Clinical outcomes of patients with mild COVID-19 following treatment with hydroxychloroquine in an outpatient setting.

The role of hydroxychloroquine (HCQ) in early outpatient management of mild coronavirus disease 2019 (COVID-19) needs further investigation. This study was a multicenter, population-based national retrospective-cohort investigation of 28,759 adults with mild COVID-19 seen at the network of Comprehensive Healthcare Centers (CHC) between March and September 2020 throughout Iran. The baseline characteristics and outcome variables were extracted from the national integrated health system database. A total of 7295 (25.37%) patients who presented with mild COVID-19 within 3-7 days of symptoms onset received HCQ (400 mg twice daily on day 1 followed by 200 mg twice daily for the next four days and were then followed for 14 days). The main outcome measures were hospitalization or death for six months follow-up. COVID-19-related hospitalizations or deaths occurred in 523 (7.17%) and 27 (0.37%) respectively, in HCQ recipients and 2382 (11.10%) and 287 (1.34%) respectively, in non-recipients. The odds of hospitalization or death was reduced by 38% (odds ratio [OR] = 0.62; 95% confidence interval [CI]: 0.56-0.68, p = < 0.001) and 73% (OR = 0.27; 95% CI: 0.18-0.41, p = < 0.001) in HCQ recipients and non-recipients. These effects were maintained after adjusting for age, comorbidities, and diagnostic modality. No serious HCQ-related adverse drug reactions were reported. In our large outpatient national cohort of adults with mild COVID-19 disease who were given HCQ early in the course of the disease, the odds of hospitalization or death was reduced significantly regardless of age or comorbidities.

Designing Excellence and Quality Model for Training Centers of Primary Health Care: A Delphi Method Study.

BACKGROUND: Excellence and quality models are comprehensive methods for improving the quality of healthcare. The aim of this study was to design excellence and quality model for training centers of primary health care using Delphi method. METHODS: In this study, Delphi method was used. First, comprehensive information were collected using literature review. In extracted references, 39 models were identified from 34 countries and related sub-criteria and standards were extracted from 34 models (from primary 39 models). Then primary pattern including 8 criteria, 55 sub-criteria, and 236 standards was developed as a Delphi questionnaire and evaluated in four stages by 9 specialists of health care system in Tabriz and 50 specialists from all around the country. RESULTS: Designed primary model (8 criteria, 55 sub-criteria, and 236 standards) were concluded with 8 criteria, 45 sub-criteria, and 192 standards after 4 stages of evaluations by specialists. Major criteria of the model are leadership, strategic and operational planning, resource management, information analysis, human resources management, process management, costumer results, and functional results, where the top score was assigned as 1000 by specialists. Functional results had the maximum score of 195 whereas planning had the minimum score of 60. Furthermore the most and the least sub-criteria was for leadership with 10 sub-criteria and strategic planning with 3 sub-criteria, respectively. CONCLUSION: The model that introduced in this research has been designed following 34 reference models of the world. This model could provide a proper frame for managers of health system in improving quality.

Development and Psychometric Evaluation of a Socioeconomic Status Questionnaire for Urban Households (SESIran): The Preliminary Version.

BACKGROUND: The aim of present study was to develop and validate an appropriate socioeconomic status (SES) assessment questionnaire to be used through health studies in Iranian urban households. METHODS: The study was conducted through a mixed method study design in Tabriz, northwest of Iran in 2014. It was conducted in several stages including: development of initial version, qualitative study, feasibility evaluation, and assessment of the validity as well as the reliability. The internal consistency, test-retest reliability, content validity, concurrent validity and construct validity were assessed. RESULTS: With respect to the assessment of construct validity, 5 domains (factors) were extracted includ-ing: main factor (α=0.84), self-evaluation of expenditure capacity (α=0.96), wealth (α=0.70), home and furniture (α=0.66) and costs related to health (α=0.55). Intraclass correlation coefficient was above 0.6 for all factors except for wealth domain. CONCLUSION: The questionnaire developed appeared to be a valid and reliable SES assessment tool. It may be of value to be used not only as a complementary questionnaire in most health surveys or clini-cal studies, but also as a main questionnaire in health equity and health economics research.

Effective interventions on service quality improvement in a physiotherapy clinic.

BACKGROUND: Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. METHODS: A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. RESULTS: In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001). CONCLUSION: Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

Experiences of adult smokers from the concepts of smoking: A content analysis.

BACKGROUND: Smoking cigarettes is a risk factor for many physical and mental diseases. About five million people die of smoking every year. Understanding the concept of cigarette smoking can help people develop their knowledge with regard to smoking. A qualitative research seems essential to detect these concepts. Therefore, the present study aims to take into account the experience of adult smokers with regard to the concept of smoking. MATERIALS AND METHODS: This is a qualitative content analysis study conducted on 12 smokers in four selected cities in Iran. Data were collected by in-depth, semi-structured interviews, transcribed verbatim, and simultaneously coded. Subsequently, they were analyzed using the content analysis method. RESULTS: In the present study, eight concepts (themes), 22 subcategories, and 81 codes have emerged. The obtained concepts are physics of a cigarette, addiction and dependency, habit, feel the need, pleasure, seeking peace, mental involvement, and self-induction. CONCLUSIONS: The participants' experiences with regard to cigarette smoking can affect their understanding of the concepts of smoking. The understanding of these concepts by nurses and smokers can enhance their knowledge about the existing facts of smoking, which can act as a foundation for designing preventive methods and smoking cessation programs.

Developing Indicators of Service Quality Provided for CardiovascularPatients Hospitalized in Cardiac Care Unit.

INTRODUCTION: Cardiovascular diseases are among the most prevalent chronic diseases leading to high degrees of mortality and morbidity worldwide and in Iran. The aim of the current study was to determine and develop appropriate indicators for evaluating provided service quality for cardiovascular patients admitted to Cardiac Care Units (CCU) in Iran. METHODS: In order to determine the indicators for evaluating provided service quality, a four-stage process including reviewing systematic review articles in premier bibliographic databases, interview, performing two rounds of Delphi technique, and holding experts panel by attendance of experts in different fields was adopted. Finally, after recognizing relevant indicators in resources, these indicators were finalized during various stages using ideas of 27 experts in different fields. RESULTS: Among 2800 found articles in the text reviewing phase, 21 articles, which had completely mentioned relevant indicators, were studied and 48 related indicators were extracted. After two interviews with a cardiologist and an epidemiologist, 32 items of the indicators were omitted and replaced by 27 indicators coping with the conditions of Iranian hospitals. Finally, 43 indicators were added into the Delphi phase and after 2 rounds of Delphi with 18 specialists, 7 cases were excluded due to their low scores of applicability. In the experts' panel stage, 6 items were also omitted and 10 new indicators were developed to replace them. Eventually, 40 indicators were finalized. CONCLUSION: In this study, some proper indicators for evaluating provided service quality for CCU admissions in Iran were determined. Considering the informative richness of these indicators, they can be used by managers, policy makers, health service providers, and also insurance agencies in order to improve the quality of services, decisions, and policies.

Quality of life in cardiovascular patients in iran and factors affecting it: a systematic review.

INTRODUCTION: Cardiovascular diseases are always one of the major causes of mortality in the world affecting all aspects of patients' lives. Therefore, this study was conducted to summarize and provide a clear view of quality of life in these patients in Iran through a systematic review on the results of previously conducted studies. METHODS: In a systematic review, required information was collected by searching keywords of Iran, quality of life, heart failure, cardiac, heart, and their Persian equivalents in databases of Science Direct, Pubmed, IRAN doc, SID, Medlib and Magiran. The selected time period for searching articles was since 2000 to 2012. Inclusion criteria were: releasing of article during 2000 to 2012, articles reporting patients' quality of life in any domains of heart diseases, and articles published in Persian and English. Extracted results first were summarized in Extraction Table, and then analyzed manually. RESULTS: Finally 18 of 1592 found articles were included in the study. A total of 3,797 cardiac patients' quality of life was measured using six different tools, the most important one of which was SF36 questionnaire. Among eight dimensions of SF36 questionnaire, the highest mean was for social role functioning with average score of 58.37 and the lowest for physical limitation (physical role functioning) with score of 42.95. Overall, mean of eight dimensions was 53.19. Among 4 general domains of quality of life, physical activity had the lowest average of 43.63 and average of general dimensions of quality of life was 47.65. The most important factors affecting quality of life were sex, age, education, marital status, occupational status, suffering duration, number of hospitalizations etc. CONCLUSION: The results of the studies showed relatively low quality of life of cardiovascular patients in general. Therefore, according to the introduced effective factors in this study, it is necessary to consider regular programs for improving quality of life in these patients and providing suitable and qualitative services.