Enhancing Public Health Surveillance: Outbreak Detection Algorithms Deployed for Syndromic Surveillance During Arbaeenia Mass Gatherings in Iraq.

BACKGROUND: Large gatherings often involve extended and intimate contact among individuals, creating environments conducive to the spread of infectious diseases. Despite this, there is limited research utilizing outbreak detection algorithms to analyze real syndrome data from such events. This study sought to address this gap by examining the implementation and efficacy of outbreak detection algorithms for syndromic surveillance during mass gatherings in Iraq. METHODS: For the study, 10 data collectors conducted field data collection over 10 days from August 25, 2023, to September 3, 2023. Data were gathered from 10 healthcare clinics situated along Ya Hussein Road, a major route from Najaf to Karbala in Iraq. Various outbreak detection algorithms, such as moving average, cumulative sum, and exponentially weighted moving average, were applied to analyze the reported syndromes. RESULTS: During the 10 days from August 25, 2023, to September 3, 2023, 12202 pilgrims visited 10 health clinics along a route in Iraq. Most pilgrims were between 20 and 59 years old (77.4%, n=9444), with more than half being foreigners (58.1%, n=7092). Among the pilgrims, 40.5% (n=4938) exhibited syndromes, with influenza-like illness (ILI) being the most common (48.8%, n=2411). Other prevalent syndromes included food poisoning (21.2%, n=1048), heatstroke (17.7%, n=875), febrile rash (9.0%, n=446), and gastroenteritis (3.2%, n=158). The cumulative sum (CUSUM) algorithm was more effective than exponentially weighted moving average (EWMA) and moving average (MA) algorithms for detecting small shifts. CONCLUSION: Effective public health surveillance systems are crucial during mass gatherings to swiftly identify and address emerging health risks. Utilizing advanced algorithms and real-time data analysis can empower authorities to improve their readiness and response capacity, thereby ensuring the protection of public health during these gatherings.

Chemical release risk assessment in earthquake: Natech event scenario.

Introduction: In recent decades, an increase in natural disasters has led to the Natech events occurrence, which are technological accidents triggered by natural hazards. This study aims to assess the risk of chemical release of the H2S toxic gas following an earthquake from the refinery. Method: The Natech risk assessment was carried out in potential earthquake risk scenarios via a semi-quantitative method using Rapid-N software. The reference scenario was obtained using the Australian SMUG Model, which has presented precise prioritization. Findings: The Natech risk assessment has shown 40 possible earthquake risk scenarios from 5 enclosing Faults in Tehran (North Tehran, Mosha, North Ray, South Ray, and Kahrizak) with an extension of more than 15 km. The earthquake moment magnitudes of 7.5, 7.1, 6.5, and 5.9 were obtained on the Richter scale and at two Focal depths of 5 and 10 km. The South-Ray Fault (HSR-1) was selected as the reference scenario with a moment magnitude of 7.5 on the Richter scale at a Focal depth of 5 km and a distance of 5.5 km from the earthquake epicenter. The highest probability of Natech risk has shown the release of H2S toxic gas in an area with a radius of 6.59 km from the studied vessel in atmospheric stability conditions. Conclusion: Legislation in line with risk reduction, planning for the transfer of potentially dangerous industries to outside urban areas, monitoring land use laws, and promoting coordination between the government, industries, and people in the management of risks caused by industries containing hazardous substances and processes, assessing the risk of Natech events and their consequences, strengthening risk communication and the installation of early warning systems, and public education to adopt personal and socially safe behaviors when facing natural disasters are recommended.

Design and psychometric evaluation of health system intervention assessment tools for children in floods.

BACKGROUND: Flood is one of the most frequent disasters in Iran, which has highly affected the population and consequences on the health system. Children as the most vulnerable group too need to receive health services during floods. The aim of the present study was to develop a national tool for evaluating the provision of health services to children in floods. MATERIAL AND METHODS: This study is a sequential-exploratory mixed method study that consists of two qualitative and quantitative stages. The qualitative part includes the analysis of documents and panel of experts while the quantitative part includes the design and validation of the tools. RESULTS: In this study, organizations providing health services to children were first identified, and according to their mission the relevant items were extracted and the initial checklist was designed. Then validity and reliability of the tools were done. The content validity ratio and content validity index for the tool were 59 and 98%, respectively. Cronbach's alpha and intraclass correlation coefficient were determined as 0.7 and 0.964, respectively. The final tool was presented with 64 items. CONCLUSIONS: The response program, the scope of interventions, service coverage, and the effectiveness of the response after the flood can help reduce the risk of disasters in children. Using the assessment tool of evaluating the health services to children can assist the stakeholder organizations to meet the standards and best quality of services. Assessing the needs of the children affected by floods, identifying the strengths and weaknesses of health services, and proposing corrective strategies according to the information extracted from this tool are other achievements of this study.

The necessity for an integrated Emergency Operations Center (EOC) among first responders: Lesson learned from two Iranian railway accidents.

Introduction: Several train accidents have occurred in Iran in the last twenty years, resulting in considerable loss of human lives. This study aims to investigate and analyze the response process and deficiencies thereof, of three responding organizations to two railway accidents in Iran. Methods: The study was performed in 2 stages to examine the challenges faced by the first responders in the said accidents. In the first stage, a descriptive statistical analysis was conducted to estimate the injuries and loss of human lives. In the second stage, qualitative description (QD) was performed. Technical reports, official documents, and interviews contributed to the sources of primary data. Study participants were members of first responders who were interviewed. Results: The lack of key components like coordination, information-sharing, a single unified command between responders from different organizations, a lack of relief and rescue railway train, and poor inter-organizational interactions in the deployment of relief teams, were found to be the most important challenges. Discussion and conclusion: The analysis of these two accidents showed that the lack of an integrated emergency operations center (EOC) among the organizations involved in the emergency response appears to be the obvious cause of initial confusion and disruption in the response phase which caused a delay which proved fatal. Designing and developing an integrated response plan among responding organizations, preparing an information sharing network, centralized deployment of forces to the site of the accident, strengthening inter-organizational interactions in the form of an incident command system, designing, launching, and using rescue trains on rail routes and use of air emergency facilities in areas with poor accessibility can reduce mortality in future in similar kind of accidents.

Deep Vein Thrombosis After Earthquake: A Systematic Review and Meta-analysis.

OBJECTIVE: Among natural disasters, earthquake is associated with heavy fatalities and financial damages, causing considerable mortality. The complications resulting from getting trapped in rubble, secondary traumas, obligation to reside in temporary shelters, along with other factors such as limited mobility, stress, and dehydration, predispose earthquake survivors to Deep Vein Thrombosis (DVT). The aim of the present study is to investigate the rate of DVT after an earthquake using a systematic review and meta-analysis. METHODS: To perform the present study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used. The protocol of this review study has been registered in the International Perspective Register of Systematic Review (PROSPERO) with the code of CRD42021290375. Credible data resources including PubMed, Scopus, Web of Science, Science Direct, Google Scholar, Magiran, SID, and Embase were used for extracting relevant studies. Random effect model was used to perform the meta-analysis. I2 was ritualized to investigate heterogeneity across the studies. Publication bias of studies was evaluated using the Begg test. RESULTS: In this study, 267 primary studies were identified and extracted. After removing the duplicate ones and the screening, eventually 12 final studies were chosen for the meta-analysis. Based on the meta-analysis results, the total rate of DVT was 9.07% (95% confidence interval [CI]: 7.32-10.81; I2 = 97.9%; P = 0<0.001). Analysis of DVT in the subgroups of the general population and patient survivors were 11.43% (95% CI: 9.06-13.79; I2 = 98%; P = 0<0.001) and 2.51% (95% CI: 0.04-4.63; I2 = 77.7%; P = 0.001). Also, based on the Begg test, the publication bias in the chosen studies was not considerable. CONCLUSIONS: DVT rate in earthquake survivors is higher compared with other disasters, and over time it finds a growing trend. After earthquake, the focus of rescue and health-care teams is on individuals with observable injuries and damages. Because DVT is first asymptomatic but has fatal consequences, including pulmonary embolism and sudden death, it should be incorporated in health's status assessment of earthquake-stricken people as well as screening and diagnostic programs of health-care providers.

Explaining of the experts' points of view about the types and importance of man-made hazards in Iran's process industries: A qualitative study.

Introduction: Process industries may have different hazards that can cause serious injury to humans, the environment, and the economy. Considering the importance of man-made risks in process industries, Experts' Points of View should be considered to apply risk reduction strategies Hence, the present study was performed to explain the views of experts regarding the types and importance of man-made hazards in process industries. Materials and methods: This study was conducted using a qualitative method of directed content analysis with a deductive approach. The participants included 22 experts in the field of process industries. The selection of samples started purposeful and continued until data saturation. Data collection was done through semi-structured interviews. Results: Based on experts' points of view, 5 man-made hazards in process industries were classified into 14 subcategories. The man category was divided into three subcategories: human error, technical knowledge error, and management error, the Material category was divided into 3 sub-categories of leakage and rupture, chemical properties, physical properties, Medium category was divided into two sub-categories of incorrect location selection and placement and harmful environmental factors, Machines category was divided into three sub-categories of failure in design, failure in Preventive Maintenance (PM), failure in Safety Instrumented System (SIS), and the Methods category was classified into three sub-categories: defects in inspection, defects in information, defects in executive instructions. Conclusion: Technical training to reduce personnel errors, conducting risk-based inspections to control leaks and possible ruptures, careful design and site selection in the initial phase of the project, is recommended. The use of engineering methods and artificial intelligence to obtain the risk number and control methods to reduce the harmful effects of risks can be helpful.

Using Artificial Intelligence for Predicting the Duration of Emergency Evacuation During Hospital Fire.

OBJECTIVE: A danger threatening hospitals is fire. The most important action following a fire is to urgently evacuate the hospital during the shortest time possible. The aim of this study was to predict the duration of emergency evacuation following hospital fire using machine-learning algorithms. METHODS: In this study, the real emergency evacuation duration of 190 patients admitted to a hospital was predicted in a simulation based on the following 8 factors: the number of hospital floors, patient preparation and transfer time, distance to the safe location, as well as patient's weight, age, sex, and movement capability. To design and validate the model, we used statistical models of machine learning, including Support Vector Machines Random Forest, Naive Bayes Classifier, and Artificial Neural Network. RESULTS: Data analysis showed that based on the Area Under the Curve, precision, and sensitivity values of 99.5%, 92.4%, and 92.1%, respectively, the Random Forest model showed a better performance compared to other models for predicting the duration of hospital emergency evacuation during fire. CONCLUSION: Predicting evacuation duration can provide managers with accurate information and true analyses of these events. Therefore, health policy makers and managers can promote preparedness and responsiveness during fire by predicting evacuation duration and developing appropriate plans using machine learning models.

The challenges of health volunteers management in COVID19 pandemic in Iran.

PURPOSE: The use of volunteers is one of the approaches to capacity building, preparedness and the response of the health system in disasters. Appropriate management of volunteers during disasters and emergencies is essential. This study aimed to explain the challenges of volunteer management in the Pandemic COVID-19 in Iran. DESIGN/METHODOLOGY/APPROACH: Qualitative research was conducted using the content analysis based on the Graneheim method. The participants' selection was done based on purposeful sampling and theoretical sampling until data saturation. Direct field observation and 26 interviews were applied to collect data. FINDINGS: Four categories and 15 sub-categories emerged to describe the challenges of volunteer management during the COVID-19 crisis including policymaking barriers (including legal barriers, insurance and support coverage and risk governance), managerial barriers (including planning, coordinating and organizing, training and awareness, command and leadership and information management and documentation), socio-cultural barriers (personal safety attitude and culture, attitudes and expectations of the community and perspectives on volunteers) and executive-operational barriers (monitoring and evaluation, cost and needs assessment). ORIGINALITY/VALUE: It is essential to increase managers', officials' and volunteers' perceptions of COVID19 risk through education and information. Preparing a database for volunteers' information, including non-governmental organization and governmental organization volunteers, planning for needs assessment, establishing a mechanism for recruiting volunteers and using their capacities and appropriate organizing, tracking and monitoring of volunteers can be among effective strategies.

Challenges and Barriers to the Participation of Non-Governmental Organizations (NGOs) in Flood Management: A Qualitative Study from Iran.

OBJECTIVE: Floods are one of Iran's most important natural hazards, which cause a lot of damage every year. Various organizations, including non-governmental organizations (NGOs), participate in flood management. The present study aimed to explore the challenges and barriers of NGOs' participation in the management of the flooding in Iran based on stakeholders' experiences. METHODS: This qualitative study is a case study that was conducted using the content analysis approach. Fifteen participants, including 3 national managers, 2 volunteers active in responding to recent floods, and 10 NGO managers/secretaries who had the knowledge or operational experience of participating in disaster management, were approached for interviews. Data were collected using a purposeful sampling method and continued until reaching data saturation. RESULTS: Challenges and barriers to NGOs' participation in flood management were categorized into 4 main categories and 14 subcategories, including policy-making challenges, managerial challenges, executive challenges, and socio-cultural challenges. CONCLUSIONS: As multiple NGOs take part in responding to disasters and performing relief operations, establishing a unified command and supervision system for effective coordination and collaborations among NGOs and other stakeholders is highly suggested. Further research is needed to develop a measurement tool for assessing the effectiveness of NGOs' activities during disasters.

Assessment of Intraorganizational Collaboration in the health sector during Disasters: Exploring a Valid and Reliable Assessment Tool for Disaster Risk Management.

Background: Collaboration, as a key factor in disaster risk management, is a mechanism that prevents the loss of time, investment, and resources. The variety of units in the health sector has made collaboration a major challenge. The present study aimed at developing a tool for assessing collaboration in the health sector during disasters. Methods: In this mixed-methods study, a questionnaire was developed by integrating the findings of a systematic literature review and a qualitative study. Face and content validation were performed. The reliability of the tool was tested through a 15-day interval test-retest by Cronbach's alpha and intraclass correlation coefficient (ICC) with 30 participants. Confirmatory factor analysis was done to test the validity and reliability of instrument using SmartPLS in a case study with 450 health sector staff. Results: The factors affecting intraorganizational collaboration of the health sector were identified in six categories and 19 subcategories by searching 46 articles in the systematic review and content analysis of 16 semistructured interviews with health sector staff. The results of content validity ratio (=0.81), content validity index (=0.92), Cronbach's alpha (=0.975), and ICC (=0.970) confirmed the validity and reliability of the tool. Convergent validity, discriminant validity, and reliability were approved by AVE (average variance extracted) >0.5, Fornell and Larcker matrix, and CR (composite reliability) >0.7. According to the positive result of R 2, Q 2, and goodness-of-fit (GOF) criteria, the model fit was confirmed. Conclusion: The results of validity and reliability measurements approved the proposed tool. The use of this tool is recommended for developing collaboration in the health sectors of different countries.

Foresight of the Consequences of the Hazmat Release From an Oil Refinery on the Surrounding Urban Community Following an Earthquake: A Natech Scenario Analysis.

OBJECTIVE: To analyze the consequences of the Natech scenario of H2S toxic gas release from an oil refinery near Tehran and its effects on surrounding residential areas following an earthquake. METHODS: This research was an applied study. The Natech risk map and the end-point distance of gas release were determined using the Rapid-n software and the Worst-Case Scenario of RMP, respectively. RESULTS: Regarding the high seismic vulnerability of the structures affected by the Natech risk, all residents of this area were simultaneously affected by earthquake and the toxic gas inhalation. In comparison to earthquake, response capacities were poor for Natech events, due to insufficient resources, limited accessibility, lack of planning, and unsafe evacuation places in exposed regions. Unlike earthquake, few studies have been conducted on Natech risk assessment and related consequences in Iran. Our study not only covered this gap but also revealed some dimensions of consequences of human, structural, and response capacities. CONCLUSIONS: It is recommended to have plans for implementing short-term such as identifying vulnerable industries and areas, public awareness and long-term such as land use planning measures to reduce Natech risk and resilience improvement.

Challenges of emergency evacuation of residential areas caused by chemical release due to the earthquake: a Natech event scenario.

BACKGROUND: In recent decades, earthquakes, as natural hazards that caused direct effects both on communities and the chemical industry, produced many Natech events. Natech term is utilizing to describe the technological disasters caused by natural hazards. This study was conducted on the emergency evacuation challenges of residential areas adjacent to a refinery near Tehran based on H2S toxic gas release following a possible earthquake scenario. METHODS: This Research was an applied study at two phases in 2020. In the first phase, a review study was conducted to identify the community's previous experiences on emergency evacuation following Natech events. In the second phase, the challenges of emergency evacuation were analyzed based on the scenario of a possible earthquake and gas release from the refinery. RESULTS: Due to the high seismic vulnerability of structures in the area affected Natech risk, the total Resident population in this area would be affected simultaneously by an earthquake and H2S gas release in concentration 30 ppm as the result of the earthquake impact on chemical facilities. Emergency evacuation would be inevitable. The existing evacuation places are very unsafe and dangerous due to having open spaces. The nearest suitable evacuation places were found in the north direction for more than 38 % of the exposed population and in the east, west, and south direction for more than 61% of them. CONCLUSIONS: The emergency evacuation challenges were discussed in 4 viewpoints, disrupted or interrupted rescue and firefighting operation, unnecessary evacuation, frequent evacuation, and evacuation behavior. The measures such as revising and updating emergency evacuation maps; public informing, training, preparedness; providing protocols and training for operational and therapeutic response teams; and coordination improvement can help resilience increasing to such disasters.

Tractor Ambulance: An Initiative of Emergency Medical Services Response to the Flood of Golestan, Iran in 2019.

Heavy rains in March 2019 led to severe floods in large parts of Iran, with severe financial and physical casualties (in the Golestan province, 11 districts were trapped in water). An increase in the EMS missions while serving a big portion of the needed population was a big problem for the health system during the flood; Therefore, a new solution was needed to overcome this problem. Using a farm tractor for transporting the patients and injured people was the first relief experience ever documented in the whole country. In the present report, despite the limitations and challenges, the tractor has been shown to be a proper and effective disaster relief vehicle. This report could help other similar countries face disasters, especially floods.

The Current State of Infectious Disasters Preparedness Around the World: A Qualitative Systematic Review (2007-2019).

Infectious disasters have specific features which require special approaches and facilities. The main challenge is the rate of spread, and their ability to traverse the Earth in a short time. The preparedness of hospitals to face these events is therefore of the utmost importance. This study was designed to assess the preparedness of countries facing biological events worldwide. A qualitative systematic review was done from PubMed (National Library of Medicine, Bethesda, MD), Scopus (Elsevier, Amsterdam, Netherlands), Web of Science (Thomson Reuters, New York, NY), ProQuest (Ann Arbor, MI), and Google Scholar (Google Inc, Mountain View, CA). Two journals were searched as key journals. The search period was from January 1, 2007 to December 30, 2018. Twenty-one (21) documents were selected including 7 (33%) from Asia, 7 (33%) from Europe, 4 (19%) from USA, 2 (10%) from Africa, and 1 (5%) multi-continental. Forty-six (46) common sub-themes were obtained and categorized into 13 themes (infection prevention control, risk perception, planning, essential support services, surveillance, laboratory, vulnerable groups, education and exercise and evaluation, human resource, clinical management of patients, risk communication, budget, and coordination). Not all articles discussed all the identified categories. There is an extended process required to reach complete preparedness for confronting biological events, including adequate and well-managed budget. Medical centers may have trouble dealing with such events, at least in some respects, but most developed countries seem to be more prepared in this regard.

Factors Influencing Hospital Emergency Evacuation during Fire: A Systematic Literature Review.

BACKGROUND: Although the hospital is known as a safe place for treating patients, due to various reasons, it is prone to several internal hazards, including fire. This study aimed to identify the factors affecting hospital emergency evacuation during fire. METHODS: This was a systematic review conducted according to the PRISMA guideline. Thematic Content analysis was utilized to analyze and extract results. We found the studies investigating the factors affecting hospital emergency evacuation during fire through a comprehensive search in various data resources (MEDLINE, Web of Science, Google Scholar, Embase, ProQuest, Scopus, IRANMEDEX, SID, ISC, and Magiran) and other sources from the beginning of January 2000 to the end of December 2019. Thematic Content analysis was also employed to analyze. RESULTS: At first and based on the initial search, 4484 studies were identified, and 48 articles were finally included in the study. Based on the results; five main themes along with 10 sub-themes were identified. The themes included the incident's characteristics, response measures, hospital preparedness, hospital residents, and hospital building, and the sub-themes were emergency evacuation features, fire characteristics, command, operation, patients' and staff's characteristics, planning, logistics, and structure and design hospital. CONCLUSIONS: Based on the results of the present study, hospital preparedness as one of the most important factors can reduce the hospital evacuation time. Therefore, hospitals can ensure a timely and more effective response in emergency evacuation during fire by improving their preparedness.

Leech therapy of nipple-areolar complex (NAC) congestion in reduction mammoplasty: A case report.

Leech therapy is a safe, easy-to-use, cost-effective traditional treatment to save reattached body parts and flaps in reconstructive plastic surgery especially in cases with blood circulatory problems.

Factors affecting management of corpses of the confirmed COVID-19 patients during pandemic: A systematic review.

INTRODUCTION: The global spread of the COVID 19 disease and the concerning rise in the number of corpses of the patients dying of the disease has caused challenges in handling the corpses by the health system and relevant organizations in most countries. The aim of the present study was to investigate factors affecting the corpse management process of the patients dying of COVID 19. MATERIALS AND METHODS: This study was a systematic review of literature using the PRISMA guideline. Without time limit until the end of January 2021, the studies related to corpse management in patients with COVID 19 were extracted from the data resources of Medline (PubMed), Web of Science, Google scholar, Embase, ProQuest, Scopus, Iranmedex, SID, and ISC, and also the reference lists of selected studies, as well as other systematic reviews, key journals, and proceedings of conferences and congresses. Finally, thematic analysis was used to analyze the obtained data. RESULTS: 190 studies were identified based on the initial search, and finally 21 studies were entered into analysis. Based on the systematic review and thematic content analysis, challenges in the process of managing the corpses of COVID-19 victims were divided into three main themes and eight sub-themes. The themes included psychosocial factors, environmental factors, and resources, and the sub-themes included supporting survivors, customs, values, infection control, corpse identification and burial, corpse transferring, equipment, and governments' capacity. CONCLUSION: Implementing psychological, social, and spiritual support programs for grieving families, the observance of customs and values governing the community at the time of funeral and burial, and planning to control infection and safety in the process of maintenance, transfer to the cemetery and safe burial are the most important strategies that can be used in the process of corpse management. Utilizing and aligning religious leaders with the health system in order to inform people about the ways of disease transmission from the bodies and to use alternative solutions for holding religious and cultural ceremonies (e.g., virtual mourning), as well as providing personal protective equipment to those in close contact with corpses, the development and implementation of health protocols for managing possibly a large number of bodies, capacity building, and anticipating necessary resources are highly recommended strategies.

Factors affecting emergency evacuation of Iranian hospitals in fire: A qualitative study.

BACKGROUND: Fire is one of the most important threatening factors for hospitals and needs special attention. The present study was conducted to explain the factors affecting hospital emergency evacuation following fire based on hospital administrators' experiences. MATERIALS AND METHODS: This was a qualitative study conducted employing the content analysis approach. Participants included 22 hospital administrators in Tehran, Lorestan, Kurdistan, and Ilam provinces. The participants were purposefully selected and included until reaching principle of data saturation. Data were collected through in-depth semi-structured interviews from November 2019 to August 2020 and analyzed by the content analysis method. RESULTS: Factors affecting hospital emergency evacuation during fire were categorized into five main categories and 17 subcategories including response to incident (five subcategories of fire nature, emergency evacuation, service provision, coordination and communication; and collaboration and companionship), human factors (two subcategories of individual characteristics and competencies), hospital preparedness (three subcategories of planning, safety and security; and information management system), environmental factors (two subcategories of hospital design and infrastructure; and weather condition), and finally ethical values (five subcategories of human dignity, trust, altruism, responsibility and accountability; and empathy). CONCLUSION: The results of this study indicated that during fire in Iranian hospitals, several factors in addition to available standard guidelines affect the emergency evacuation process that need to be considered. Hospital emergency evacuation during fire is a complex process and necessitates a full and high-level hospital preparedness, so using the results of this study can be used to develop and practice evacuation plans and improve the hospital preparedness.

Adapted fairness benchmarks for the evaluation of Iran health system reform.

INTRODUCTION: This study has been designed to localize fairness benchmarks for the evaluation of health system reform with an ethical approach. METHODS: A descriptive-analytic study was applied in which a questionnaire with selected indicators and based on main fairness benchmarks was validated. Besides, the final indicators were chosen for surveys of 255 health equity experts from 31 provinces of Iran to localize fairness benchmarks using the exploratory factor analysis through the SPSS software. RESULTS: Seven fairness benchmarks were adopted: (1) Efficacy, Efficiency, and Quality of Health Care; (2) Impact of Information Infrastructure on Health Reform; (3) Responsiveness; (4) Equitable Access, and Universal Health Coverage; (5) Equitable Financing; (6) Social Determinant of Health; and (7) Financial Barriers to Equitable Access. CONCLUSION: The priorities of fairness benchmarking through localization included focusing on the quantity and quality of primary health care, allocating resources based on the need; for equitable efficiency, and paying attention to community-based information infrastructure, and social determinants for fair reform. Moreover, respecting patient rights as a part of democratic accountability was more close to equity. Elimination of financial and nonfinancial barriers for health access and coverage based on vulnerability, through fair financing, was also confirmed.

Survey of Critical Standards of Patient Safety in Hospitals of Iran: A Systematic Review and Meta-Analysis.

BACKGROUND: Patient safety is an important and mandatory component of quality health services. Insecure health services, in addition to inflicting pain and suffering to patients, impose a high financial burden on the health system of every society. The present study was conducted to evaluate the critical standards of patient safety based on the Patient Safety Friendly Hospital Initiative (PSFHI) checklist in Iran. METHODS: The present systematic review and meta-analysis were performed based on the PRISMA guideline. For this purpose, articles related to the critical standards of patient safety based on the PSFHI checklist were obtained by searching valid Persian and English keywords in SID, Magiran, PubMed, Scopus, Web of Science, and Google scholar data resource through the end of 2019. The studies were analyzed using the STATA (version 14) software. RESULTS: In the initial search, 533 articles were extracted among which 7 were eligible and entered into the meta-analysis process. Overall, 55 hospitals were surveyed, and the results of the meta-analysis showed that the average critical standards of patient safety were 69.52% (95%, CI = 57.09-81.95, I2 = 69%, P = 0.004). CONCLUSIONS: The results showed that a moderate level of critical standards of patient safety in hospitals in Iran. Since meta-regression analysis revealed a decreasing trend in compliance rate, hospital managers should implement principals designated by the World Health Organization to achieve the required standards that are the basis and pillar of a patient-friendly hospital. With proper management, hospitals should set goals and take steps based on a strategic plan toward achieving these goals.