Nurse managers can contribute to promoting a safety culture by encouraging staff to report errors, fostering learning from errors and addressing inter-professional communication problems.

Background: Determining the optimal number of hospital beds is a complex and challenging endeavor and requires models and techniques which are sensitive to the multi-level, uncertain, and dynamic variables involved. This study identifies and characterizes extant models and methods that can be used to determine the required number of beds at hospital and regional levels, comparing their advantages and challenges. Methods: A systematic search was conducted using Web of Science, Scopus, Embase and PubMed databases, with the search terms hospital bed capacity, hospital bed need, hospital, bed size, model, and method. Results: Twenty-three studies met the criteria to be included in the review. Of these studies, a total of 11 models and 5 methods were identified, mainly designed to determine hospital bed capacity at the regional level. Common determinants of the required number of hospital beds in these models included demographic changes, average length of stay, admission rates, and bed occupancy rates. Conclusions: There are no specific norms for the required number of beds at hospital and regional levels, but some of the identified models and methods may be used to estimate this number in different contexts. Moreover, it is important to consider alternative approaches to planning hospital capacity like care pathways to fix the limitations of "bed numbers".

Background: Self-medication can lead to serious consequences but its overall prevalence in students is not known. Aims: The aim of this study was to determine the prevalence of self-medication in students through a systematic review and meta-analysis of studies on the prevalence of self-medication in students across the world. Methods: PubMed/MEDLINE, EMBASE, ISI/Web of Science and Google Scholar were searched up to October 2017. Studies reporting the prevalence of self-treatment in university students were selected. Data recorded included year of publication, country where the study was conducted, sample size, prevalence of self-medication, sex and mean age of students, and faculty of students (medical or non-medical). A random-effect model was used to determine effect size with a 95% confidence interval (CI). Heterogeneity across studies was assessed with the I 2 test. A sensitivity analysis assessed stability of the findings. Results: A total of 89 studies were included in the analysis, which comprised 60 938 students. The overall prevalence of self-medication in university students was 70.1% (95% CI: 64.3-75.4%). Female students self-medicated more often than male students: odds ratio = 1.45 (95% CI%: 1.17-1.79). The prevalence of self-medication in medical students (97.2%) was higher than in non-medical students (44.7%). The I 2 test indicated high, statistically significant heterogeneity. The sensitivity analysis showed that the results were stable. Conclusion: The prevalence of self-medication among students worldwide is high. Programmes on the risks of self-medication and increasing control and monitoring of the sale of drugs are recommended. Facilitating students' access to doctors and health centres could reduce self-medication in students.

Hospitals all around the world play an essential role in response to the COVID-19 pandemic. During an epidemic event, hospital leaders frequently face new challenges requiring them to perform unaccustomed tasks, which might be well beyond the scope of their previous practice and experience. While no absolute set of characteristics is necessary in all leadership situations, certain traits, skills and competencies tend to be more critical than others in crisis management times. We will discuss some of the most important ones in this manuscript. To strengthen those managerial competencies needed to face outbreaks, healthcare leaders should be better supported by competency-based training courses as it is more and more clear that traditional training courses are not as effective as they were supposed to be. It seems we should look at the COVID-19 pandemic as a learning opportunity to re-frame what we expect from hospital leaders and to re-think the way we train, assess and evaluate them.

BackgroundWith the successful improvement of global health systems and social security in societies, the world is now advancing toward aging. All countries have to face the phenomenon of population aging sooner or later depending on their degree of development; however, elderly care is predicted to soon become a major concern for developing countries such as Iran.ObjectivesThis study was conducted to identify the challenges of elderly care in Iran and to help policymakers develop roadmaps for the future through providing a clearer image of the current state of affairs in this area of healthcare.DesignThis study has adopted a framework approach to qualitative data analysis. For this purpose, 37 semi-structured interviews were conducted in 2015 with a number of key informants in elderly care who were familiar with the process at macro-, meso-, and micro-levels. Maximum variation purposive sampling was performed to select the study samples. A conceptual framework was designed using a review of the literature, and key issues were then identified for data analysis.ResultsThe elderly care process yielded five major challenges, including policymaking, access, technical infrastructure, integrity and coordination, and health-based care services.DiscussionAccording to the stakeholders of elderly care in Iran, the current care system is not well-suited for meeting the needs of the elderly, as the elderly tend to receive the services they need sporadically and in a non-coherent manner. Given the rapid growth of the elderly population in the coming decades, it is the authorities’ job to concentrate on the challenges faced by the health system and to use foresight methods for the comprehensive and systematical management of the issue.

Background A huge number of people living with HIV / AIDS lives in developing countries. Thus, strengthening health systems in these countries is a prerequisite for improving disease prevention and care. After three decades of HIV/AIDS policy-making in Iran, conducting a comprehensive analysis on the policy process seems to be essential. In the present study, we aimed to analyse the HIV/AIDS policy-making process in Iran from 1986 to 2016. Methods This was a theory-based, multi-method and retrospective study. Interviewing of key informants and review of policy documents were concurrently conducted to identify and include further key informants (39 participants) and documents in the study. Framework analysis was used to analyse data. Results The mean age of participants working in HIV/AIDS policy-making was of 48 years and participants had a mean of 14 years of working experience. Findings were categorized as contextual factors, content of HIV/AIDS policies, actors involved in the policy process, and evidence use in the policy process. Contextual effective factors on the HIV/AIDS policy-making process were categorized into five major themes, namely situational factors, structural-managerial factors, socioeconomic factors, political and legal factors, and international factors. The HIV/AIDS phenomenon in Iran was identified to be deeply rooted in the culture and traditions of society. The HIV/AIDS policy content has, recently, been crystallized in the national strategic plans and harm reduction policies of the country. The policy process has been conducted with a solely governmental top-down approach and is now suffering from poor evidence and lack of sufficient consideration of contextual factors. Conclusions There is a great need for change in the approach of government towards the issue and to increase the participation of non-governmental sectors and civil society in the policy process.

BackgroundEvaluating hospital efficiency is a process to optimize resource utilization and allocation. This is vital due to hospitals being the largest financial cost in a health system. To limit avoidable uses of hospital resources, it is important to identify the sources of hospital inefficiencies and to put in place measures towards their reduction and elimination. Thus, the purpose of this research is to examine the sources of hospital inefficiency in the Eastern Mediterranean Region, and existing strategies tackling this issue.MethodsIn this study, the electronic databases MEDLINE (via PubMed), Web of Science, Embase, Google, Google Scholar, and reference lists of selected articles, were explored. Studies on inefficiency, sources of inefficiency, and strategies for inefficiency reduction in the Eastern Mediterranean region hospitals, published between January 1999 and May 2018, were identified. A total of 1466 articles were selected using the initial criteria. After further reviews based on the inclusion and exclusion criteria, 56 studies were eligible for this study. The chosen studies were conducted in Iran (n = 35), Saudi Arabia (n = 5), Tunisia (n = 5), Jordan (n = 4), Pakistan (n = 2), the United Arab Emirates, Palestine, Iraq, Oman, and Afghanistan (n = 1 each). These studies were analyzed using content analysis in MAXQDA 10.ResultsThe analysis showed that approximately 41% of studies used data envelopment analysis (DEA) to measure hospital efficiency. Sources of hospital inefficiency were divided into four categories for analysis: Hospital products and services, hospital workforce, hospital services delivery, and hospital system leakages.ConclusionThis study has revealed some sources of inefficiency in the Eastern Mediterranean Region hospitals. Inefficiencies are thought to originate from excess workforce, excess beds, inappropriate hospital sizes, inappropriate workforce composition, lack of workforce motivation, and inefficient use of health system inputs. It is suggested that health policymakers and managers use this evidence to develop appropriate strategies towards the reduction of hospital inefficiency.

Trend analysis in 2005 to 2011 showed high growth in diabetes prevalence in Iran. Considering the high prevalence of diabetes in the country and likely to increase its prevalence in the future, the analysis of diabetes-related policies and programs is very important and effective in the prevention and control of diabetes. Therefore, the aim of the study was an analysis of policies and programs related to prevention and control of diabetes in Iran in 2014.This study was a policy analysis using deductive thematic content analysis of key documents. The health policy triangle framework was used in the data analysis. PubMed and ScienceDirect databases were searched to find relevant studies and documents. Also, hand searching was conducted among references of the identified studies. MAXQDA 10 software was used to organize and analyze data.The main reasons to take into consideration diabetes in Iran can be World Health Organization (WHO) report in 1989, and high prevalence of diabetes in the country. The major challenges in implementing the diabetes program include difficulty in referral levels of the program, lack of coordination between the private sector and the public sector and the limitations of reporting system in the specialized levels of the program.Besides strengthening referral system, the government should allocate more funds to the program and more importance to the educational programs for the public. Also, Non-Governmental Organizations (NGOs) and the private sector should involve in the formulation and implementation of the prevention and control programs of diabetes in the future.