Treatment of osteochondral lesions of the talus: a systematic review

The aim of this study was to summarize all eligible studies to compare the effectiveness of treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from January 1966 to December 2006 were systematically screened. The proportion of the patient population treated successfully was noted, and percentages were calculated. For each treatment strategy, study size weighted success rates were calculated. Fifty-two studies described the results of 65 treatment groups of treatment strategies for OCD of the talus. One randomized clinical trial was identified. Seven studies described the results of non-operative treatment, 4 of excision, 13 of excision and curettage, 18 of excision, curettage and bone marrow stimulation (BMS), 4 of an autogenous bone graft, 2 of transmalleolar drilling (TMD), 9 of osteochondral transplantation (OATS), 4 of autologous chondrocyte implantation (ACI), 3 of retrograde drilling and 1 of fixation. OATS, BMS and ACI scored success rates of 87, 85 and 76%, respectively. Retrograde drilling and fixation scored 88 and 89%, respectively. Together with the newer techniques OATS and ACI, BMS was identified as an effective treatment strategy for OCD of the talus. Because of the relatively high cost of ACI and the knee morbidity seen in OATS, we conclude that BMS is the treatment of choice for primary osteochondral talar lesions. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Further sufficiently powered, randomized clinical trials with uniform methodology and validated outcome measures should be initiated to compare the outcome of surgical strategies for OCD of the talus

Strategic purchasing in the market of advanced medical equipment: an applied model for developing countries

Background: Purchasing health services related to advanced medical equipment is merely based on the decision of the providers in Iran as a developing country in West Asia. This passive process makes health insurance organizations reimburse the bills retrospectively. This study aimed at developing a model for the strategic purchasing of high-tech medical services in Iranian health insurance organizations. Methods: This was a mixed-method study consisting of a qualitative and a quantitative phase. In the qualitative phase, a scoping study was performed to identify the indicators and strategies of strategic purchasing of high-tech medical services in the world and then the primary model of strategic purchasing of high-tech medical services was developed for Iranian health insurance organizations by an expert panel. In the quantitative phase, the developed model was validated by the Delphi technique. Results: Narrative analysis of the articles yielded six main dimensions and 36 sub-dimensions of strategic purchasing of high-tech medical services each of which was relevant to one of the five main questions of strategic purchasing. The main dimensions were the position of strategic purchasing in the health system, organization and management, position of internal and external stakeholders, health technology assessment, pricing, and indicators of contracting. Conclusion: In the present model, six applied dimensions were achieved for implementing strategic purchasing in Iranian Health Insurance Organization. The relationship of �stewardship and position of health system� and �Position of health stakeholders� which are responsible for all resource allocation and purchasing mechanism in the health system are emphasized. Simultaneously, the model emphasized �structure and management of the provider organizations� that is important for determining the real needs of the community and managing the correct medical demand. © 2020 Fellowship of Postgraduate Medicin

Designing a pragmatic model for strategic purchasing of health services in health insurance companies: The feasible pivot of strategic purchasing in a developing country

Purpose: The purpose of this paper is to identify the most important factors for strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an applicable model for other similar organizations in developing countries. Design/methodology/approach: The present qualitative study was conducted in 2017 to identify the factors affecting the implementation of strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an indigenous and practical model through two phases: semi-structured interview followed by a Delphi process. Findings: According to the findings of this study, Ministry of Welfare, Labor and Social Security plays a central role in the strategic purchasing. In addition, this was also approved by the representatives of citizens in communities concerning professional associations, insurance agencies and representative of the Council of Ministers. Model development explored 9 themes and 54 sub-themes. Research limitations/implications: Based on the model, most attention has been paid to consumer role and inter-sector leadership of the company with other relevant organizations and systems including other insurance organizations and the welfare ministry. More importantly, the health insurance company should be able to communicate with providers and to choose the best providers, receiving price information through competition in the most appropriate mechanism. Guided by this model, it can strategically buy the best and the most effective services for its insured population. Social implications: It might help developing societies to promote their health systems based on targeting the health budgeting and financial constraints so that it is prioritized according to the strategic purchasing criteria and consequently, economic evaluation. Originality/value: The linchpins of the present study are as follow: first, the pragmatic model presented in the paper could help developing health systems to overcome the impediment in the implementation progress of strategic purchasing. Second, the model satisfies the need of enough knowledge to apply strategic purchasing in the health system. Third, the indigents have long been given special protection and consideration in the model that has continued to capture the attention of every policy-maker, in particular, developing countries, the portion of which is significant. Fourth, based on this model, attention has been paid to consumer role and inter-sector leadership of organization with other relevant organizations and systems. Fifth, this model could be correspondent for every insurance company in countries with similar developing conditions. © 2018, Emerald Publishing Limited

A community pharmacy-based cardiovascular risk screening service implemented in Iran

Background: Cardiovascular disease is a major health concern around the world. Objective: To assess the outcomes and feasibility of a pharmacy-based cardiovascular screening in an urban referral community pharmacy in Iran. Methods: A cross sectional study was conducted in a referral community pharmacy. Subjects aged between 30-75 years without previous diagnose of cardiovascular disease or diabetes were screened. Measurement of all major cardiovascular risk factors, exercise habits, medical conditions, medications, and family history were investigated. Framingham risk score was calculated and high risk individuals were given a clinical summary sheet signed by a clinical pharmacist and were encouraged to follow up with their physician. Subjects were contacted one month after the recruitment period and their adherence to the follow up recommendation was recorded. Results: Data from 287 participants were analyzed and 146 were referred due to at least one abnormal laboratory test. The results showed 26 patients with cardiovascular disease risk greater than 20%, 32 high systolic blood pressure, 22 high diastolic blood pressures, 50 high total cholesterol levels, 108 low HDL-C levels, and 22 abnormal blood glucose levels. Approximately half of the individuals who received a follow up recommendation had made an appointment with their physician. Overall, 15.9% of the individuals received medications and 15.9% received appropriate advice for risk factor modification. Moreover, 7.5% were under evaluation by a physician. Conclusion: A screening program in a community pharmacy has the potential to identify patients with elevated cardiovascular risk factor. A plan for increased patient adherence to follow up recommendations is required

Circulating MicroRNAs Characterize Insufficient Coronary Collateral Artery Development in Patients with Chronic Total Occlusion

Vascular Surger