Patient safety culture in hospitals of Iran: A systematic review and meta-analysis

Background: Nowadays, for quality improvement, measuring patient safety culture (PSC) in healthcare organizations is being increasingly used. The aim of this study was to clarify PSC status in Iranian hospitals using a meta-analysis method. Methods: Six databases were searched: PubMed, Scopus, Google Scholar, Cochrane Library, Magiran, SID and IranMedex using the search terms including patient safety, patient safety culture, patient safety climate and combined with hospital (such as "hospital survey on patient safety culture"), measurement, assessment, survey and Iran. A total of 11 articles which conducted using Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire initially were reviewed. To estimate overall PSC status and perform the meta-analyses, Comprehensive Meta-Analysis (CMA) software v. 2 was employed. Results: The overall PSC score based on the random model was 50.1. "Teamwork within hospital units" dimension received the highest score of PSC (67.4) and "Non-punitive response to error" the lowest score (32.4). About 41 of participants in reviewed articles evaluate their hospitals' performance in PSC as 'excellent/very good'. Approximately 52.7 of participants did not report any adverse event in the past 12 months. Conclusion: The results of this study show that Iranian hospitals' performances in PSC were poor. Among the 12 dimensions of HSOPSC questionnaire, the "Non-punitive response to error" achieved the lowest score and could be a priority for future interventions. In this regard, hospitals staff should be encouraged to report adverse event without fear of punitive action

Cardiovascular patients� experiences of living with pacemaker: Qualitative study

BACKGROUND: A pacemaker implantation is considered major life event for cardiovascular patients, so they will probably have very interesting experiences of living with this device. The aim of this study was to explore the experiences of cardiovascular patients living with the pacemaker. METHODS: In this qualitative study, 27 patients were chosen through purposive sampling to achieve data saturation, and their experiences were examined using semi-structured interviews. The patients� statements were recorded with their consent and analyzed using content analysis method. RESULTS: Participants� experiences included three main themes: �Problems and limitations,� �feeling and dealing with pacemaker�, and �sources of comfort� and 10 sub-themes including: physical problems, financial problems, social problems, the first encounter, the feeling of living with the pacemaker, how to cope with pacemaker, satisfaction with pacemaker, good family support, hospital and hospital staff performance, and role of religious beliefs. CONCLUSION: Planning to solve social problems, identifying and changing feelings of patients using pacemakers, reinforcing the resources of comfort especially family support seem to be necessary steps for improving quality of life and impact of using pacemaker. © 2015 Isfahan University of Medical Sciences(IUMS). All rights reserved

Perspectives of faculty members toward Iranian National Olympiad for medical students: A qualitative study

Objective - Regarding to the status of medical science Olympiads in medical science pedagogy, the views of beneficiaries are needed to be examined on them, in particular, faculty members who are the most interested group in the given issue. As such, the purpose of this study is the evaluation of views of the faculty members on the mission and performance of medical science Olympiads in Iran. Material and Methods - The data for this qualitative study were collected through semi-structured interviews and then were analyzed using the content-analysis method. Finally, 95 members of faculty board were selected from universities of medical sciences in Iran and data collection continued till data saturation. Results - Four themes including: points of strength in Olympiads, points of weakness in Olympiads, attitudes of faculty members to Olympiads, and suggestions for better performance of the Olympiads were extracted. The points of strength consisted of: mission, the performing procedures, and the scientific level of the competitions. The points of weakness included: mission, the performing procedures, and the scientific level of the competitions. Most of the participants (79) had positive attitude toward the Olympiads. Participants presented 8 strategies in order to manage the competitions better. Conclusion - It necessary to do more researches to identify the related problems and to use the required. Applying instructor's points and views on the strengths, weakness, and suggestions can be efficient in policy making, designing and performing medical Olympiads. © 2016, Azami-Aghdash S., Ghojazadeh M., Nazavar R., Yaghoubi S., Vahedi L

Perspectives of cardiac care unit nursing staff about developing hospice services in Iran for terminally ill cardiovascular patients: A qualitative study

Introduction: The present study was conducted aiming to determine the points of view of cardiac care units' nursing staff about designing and providing Hospice services in Iran for cardiovascular patients in the final stages of life. Materials and Methods: In this qualitative study, the perspectives of 16 Cardiac Care Unit (CCU) nurses selected purposefully among hospitals of Tabriz-Iran University of Medical Sciences were investigated using semi-structured interviews and were analyzed in content analysis method. Results: 33 themes were finally extracted. Some nurses were for and some were against designing and providing Hospice services in Iran. The main reasons identified for supporting this plan included: Possibility of designing and providing these services consistent with high ethical values of Iranian society; approval of authorities due to increasing the load of chronic diseases and aged population; need of families due to the problems in taking care of patients and life concerns; better pain relief and respectful death; decrease of costs as a result of lower usage of diagnostic-therapeutic services, less use of expensive facilities and drugs, and better usage of hospital beds. Conclusion: Growing load of chronic diseases has made the need for Hospice as a necessary issue in Iran. In order to provide these services, studying the viewpoints of health service providers is inevitable. Therefore using and applying the results of this study in planning and policy making about designing and providing these services in Iran for cardiovascular patients in their final stages of lives could be helpful. © 2015, Medknow Publications. All rights reserved

Developing performance indicators for clinical governance in dimensions of risk management and clinical effectiveness

Objective: This study has been designed and conducted to develop domestic indicators for evaluating the performance of clinical governance in dimensions of risk management and clinical effectiveness. Design: This study implemented a 5-stage process including conducting a comprehensive literature review, expert panel (~1000 h per person per session, 11 experts), semi-structured interviews, a 2-round Delphi study (33 experts were in attendance) and a final expert panel (8 experts were in attendance). Setting: East Azerbaijan-Iran Province. Participants: Fifty-six specialists and experts in different fields of medical sciences. Main Outcome Measures: Importance and applicability of indicators. Results: Using a thorough literature review, 361 indicators (129 risk management indicators in 4 dimensions and 232 clinical effectiveness indicators in 18 dimensions) were found. After conducting expert panels and interviews, the number of indicators decreased to 168 cases (65 risk management indicators in 4 dimensions and 103 clinical effectiveness indicators in 12 dimensions). Two rounds of Delphi identified four indicators that were omitted. The members of the final expert panel agreed on 113 indicators (43 risk management indicators in 4 dimensions and 70 clinical effectiveness indicators in 11 dimensions). Conclusion: In this study, indicators for assessing clinical governance in domains of risk management and clinical effectiveness were designed that can be used by policy-makers and other authorities for improving the quality of services and evaluating the performance of clinical governance. Those indicators can be used with slight modifications in other countries having healthcare systems similar to that of Iran. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

Breast cancer screening barriers from the womans perspective: A meta-synthesis

Background: The principal aim of health service providers in the field of breast cancer is to detect and treat lesions at an appropriate time. Therefore, identification of barriers to screening can be very helpful. The present study aimed to systematically review the qualitative studies for extracting and reporting the barriers of screening for breast cancer from the womans perspective. Materials and Methods: In this systematic review; Pubmed, Google Scholar, Ovid Scopus, Cochrane Library, Iranmedex, and SID were searched using the keywords: screening barriers, cancer, qualitative studies, breast and their Persian equivalents, and the needed data were extracted and analyzed using an extraction table. To assess the quality of the studies, the Critical Appraisal Skills Programme (CASP) tool was used. Results: From 2,134 related articles that were found, 21 articles were eventually included in the study. The most important barriers from the point of view of 1,084 women were lack of knowledge, access barriers (financial, geographical, cultural), fear (of results and pain), performance of service providers, women's beliefs, procrastination of screening, embarrassment, long wait for getting an appointment, language problems, and previous negative experiences. Articles' assessment score was 68.9. Conclusions: Increasing women's knowledge, reducing the costs of screening services, cultural promotion for screening, presenting less painful methods, changing beliefs of health service providers, provision of privacy for giving service, decreasing the waiting time, and providing high quality services in a respectful manner can be effective ways to increase breast cancer screening

Inequity in household's capacity to pay and health payments in Tehran-Iran-2013

Background: Health inequality monitoring especially in Health care financing field is very important. Hence, this study tends to assess the inequality in household's capacity to pay and out-ofpocket health carepaymentsin Tehran metropolis. Methods: This cross-sectional study was performed in 2013.Thestudy population was selected by stratified cluster sampling, and they constitute the typical households living in Tehran (2200 households). The required data were collected through questionnaires and analyzed using Excel and Stata v.11. Concentration Index on inequality was used for measuring inequality status in capacity to pay and household payments for health care expenses; and also the concentration index for out-of-pocket payments and capacity to pay was used to determine the extent of inequality. The recall period for inpatient care was one year and 1 month for outpatient. Results: The average of out-of-pocket payments for receiving the outpatient services was determined to be 44.33US and for each inpatient1861.11 US. Concentration index for household's outof- pocket payments for inpatient health care, out-of-pocket payments for outpatient health care and health prepayments were calculated 0.13, -0.10 and -0.11, respectively. Also, concentration index in household's capacity to pay was estimated to be 0.11whichindicatedinequality to the benefit of the rich. The households used financing strategies like savings, borrowing or lending to pay their health care expenditures. Conclusion: According to this study, the poor spend a greater portion of their capacity to pay for outpatient and inpatient health care costs and prepayment, in comparison to the rich. Thus, supporting the vulnerable groups of the society to decrease out-of-pocket payments and increasing the household's capacity to pay through government support in order to improve the household economic potential, must be considered very important

Experts� perspectives on the application of public-private partnership policy in prevention of road traffic injuries

Purpose: Successful application experiences on public-private partnership (PPP) in different countries, suggest that PPP could be an option in road traffic injury (RTI) prevention. The present study aims at investigating the applicability of PPP policy in RTI prevention in Iran based on the experts� perspectives. Methods: This is a qualitative study with grounded theory approach which has been conducted in Tabriz University of Medical Sciences, Iran in 2018. The participants were 22 experts in the field of RTIs selected using purposive sampling method. Data were collected by semi-structured interviews and analyzed with content-analysis method. Results: The results were classified under 5 main themes (applicability, scopes and services, challenges, advantages, and strategies) for applying PPP policy and 37 sub-themes. Due to the prevalence of RTIs, the present challenges in public sector, existence of qualified private sector, and successful experiences in other areas, there are opportunities for private sector partnership in prevention of RTIs. Private sector could participate in different scopes and services regarding RTI prevention, including road construction and maintenance, maintenance and provision of vehicles safety and public education. The main challenges including legislation issues, ambiguities in collaboration, political and organizational unsustainability, government's financial hardship and lack of experienced experts in the field of RTI. However, there are significant advantages including high efficiency in program implementation, covering the weaknesses of public sector, effective and efficient management on application of PPP in RTI prevention. The strategies include identifying and prioritizing the assignable activities, identifying the qualified private sector, developing PPP policies and legal frameworks, creating a common language between public and private parties, trying to meet the expectations of the private sector by public sector, developing a comprehensive and sound contract, and cultivating public culture to accept private sector in the field of RTI prevention. Conclusion: This study sought to determine whether PPP could be used as strategy to reduce the burden of RTIs in Iran. But it requires a lot of preliminary studies to provide the context and conditions for applying this policy. © 2020 Chinese Medical Associatio

Ki-67/MIB-1 as a prognostic marker in cervical cancer - a systematic review with meta-analysis

Background: In cervical cancer patients it has been reported that there in a significant Ki-67/MIB-1 expression is correlated with survival in cervical cancer patients. However, the prognostic value is still not well understood. Materials and Methods: In the present meta-analysis the prognostic value of Ki-67/MIB-1 with regard to overall survival (OS) and disease-free survival (DFS) in cervical cancer was investigated. The databases of PubMed, ISI Web of Science, Cochrane Central Register of Controlled Trials, EMBASE, Science Direct and Wiley Online Library were used to identify appropriate literature. Results: In order to explore the relationship between Ki-67/MIB-1 and cervical cancer, we have included 13 studies covering 894 patients in the current meta-analysis. The effect of Ki-67/MIB-1 on OS for pooled random effects HR estimate was 1.63 (95confidence interval (CI) 1.09-2.45; P0.05) and the subgroup analysis indicated Ki-67/MIB1 was associated with DFS (HR=3.67, 95CI 2.65-5.09) in Asians. Conclusions: According to this meta-analysis, Ki-67/MIB-1 has prognostic value for OS in patients suffering from cervical cancer. For better evaluation of the prognostic role of Ki-67/MIB-1 on DFS, studies with larger numbers of patients are needed to validate present findings in the future

Challenges of managing diabetes in Iran: Meta-synthesis of qualitative studies

Background: Although several diabetes management and control programmes are introduced in Iran, many patients do not achieve diabetes-related clinical goals as recommended. The aim of this study was to identify the qualitative evidence for the challenges regarding diabetes management. Methods: A systematic review of qualitative studies following PRISMA guidelines was undertaken. Scopus, PubMed, Science Direct, and Web of Knowledge were searched as well as Persian databases including Magiran, Irandoc and SID from inception to August 2019. The included Studies were either in English- or Persian-language qualitative studies reporting the perspectives of patients, their relatives, or healthcare service providers. Content of the findings were analysed and organized according to Chronic Care Model framework. Results: Twelve studies met the inclusion criteria. Six main themes were identified including holistic understanding of patients, leadership and governance difficulties, service delivery, workforce, financing, and information and research. Conclusion: Challenges regarding the management of diabetes in Iran is multifaceted. Reforming the health care system or developing complementary strategies is essential to improve suitable health care model for patients with chronic conditions such as diabetic patients. © 2020 The Author(s)