Physician preferences for working in deprived areas: a systematic review of discrete choice experiment.

Background: Physician shortages in rural areas is a universal concern, and most countries face this challenge. Many attributes influence the physician preferences about the choice of working location. The aim of this systematic review was to investigate which attributes were included in discrete choice experiment studies and which of them valued the most by physicians. Methods: The following databases were searched: PubMed, Embase, and Web of Science Core Collection. Further studies were retrieved from reference lists of included studies, and grey literature. Studies used discrete choice experiments methods to elicit preferences for working in the deprived area, focus on physicians or medical students, and published between 2000 and 2017 in the English language were included. Results: The literature search yielded 192 studies, of which 14 studies met inclusion criteria. The attributes and attribute levels were identified by literature review and qualitative research. The number of attributes varied from five to ten, and the most frequent number was six attributes. In most studies, maximum of sixteen different scenarios were given to the study samples. The "salary or income" attribute was the most important in fifty percent of the studies and the attributes related to "study and education" was at the next level. Conclusion: Financial attributes are not the only significant attributes considered by the physicians for deciding where to practice, but also the other non-financial attributes are important. It is suggested that based on the economic, social and cultural conditions of each country, a specific incentive package, including a set of financial and non-financial incentives, is developed to attract physicians to the deprived areas.

Health technology assessment of magnet therapy for relieving pain.

Background: Magnet therapy has been used increasingly as a new method to alleviate pain. Magnetic products are marketed with claims of effectiveness for reducing pain of various origins. However, there are inconsistent results from a limited number of randomized controlled trials (RCTs) testing the analgesic efficacy of magnet therapy. This study aimed to evaluate the safety and effectiveness of magnet therapy on reliving various types of pain. Methods: A systematic search of two main medical databases (Cochrane Library and Ovid Medline) was conducted from 1946 to May 2014. Only English systematic reviews that compared magnet therapy with other conventional treatments in patients with local pain in terms of pain relieving measures were included. The results of the included studies were thematically synthesized. Results: Eight studies were included. Magnet therapy could be used to alleviate pain of various origins including pain in various organs, arthritis, myofascial muscle pain, lower limb muscle cramps, carpal tunnel syndrome and pelvic pain. Results showed that the effectiveness of magnetic therapy was only approved in muscle pains, but its effectiveness in other indications and its application as a complementary treatment have not been established. Conclusion: According to the results, it seems that magnet therapy could not be an effective treatment for relieving different types of pain. Our results highlighted the need for further investigations to be done in order to support any recommendations about this technology.

Health technology assessment of image-guided radiotherapy (IGRT): A systematic review of current evidence.

BACKGROUND: Image-guided radiotherapy used multiple imaging during the radiation therapy course to improve the precision and accuracy of health care provider's treatment. OBJECTIVES: This study aims to assess the safety, effectiveness and economic aspects of image-guided radiation therapy for decision-making about this technology in Iran. METHODS: In this study, the most important medical databases such as PubMed and Cochrane Library were searched until November 2014. The systematic reviews, health technology assessment reports and economic evaluation studies were included. The results of included studies were analyzed via the thematic synthesis. RESULTS: Seven articles were included in the study. The results showed that image-guided radiation therapy, regardless of the imaging technique used in it, is associated with no major toxicity and has the potential to reduce the symptoms of poisoning. Using image-guided radiation therapy for prostate cancer resulted in substantial improvement in the quality of the received dose and optimal therapeutic dose of radiation to the targeted tumor while the radiation dose to the surrounding healthy tissues was minimal. Additionally, image-guided radiation therapy facilitated the diagnosis and management of exception deviations, including immediate changes and gross errors, weight loss, significant limbs deformity, systematic changes in the internal organs and changes in respiratory movements. Usage of image-guided radiation therapy for prostate cancer was associated with increased costs. CONCLUSION: Current available evidence suggests that the image-guided radiation therapy can reduce the amount of radiation to healthy tissue around the tumor and the toxicity associated with it. This can enhance the safe dose of radiation to the tumor and increase the likelihood of destruction of tumor. The current level of evidence required conducting further studies on the costs and effectiveness of this technology compared with conventional technology.

Safety, effectiveness and economic aspects of maggot debridement therapy for wound healing.

BACKGROUND: Maggot therapy has recently attracted considerable attention as an emerging debridement technique for wound healing. This study aimed to review the safety, effectiveness and economic evaluations of Maggot Debridement Therapy for wound healing. METHODS: To retrieve the relevant evidences, the Cochrane Library (until September 2014) was searched by appropriate keywords, using free text and Mesh. Systematic reviews, HTA reports and economic evaluation studies that compared larval therapy with other debridement therapies, such as hydrogel in patients with various kinds of ulcers in terms of side effects, the wound healing rate, the healing time, and cost per QALY, were included. RESULTS: Five studies met the inclusion criteria which showed that healing with larval therapy happened a little earlier than the usual methods and that pain perception in larval therapy was a little more than usual methods (as by anesthetic conventional methods). However, the quality of life of those patients who received larval therapy was better and they showed a greater tendency to larval therapy as it was relatively safe and had a low rate of side effects. CONCLUSION: It seems that larval therapy has several advantages such as rapid wound debridement, infection elimination, pain control and ulcer healing. The use of larval therapy has the potential to reduce side effects and decrease the need for amputation.

A systematic review of the effectiveness of catheter ablation NavX mapping system for treatment of the cardiac arrhythmia.

BACKGROUND: Catheter ablation is widely used for treatment of atrial fibrillation. The use of fluoroscopic and non-fluoroscopic mapping systems in catheter ablation is common. This study conducted to investigate the safety and effectiveness of Navx non-fluoroscopic mapping system. METHODS: In this study, the appropriate electronic databases including Cochrane Library and Ovid Medline searched until August 2013 using free text and MeSH. Systematic reviews, health technology assessment reports in which systematic review was conducted and controlled trials with the sample size of 100 patients and more were included into the study. RESULTS of included studies were analyzed qualitatively. RESULTS: Seven papers were included in this study. According to these studies, non-fluoroscopic guidance systems may reduce the exposure to radiation compared to fluoroscopic system. NavX system has minimum exposure time. Non-fluoroscopic guidance systems are safer than fluoroscopic guidance system. NavX system reduces the procedure and fluoroscopy time. There was no significant difference between two systems, NavX and Carto, based on their safety and effectiveness. CONCLUSION: Ensite NavX system is relatively safer and more effective than fluoroscopic guidance systems for treating the cardiac arrhythmia.

Safety, effectiveness and economic evaluation of intra-operative radiation therapy: a systematic review.

BACKGROUND: Intra-operative radiation therapy (IORT) is the transfer of a single large radiation dose to the tumor bed during surgery with the final goal of improving regional tumor control. This study aimed to investigate the safety, effectiveness and economic evaluation of intra-operative radiation therapy. METHODS: The scientific literature was searched in the main biomedical databases (Centre for Reviews and Dissemination, Cochrane Library and PubMed) up to March 2014. Two independent reviewers selected the papers based on pre-established inclusion criteria, with any disagreements being resolved by consensus. Data were then extracted and summarized in a structured form. RESULTS from studies were analyzed and discussed within a descriptive synthesis. RESULTS: Sixteen studies met the inclusion criteria. It seems that outcomes from using intraoperative radiation therapy can be considered in various kinds of cancers like breast, pancreatic and colorectal cancers. The application of this method may provide significant survival increase only for colorectal cancer, but this increase was not significant for other types of cancer. This technology had low complications; and it is relatively safe. Using intra-operative radiation therapy could potentially be accounted as a cost-effective strategy for controlling and managing breast cancer. CONCLUSION: According to the existing evidences, that are the highest medical evidences for using intra-operative radiation therapy, one can generally conclude that intra-operative radiation therapy is considered as a relatively safe and cost-effective method for managing early-stage breast cancer and it can significantly increase the survival of patients with colorectal cancer. Also, the results of this study have policy implications with respect to the reimbursement of this technology.

Is Scores Derived from the Most Internationally Applied Patient Safety Culture Assessment Tool Correct?

BACKGROUND: Hospital Survey on Patient Safety Culture, known as HSOPS, is an internationally well known and widely used tool for measuring patient safety culture in hospitals. It includes 12 dimensions with positive and negative wording questions. The distribution of these questions in different dimensions is uneven and provides the risk of acquiescence bias. The aim of this study was to assess the questionnaire against this bias. METHODS: Three hundred nurses were assigned into study and control groups randomly. Short form of HSOPS was distributed in the control group and totally reversed form of it was given to the study group. Percent positive scores and t-test were applied for data analysis. Statistical analyses were conducted using SPSS Version 16. RESULTS: Finally a total of 272 nurses completed the questionnaire. All dimensions with positive wording items in both groups had higher scores compared with their negative worded format. The first dimension "organizational learning and continued improvement" which had the only statistically significant difference, got 16.2% less score in the study group comparing the other group. In addition six out of 18 differences in questions were statistically significant. CONCLUSION: The popular and widely used HSOPS is subject to acquiescence bias. The bias might lead to exaggerate the status of some patient safety culture composites. Balancing the number of positive and negative worded items in each composite could mitigate the mentioned bias and provide a more valid estimation of different elements of patient safety culture.