Which Solution is better for the prevention and even treatment of diabetes in Iran?

The present article was written under the pretext of World Health Day 2016 to attract the attention of society and health policy makers toward this issue. Due to the importance of this issue, WHO is marking World Health Day, April 7th, by calling for action on beating diabetes. Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar. Hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes and, over time, leads to serious damage to many of the body's systems, especially the nerves and blood vessels (1). In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2012, diabetes was reported to be the direct cause of 1.5 million deaths and high blood glucose was the cause of another 2.2 million deaths (2)

Patient and Health Professional Perspectives about Engaging Patients in Addressing Patient Safety: A Systematic Review Protocol

BACKGROUND: Patient safety is crucial to the provision of quality healthcare and has become increasingly important with the world health organisation recognising the significance of patient engagement in safety issues. Despite an increasing amount of literature examining the engagement of patients in addressing their safety, there has been little research examining the perspectives of patients and health professionals regarding the engagement of patients in safety issues. AIM: This protocol aimed to explore the perspectives of patients and health professionals regarding the engagement of patients in safety issues. METHODS: During February 2019, a literature search was conducted using four databases, PubMed/MEDLINE, Embase, Web of Science and Scopus. There were no limits on the year of publication. Two authors were screening the titles, abstracts and full texts of all the studies independently of each other and potential discrepancies will be resolved in consultation with the third author. Studies identified in the literature search were assessed using the Mixed Methods Appraisal Tool (MMAT), and a ‘best fit’ framework synthesis approach was adopted to combine evidence from studies that have used qualitative and mixed methods. CONCLUSION: The results from this study can be used to develop interventions to increase patient engagement with patient safety

Survey on waiting time and visit time in plan of health sector evolution in Iran: A case study in Tabriz

Background and aims: Visit quality is a crucial component of patient-physician interaction that its inadequacy can negatively influence the diagnosis and treatment efficiency. The waiting time and visit length are important determinants of quality in the outpatient care setting. Thus, the aim of this study was to determine waiting time and visit length and to compare them before Implementation of health sector evolution in Iran. Methods: A cross-sectional study was conducted during autumn 2014. A sample of 540 patients who referred to the outpatient clinics of Sheikh Al Raeis of Tabriz Province (North West of Iran) were randomly selected and surveyed. Data were collected by the collection tools and analyzed using descriptive statistical methods. Results: The average visit time and standard deviation were 8.52 min and 3.14 respectively, which is significantly lower than the minimum average of 15 min approved by the Iranian Ministry of Health and Medical Educations (MOHME). Average of waiting time was 101.57 min for patients. The result showed that visit time was shorter than standard (7.5 min per patient) of health sector evolution in specialties of general Surgery, ophthalmologist, ENT, orthopedics and pediatrics. Also, the variables such as: number of visits, age of physicians, experience of physicians, men physicians, working shift of afternoon influenced on visit time significantly. Conclusions: The starting points of health care delivery to patients are consultations. This study showed that visit time is short and waiting time is very long. But, it seems that implementation of health sector evolution and plan of visit quality improvement led to increased visit time

Balancing Overuse and Underuse in the Iranian Healthcare System: A Force Field Theory Analysis

BACKGROUND: Overuse and underuse of healthcare services occure within population, organizations and even patients around the world. Producing a balance between these two can increase efficiency, service quality and patient satisfaction. It also decrease extra costs. The aim of this study was to identify forces for change and forces against change for generating balance between overuse and underuse to achieve right care.METHODS: This study was conducted in five steps: 1) describe our plan or proposal for change; 2) identify forces for change; 3) identify forces against change; 4) assign forces; and 5) analyze and apply. We used purposive sampling strategy. The number of participants in the expert panel were eight. Each participant signed informed consent form before starting the study (Ethical code: IR.TBZMED.REC.1396.908).RESULTS: The driving factors for balancing overuse and underuse were education, preparing clinical guideline and standard protocols, resource allocation, using evidence-based medicine, evidence-based management and evidence-informed policy making approaches and social prescribing. The restraining factors for balancing overuse and underuse were conflict of interest issues, payment systems, paternalism and medicalization, patients and physicians’ side problems and culture of consumerism in the community. The total scores for and against change were 14 and 17, respectively.CONCLUSION: It seems that the emphasis on education and training in this field is essential for physicians, patients and all people in the community. Also, making reforms in payment systems and changing the rules and regulations in this area could be major drivers

A critique of the hospital services provision in Iran after implementing Health Sector Evolution Plan: A case report

Background and aims: Public sector in Iran is responsible for providing whole primary health care and approximately 85 of the second and third level services. Following the previous programs, and in order to improve health system performance, Iranian Ministry of Health and Medical Education launched Health Sector Evolution Plan of Iran (HSEP) in 2014 aimed to reduce patients’ cost, improve quality, and provide equal access for all. Methods: We examined the achievement of these objectives through reporting a case and comparing current and past situation. The data related to the case were collected by interview and surveying patient documents. Published articles were considered as a base to compare some indices before and after the plan. Results: Our case was a Ph.D. student who sought out health care for his wound treatment. Total treatment expenses were 195 and many medical supplies were used. Waiting time and visit length were calculated 345 minutes and 1 minute, respectively. Paying an amount of money equivalent to almost 57 of his salary and too long waiting time to receiving short visit are in contrast to the primary objectives of HSEP and show no improvement in these indices compared with prior to the plan. Conclusion: With regard to increasing financial resources through HSEP (70) compared with the same time before HSEP, it is necessary to manage these funds properly to achieve objectives more effective and efficient than the current ones

Leadership and management competencies for hospital managers: a systematic review and best-fit framework synthesis

Objective: Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system. To improve their management competence, understanding of management competency requirements is important. The purpose of this study was to synthesize the evidence related to the leadership and management competencies in healthcare organizations through the best-fit method. Methods: A systematic review of literature published between 2000 and 2020 was performed to identify studies focusing on confirming and/or identifying the competency requirements of hospital managers. The best-fit framework synthesis method was used to map the identified competencies and associated behavioral items against the validated management competency assessment program (MCAP) management competency framework. Results: Twelve studies were identified for inclusion in the review. The mapping of the identified competencies and behavioral items generated a competency model for hospital managers that can apply for different healthcare context. The new competency model includes the following seven core leadership and management competencies: evidence-informed decision-making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism. Conclusion: This review and the mapping of the competencies identified in previous studies against the validated MCAP framework has resulted in the recommendation for an extended leadership and management competency framework for health service managers. It provides guidance for the formulation of training and development directions for the health service management workforce in a different healthcare context

Comparing sexual dysfunction in maintenance therapy with Methadone and Buprenorphine in married male

Background and aims: Sexual dysfunction is a common complaint among drug abusers in the treatment with Methadone and Buprenorphine. The aim of this study was to assess sexual dysfunction in patients undergoing Methadone or Buprenorphine for maintenance therapy. Methods: This research was a cross-sectional study. A 3-parts questionnaire (demographic questions, international index of erectile function questionnaire (IIEF) and Beck Depression Inventory (BDI-II)) was used for data collection. Results: Overall, 3.5% reported no Erectile Dysfunction (ED), 79.9 % reported mild to moderate ED, and 10% reported severe ED. There were no statistical differences in the components of the IIEF questionnaire between Methadone maintenance treatment (MMT) and Buprenorphine maintenance treatment (BMT) group. Statistical analysis show that depressed subjects has a higher sexual dysfunction (r= -0.435, P<0.001). The results showed no significant relation between drug dose and sexual function (r= 0.031, P= 780). Conclusions: Based on our findings, sexual dysfunction was relatively high among males who received MMT and BMT and the disorder was more prevalent in depressed people. As the results, the problem needs more attention and should be offered the right solution to solve it

Experiences of critical care nurses fighting againstCOVID‐19: A qualitative phenomenological study

Aim: This study sought to describe the experiences of critical care nurses caring for patients infected by coronavirus disease 2019 (COVID‐19). Design: A qualitative phenomenological design was used. Methods: We enrolled 15 nurses who provided care for patients infected by COVID‐19 purposively and through snowballing, using a phenomenological approach in critical care units of Iran's public hospitals between May and June 2020. The semi‐structured interviews were carried out either via face‐to‐face or telephone and were analyzed using the 7‐step method of Colaizzi. Results: The experiences of nurses caring for patients infected with COVID‐19 were categorized into four challenges, including psychological (eight subthemes), organizational (six subthemes), social (six subthemes), and professional (five subthemes). In general, based on the current classification, there seems to be a mixture of positive and negative effects on the psychological, social, and professional challenges and the negative effect only on the organizational challenges. Conclusions: Positive and negative emotions and experiences have coexisted for the critical care nurses since the COVID‐19 outbreak. Emotional support and psychological counseling play an important role in maintaining nurses' optimal mental health during the COVID‐19 crisis. Adequate protective equipment, financial and nonfinancial supports, effective communication, training and hiring of staff, and appropriate work shifts are also required to reduce nurses' negative experiences when providing care for the affected individuals

Combination therapy with everolimus and tacrolimus in kidney transplantation recipients: A systematic review

Background and aims: Immunosuppressive regimens are a key component for successful kidney transplantation. This systematic review aimed to assess the efficacy and safety of combination therapy of everolimus with tacrolimus in kidney transplantation recipients. Methods: Results were limited to English-language articles. Trials where recipients received another regimen were excluded. The Cochrane Central Register of Controlled Trials and MEDLINE were searched via the optimally sensitive strategies for the identification of randomized trials, combined with the following MeSH headings and text words: Everolimus, Certican, Zortress, tacrolimus, prograf, and kidney transplantation. Results: Five relevant studies of everolimus in combination with tacrolimus were identified and results of them were interpreted. Two trials investigated Fix dose of everolimus in combination with low (1.5-3 mg) versus standard dose of tacrolimus (4-7 mg). One trial investigated variable doses of everolimus (1.5 mg/day or 3 mg/day) in combination with fix dose of tacrolimusand two trials compared fix dose of everolimus versus reduction or elimination of tacrolimus. Sample size of RCTs ranged from 20 to 398 and the follow up time ranged from six to 24 months. The quality score on the Jadad score was 3 in all five trials indicating moderate quality. Conclusion: Immune suppressive regimens including everolimus in combination with tacrolimus therapy show better safety and efficacy compared with single-mode but these differences were not significant in overall studies. In general, compared with a regimen without combination of everolimus with tacrolimus, the newer immunosuppressive regimen consistently reduced the incidence of short-term biopsy-proven acute rejection. However, evidence about impact on side-effects, long term graft loss, compliance and overall health-related quality of life is limited