Quality of life and toxicity in breast cancer patients using adjuvant TAC (docetaxel, doxorubicin, cyclophosphamide), in comparison with FAC (doxorubicin, cyclophosphamide, 5-fluorouracil).

OBJECTIVES: The aim of this study was to compare two regimens of chemotherapy in patients with breast cancer, including FAC (doxorubicin, cyclophosphamide, and 5-fluorouracil) and TAC (docetaxel, doxorubicin and cyclophosphamide); and analyze the toxicity of these treatments and observe patient's health-related quality of life. METHODS: Health-related quality of life was assessed for up to 4 months (from the beginning to the end of chemotherapy cycles), using European organization and cancer treatment quality of life questionnaire (EORTC) QLQ-C30. A group of 100 patients, with node-positive breast cancer were studied in order to compare the toxicity of adjuvant therapy TAC with FAC and the subsequent effects on the patient's quality of life. RESULTS: After a 4-month follow-up of patients, our findings showed that despite having the same mean score of QOL at the start of adjuvant chemotherapy, the QOL in TAC arm was decreased more as a result of the higher range of toxicity in TAC regimen. CONCLUSION: In spite of increase in disease-free patients who received TAC regimen and increase their survival rate, there is significant toxicity and decrease in QOL in TAC protocol compare to FAC protocol. Using prophylactic granulocyte colony stimulating factor (G-CSF) along with increased education aimed at improving patient's knowledge and also the provision of a supportive group involving psychiatrics and patients that have successfully experienced the same treatment may be helpful.

Smart Phone Acceptance among Physicians: Application of Structural Equation Modelling in the Largest Iranian University.

BACKGROUND: The present study aimed to determine attitudes and effective factors in the acceptance of smart phones by physicians of the largest University of Medical Sciences in the south of Iran. METHODS: This cross-sectional study was performed using Structural Equation Modelling (SEM) in 2014. Study participants included 200 physicians working in the hospitals of Shiraz University of Medical Sciences selected through two-stage stratified sampling, but 185 participants completed the study. The study data were collected using a researcher-made questionnaire completed through a 5-point Likert scale. The content validity of the questionnaire was confirmed by a panel of experts, its construct validity by confirmatory factor analysis, and its reliability by Cronbach's alpha of 0.802. All data analyses were performed using SPSS (version 22) and LISREL (version 8.8). RESULTS: Results showed that most physicians had a desirable attitude towards using smart phones. Besides, the results of SEM indicated a significant relationship between attitude and compatibility, observability, personal experience, voluntariness of use and perceived usefulness. Moreover, some important fitness indices revealed appropriate fitness of the study model (p=0.26, X2/df=1.35, RMR=0.070, GFI=0.77, AGFI=0.71, NNFI=0.93, CFI=0.94). CONCLUSION: The results revealed that compatibility, observability, personal experience, voluntariness of use and perceived usefulness were effective in the physicians' attitude towards using smart phones. Thus, by preparation of the required infrastructures, policymakers in the field of health technology can enhance the utilization of smart phones in hospitals.

Determinants of catastrophic health expenditure in iran.

BACKGROUND: This study will provide detailed specification of those variables and determinants of unpredictable health expenditure in Iran, and the requirements to reduce extensive effects of the factors affecting households' payments for health and other goods and services inappropriately. METHOD: This study aims to identify measures of fair financing of health services and determinants of fair financing contribution, regarding the required share of households that prevents their catastrophic payments. In this regard, analysis of shares of households' expenditures on main groups of goods and services in urban and rural areas and in groups of deciles in the statistics from households' expenditure surveys was applied. RESULTS: The growth of spending in nominal values within the years 2002-2008 was considerably high and the rate for out-of-pocket payments is nearly the same or greater than the rate for total health expenditure. In 2008, urban and rural households in average pay 6.4% and 6.35% of their total expenditure on health services. Finally three categories of determinants of unfair and catastrophic payments by households were recognized in terms of households' socio-economic status, equality/inequality conditions of the distribution of risk of financing, and economic aspects of health expenditure distribution. CONCLUSION: While extending the total share of government and prepayment sources of financing health services are considered as the simplest policy for limiting out-of-pocket payments, indicators and policies introduced in this study could also be considered important and useful for the development of health sector and easing access to health services, irrespective of health financing fairness.

Allocation of health resources according to the type and size of Iranian governmental hospitals.

BACKGROUND: Due to consuming about 50%-80% of health resources, hospitals are the greatest and costly operational units in Iranian Health system. so allocation of resources specially human and space resources as the most expensive ones is really important for further controlling of costs, analysis of costs and making suitable policies for increasing the profitability and allocation of resources and improvement of quality. METHOD: This paper intends to describe and analyze any allocation of resources in 530 university hospitals in Iran. The final goal of this research is to provide a data bank according which there is a basis for more scientific budget allocation of state's hospitals from the size and type of application points of view. RESULTS: The relevant index of person to bed was 2.04 for human resources. All hospitals more than 300 beds are located in benefiting areas from which 17 cases are educational and 2 cases are therapeutic. This is necessary to mention that the rate of management group forces to total personnel at deprived areas is about 2.5% more than benefiting areas. CONCLUSION: Because 60-80% of hospital costs are applied for human forces, all managers of hospitals are obliged to revise their policies in attraction and employment of human force in order to benefit from such a valuable resource and prevent from expensive costs. So any employment of personnel should be based upon real needs of hospital.

Prediction of latency interval in preterm premature rupture of membranes using sonographic myometrial thickness.

Despite recent advances in perinatal care, Preterm Premature Rupture of Membranes (PPROM) continues to lead to important obstetric complications. This study was aimed to evaluate the role of sonographic measurement of myometrial thickness in prediction of latency interval in women with PPROM. This analytic- descriptive and case- control study was performed on pregnant women with PPROM presenting to Tabriz Al-Zahra Hospital since 2006 to 2008. Thirty pregnant women with PPROM and 30 pregnant women with normal pregnancy were enrolled. Mean gestational age was 30.60 +/- 1.99 week and in case and 31.13 +/- 20.01 week in control group (p = 0.307). Mean gravidity was 1.63 +/- 0.49 in case and 1.47 +/- 0.50 in control group (p = 0.210). Mean parity was 0.53 +/- 0.62 in case and 0.57 0.50 in control group (p = 0.819). Mean anterior myometrial thickness was 8.23 +/- 2.59 mm in case and 7.71 +/- 1.45 mm in control group (p = 0.344). Mean posterior myometrial thickness was 8.90 +/- 2.86 mm in case and 8.12 +/- 1.54 mm in control group (p = 0.197). Mean fundus myometrial thickness was 9.10 +/- 3.54 mm in case and 8.77 +/- 1.77 mm in control group (p = 0.648). Mean latency interval of women with PPROM was 18.70 +/- 20.68 day and mean sonography to labor interval was 57.30 +/- 16.14 day (p < 0.01). Mean latency interval of women with PPROM was significantly shorter than mean sonography to labor interval in control group patients (p < 0.05). In our study, 50% of women in 10 first days after PPRM labored and only 43.3% of women labored in 7 first days after PPROM. In this study, significant correlation was not found between myocardial sickness in anterior, posterior and fundus with latency interval.