Evaluating Primary Healthcare Quality from Migrants and Refugees' Viewpoint

Background

The likelihood of poor health outcomes for refugees is increased due to a variety of complicated causes. Lack of access to high-quality care during resettlement is frequently cited by migrants. Therefore, this study was carried out to assess the quality of primary care services from the perspective of refugees and migrants.

Methods

This cross-sectional study was conducted in three health networks affiliated with Iran University of Medical Sciences in 2021. Data were collected by using a self-administrative questionnaire, the validity and reliability of which were checked and confirmed. The questionnaires were randomly completed by 280 migrants and refugees. Data were analyzed by using Kruskal-Wallis, Mann-Whitney U, Spearman correlation, exploratory factor analysis, and Cronbach's α with SPSS 22.

Results

According to the results, the overall service quality was 3.86 out of 5. The highest and lowest mean scores were related to efficiency (4.12 ±0.64) and tangibility (3.28 ±0.39). Furthermore, there was a significant relationship between the perception of service quality and gender, education, residence area, and the rate of center visits (P < 0.05).

Conclusion

The quality of services was generally rated favorably by the refugees. Managers and decision-makers are recommended to allocate enough funds to equip and upgrade the amenities at health centers to increase the quality of services.

Cervical Cancer Prevention, Its Challenges and Solutions in Iran and Worldwide: A Systematic Review

Background

Widespread use of screening in high-income countries has led to significant reductions in mortality from cervical cancer. However, in Iran, the main reason for the late diagnosis of cervical cancer was the failure to perform a Pap smear (Papanicolaou). We aimed to investigate the status of cervical cancer prevention and its challenges and solutions in Iran.

Method

We conducted a systematic review of literature published from 1974 to 2021 in the electronic databases, including PubMed, Web of Science, Embase, Scopus, and Google Scholar, and retrieved all English-language articles. Following the application of the inclusion and exclusion criteria, full-text articles were identified and evaluated for eligibility. Finally, these publications were analyzed as part of the synthesis.

Results

Lower social-economic level, inadequate knowledge of screening tests and health centers for Pap test performance leading to worse outcomes such as lower screening participation or coverage.

Conclusion

By addressing these challenges through increasing education, increasing service accessibility, expanding screening programs, improving public awareness, improving insurance coverage, and establishing a control protocol for follow-up, it is possible to reduce cervical cancer incidence and mortality.

Development and validation of primary health care quality assessment tool

BACKGROUND

Assessing the quality of health services gives insights to managers about the status of services delivered by them, especially from the client's perspective. Although various tools have been developed to measure the quality of primary health care (PHC), no specific tool was found in this field in Iran. Therefore, the present study was conducted to develop and validate the quality assessment tool of PHC in Iran.

METHODS

This methodological study was conducted in 2021. In the first step, based on a literature review, an initial questionnaire was designed, and its face validity, content validity, construct validity, and reliability were evaluated. Descriptive tests, Kolmogorov-Smirnov, exploratory factor analysis, Kaiser-Myer-Olkin (KMO), and Cronbach's alpha were performed by using SPSS 22.

RESULTS

The initial questionnaire included 33 items, of which three items were removed due to inconsistency with factorization. The final questionnaire consisted of 30 items and nine dimensions: interaction, efficiency, timeliness, accuracy, consultation, tangibility, safety, accessibility, and environment. The KMO and Cronbach's alpha index values were 0.734 and 0.82, respectively, indicating acceptable reliability and validity. The developed dimensions represented about 73% of the total variance.

CONCLUSION

The designed questionnaire has relatively good validity and reliability and can be used to measure the quality of PHC and to identify weaknesses in service delivery. However, researchers should carefully examine it to enhance its applicability as a standard tool for measuring PHC quality.

The effects of synbiotics supplementation on reducing chemotherapy-induced side effects in women with breast cancer: a randomized placebo-controlled double-blind clinical trial

BACKGROUND

The prevalence of breast cancer and its mortality rate are increasing rapidly among women worldwide. On other hand, the courses of chemotherapy as the main treatment for these patients are too much exhaustive and annoying. This study was designed to evaluate the use of synbiotics (probiotics + prebiotics) supplementation as a safe and inexpensive adjuvant treatment in reducing common chemotherapy side effects in women with breast cancer.

METHODS

The current study was conducted on 67 women with definitive diagnosis of breast cancer who were hospitalized to receive one-day chemotherapy sessions, and met the inclusion criteria. The patients were randomly allocated to the intervention or control group to receive synbiotics or placebo, respectively. They received oral consumption of synbiotics supplements twice a day for 8 weeks. The primary outcome was the changes in severity or experience of chemotherapy complication, analyzed by intention to treat (ITT). The instruments included 7 validated questionnaires which were used to assess chemotherapy complications in the initiation, 4 weeks and 8 weeks after intervention. Dietary intake was measured by 24-h dietary recall at the beginning, week 4 and week 8. Data were analyzed by SPSS software version 24. P-value < 0.05 was considered as statistically significant.

RESULTS

67 breast cancer patients participated in the study. 8 weeks after intervention and adjusting the confounders, the severity of chemotherapy complications including unnormal defecation (P = 0.005) and fatigue (P < 0/001) decreased significantly in the synbiotics group compared to the placebo group. Furthermore, nausea/vomiting (P = 0.015), and anorexia (P < 0.001) were decreased at the end of the study compared to the first visit, but it was not statistically significant compared to the placebo group.

CONCLUSIONS

Synbiotics supplementation during chemotherapy can potentially reduce the severity of fatigue and abnormal defecation. It can help reduce anorexia and nausea/vomiting.

TRIAL REGISTRATION

This study was registered in the Iranian Registry of Clinical Trials (IRCT) (registered code: IRCT20091114002709N56) (date of registration: 5/5/2021). Direct link to the trial page: https://www.irct.ir/trial/54559 .

Assessing the quality of hospital outpatient services in Iran: a systematic review and meta-analysis

BACKGROUND

Quality healthcare services are considered one of the most effective vehicles for healthcare managers to achieve organizational goals. Therefore, this study aimed to combine the findings of comparable studies to identify consistencies and contradictions in the quality of outpatient services in Iran.

METHODS

The current systematic review and meta-analysis study was conducted in 2022 according to PRISMA guideline. All relevant English and Persian studies were searched in databases, including Web of Sciences, PubMed, Scopus, Scientific Information Database, and Magiran. No year restriction was applied. The quality of the studies was assessed by the 22-item Strengthening the Reporting of Observational Studies in Epidemiology checklist. The meta-analysis was conducted by using Open Meta Analyst, and between-study heterogeneity was investigated with I-squared statistic.

RESULTS

Of the 106 retrieved articles, seven studies with a total sample size of 2600 were included in the meta-analysis. The pooled estimate of mean for overall perception was 3.95 (95% CI: 3.34- 4.55, P< 0.001, I2= 99.97), while the pooled estimate of the mean for the overall expectation was 4.43 (95% CI: 4.11- 4.75, P< 0.001, I2= 99.93). The highest and lowest perception mean scores were related to tangibility (3.52, Gap= -0.86) and responsiveness (3.30, Gap= -1.04) dimensions.

CONCLUSION

Responsiveness was identified as the weakest dimension. Therefore, managers are recommended to design suitable workforce-development programs which focus on the provision of timely and prompt services, polite and courteous interactions with patients, and prioritization of patients' needs. Moreover, training public sector practitioners along with incentives can fill up the existing gaps.

A systemmatic literature review on indirect costs of women with breast cancer

INTRODUCTION

The rising incidence of breast cancer places a financial burden on national health services and economies. The objective of this review is to present a detailed analysis of the research and literature on indirect costs of breast cancer.

METHODS

English literature databases from 2000 to 2020 were searched to find studies related to the objective of the present review. Study selection and data extraction was undertaken independently by two authors. Also, quality assessment was done using a checklist designed by Stunhldreher et al. RESULTS: The current study chose 33 studies that were eligible from a total of 2825 records obtained. The cost of lost productivity due to premature death based on human capital approach ranged from $22,386 to $52 billion. The cost burden from productivity lost due to premature death based on friction cost approach ranged from $1488.61 to $4,518,628.5. The cost burden from productivity lost due to morbidity with the human capital approach was reported as $126,857,360.69 to $596,659,071.28. The cost of lost productivity arising from informal caregivers with the human capital approach was $297,548.46 to $308 billion.

CONCLUSION

Evaluation of the existing evidence revealed the indirect costs of breast cancer in women to be significantly high. This study did a thorough review on the indirect costs associated with breast cancer in women which could serve as a guide to help pick the appropriate method for calculating the indirect costs of breast cancer based on existing methods, approach and data. There is a need for calculations to be standardised since the heterogeneity of results in different domains from various studies makes it impossible for comparisons to be made among different countries.

Predicting major adverse cardiovascular events in acute coronary syndrome: A scoping review of machine learning approaches

BACKGROUND

Acute coronary syndrome is the topmost cause of death worldwide; therefore, it is necessary to predict major adverse cardiovascular events and cardiovascular deaths in patients with acute coronary syndrome to make correct and timely clinical decisions.

OBJECTIVE

The current review aimed to highlight algorithms and important predictor variables through examining those studies which used machine learning algorithms for predicting major adverse cardiovascular events in patients with acute coronary syndrome.

METHODS

In order to predict major adverse cardiovascular events in patients with acute coronary syndrome, the preferred reporting items for scoping reviews guidelines were used. PubMed, Embase, Web of Science, Scopus, Springer, and IEEE Xplore databases were searched for articles published between 2005 and 2021. The findings of the studies are presented in the form of a narrative synthesis of evidence.

RESULTS

According to the results, 14 (63.64%) studies did not perform external validation and only used registry data. The algorithms used in this study comprised, inter alia, Regression Logistic, Random Forest, Boosting Ensemble, Non-Boosting Ensemble, Decision Trees, and Naive Bayes. Multiple studies (N=20) achieved a high Area under the ROC Curve between 0.8 to 0.99 in predicting mortality and major adverse cardiovascular events. The predictor variables used in these studies were divided into demographic, clinical, and therapeutic features. However, no study reported the integration of machine learning model into clinical practice.

CONCLUSION

Machine learning algorithms rendered acceptable results to predict major adverse cardiovascular events and mortality outcomes in patients with acute coronary syndrome. However, these approaches have never been integrated into clinical practice. Further research is required to develop feasible and effective machine learning prediction models to measure their potentially important implications for optimizing the quality of care in patients with acute coronary syndrome.

Hospital Management in Infectious Disease Outbreak: Lessons Learned From COVID-19 Epidemic

Background: Biological events, including epidemics, pandemics, and emerging and reemerging infectious diseases, have significant adverse consequences on human health. Hospitals have a major role in the management of outbreaks and mitigation of their consequences. During pandemics, health systems, especially hospitals, are affected. The current study aims to collect and analyze hospital lessons learned during the COVID-19 epidemic in Iran. Materials and Methods: The study data were collected through document analysis, direct observation, and taking the opinions of an expert panel (including hospital chiefs, hospital managers, disaster committee managers, matrons, and other hospital staff) at hospitals involved with coronavirus patients. Results: The practical measures performed in Iran hospitals included the development of the hospital incident command system, screening and triage, establishing a call center, patient and family management, personnel management, volunteers management, education, planning, safety, environmental health, dead patients management, sampling, food hygiene of staff and patients, coordination and cooperation, sharing information, home treatment and care, infection prevention, and control and isolation. Conclusion: COVID-19 pandemic has significant adverse consequences on human health, hospital, and medical staff. During COVID-19, hospitals will face a high surge in suspected and confirmed patients. Therefore, hospitals should perform the proper measures to manage an emergency.

Asthma Management System in Primary Care Based on Global Initiative for Asthma and Snell's Drug Interaction: Accuracy and Usability

Background

The two main pillars of asthma management include regular follow-up and using guidelines in the treatment process. Patient portals enable regular follow-up of disease, and guideline-based decision-support-systems can improve the use of guidelines in the treatment process. Based on the Global Initiative for Asthma (GINA) and Snell's drug interaction, asthma management system in primary care (AMSPC) includes the capabilities of both mentioned systems. This system was developed to improve regular follow-up and use GINA in the asthma management process. This study aimed to assess the accuracy and usability of the AMSPC based on the GINA and Snell's drug interaction.

Materials and Methods

To assess the accuracy of the system, kappa test was used to calculate the degree of agreement between the suggestions made by the system and the physician's decision for a total of 64 patients selected through convenience sampling method. To assess usability, the Questionnaire for User Interface Satisfaction (QUIS) was used.

Results

The scores of the Kappa for the agreements between the system and the physician in determining "drug type and dosage", "follow-up time", and "drug interactions" were 0.90, 0.94, and 0.94, respectively. The average score of the QUIS was 8.6 out of 9.

Conclusion

Due to the high accuracy of the system in computerizing the GINA and Snell's drug interaction, as well as its proper usability, it is expected that the system be widely used to improve asthma management and reduce drug interactions.

The Economic Burden of Cancer in Iran during 1995-2019: A Systematic Review

Background

Cancer is the third cause of death following cardiovascular disease and accidents, in Iran. The purpose of this study was to systematically review the economic burden of cancer studies in Iran.

Methods

This systematic review examined the types of direct medical and non-medical costs and indirect costs in cancer patients and includes studies in English and Persian that were reviewed in Scopus, Web of science, SID, Iranmedex, Magiran and databases of Medline, etc., from 1995-2019.

Results

Twenty-one articles were included. Most studies have examined the direct costs of all types of cancers. The articles reviewed different types of cancer, such as prostate cancer (n=2), colorectal cancer (n=2), breast cancer (n=4), gastric cancer (n=2), oral and pharyngeal cancer (n=1), lung cancer (n=3), and blood cancer (n=4). The great number of studies were related to the gastrointestinal, breast and blood cancers. The gastrointestinal (gastric and colorectal) and breast cancer had the major economic burden than others.

Conclusion

It is necessary that special attention to patients, supportive measures to reduce the share of costs, and more budget allocation for prevention, screening and early detection being at priorities in the health system planning.

The Impact of Inflation and Its Uncertainty on Pharmaceutical Prices: Evidence from Iran

Pharmaceutical productions are recognized as an essential commodity in the economical literature; therefore, an increase in their prices leads to an increase in the household budget. Currently, about 15-20% of the entire health expenditure in Iran is allocated to the pharmaceutical sector. This study aimed to investigate the effect of inflation and its uncertainty on inflation in pharmaceutical prices in Iran. In this study, the monthly time series of consumer price index from 2001 to 2017 was used to calculate inflation uncertainty based on a generalized autoregressive conditional heteroscedasticity model. Hylleberg-Engle-Granger-Yoo test was performed to determine the stationary of the data. Feasibility tests were also used to explore the application of Autoregressive conditional heteroscedasticity family models to these data. The causal relationship between inflation uncertainty and inflation in the pharmaceutical sector was investigated using the Granger causality test. A causal relationship was found between inflation and inflation uncertainty at the 95% confidence interval for the monthly data during the study. It was revealed that Inflation uncertainty did not affect the inflation in the pharmaceutical prices, but inflation can be a cause of pharmaceutical inflation. Although inflation uncertainty has no association with pharmaceutical inflation, it seems that it could affect pharmaceutical inflation through inflation in other sectors. Therefore, adopting appropriate monetary policies aimed at controlling liquidity and inflation can effectively control pharmaceutical prices.

A model of reopening businesses to decrease the heath and economic impacts of the COVID-19 pandemic: Lessons from Iran

Background: OVID-19 is a major cause of morbidity and mortality worldwide. The closure of governmental and nongovernmental centers as well as social, cultural, and economic activities are other major negative impacts of the virus. The present paper aimed to develop a model of economic and health-related factors which affect the reopening of businesses and the proper management of the effect of virus on different aspects, particularly on people’s health and economy.

Methods: In order to facilitate decision-making and model risk analysis of guilds and occupations, an expert panel, including eight 8 experts, was convened by the Ministry of Health in Iran to prepare a strategic framework for the national taskforce of COVID-19 management. The panel spent many hours to prepare a simple model of reopening businesses and prioritize them from low to high risks.

Results: The experts identified and weighed seven health and three economic-related factors. The businesses and jobs were classified into 69 categories based on their similarities; they were also graded according to a predefined five- point Likert scale and categorized into three levels of low, medium, and high risk. The policymakers recommended to reopen businesses stratified by risk levels at least two weeks’ intervals.

Conclusion: The relaunch strategy in Iran put health and safety first while gradually reopening businesses, resuming activities, and getting people back to work. At the same time, attempts were made to slow the spread of the virus through following public health measures, social distancing, good hygiene, and continued acting responsibly. As many countries may have to deal with the same issue, this model can help them adopt appropriate policies and strategies for disease containment.

Medical costs of osteoporosis in the Iranian elderly patients

Background: In the coming years and near future, Iran will experience a main demographic transition resulting in an aging phenomenon and increased number of people over 65 years. Aging leads to increased medical expenditures associated with chronic diseases such as osteoporosis. This study aimed to investigate the patient-specific hospitalization costs of osteoporosis treatment in elderly patients.

Methods: A retrospective cost analysis of hospitalization arising from osteoporosis conducted on all the elderly patients (adults aged 65 years and above) in a teaching hospital in Tehran through examining hospital admissions during 2017. The elderly patients consisted of 295 with a length of stay ≥ 24 hours. Cost analysis was performed using a bottom-up micro-costing approach and payer perspective (patient and insurer); and the result was statistically significant (p≤0.05). Nonparametric tests, including Mann–Whitney and Kruskal–Wallis tests, were used to investigate the relationship between affecting variables. Hospital training was considered as a control variable. The data were analyzed using SPSS 11 software

Results: The mean age of the patients was 71.3 years; of the patients, 79% were female and 21% male. The overall crude prevalence of osteoporosis was 80% among people ≥ 65 years and 85% among patients who experienced relevant surgeries. The average cost of hospitalization was $3794.13. Also, 3 main areas of hospital costs were identified: consumables (57.70%), hoteling (17.24%), and surgical services (15.76%). The prevalence of osteoporosis was 4 times higher in women compared with men. Moreover, there were significant differences between the variables affecting hospital costs, such as gender, length of stay, diagnosis, intensive care unit services, and surgery (p<0.05).

Conclusion: Age-associated diseases such as osteoporosis increase the health care costs. The dominant cost drivers in this study were the consumables, hoteling, and surgical services, respectively. Policymakers and health care planners should consider such variables as gender, previous surgeries in the patients’ records, length of stay, and intensive care unit services as driving factors and determinants of hospital costs for older seniors with osteoporosis.

Evaluation of service quality from patients' viewpoint

Background

Measuring patients’ perception from health service quality as an important element in the assessment of service quality has attracted much attention in recent years. Therefore, this study was conducted to find out how the patients evaluated service quality of clinics at teaching hospitals affiliated with Tehran University of Medical Sciences in Iran.

Methods

This cross-sectional study was conducted in Tehran in 2017 and 400 patients were randomly selected from four hospitals. Data were collected using a questionnaire, the validity and reliability of which were confirmed in previous study. In order to analyze the data, T-test, ANOVA, and Pearson correlation coefficient were calculated using SPSS 23.

Results

The results indicated that among eight dimensions of health service quality, the patients were more satisfied with physician consultation, services costs and admission process. The highest and lowest mean scores were related to physician consultation (Mean = 4.17), and waiting time (Mean = 2.64), in that order. The total mean score of service quality was 3.73 (± 0.51) out of 5. Outpatient services were assessed as good, moderate and weak by 57.5, 40 and 2.5% of the patients, respectively. There was a significant relationship between the positive perception of service quality and reason for admission, source of recommendation, gender, education level, health status, and waiting time in the clinics (p <  0.05).

Conclusion

The majority of the patients had a positive experience with visiting clinics and perceived service provision as good. In fact, patients’ perceptions of physician consultation, provision of information to patients and the environment of delivering services, are the most important determinants of service quality in clinics.

Validity testing of classroom community scale in virtual environment learning: A cross sectional study

Background

Fostering a Sense of Classroom Community is considered to be associated with the reduction of student's dropout rate in an online environment. Many scales have been developed to measure sense of community in online and traditional learning, and Rovai's Classroom Community Scale has been widely used. This study was designed to examine the psychometric properties and the theoretical structure of the Classroom Community Scale.

Materials and methods

A total of 215 postgraduate virtual students responded to the Classroom Community Scale. A measurement model was evaluated using confirmatory factor analysis to determine the adequacy of goodness-of-fit to sample data.

Results

The confirmatory factor analysis provided valid data that the Classroom Community Scale with a two-factor structure is a valid scale with adequate model fit. Connectedness and learning subscales were also valid and reliable. Overall, the results supported the high reliability, face and content validity of all items of the scale.

Conclusions

The 20 item Classroom Community Scale provides a valid and reliable scale to measure sense of community among postgraduate medical education students.

•

The Persian version of CCS is a psychometrically sound scale to measure SCC in virtual environment.

•

It is a valuable assessment tool that can be used for various purposes: (1) to measure SCC in online learning; (2) to measure the efficacy of courses designed to promote online classroom community; (3) to reduce feelings of isolation experienced in online learning, (4) to create classroom and school environments that promote community learning, and (5) to enhance student satisfaction, learning, and persistence in virtual environments.

•

Fostering a sense of classroom community (SCC), would reduce students dropout rate in the online environment.

Detection of masses and microcalcifications in digital mammogram images using fuzzy logic

Background

Detection of small breast lesions is a challenging task for radiologists. Computer aided detection (CAD) systems are implemented to aid radiologists in detecting masses and microcalcifications. This has the potential to raise the level of sensitivity in breast cancer detection.

Objectives

To evaluate a new system to detect suggestions of suspicious small lesions.

Methods

Small samples were extracted from different tissue types. Texture features were calculated, and the best features were selected using Waikato Environment for Knowledge Analysis (WEKA) software. Subsequently, 7 selected features were used to form a decision tree. To reduce false negative cases, fuzzy logic was used. In the implementation phase, input images were divided into 8 pixel ´ 8 pixel tiles. For each tile, all selected features were computed as fuzzy inputs.

Results

To evaluate the technique, the suggested system was applied to 326 images obtained from the National Cancer Society of Malaysia. Based on this application, results showed that the suggested system has an acceptable sensitivity of 85.6% and specificity of 90.7%.

Conclusions

The fuzzy system is a promising technique for early detection of breast cancer.

Post graduate ESP curriculum: reading and writing needs

Assessing learners' needs is an integral part of any curriculum and course design , namely English for specific purposes (ESP), syllabus design, materials development, teaching methods and testing issues. Critical approach to needs analysis, which is a relatively recent approach, acknowledges the rights of different stakeholders including teachers, students and administrators in the process of needs analysis. However, there has been no formal need analysis for syllabus design at postgraduate level in Medical Universities affiliated to the Ministry of Health in Iran. This study, conducted in 2011, was an attempt to assess the reading and writing needs of postgraduate students in ESP courses on the basis of critical approach to needs analysis. The study population consisted of 67 people: 56 postgraduate students, 5 heads of departments, 5 ESP instructors and 1 executive manager at the Ministry of Health in Iran. Ethical and demographic forms, needs analysis questionnaires, and a form of semi-structured interview were the instruments of the study. According to the findings, there was a discrepancy between students' and instructors' perception of learners' needs and the assumed needs appearing in the syllabi prescribed by the Ministry of Health in Iran. This study showed that a call for critical needs analysis in which the rights of different stakeholders are acknowledged is necessary for meeting the requirements of any ESP classes especially at postgraduate level where the instructors and learners are fully aware of learners' needs.

Effect of distraction on children's pain during intravenous catheter insertion

PURPOSE

This study examined the effect of pressing a soft ball during intravenous catheter insertion (IVCI) on the intensity of pain in children ages 4-6 years.

DESIGN AND METHODS

In this quasi-experimental study, children in the intervention group were asked to press a soft ball with the opposite hand during IVCI and to immediately mark the Wong-Baker FACES Pain Rating Scale.

RESULTS

There was a significant difference in the intensity of pain between the control group (n = 30) and the intervention group (n = 30; p =.012).

PRACTICE IMPLICATIONS

Pressing a soft ball during IVCI may be an easily accessed, inexpensive, and effective technique to control or reduce pain in young children.