New insight into the informal patients' payments on the evidence of literature: a systematic review study.

BACKGROUND: Nowadays, a growing literature reveals how patients use informal payments to seek either better treatment or additional services, but little systematic review has been accomplished for synthesizing the main factors. The purpose of this study was to analyze the content of literatures to demonstrate the factors for informal patient payments. METHODS: In this systematic review study, PubMed, Web of Science, Wiley Online Library, Science Direct, Ovid, Scopus, and Iranian databases were investigated without time limitation for eligible English and Persian studies. Achieved data were analyzed using content analysis approach and MAXQDA 10 software. RESULTS: Themes related to informal payments in external context of health system were demographic features of health service consumers, patient's personality features and social & cultural backgrounds of the community. Health system challenges' themes were about stewardship weakness, and sustainable financing and social protection weakness. These were followed by human resources' organizational behavior challenges, drugs, medical products, and services delivery provision process challenges and finally change management weakness for reducing and dealing with IPs. CONCLUSION: It appears that improving the quality of health care services and accurate monitoring of delivery processes, along with performing some strategies for regulating payroll and medical tariffs, strict rules and regulations and improving health staff motivation, would be effective ways against informal payments. Improving the health insurance contribution, promoting transparency & accountability in health system especially in financing, identify precise control mechanism, using empower patient/public related approach, modifying community perception, reinforcing social resistance to unofficial payments and rebuilt lost social capital in health care are some of the other recommendations in this field. To practice these strategies, a comprehensive and systemic vision and approach is needed, however, the key point is that before applying any strategy the impact of this strategy on access, efficiency, equity, and other health systems' goals and policies should be investigated due to the consideration.

A model of reopening businesses to decrease the heath and economic impacts of the COVID-19 pandemic: Lessons from Iran.

Background: OVID-19 is a major cause of morbidity and mortality worldwide. The closure of governmental and nongovernmental centers as well as social, cultural, and economic activities are other major negative impacts of the virus. The present paper aimed to develop a model of economic and health-related factors which affect the reopening of businesses and the proper management of the effect of virus on different aspects, particularly on people's health and economy. Methods: In order to facilitate decision-making and model risk analysis of guilds and occupations, an expert panel, including eight 8 experts, was convened by the Ministry of Health in Iran to prepare a strategic framework for the national taskforce of COVID-19 management. The panel spent many hours to prepare a simple model of reopening businesses and prioritize them from low to high risks. Results: The experts identified and weighed seven health and three economic-related factors. The businesses and jobs were classified into 69 categories based on their similarities; they were also graded according to a predefined five- point Likert scale and categorized into three levels of low, medium, and high risk. The policymakers recommended to reopen businesses stratified by risk levels at least two weeks' intervals. Conclusion: The relaunch strategy in Iran put health and safety first while gradually reopening businesses, resuming activities, and getting people back to work. At the same time, attempts were made to slow the spread of the virus through following public health measures, social distancing, good hygiene, and continued acting responsibly. As many countries may have to deal with the same issue, this model can help them adopt appropriate policies and strategies for disease containment.

Conceptual model of managing health care volunteers in disasters: a mixed method study.

BACKGROUND: Shortage of specialized healthcare volunteers is a major challenge during disasters and one solution could be pre-identified healthcare volunteers. This study aimed to develop a conceptual model of managing Iranian healthcare volunteers in disasters. METHODS: This mixed method study was designed in two phases. A qualitative study using semi-structured interviews was conducted with 22 health professionals and key informant. The interviews were analyzed by framework analysis. In the second phase, concepts derived from the first step were evaluated in a two round Delphi study by an expert panel comprised of 42 experts. RESULTS: Two themes and eight subthemes were identified based on the results of the first phase. The theme of background requirements included three sub-themes of laws and regulations, NGOs and socio-cultural factors. The second theme was called operational requirements which included six subthemes of preparedness, response, retention, relocation, terminating and follow-up. According to the results of the Delphi study, all of the concepts were confirmed. CONCLUSION: In addition to the need for supportive legal framework and building the culture of volunteering, it seems it is crucial to identify and prepare the health care volunteers in the preparedness phase and assign them appropriately in the response phase. Furthermore, the necessary measures should be prioritized to enhance volunteers' retention rate and motivation. Plans should also be implemented for volunteers' termination and volunteers' physical and mental health follow up after their mission.

Correction to: Conceptual model of managing health care volunteers in disasters: a mixed method study.

In the original publication of this article [1], the percent sign at the first row of the Table 2 needs to be deleted. The updated Table 2 is shown below.

Prevalence of nosocomial infections in Iran: A systematic review and meta-analysis.

Background: Nosocomial infections represent a serious public health concern worldwide, and, especially, in developing countries where, due to financial constraints, it is difficult to control infections. This study aimed to review and assess the prevalence of nosocomial infections in Iran. Methods: Different databases were searched between January 2000 and December 2017. To determine the pooled prevalence, the stochastic DerSimonian-Laird model was used, computing the effect size with its 95% confidence interval. To examine the heterogeneity among studies, the I2 test were conducted. The reporting of observational studies in epidemiology (STROBE) checklist was used to assess the methodological quality of observational studies. To further investigate the source of heterogeneity, meta-regression analyses stratified by publication year, sample size and duration of hospitalization in the hospital were carried out. Results: 52 studies were included. Based on the random-effects model, the overall prevalence of nosocomial infection in Iran was 4.5% [95% CI: 3.5 to 5.7] with a high, statistically significant heterogeneity (I2=99.82%). A sensitivity analysis was performed to ensure the stability results. After removing each study, results did not change. A cumulative meta-analysis of the included studies was performed based on year of publication and the results did not change. In the present study, a high rate of infections caused by Klebsiella pneumoniae (urinary tract, respiratory tract, and bloodstream infections) was found. Conclusion: Preventing and reducing hospital infections can significantly impact on reducing mortality and health-related costs. Implementing ad hoc programs, such as training healthcare staff on admission to the hospital, may play an important role in reducing infections spreading.

Development and Psychometric Evaluation of the Pre-hospital Medical Emergencies Early Warning Scale.

INTRODUCTION: The number of requests for emergency medical services (EMSs) has increased during the past decade. However, most of the transports are not essential. Therefore, it seems crucial to develop an instrument to help EMS staff accurately identify patients who need pre-hospital care and transportation. The aim of this study was to develop and evaluate the psychometric properties of the Pre-hospital Medical Emergencies Early Warning Scale (Pre-MEWS). MATERIALS AND METHODS: This mixed-method study was conducted in two phases. In the first phase, a qualitative content analysis study was conducted to identify the predictors of medical patients' need for pre-hospital EMS and transportation. In the second phase, the face and the content validity as well as the internal consistency of the scale were evaluated. Finally, the items of the scale were scored and scoring system was presented. RESULTS: The final version of the scale contained 22 items and its total score ranged from 0 to 54. CONCLUSIONS: Pre-MEWS helps EMS staffs properly understand medical patients' conditions in pre-hospital environments and accurately identify their need for EMS and transportation.

Depression among Iranian nurses: A systematic review and meta-analysis.

Background: Depression is one of the most commonly diagnosed mental disorders. Nurses and other hospital service providers are a group at high risk for developing depression. Thus, knowing the prevalence of depression among nurses can help the health care decisionmakers to plan ad hoc prevention programs to control depression in this group. This study was conducted to quantitatively assess the prevalence of depression in nurses by performing a systematic review and meta-analysis. Methods: ISI/Web of Science (WoS), PubMed/MEDLINE via Ovid, PsychInfo, and Embase, as well as Iranian databases such as Irandoc, SID, and Magiran were searched from January 2000 to March 2017. To calculate the pooled prevalence rate, the random effects model based on the DerSimonian-Laird approach was used. I2 and the Q tests were used to examine heterogeneity among studies. To investigate the causes and sources of heterogeneity, the impact of such variables as quality, sample size, geographic region, and criteria used to diagnose depression was analyzed performing subgroup analyses. The quality of reviewed studies was assessed according to the 22-item STROBE checklist. Sensitivity analysis was performed to investigate the stability and robustness of the obtained results. All data were analyzed using the "meta" package included in the R Software Version 3.4.0. Results: A total of 30 studies were retained in the current investigation. The overall prevalence of depression was 22% [95%CI 19- 27] among nurses, with a high statistically significant heterogeneity (I2= 94% and Q-test= 479.87). Conclusion: This rate was higher than the prevalence of depression among the general population in Iran. Presence of happy nurses with good mental state at hospitals is essential for promoting the care provided to patients.

Patient education process in teaching hospitals of Tehran University of Medical Sciences.

BACKGROUND: Patient education is widely recognized as a core component of nursing. Patient education can lead to quality outcomes including adherence, quality of life, patients' knowledge of their illness and self-management. This study aimed to clarify patient education process in teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) in Iran. METHODS: This cross-sectional study was conducted in 2013. In this descriptive quantitative study, the sample covered 187 head nurses selected from ten teaching hospitals through convenience sampling. Data were collected with a questionnaire developed specifically for this study. The questionnaire measured patient education process in four dimensions: need assessment, planning, implementing and evaluating. RESULTS: The overall mean score of patient education was 3.326±0.0524. Among the four dimensions of the patient education process, planning was in the highest level (3.570±0.0591) and the lowest score belonged to the evaluation of patient education (2.840 ±0.0628). CONCLUSION: Clarifying patient education steps, developing standardized framework and providing easily understandable tool-kit of the patient education program will improve the ability of nurses in delivering effective patient education in general and specialized hospitals.

Knowledge and Skills Needed for Future Health Administrators: A Systematic Review.

Background: The educational needs of future health administrators, prioritizing their needs, and developing a relationship between these needs and the needs of the community are very important to provide better responsiveness. We aimed to identify the knowledge and skills required for health care management students as future managers of the health community. Methods: In this systematic literature review, all studies conducted between 1990 and 2021 were searched in such databases as MEDLINE, Scopus, Web of Science, ProQuest Iran Medex, Magiran and Scientific Information Database (SID), and the collected data were analyzed via the thematic analysis method. Results: Findings of this study were divided into two main categories and fourteen subcategories, including knowledge-related factors (awareness of the structure and processes in the field of health and knowledge of management science) and skill-related factors (planning, coordination, organization, leadership, control and evaluation, management of financial resources and budgeting, service management, communication and information management, human resource management, implementation of participatory and team activities, crisis management, entrepreneurship, innovation, marketing, policymaking, and decision-making). Conclusion: By identifying the knowledge and skills that students need, it is possible to empower them through necessary education. Therefore, by providing responsive education, developing skills, and improving capabilities, we can take an effective step to improve the quality of health system services.

Developing a conceptual model of post-disaster damage and loss assessment program in the Iranian health sector: a qualitative study protocol.

INTRODUCTION: Annual natural and man-made disasters in Iran eventually lead to casualties and considerable financial loss. The success of a reconstruction programme depends on accurate postdisaster damage and loss assessment. Based on these assessments, the goals, priorities and approaches required for reconstruction are prepared and formulated. To effectively implement a reconstruction and rehabilitation programme in the country's health sector, it is necessary to prepare and compile a postdisaster damage and loss assessment programme. METHODS AND ANALYSIS: This qualitative study will be conducted to develop a conceptual model of a postdisaster damage and loss assessment programme in Iran's health sector. First, a scoping review method will be conducted to identify the entities and components of the postdisaster damage and loss assessment programme. Then, using semistructured interviews, the opinions of university professors and disaster damage and loss assessors in the health sector will be obtained. Next, by conducting a focus group discussion, the initial programme of disaster damage and loss assessment in the Iranian health sector will be developed and then, the modified Delphi method will be used to validate it. ETHICS AND DISSEMINATION: Ethical approval for this study was obtained from the research ethics committee of Isfahan University of Medical Sciences (IR.MUI.NUREMA.REC.1400.171). The study results will be disseminated to stakeholders, published in peer-reviewed journals and presented at conferences.

A comparative study: Accreditation of universities' disaster risk management for health promotion.

BACKGROUND: Risk management processes accreditation in emergencies and disasters can determine the effectiveness and efficiency of these processes. Universities, as the highest level of education, should provide a safe environment for educational services and activities of these people. AIMS: The present study aimed to review and compare different accreditation models for emergencies and disaster risk management in selected countries. Reaching other accreditation models together and identifying their similarities and differences, along with considering the implementation of each model, can significantly help the countries which aim to design and develop a risk management accreditation model or upgrade their models. MATERIALS AND METHODS: In this qualitative comparative study, the US, UK, Canada, Australia, Japan, and South Africa were selected based on research criteria. A literature review compared university emergency and disaster risk management accreditation models. The obtained data were collected in a researcher-made matrix, and a content analysis method was used for data analysis. Differences and similarities of selected countries in the fields of accreditation program(s), accreditation institute, start year, obligation, accredited organizations, number of criteria, criteria titles, accreditation focus, accreditation stages, number of stages, scoring method, and ranking method were compared. RESULT: Designing a local model for the accreditation of disaster risk management in universities based on the crisis management system in each country can lead to improving the level of responsiveness and quality of services in emergency situations and health promotion.

Understanding conflicts of interest in rational drug prescription in a developing country: A stakeholder analysis, healthcare guidelines and ethical public health issues.

Background: Rational drug prescription (RDP) is one of the main components of the healthcare systems. Irrational prescribing can bring about numerous negative consequences for the patients and governmental agencies. This study aims to analyze the involvement of stakeholders in rational drug prescribing, their position (opponent or proponent), and the rationale behind it. Methods: This was a qualitative study conducted in 2019. Semi-structured face-to-face interviews were conducted with 40 stakeholders. Purposive and snowball sampling techniques with maximum heterogeneity were adopted to select the interviewees. Data was analyzed by MAXQDA software using thematic approach. Results: Iranian Food and Drug Administration employs the highest authority on the rational prescribing policy. Although the Ministry of Health and Medical Education, the Social Security Organization as one of the main health insurance organizations, pharmaceutical companies, and the Medical Council of the Islamic Republic of Iran, are among agencies that have great authority to improve rational prescribing, they fail to act professionally as they have conflicting interests. Remarkably, the Iran Food and Drug Administration, insurance organizations, family physicians, and patients, highly support the rational prescribing policy while the pharmaceutical companies display the least support for it. Conclusions: To make the prescription and using drugs more rational, policy makers should focus on different sources of conflicts of interest that different actors have. They should devise legal, behavior and financial policies accordingly to lessen or at least neutralize these conflicting interests, otherwise achieving RDP would be impossible in short and long terms.

Integrated operations for natural disaster management: A systematic Review.

Background: This study aimed to conduct a systematic review of models describing the integrated logistics operations performed as a response to natural disasters, with the hope to identify the challenges and limitations of healthcare systems in natural disaster management. Methods: A systematic literature search was carried out in PubMed/Medline, Scopus, Google Scholar, and bibliographies of retrieved articles using MeSH headings and keywords such as natural disaster, logistics, model. A total of 98 publications were identified through the search process. Seven potentially relevant articles met the inclusion criteria. The key demographic, clinical, and pathological information of all qualified studies were extracted from the full-text articles. Results: Among the seven included studies, six had either model data or considerations on distribution methods. Storage, human resources, infrastructures, primary priority items, coordination of organizations, and information and communication with the media were also the focus of studies. The articles were mainly from Iran (n=2), the United States (n=2), and Indonesia (n=2). The models presented in the studies has mainly focused on a specific aspect of disaster management, such as smart government development, use of military services, people with logistic training and/or medical team model. Conclusion: This study systematically highlighted the crucial points that should be considered in managing natural disasters including human resources, infrastructure, storage, priority items, distribution, access system, coordination of organizations, information, and communication with the media. In this regard, we prepared a comprehensive comparison of possible models and logistics.

Hospital management model for biological hazards: A qualitative content analysis study.

BACKGROUND: Biological hazards such as epidemic, pandemic, and bioterrorism are the most probable types of emergencies and disasters, which cause a high rate of mortality and morbidity. Hospitals have an important role in reducing the consequences of biological hazards. Given this, we set out the present study to design a model for managing biological hazards in hospitals. METHODS: A qualitative content analysis study was performed using in-depth semistructured interviews with 40 experts. We selected participants through purposeful sampling; also, we interviewed experienced experts, policy makers, and managers in the field of hospital management regarding biological hazards. The study setting was Iran Ministry of Health and hospitals as well as other relevant organizations responsible for hospital management in biological hazards. We analyzed the data concurrently using the method recommended by Graneheim and Lundman. RESULTS: After collecting and analyzing the data obtained from the interviews, we extracted the dimensions of our model in the form of four themes, including mitigation, preparedness, response, and recovery. CONCLUSION: Based on the results of the present study, we believe that a comprehensive and practical model for hospital preparedness regarding management of biological hazards is essential. The model of hospital preparedness in biological hazards leads to an effective response and reduces the physical, psychological, social, and economic consequences of biological hazards.

Disaster and Multiple Sclerosis: A Systematic Review.

Background: Multiple Sclerosis (MS) patients experience a variety of disease caused disabilities that makes them more vulnerable to the effects of disasters. This study aimed to review all existed studies about disasters and related disaster management planning about MS patients. Methods: The PubMed, Google Scholar, Scopus, and Web of Science, ProQuest, science direct , and grey literature databases were searched up to the mid of 2021. All obtained titles were assessed by the inclusion criteria. Abstracts of the relevant titles were reviewed and eligible articles/documents were included for full text review and data abstraction. Results: From 24616 Articles/documents, finally 15 documents (13 articles, and 2 books) were selected. In 8 articles (53%) specifically, focused on MS patients and, in the rest focused on them as a member of people with disabilities. Most studies (10, 71.4%), emphasized on the disaster induced stress effect on MS patients. In two books/book sections, the disaster preparedness plan for all types of disabilities was presented in general, and MS patients were mentioned as a member of the group of patients with disabilities. Conclusion: Despite the importance of planning in response to disasters to address specific problems of MS patients, there is a lack of proper planning. This is very important and there is an urgent need to develop appropriate planning protocols for addressing the special conditions of MS patients in response to disasters.

Explore of the reasons of irrational prescribing in Iran: A qualitative study.

Background: Irrational prescribing is highly prevalent in Iran, and it is under the impact of different factors. Objective: This research aims to recognize the reasons for Irrational prescribing in Iran. Methods: A qualitative approach and a conventional content analysis were employed to perform this research. The research community includes some experts and key specialists in medication prescribing. Semi-structured interviews were used for data collection. The intentional sampling method was applied, and theoretical saturation was reached by conducting 40 interviews with experts. The data analysis process was done following the steps suggested by Graneheim and Lundman. Results: Four main categories and 12 subcategories appeared after analyzing the data. The main categories are organizational and management factors, legal factors, cultural factors, and economic factors. Conclusion: Irrational prescribing can be prevented by reforming the referral system, overseeing pharmacies and physicians, raising public awareness and correcting their misconceptions about the medications, and creating an appropriate mechanism for pricing and selling medicines.

Developing a Roadmap for Mass Vaccination of COVID-19 in Iran: A Qualitative Study.

BACKGROUND: Nowadays, the Covid-19 pandemic is 1 of the most important challenges worldwide, especially in terms of health. The most important strategy to prevent and control the Covid-19 pandemic is mass vaccination. This study aimed at developing a roadmap for the mass vaccination of COVID-19 in Iran. METHODS: The current study was conducted using a qualitative approach with a content analysis method. In the first step, the review of literature and documents was carried out by a search in scientific databases. In the next step, the data were amassed via in-depth and semi-structured interviews with experts who were selected purposefully, including policymakers, health care workers, and managers. After this, 3 multidisciplinary expert panels for roadmap development were held. RESULTS: Based on the literature review, interviews, and 3 stages of an expert panel, the final roadmap was developed with 5 dimensions. These included outcomes, planning and preparation, strategies, and preparation, implementation, monitoring, and evaluation. CONCLUSIONS: This roadmap was developed to improve mass vaccination during the COVID-19 pandemic. According to our findings, it is strongly recommended that the vaccination roadmap with all the above-mentioned features and comprehensive structure should be applied to mitigate the consequences of the COVID-19 pandemic.

Lessons learnt from the past and preparedness for the future: how a developing country copes with major incidents.

OBJECTIVE: Research shows that previous experience of major incidents has positive impacts on awareness and preparedness of organisations. This manuscript aims to examine the preparedness indicators of health organisations against major incidents in two different types of organisation: those with direct involvement in response to the Bam earthquake and other organisations. METHOD: A descriptive study was conducted, and 230 questionnaires were distributed among the health managers in both types of organisations to compare the questionnaire results between them. RESULT: A total of 114 questionnaires were returned. 85% of the respondents were male, and 15% were female. Considering the organisational factor, a significant difference between the organisations was observed. Considering the communication factor, only differences in relationship with outside stakeholders and knowing the responsibility of other organisations were significant. Rehearsal and multiagency plans for warning were considerably different in the organisations. In planning, coordination, training, business continuity and cultural factors, there were no important differences. For resource variables, only the statement of sufficient resources and tools for the employees was significantly different, and, for the policy factor, there were significant differences in two variables: incorporation of major incident issues into the service design and management of voluntary efforts in a major incident. CONCLUSION: The findings have implications for health organisations in developing countries, especially in the Middle East. A major incident-management system re-engineering is required to bring the lessons learnt from previous major incidents into preparedness efforts and to shift individual-based activities toward systematic approaches in major incident management.

Hospital Preparedness Measures for Biological Hazards: A Systematic Review and Meta-Synthesis.

BACKGROUND: Biological hazards are one of the most important and common types of hazards in emergencies and disasters. Hospital preparedness measures for biological hazards are essential for a proper response and mitigation of its effects. The aim of this systematic review is to investigate hospital preparedness measures for biological hazards. METHODS: For this research, electronic databases including Web of Science, PubMed, ScienceDirect, Scopus, ProQuest, Google Scholar, and Cochrane Library from March 1950 to June 2019 were searched. Key words such as hospital, emergency department, preparedness, plan, management, and biological hazards were used in combination with the Boolean operators OR and AND. A thematic synthesis approach through the use of MAXQDA software was applied to analyze the data. RESULTS: In total, 5257 articles were identified, in which 23 articles meet the inclusion criteria for entering the process of final analysis. The findings showed three main administrative, specialized, and logistical issues regarding preparedness measures for biological hazards in hospitals. CONCLUSION: Hospital preparedness for biological hazards is one of the most important hospital disaster plans. Results of this systematic review present valuable advice for policy-makers and hospital managers to prepare and enhance hospital performance against biological hazards.

Developing a hospital preparedness checklist to assess the ability to respond to the COVID-19 pandemic.

BACKGROUND: During epidemics and pandemics, health systems, and especially hospitals, face many challenges in the management of patients and staff. Hospital preparedness measures are critical for hospitals to respond effectively to the admission and management of COVID-19 patients. Ministry of health policy for pandemics must cover the ability of hospitals to respond to COVID-19. AIMS: The aim of this study was to develop a checklist for evaluating the preparedness of hospitals to respond to the COVID-19 pandemic. METHODS: We searched for and reviewed available evidence, including the literature and guidelines presented by related organizations. Due to the COVID-19 outbreak, face-to-face interview was not possible so we used telephone and video connections, mobile applications and email for unstructured interviews. Checklist development was carried out by a multidisciplinary panel of experts. RESULTS: After applying the opinions of the experts, the final checklist had 2 main domains: measures at national and measures at hospital level. Preparedness at national level was categorized into 3 aspects that are implemented by the health ministry. Preparedness at hospital level was categorized in 24 subgroups. CONCLUSION: Hospital preparedness for admission and management of COVID-19 patients is essential. A checklist for the assessment of hospital preparedness for COVID-19 patient management and hospital management was designed and developed. Our preparedness assessment checklist is an expanded tool that provides clear and practical guidance that can be adapted for any hospital admitting COVID-19 patients.