Estimating willingness to pay for an improved service delivery to patients referring namazi hospital chemical therapy ward in Iran using contingent valuation

Objective: The aim of this study was to estimate patients' willingness to pay (WTP) for improving the quality of non-medical aspect in Namazi hospital patients chemotherapy an assessment using the contingent valuation method (CVM). Patients and Methods: This was an applied, cross-sectional and analytical-descriptive study carried out in Iran, Shiraz in 2013. A sample of 185 patients was determined using random sampling. Multiple choice questions and follow-up open-ended questions were employed to elicit patients' WTP. The question asked patients would have to pay for this improving their own pocket. linear regression were used to Econometrically estimate the maximum WTP using STATA 11 software. Results: The results of this study indicated that 31 were male and 69 were female and the adjusted mean WTP was PPPUS15 for pat maximum amount of willing to pay was for to get the same quality service in own city respondents (PPPUS16) and minimum amount of willing to pay was to get advice of experienced nurse(PPPUS10) Patients were willing to pay more if their satisfaction with two attributes of care were increased. The cancer type and income taking care of you are significant factors influencing a patient's WTP. Conclusions: In the worst socio-economic conditions of the people were willing to pay to improve the reducing wait times in receiving a drug and get the same quality service in own city respondents. In Future efforts Health policymakers should consider the ability to pay when making their decision. © 2018 Asian Pacific Organization for Cancer Prevention

The effects of melatonin supplementation on blood pressure in patients with metabolic disorders: a systematic review and meta-analysis of randomized controlled trials

The current systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate the potential effect of melatonin supplementation on blood pressure in patients with metabolic disorders. The following databases were searched until June 2018: PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. Two reviewers independently assessed the eligibility of retrieved studies, extracted data from included trials, and evaluated the risk of bias of included studies. Statistical heterogeneity was tested using Cochran�s Q test and I-square (I 2 ) statistic. Data were pooled using random-effect models and standardized mean difference (SMD) was considered as the effect size. Eight RCTs, out of 743 potential citations, were eligible to be included in the current meta-analysis. The pooled findings indicated a significant reduction in systolic (SBP) (SMD = �0.87; 95 CI, �1.36, �0.38; P = 0.001; I 2 : 84.3) and diastolic blood pressure (DBP) (SMD = �0.85; 95 CI, �1.20, �0.51; P = 0.001; I 2 : 68.7) following melatonin supplementation in individuals with metabolic disorders. In summary, the current meta-analysis demonstrated that melatonin supplementation significantly decreased SBP and DBP in patients with metabolic disorders. Additional prospective studies are recommended using higher supplementation doses and longer intervention periods to confirm our findings. © 2019, Springer Nature Limited

Endovascular Thrombectomy for Ischemic Stroke Increases Disability-Free Survival, Quality of Life, and Life Expectancy and Reduces Cost

Background: Endovascular thrombectomy improves functional outcome in large vessel occlusion ischemic stroke. We examined disability, quality of life, survival and acute care costs in the EXTEND-IA trial, which used CT-perfusion imaging selection. Methods: Large vessel ischemic stroke patients with favorable CT-perfusion were randomized to endovascular thrombectomy after alteplase versus alteplase-only. Clinical outcome was prospectively measured using 90-day modified Rankin scale (mRS). Individual patient expected survival and net difference in Disability/Quality-adjusted life years (DALY/QALY) up to 15 years from stroke were modeled using age, sex, 90-day mRS, and utility scores. Level of care within the first 90 days was prospectively measured and used to estimate procedure and inpatient care costs (US$reference year 2014). Results: There were 70 patients, 35 in each arm, mean age 69, median NIHSS 15 (IQR 12-19). The median (IQR) disability-weighted utility score at 90 days was 0.65 (0.00-0.91) in the alteplase-only versus 0.91 (0.65-1.00) in the endovascular group (p = 0.005). Modeled life expectancy was greater in the endovascular versus alteplaseonly group (median 15.6 versus 11.2 years, p = 0.02). The endovascular thrombectomy group had fewer simulated DALYs lost over 15 years [median (IQR) 5.5 (3.2-8.7) versus 8.9 (4.7-13.8), p = 0.02] and more QALY gained [median (IQR) 9.3 (4.2-13.1) versus 4.9 (0.3-8.5), p = 0.03]. Endovascular patients spent less time in hospital [median (IQR) 5 (3-11) days versus 8 (5-14) days, p = 0.04] and rehabilitation [median (IQR) 0 (0-28) versus 27 (0-65) days, p = 0.03]. The estimated inpatient costs in the first 90 days were less in the thrombectomy group (average US$15,689 versus US$30,569, p = 0.008) offsetting the costs of interhospital transport and the thrombectomy procedure (average US$10,515). The average saving per patient treated with thrombectomy was US$4,365. c Conclusion: Thrombectomy patients with large vessel occlusion and salvageable tissue on CT-perfusion had reduced length of stay and overall costs to 90 days. There was evidence of clinically relevant improvement in long-term survival and quality of life.Peer reviewe

Comparison of the patient satisfaction from inpatient and outpatient fissurectomy in Motahari clinic and Shahid Faghihi hospital, Shiraz, Iran

Introduction: Satisfaction of the patients is considered as an important index in evaluating the performance of the hospitals and is highly effective in developing and improving the quality of the provided services .so, the present study aims to compare the satisfaction of the patients suffering from anal fissure from inpatient and outpatient treatments. Method: This cross-sectional study was conducted on 212 subjects who were selected through systematic sampling from the patients with anal fissure referring to Motahari clinic and Shahid Faghihi hospital. In order to compare the patient satisfaction in two inpatient and outpatient groups, 21-item questionnaire was designed in order to assess the patient satisfaction. Independent t-test and chi-square test were used to analyze this data. Results: satisfaction of the inpatients was significantly more than that of the outpatients (P<0.001). The inpatients’ waiting time for operation was significantly longer than that of the outpatients (P=0.029). In comparison to the inpatients, the outpatients were more satisfied with the explanations provided regarding food diets after the operation (P=0.004). Of course, outpatients had felt more stress during the operation compared to the inpatients (P=0.002). Concerning the treatment environment, the outpatients were more satisfied than the inpatients (P0.001), quality, and other services compared to the outpatients (P=0.041). Conclusion: According to the advantages that mentioned, outpatient operations can be a better choice for small surgeries; of course, health planners should pay more attention to its importance and necessity and provide more equipments and welfare facilities in treatment centers

Correction: The effects of melatonin supplementation on blood pressure in patients with metabolic disorders: a systematic review and meta-analysis of randomized controlled trials (Journal of Human Hypertension, (2019), 33, 3, (202-209), 10.1038/s41371-019-0166-2)

In the original Review Article, it was discovered that there were methodological issues that invalidated the reported results of the meta-analyses performed in the study, as well as a number of references and citations not being entered correctly. In addition, concerns were raised regarding the present paper and the results and conclusion, namely in regards to the effect sizes used in the present study. In light of these errors the authors re-assessed and re-ran the whole analyses and the below corrections now apply:. © 2019, The Author(s), under exclusive licence to Springer Nature Limited

A new EC-PC threshold estimation method for in vivo neural spike detection

10.1088/1741-2560/9/4/046017Journal of Neural Engineering94