The effectiveness of Balint group work on the quality of work life, resilience, and nurse-patient communication skills among psychiatric nurses: a randomized controlled trial.

Background: Balint group training has gained popularity in medical practices as an intervention designed to enhance the quality of life, well-being, and communication skills of healthcare practitioners. Psychiatric nurses, in particular, encounter distinct challenges and stressors inherent in their profession, necessitating the development and implementation of effective interventions to assist them in coping with the difficulties they experience. In this vein, the current study aimed to investigate the effectiveness of Balint group training on quality of work life, resilience, and nurse-patient communication skills among psychiatric nurses. Methods: Thirty psychiatric nurses from Razi Hospital in Tehran were recruited via the purposeful sampling method in 2022 and were randomly assigned to either the Balint group, consisting of eight weekly one-hour training sessions, or a control group. Participants completed the Walton Quality of Work Life Questionnaire, Connor-Davidson Resilience Scale, and Communication Skills Scale before and after the intervention. The data were analyzed using the Analysis of Covariance (ANCOVA). Results: The study found no significant differences between the Balint group and the control group in terms of quality of work life, resilience, and nurse-patient communication skills. Conclusion: Findings suggest that Balint group training was not an effective intervention for improving the well-being and communication skills of psychiatric nurses. However, the study highlights the need for further investigation into the potential factors that may explain the lack of significant gains and offers insights for future research in this area.

Cost Effectiveness of Adding Dapagliflozin to Standard Care in Heart Failure Patients with Reduced Ejection Fraction: A Systematic Review.

INTRODUCTION: Dapagliflozin, a new treatment option for heart failure, leads to a significant reduction in the hospitalization of patients with heart failure. We aimed to review studies on the economic evaluation of adding dapagliflozin to standard care compared with standard care alone in heart failure patients with reduced ejection fraction (HFrEF). METHODS: For this systematic review, the PubMed, EMBASE, Web of Science, Cochrane, Scopus, and CEA Registry scientific databases were searched from 1 January 2020 to 25 March 2022. Two of the present researchers screened titles and abstracts, extracted data from full-text articles, and evaluated their quality using the Quality of Health Economic Studies (QHES) checklist for the quality assessment of health economic studies. RESULTS: Of the 456 abstracts screened, 19 studies met the inclusion criteria. The mean QHES score for the studies was 0.87 (high quality). Eight studies on cost-effectiveness analysis, ten studies on cost-utility analysis, and one study on cost-minimization analysis were conducted. Based on the available evidence and the present findings, the addition of dapagliflozin to standard care in patients with HFrEF was cost effective in most countries. CONCLUSIONS: Based on the results of the present study, the addition of dapagliflozin to standard care in patients with HFrEF was cost effective. More studies investigating the cost effectiveness of dapagliflozin in patients with HFrEF are required in light of the actual epidemiological data of countries in the relevant input parameters. It is also recommended to conduct cost-effectiveness studies of dapagliflozin taking into account costs and benefits from a societal perspective.

The Development and Validation of Elder Self-Neglect Scale (ESNS) in Iranian Community-dwelling Older Population.

The aim of this study was to develop a valid and reliable elder self-neglect scale (ESNS) for field research on Iranian community-dwelling older adults. This mixed-method exploratory study was conducted in three stages: (1) item generation using literature review, (2) item reduction by expert panels, and (3) assessing the psychometric properties. In the third stage, the face, content, and construct validity (exploratory factor analysis) were performed on the first sample (n = 450), and the final 26-item scale was developed. After that, confirmatory factor analysis and reliability were assessed on the second sample (n = 250). Data were analyzed using IBM-SPSS v.23 and AMOS v.24. Exploratory factor analysis identified six factors with a total variance of 77.53%. The goodness of fit was indicated by Structural Equation Modeling. The Cronbach's alpha was estimated at 0.85. The optimal cutoff point was 73. This scale with 26 items seems to be an effective tool in screening elder self-neglect.

Current knowledge of physicians' dual practice in Iran: A scoping review and defining the research agenda for achieving universal health coverage.

BACKGROUND: Physicians' dual practice (simultaneous practice in both public and private sectors) may be challenging for achieving universal health coverage. The purpose of this review is to identify the types of available evidence in physicians' dual practice in Iran and define the research agenda for achieving universal health coverage (UHC). METHODS: We conducted a scoping review of the literature using Arksey and O'Malley's approach. We searched Embase, PubMed, the Cochrane Library, Scopus, Web of Science core collection, as well as internal databases including the National Magazine Database (Magiran) and the Scientific Information Database (SID) until August 3, 2020. Studies published in Persian or English and investigating physicians' dual practice in the health system of Iran were included. Each step of the study was performed by two of the present researchers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) recommendations were used to conduct this study and report the findings. RESULTS: Fourteen studies were included in the current review. The findings were categorized and synthesized into five themes including the forms of dual practice, the extent of dual practice, the motivators and factors affecting dual practice, the policy options, and the consequences of dual practice. There were limited evidence on the nature, types, and prevalence of this phenomenon for different provinces and medical specialties and on health policy options in Iran. There seems to be a methodological gap (a gap in the type of study and its method) in the subject area. Most studies have only used quantitative or qualitative study methods and based on the self-report of research samples in most of the included studies. CONCLUSIONS: More research is required at national level on the nature, types, and prevalence of this phenomenon, focusing on clarifying the root causes of this phenomenon and on the effects of dual practice on the indicators of accessibility to health services, especially for vulnerable populations, the quality of care provided, and equity, and on complex policy research on health policy options in Iran. The research questions proposed in the present study can help to bridge the knowledge gap in this area. Additional studies should address issues related to the quality of data collection in physicians' dual practice.

A Systematic Review on the Economic Evaluations Evidence of Enhanced External Counter-Pulsation (EECP) for Managing Chronic Stable Angina.

Background: Chronic Stable Angina (CSA) does not respond to clinical interventions always. Therefore, enhanced external counter pulsation (EECP) has been approved by the Food and Administration Drug (FDA) as an effective technology. This study aimed to synthesize evidence on the economic evaluation of EECP in managing CSA through a systematic approach. Methods: In this systematic review study, PubMed/Medline, Cochrane Library, Web of Sciences, Scopus, National Institute for Health Research Journals Library, and the University of York Centre for Review and Dissemination (CRD) were searched. The targeted population was people who suffered from CSA, and the main therapeutic intervention was EECP. The comparators were not limited to any particular ones. Outcomes were changes in the Canadian Cardiovascular Society grading of angina pectoris, quality of life, and any other investigated relevant outcomes in the retrieved studies. The quality of studies was assessed through Philips et al and Joanna Briggs Institute Critical Appraisal tools. We synthesized data through a narrative approach. Results: We retrieved 7821 studies; among which 3 studies were included in the final phase. Two studies were systematic reviews and the Markov model economic evaluation. Another study was a partial economic evaluation. Conclusion: All studies only considered direct costs. EECP is a cost-effective technology in managing CSA, however, the sensitivity analysis of the studies showed the cost-effectiveness ratio is varied considerably and further studies are needed to extrapolate its economic value.

A Systematic Review of Potentially Inappropriate Medications Use and Related Costs Among the Elderly.

OBJECTIVE: Potentially inappropriate medications (PIMs) use is a common phenomenon among older adults. This paper aimed to perform a systematic literature review to assess PIMs use and related costs among elderly persons. METHODS: This study was a systematic review. PubMed, Scopus, and the Institute for Scientific Information engines were used to search for all relevant studies published until 2020. Studies were excluded if they did not estimate the cost of PIMs for the elderly. In addition, non-English articles, editorials, letters, and review articles were excluded. All eligible articles were assessed for methodological quality. Finally, we extracted general characteristics from each eligible study. RESULTS: This study showed that the prevalence of PIMs use among older adults was more than 30%. Drugs related to the central nervous system and cardiovascular disease, benzodiazepines, analgesics, and nonsteroidal anti-inflammatory drugs were most commonly used as PIMs. These studies concluded that PIMs could impose a high economic burden on the elderly and society. The mean cost for older adults with PIMs use was almost USD$2000 more than the mean cost for older adults without PIMs. Additionally, the total cost of PIMs use for all elderly persons in Canada in 2013 was estimated at USD$419 million. CONCLUSIONS: Focusing on the most common PIMs, such as benzodiazepines and nonsteroidal anti-inflammatory drugs, helps implementing cost-effective strategies for reducing PIMs use and decreasing their clinical and economic effects.

Predicting Inpatient Length of Stay in Iranian Hospital: Conceptualization and Validation.

OBJECTIVE: The length of stay is an important indicator of hospital performance and efficiency. Regarding the importance of the length of stay, this study aimed to design a structural model of the inpatients' length of stay in the educational and therapeutic health care facilities of Iran in order to identify the influencing dimensions. METHODS: The present study was an analytical and applied study. The face validity of the data gathering tool was investigated by the expert judgment and the construct validity was examined by using the exploratory factor analysis. In order to verify the reliability of the tool, the internal consistency was also trialed by using the Cronbach's alpha. For ranking the influencing dimensions and factors and also in order to examine the causal relationships between the variables in a coherent manner and presenting the final model, the structural equation modeling technique was used in AMOS software at a significant level of 0.05. RESULTS: The mentioned structural model consists of 4 dimensions and 29 factors influencing the length of stay of hospitalized patients. The independent variables are based on priority and importance as follows: patients' conditions, the underlying factors, the clinical staff performance, and hospitals' service delivery, which were examined by second-order factor analysis in order to study the relationship between them and the inpatients' length of stay. CONCLUSION: Considering the importance of each one of the proposed dimensions from the point of view of service providers in some therapeutic centers of the country by paying attention to the role of each one of them in preventing prolonged hospitalization can be essential in the effectiveness of the treatment and cost reduction.
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The challenges of implementation of clinical governance in Iran: a meta-synthesis of qualitative studies.

BACKGROUND: Policy- and decision-makers seek to improve the quality of care in the health sector and therefore aim to improve quality through appropriate policies. Higher quality of care will satisfy service providers and the public, reduce costs, increase productivity, and lead to better organisational performance. Clinical governance is a method through which management can be improved and made more accountable, and leads to the provision of better quality of care. In November 2009, the Iranian Ministry of Health and Medical Education implemented new clinical guidelines to standardise and improve clinical services as well as to increase efficiency and reduce costs. The purpose of this study was to assess the challenges of implementing clinical governance through a meta-synthesis of qualitative studies published in Iran. METHODS: Ten databases, including ISI/Web of Sciences, PubMed/MEDLINE, Embase, PsycINFO, the Cochrane Library, CINAHL, Scopus, Barakatns, MagIran and the Scientific Information Database, were searched between January 2009 and May 2018. The quality of the included studies was assessed using the Critical Appraisal Skills Programme tool. This study was reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research guidelines. Thematic synthesis was used to analyse the data. RESULTS: Ten studies were selected and included based on the inclusion/exclusion criteria. In the first stage, 75 items emerged and were coded, and, following comparison and combination of the codes, 32 codes and 8 themes were finally extracted. These themes included health system structure, management, person-power, cultural factors, information and data, resources, education and evaluation. CONCLUSION: The findings of the study showed that there exist a variety of challenges for the implementation of clinical governance in Iran. To successfully implement a health policy, its infrastructure needs to be created. Using the views and support of stakeholders can ensure that a policy is well implemented. TRIAL REGISTRATION: CRD42017079077 . Dated October 10, 2017.

Cost-effectiveness of lung cancer screening and treatment methods: a systematic review of systematic reviews.

BACKGROUND: Due to extensive literature in the field of lung cancer and their heterogeneous results, the aim of this study was to systematically review of systematic reviews studies which reviewed the cost-effectiveness of various lung cancer screening and treatment methods. METHODS: In this systematic review of systematic reviews study, required data were collected searching the following key words which selected from Mesh: "lung cancer", "lung oncology", "lung Carcinoma", "lung neoplasm", "lung tumors", "cost- effectiveness", "systematic review" and "Meta-analysis". The following databases were searched: PubMed, Cochrane Library electronic databases, Google Scholar, and Scopus. Two reviewers (RA and A-AS) evaluated the articles according to the checklist of "assessment of multiple systematic reviews" (AMSTAR) tool. RESULTS: Overall, information of 110 papers was discussed in eight systematic reviews. Authors focused on cost-effectiveness of lung cancer treatments in five systematic reviews. Targeted therapy options (bevacizumab, Erlotinib and Crizotinib) show an acceptable cost-effectiveness. Results of three studies failed to show cost-effectiveness of screening methods. None of the studies had used the meta-analysis method. The Quality of Health Economic Studies (QHES) tool and Drummond checklist were mostly used in assessing the quality of articles. Most perspective was related to the Payer (64 times) and the lowest was related to Social (11times). Most cases referred to Incremental analysis (82%) and also the lowest point of referral was related to Discounting (in 49% of the cases). The average quality score of included studies was calculated 9.2% from 11. CONCLUSIONS: Targeted therapy can be an option for the treatment of lung cancer. Evaluation of the cost-effectiveness of computerized tomographic colonography (CTC) in lung cancer screening is recommended. The perspective of the community should be more taken into consideration in studies of cost-effectiveness. Paying more attention to the topic of Discounting will be necessary in the studies.

Measuring equity in household's health care payments (Tehran-Iran 2013): technical points for health policy decision makers.

BACKGROUND: Households' financial protection against health payments and expenditures and equity in utilization of health care services are of the most important tasks of governments. This study aims to measuring equity in household's health care payments according to fairness in financial contribution (FFC) and Kakwani indices in Tehran-Iran, 2013. METHODS: This cross-sectional study was conducted in 2014.The study sample size was estimated to be 2200 households. Households were selected using stratified-cluster sampling including typical families who reside in the city of Tehran. The data were analyzed through Excel and Stata v.11software. Recall period for the inpatient care was 1 year and for outpatient1 month. RESULTS: The indicator of FFC for households in health financing was estimated to be 0.68 and the trend of the indicator was ascending by the rise in the ranking of households' financial level. The Kakwani index was estimated to be a negative number (-0.00125) which indicated the descending trend of health financing system. By redistribution of incomes or the exempt of the poorest quintiles from health payments, Kakwani index was estimated to be a positive number (0.090555) which indicated the ascending trend of health financing system. CONCLUSION: According to this study, the equity indices in health care financing denote injustice and a descending trend in the health care financing system. This finding clearly shows that deliberate policy making in health financing by national health authorities and protecting low-income households against health expenditures are required to improve the equity in health.