, evidence-based, and needs-based guidance to care for gamete and embryo donors. Therefore, this systematic review aimed to synthesize current assisted and third-party reproduction guidelines regarding management and care of donors. METHODS: The databases of ISI, PubMed, Scopus, and websites of organizations related to the assisted reproduction were searched using the keywords of "third party reproduction", "gamete donation", "embryo donation", "guidelines", "committee opinion", and "best practice", without time limit up to July 2023. All the clinical or ethical guidelines and best practice statements regarding management and care for gamete and embryo donors written in the English language were included in the study. Quality assessment was carried using AGREE II tool. Included documents were reviewed and extracted data were narratively synthesized. RESULTS: In this systematic review 14 related documents were reviewed of which eight were guidelines, three were practice codes and three were committee opinions. Five documents were developed in the United States, three in Canada, two in the United Kingdom, one in Australia, and one in Australia and New Zealand. Also, two guidelines developed by the European Society of Human Reproduction and Embryology were found. Management and care provided for donors were classified into four categories including screening, counseling, information provision, and ethical considerations. CONCLUSION: While the current guidelines include some recommendations regarding the management and care of gamete/embryo donors in screening, counseling, information provision, and ethical considerations, nevertheless some shortcomings need to be addressed including donors' psychosocial needs, long-term effects of donation, donors' follow-up cares, and legal and human rights aspects of donation. Therefore, it is needed to conduct robust and well-designed research studies to fill the knowledge gap about gamete and embryo donors' needs, to inform current practices by developing evidence-based guidelines.

Gamete and embryo donors face complex challenges affecting their health and quality of life. To manage these challenges, healthcare providers need guidelines that are based on evidence and donors' real needs. In order to develop a comprehensive guideline that meets the needs of donors; it is important to review the current guidelines. So, in this study we reviewed the current assisted and third-party reproduction guidelines regarding management and care of donors. We searched databases and relevant websites and found 14 related documents. The main topics recommended for management and care of donors in these guidelines included screening, counseling, information provision, and ethical considerations. We recognized that some of donors' needs are neglected in these documents including donors' psychosocial needs, long-term effects of donation on donors, their follow-up cares, and legal and human rights aspects of donation. Therefore, there is need for further research to develop guidelines based on donors' unmet needs.

Using social marketing theory as a framework for understanding barriers and facilitators of human papillomavirus screening in women: A qualitative study.

BACKGROUND: Human papillomavirus (HPV) is known as the common sexually transmitted disease and the cause of cervical cancer. The HPV test is being proposed as the primary screening tool for cervical cancer. This study aimed to identify barriers and facilitators of screening based on the social marketing model in designing interventions and planning to increase HPV screening. MATERIALS AND METHODS: This qualitative directed content analysis was conducted between December 2020 to September 2021 to identify the key concepts of social marketing theory (i.e., the four P's: product, price, place, and promotion) in Mashhad, Iran. Semistructured interviews were fulfilled with 24 individuals (10 women with HPV and 14 key informants) after obtaining participants' consent, who were initially purposively sampled and snowball sampling was then used to facilitate further recruitment. Data analysis was carried out simultaneously with data collection. RESULTS: Following the code extraction, four main categories (themes) and 10 subcategories extracted. Subcategories included knowledge on screening, screening benefits, and motivational factors for screening (product), individual inhibitors, environmental inhibitors, and facility problems related to price, place of service delivery, and service delivery channels (place) and health promotion and education. DISCUSSION: Lack of knowledge about HPV and screening, negative attitudes toward sexually transmitted diseases, taboo about sexual issues in society, fear of the reaction of spouse and family members, lack of proper policies and information and communication challenges, high costs of screening, access barriers to facilities such as difficult transportation have been challenges of health systems. It is suggested that HPV screening as a standard method for detection of cervical cancer be considered and the barriers to access are removed.

Colorectal Cancer Awareness and Related Factors Among Adults Attending Primary Healthcare in North-Eastern of Iran: A Cross-sectional Study.

BACKGROUND: Colorectal cancer (CRC) is the third most prevalent cancer in Iran. This study aimed to assess the level of awareness regarding CRC warning signs, risk factors, screening program, and related factors among adults in North-Eastern Iran. Study Design: A cross-sectional study. METHODS: The multi-stage sampling method was used to survey 2614 participants attending primary healthcare centers in Mashhad, Iran. The data collection tools were the demographics section and Bowel/ CRC Awareness Measure (Bowel/Colorectal CAM). The data were analyzed by SPSS, version 25. The significance level of the data analysis was less than 0.05. RESULTS: Mean awareness for CRC warning signs and CRC risk factors were 2.85±2.13 and 3.63±1.85, respectively. Most participants (97.2%) had no awareness of the CRC screening program. There was a significant association between marital status, education, job, income, and family history of CRC with awareness of warning signs (P<0.001); moreover, there was a significant association between age, education, job, income, and family history of CRC with awareness of risk factors (P<0.001). The results of logistic regression indicated that there was a significant association between age (P=0.022, OR=1.794, 95% confidence interval [CI]: 1.087, 2.962), gender (P=0.005, OR=0.488, 95% CI: 0.296, 0.803) and warning sign awareness (P<0.001, OR=1.278, 95% CI: 1.124, 1.454) with awareness of the CRC screening program. CONCLUSION: In this study, most of the participants had low awareness of CRC. More aimed educational interventions are needed to promote Iranian adults' awareness of CRC.

Explaining the Disease Management Experiences of Patients With Inflammatory Bowel Disease: A Qualitative Study.

Inflammatory bowel disease is an unpredictable, chronic, recurrent gastrointestinal disorder with a wide range of social, physical, and psychological problems experienced by patients. The identification of these concerns is important to provide better healthcare. The purpose of this study was to understand the experiences and concerns of these patients. This study was conducted using a qualitative content analysis approach. The participants were 20 inflammatory bowel disease patients. Data were collected through unstructured interviews with purposive sampling and continued until data saturation. Data were comparatively analyzed continuously and simultaneously with data collection. Data analysis revealed two themes of "tension due to possible recurrence" and "fear of decline and deterioration." The integration of these concepts suggested that patients experience "sinking into the marsh of recurrence" as a major concern that disrupts their successful management of inflammatory bowel disease. Identifying the concerns of inflammatory bowel disease patients regarding their cultural and social context is of paramount importance. The integration of such concerns into treatment can improve patients' coping abilities and improve their quality of life.

Iranian medical university board of trustees' challenges in practice: A qualitative study.

Background: Board of Trustees (BOTs) in Iranian medical universities has been considered as one of the most important structural and managerial changes to create a revolution in decision-making and accountability. This study aimed to explore challenges facing BOTs in governing Medical Universities (MUs). Methods: In this qualitative study, 27 semi-structured interviews were conducted with current and former members of BOTs, chancellors of universities, BOTs' secretaries, and staff in the Ministry of Health and Medical Education in 2017. These participants were selected using a purposive and snowball sampling method. Data were analyzed by framework analysis and using Atlas-Ti software. Results: Five key themes were identified, including 1) infrastructure (problems in BOT laws and membership requirement), 2) planning and decision-making (evidence-based decision making and planning and meeting), 3) organizing (ambiguity in positions and lack of necessary administrative structure), 4) performance evaluation (self-reporting, lack of time allocation, lack of evaluation criteria and lack of required structure for evaluation), 5) independence and influence on performance (dependency on the Ministry of Health and Medical Education and financial independence). Conclusion: Due to obsolete laws, it seems that the structural and executive reform of BOTs is essential. The issues of university autonomy and empowerment of the boards' members should particularly be considered in such reforms. However, it appears that more delegation and empowering the position of the boards could be effective strategies in governance medicals universities.

The Experiences of Women who Live with Pelvic Floor Disorders: A Qualitative Study.

BACKGROUND: Pelvic floor disorders (PFDs) are common and complicated problems that occur in women with different ages and cultural backgrounds and affect various dimensions of their life. Because of the dearth of information about how the Iranian women manage these disorders, this study was conducted to explore the experiences of women who live with PFDs. METHODS: This qualitative study was conducted between 2018 -2019 on women who referred to the clinics of Mashhad educational hospitals . 25 deep and semi-structured interview with 22 patients with PFDs was done. They were recruited through a purposive sampling method among women with diagnosis of PFDs. Data were analyzed using conventional content analysis adopted by Graneheim and Lundman and organized using the MAXQDA software (Ver.10). RESULTS: The analysis of the data led to the emergence of a theme of "Acceptance and Tolerance", including four categories: "Trying to adopt sexual conflicts", " Concealing the disease", "Trying to modify the lifestyle", and "Controlling negative emotions", and 15 sub-categories. CONCLUSION: This study provides an insight into self-management strategies for different aspects of challenges faced by women with PFDs.They try to resolve, conceal, modify, and control some issues to accept and tolerate their disease. By identifying self-management strategies, care providers can design and implement counseling, educating and supporting interventions, and also a program through which the patients help and guide each other.

Response Time and Causes of Delay in Prehospital Emergency Missions in Mashhad, 2015.

Background: The response time is considered as one of the most important criteria for the quality of given care to the injured. This research aimed to investigate the frequency and causes of prehospital emergency delays in the 115 emergency center, in city of Mashhad, in 2015. Methods: In this cross-sectional study, 21,142 missions performed in 2015 were investigated, from among which 640 missions with delays in systematic sampling were recognized. For data analysis purposes, descriptive statistics (frequency, mean and SD) in Excel 2013 software was implemented. Results: Nearly 60% of the injured were men, 23% women, and the gender of 17% was not recorded in their profiles. The mean age of the injured was 29.8+15.9 years and 30% of the injured were in the age group of 16 to 25. The mean response time was 9:01+2:46. The most prevalent causes related to missions out of the operational zone (29.3%) and the second cause has been related to traffic groups (24.2%). Conclusion: Establishing new bases and completing the number of ambulances and human recourses, intervention in traffic causing factors, and training the public about emergency cases can be effective in reducing the number of missions and the pace and quality of services provided to the injured.

Reconstruction of individual, social, and professional life: Self-management experience of patients with inflammatory bowel disease.

BACKGROUND: Patients with inflammatory bowel disease (IBD) experience wide range of physical and psychological problems experience. The use of strategies to improve disease management by patients is of has special importance in solving these problems. The aim of present study was to discover the strategies and behaviors of patients to manage their disease. MATERIALS AND METHODS: The present study was conducted with a qualitative research approach and a qualitative content analysis method. The research participants included 20 patients with IBD referred to gastrointestinal wards in 2020 in Mashhad. Data were collected through unstructured interviews and purposeful sampling method and continued until data saturation. Data analysis was performed continuously and simultaneously with data collection and comparatively. RESULTS: Data analysis provided five themes of "Improving self-efficacy and problem-solving skills," "Coexistence with disease," "Reviewing and modifying of interactions," "Adjusting job and professional conditions" and "Commitment to self-care." The combination of these concepts indicated that is the main theme in disease management for these patients. CONCLUSIONS: Reconstruction of individual, social, and professional life can improve self-regulation and problem-solving skills in these patients and make them a sense of control on their lives and disease.

Challenges faced by nurses while caring for COVID-19 patients: A qualitative study.

INTRODUCTION: In the COVID-19 crisis, nurses are directly involved in patient care, so they face many challenges. This study was performed to determine the challenges faced by nurses while caring for COVID-19 patients in Iran in 2020. MATERIALS AND METHODS: This qualitative, content analysis was conducted in Iran on ten nurses directly involved in the fight against the corona epidemic, selected through a purposeful sampling strategy. Data were collected through deep interviews consisting of open questions. All the interviews were recorded, and immediately after each interview, it was transcribed into written form. The data were analyzed using MAXQDA software. RESULTS: All the challenges could be classified into three main categories and 17 subcategories. The main categories were miss-management in controlling corona conditions, mental and physical complications and challenges in corona work conditions, and lack of sufficient workforce. CONCLUSION: Hospital managers and authorities play a significant role in meeting the financial needs and requirements of nurses, and can minimize the job discrimination prevalent at medical centers through providing financial and nonfinancial incentives for nurses. Moreover, the findings of the present study can help hospital managers and authorities to gain a better understanding of the experiences of nurses, and to take the necessary measures to obviate the challenges faced by nurses in public health emergencies.

Family caregivers' burden in inflammatory bowel diseases: An integrative review.

Inflammatory bowel disease (IBD), including Crohn's and ulcerative colitis diseases, is characterized by clinical periods of remission and relapse. Excessive care stress can have long-term negative physical and psychological consequences not only for caregivers but also for the recipients of care. This integrative review aims to identify, describe, and synthesize the results of current available research focused on the burdens of IBDs on family caregiver. An integrative review was performed using Whittemore and Knafl methodology. A systematic search of electronic databases including Web of Science, PubMed, Embase, and Scopus from January 2000 to October 2019 was conducted. Articles were included if published in English and focus on IBD burden on family caregivers. Of 730 records, 16 articles with quantitative, qualitative, and Q methodology study designs were eventually included in the review. The synthesis of these articles led to the identification of four key types of effects: biopsychosocial, daily life activities, physical health, and financial. The chronic and relapsing nature of IBD exposes family caregivers to considerable risk. Thus, the care burden of IBD patients' caregivers needs to be evaluated continuously and relieved through family-centered interventions.

Behavioral determinants of brucellosis incidence among stockbreeders and their family members in rural area based on PRECEDE model.

INTRODUCTION: Brucellosis is one of the common diseases between humans and animals. The purpose of this study was to investigate behavioral determinants of brucellosis incidence among stockbreeders and their family members in a rural area based on the PRECEDE model. MATERIALS AND METHODS: This cross-sectional study was carried out among 540 stockbreeders and their family members in Northeastern Iran in 2019. Sampling was done in two stages including stratified sampling and random sampling method. Data collection was conducted by a valid and reliable questionnaire developed based on the PRECEDE model. Data were analyzed using SPSS16 through Pearson correlation coefficient, independent t-test, and ANOVA. Furthermore IBM SPSS AMOS version 20 was used for the path analysis. RESULTS: The mean age of the participants was 39.02 ± 16.41 years, of whom 53.1% and 46.9% were men and women, respectively. About 23.9% of the participants had a history of brucellosis in their families. Enabling factors were the most important determinant of self-efficacy and self-efficacy was the most important determinants of behavior. Evaluation of the chi-square indicators, chi-square ratio to degree of freedom, root mean square error of approximation, adjusted goodness of fit index, parsimony comparative fit index, comparative fit index, incremental fit index, and parsimonious normed fit index indices indicated that the model was well fitted and there was a positive and significant relationship between the predisposing, enabling, and reinforcing factors on the one hand and behavior on the other. chi-square indicators, chi-square ratio to degree of freedom, root mean square error of approximation, adjusted goodness of fit index, parsimony comparative fit index, comparative fit index, incremental fit index, and parsimonious normed fit index. CONCLUSION: Designing and implementing health plans based on the PRECEDE model with more emphasis on self-efficacy as the most important behavioral determinants can bring about a positive effect on enhancing the brucellosis preventing behaviors.

Psychometric Properties of a Questionnaire on Brucellosis Prevention Behaviors Based on the PRECEDE Model Among Rural Farmers and Their Family Members.

INTRODUCTION: Brucellosis is one of the most prevalent diseases in Torbate Heidarieh, Iran; it is a common disease between human and animals. The present study aimed to review the psychometric properties of a questionnaire on brucellosis prevention behaviors based on the PRECEDE model among rural farmers and their family members (PRECEDE-QBPB). MATERIALS AND METHODS: The study was a combination of qualitative and quantitative stages. In the qualitative stage, an 86-item questionnaire including interviews with 30 farmers, their family members and other effective people, as well as literature review, was designed. In the quantitative stage, psychometric properties of the PRECEDE-QBPB including the face, content, and constructs validities, as well as reliability measurement of the questionnaire were evaluated. Item impact, content validity ratio (CVR) and content validity index (CVI) for all items were calculated. Besides, confirmatory factor analysis (CFA) was done to evaluate the construct's validity; AMOS 20 was used for this purpose. In this stage, a cross-sectional study was conducted on 500 rural farmers and their family members. To estimate the internal consistency of this questionnaire, Cronbach's alpha was used for each variable. Further, descriptive statistics and Kaiser-Meyer-Olkin and Bartlett's test of sphericity were used to describe the characteristics of the participants and collect samples, respectively. RESULTS: Based on the results of face validity and content validity (CVR, CVI and CFA 9), 19 and 22 items were removed, respectively, leaving the final questionnaire with 36 items and eight subscales including knowledge, attitude, self-efficacy, social support, enabling factors, environmental factors, behavioral factors, and reinforcing factors. The Cronbach's coefficient alpha was calculated for the total questionnaire (α= 0.92, 0.69-0.87 for subscales). The evaluation of model fit indices showed that all indices confirmed the suitability of the final model fit; therefore, the questionnaire has suitable construct validity. CONCLUSION: A questionnaire, as a valid tool, was designed in the present study. Healthcare providers, policymakers, planners, researchers may use this tool to find a comprehensive understanding of enabling, reinforcing, environmental and behavioral factors that affect brucellosis before implementing health education and health promotion programs.

A historical review of the concept of labor support in technocratic, humanistic and holistic paradigms of childbirth.

BACKGROUND: In the past century, maternal support during childbirth has been changed according to the different approaches suggested by various health care paradigms. OBJECTIVE: The aim of this review was to argue the maternity supportive care paradigms of the past century and to closely analyze each paradigm. METHODS: This is a historical review, in which published articles were retrieved from databases including Scopus, Science Direct, PubMed and Google Scholar. Sage Journals and Springer's publications were also searched due to the high citation rate of their articles. The keywords entered were "Labor support", "Normal delivery", "Birth attendance", "Supportive approaches", "Health care paradigms", and "Midwifery models of care". They were entered alone or in combinations using "AND". Also, Persian articles were searched in local databases including Irandoc, SID, IranMedex, and Magiran using the above-mentioned keywords in Persian. Sixty articles met inclusion criteria. RESULTS: The review revealed four main themes including the definitions of continuous labor support, the technocratic paradigm, the humanistic paradigm and the naturalistic paradigm as models of labor support. According to the evidence, labor support has changed from technocratic to humanistic and holistic approaches, which in turn, caused some changes in midwifery models of care used by midwives in the practice. CONCLUSION: Labor support based on the holistic approaches and the naturalistic paradigms could bring about remarkable outcomes, the most important being satisfied with the birth experience, increased mother's self-confidence, enhanced mother's ability in childbirth and better completion of the childbirth process.

The best encouraging persons in labor: A content analysis of Iranian mothers' experiences of labor support.

BACKGROUND AND AIMS: The process of giving birth is very stressing for the mother. Meanwhile, maternity ward staff's lack of awareness of mothers' fears make mothers feel lonely and helpless. This study aimed to explore women's perceptions of labor support during vaginal delivery. MATERIALS AND METHODS: This exploratory qualitative study used qualitative content analysis to explore Iranian mothers' experiences of labor support. Data were collected using observations and semi-structured interviews with 25 individuals. The participants were recruited through a purposive sampling method. RESULTS: Three categories, including "involvement of the spouse in the labor process", "asking for a companion during labor", and "mother's self-care to cope with labor pain", emerged during data analysis. These categories were merged to form the main theme of "trying to comply with the labor process". CONCLUSION: Women believed that the presence of a companion, e.g. their husband, a family member, or a doula, during labor helped them better deal with the labor process, particularly when they felt lonely. Health care providers are expected to consider the needs of mothers and try to provide holistic support for mothers during labor pain. IMPLICATIONS FOR PRACTICE: It seems that some mothers adopted particular coping strategies without receiving any relevant training. It is noteworthy that although mothers may make every effort to minimize their pain, health professionals should also practice medical approaches to help them through the process of labor.

At first glance, informal payments experience on track: why accept or refuse? Patients' perceive in cardiac surgery department of public hospitals, northeast of Iran 2013.

BACKGROUND: Patient's Informal payments is among the main source of health care financing in some countries. This paper aimed at determining the patient informal payments and relative factors in Cardiac Surgery Departments (CSD) in hospitals affiliated to Mashhad University of Medical Sciences (MUMS) in 2013. METHODS: In this cross-sectional study, 316 discharged patients were selected using multi-stage sampling. Data gathering tool was a questionnaire which was filled by structured telephone interviews. We used quantitative content analysis for open-ended questions besides descriptive statistics and nonparametric tests by SPSS 16 at 0.05 Sig level. RESULTS: Sixteen (5.93%) patients made voluntary informal payments. The purpose of payment was: "gratitude" (43.75%), satisfaction with health services provided" (31.25%) and (18.75%) for better quality of services. About 75% of the payments were occurred during receiving health care services. The main causes were "no request for informal payments" (98.14%), "not affording to pay for informal payments" (73.33%) and "paying the hospital expenses by taking out a loan" (55.91%). Responders said they would pay informally in demand situation (51.85%) just for patient's health priority, 40.71% would also "search for other alternative solutions" and 27.33% "accepted the demand as a kind of gratitude culture". Twenty four patients (8.9%) had experienced mandatory informal payments during the last 6 months. The minimum amount of payment was 62.5$ and the maximum was 3125$. There was a significant relationship between the way of referring to medical centers and informal patient's payment (P ≤0.05). CONCLUSION: Despite the widespread prevalent belief about informal payments in public hospitals -particularly to the well-known physicians - such judgment cannot be generalized. The main reasons for the low informal payments in the current study were the personality characteristics of the physicians and hospital staff, their moral conscience and commitment to professional ethics, cultural factors and social-economic status of the patients. Health care system should notify people about their rights specially the payments calculation mechanism and methods. Better communication with the public and especially the media can help to correct attitude toward these payments.

Validating and determining the weight of items used for evaluating clinical governance implementation based on analytic hierarchy process model.

BACKGROUND: The purpose of implementing a system such as Clinical Governance (CG) is to integrate, establish and globalize distinct policies in order to improve quality through increasing professional knowledge and the accountability of healthcare professional toward providing clinical excellence. Since CG is related to change, and change requires money and time, CG implementation has to be focused on priority areas that are in more dire need of change. The purpose of the present study was to validate and determine the significance of items used for evaluating CG implementation. METHODS: The present study was descriptive-quantitative in method and design. Items used for evaluating CG implementation were first validated by the Delphi method and then compared with one another and ranked based on the Analytical Hierarchy Process (AHP) model. RESULTS: The items that were validated for evaluating CG implementation in Iran include performance evaluation, training and development, personnel motivation, clinical audit, clinical effectiveness, risk management, resource allocation, policies and strategies, external audit, information system management, research and development, CG structure, implementation prerequisites, the management of patients' non-medical needs, complaints and patients' participation in the treatment process. The most important items based on their degree of significance were training and development, performance evaluation, and risk management. The least important items included the management of patients' non-medical needs, patients' participation in the treatment process and research and development. CONCLUSION: The fundamental requirements of CG implementation included having an effective policy at national level, avoiding perfectionism, using the expertise and potentials of the entire country and the coordination of this model with other models of quality improvement such as accreditation and patient safety.

Personal and socio-cultural barriers to cervical cancer screening in Iran, patient and provider perceptions: a qualitative study.

BACKGROUND: Although cervical cancer is preventable and early screening might decrease the associated mortality, challenges faced by the women and health care providers can postpone early detection. This qualitative study aimed to establish patient and provider perceptions about personal and socio-cultural barriers for cervical cancer screening in Mashhad, Iran. MATERIALS AND METHODS: In the present study, which was conducted in 2012, eighteen participants, who were selected purposefully, participated in individual in-depth, semi-structured interviews, which were recorded, transcribed verbatim, and analyzed using conventional content analysis and Atlas-Ti software. RESULTS: One theme and two categories were derived from data including: cognitive/behavioral factors (lack of a community-based approach to cervical cancer, lack of awareness, wrong attitude and lack of health seeking behaviors) and socio/cultural issues (socio-cultural invasion, mismatch between tradition, modernity and religious, extra marital relationships and cultural taboos). CONCLUSIONS: Providing community based approach education programs and employing social policy are needed for preventing of cervical cancer in Iran.

Risk Assessment of Drug Management Process in Women Surgery Department of Qaem Educational Hospital (QEH) Using HFMEA Method (2013).

Evaluation and improvement of drug management process are essential for patient safety. The present study was performed whit the aim of assessing risk of drug management process in Women Surgery Department of QEH using HFMEA method in 2013. A mixed method was used to analyze failure modes and their effects with HFMEA. To classify failure modes; nursing errors in clinical management model, for classifying factors affecting error; approved model by the UK National Health System, and for determining solutions for improvement; Theory of Inventive Problem Solving, were used. 48 failure modes were identified for 14 sub-process of five steps drug management process. The frequency of failure modes were as follow :35.3% in supplying step, 20.75% in prescription step, 10.4% in preparing step, 22.9% in distribution step and 10.35% in follow up and monitoring step. Seventeen failure modes (35.14%) were considered as non-acceptable risk (hazard score≥ 8) and were transferred to decision tree. Among 51 Influencing factors, the most common reasons for error were related to environmental factors (21.5%), and the less common reasons for error were related to patient factors (4.3%). HFMEA is a useful tool to evaluating, prioritization and analyzing failure modes in drug management process. Revision drug management process based focus-PDCA, assessing adverse drug reactions (ADR), USE patient identification bracelet, holding periodical pharmaceutical conferences to improve personnel knowledge, patient contribution in drug therapy; are performance solutions which were placed in work order.

Improvement of hospital processes through business process management in Qaem Teaching Hospital: A work in progress.

In a world of continuously changing business environments, organizations have no option; however, to deal with such a big level of transformation in order to adjust the consequential demands. Therefore, many companies need to continually improve and review their processes to maintain their competitive advantages in an uncertain environment. Meeting these challenges requires implementing the most efficient possible business processes, geared to the needs of the industry and market segments that the organization serves globally. In the last 10 years, total quality management, business process reengineering, and business process management (BPM) have been some of the management tools applied by organizations to increase business competiveness. This paper is an original article that presents implementation of "BPM" approach in the healthcare domain that allows an organization to improve and review its critical business processes. This project was performed in "Qaem Teaching Hospital" in Mashhad city, Iran and consists of four distinct steps; (1) identify business processes, (2) document the process, (3) analyze and measure the process, and (4) improve the process. Implementing BPM in Qaem Teaching Hospital changed the nature of management by allowing the organization to avoid the complexity of disparate, soloed systems. BPM instead enabled the organization to focus on business processes at a higher level.