Facilitators of improving the function of nongovernmental organizations (NGOs) in Iran's health system.

BACKGROUND: Iranian health nongovernmental organizations (NGOs) could play a variety of roles at many levels of Iran's health system, but their participation in the health sector is far from ideal. Therefore, this study was conducted to identify practical solutions for increasing the role and function of NGOs in the Iranian health system. MATERIALS AND METHODS: This qualitative study was conducted between 2020 and 2021 in Tehran, Iran. The data for this study were gathered through 32 in-depth semi-structured interviews with 11 managers from the Ministry of Health as well as from Iran and Tehran universities of medical sciences and 21 Chief executive officers and directors of health NGOs. Data were analyzed by the content analysis approach using the MAXQDA 10 software. RESULTS: The facilitators for expanding the function and roles of NGOs in Iran's health system are classified into two groups of legal and structural mechanisms. "The existence of mandatory laws," "government support for NGOs," "the formulation of standard strategic planning and goals," "the establishment of a database and a network of NGOs," and "the establishment of independent organizational units as the connectors and coordinators of NGOs' affairs in the public sector" are the critical facilitators for the improvement of NGOs' roles in Iran's health system. CONCLUSION: According to the findings of this study, only limited measures and efforts have been made to improve NGOs' roles and participation in the Iranian health system; at the same time, NGOs' participation in the health sector is far from ideal. Iranian health NGOs are at the beginning of this route, and they would inevitably require various legislative and structural mechanisms to succeed.

Hospitals during economic crisis: a systematic review based on resilience system capacities framework.

BACKGROUND: Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals' policy solutions during the economic crisis using the resilience system capacities framework. METHOD: This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system's six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment). FINDINGS: After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers' competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies. CONCLUSION: The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC.

Role of nongovernmental organizations in Iran's health system: What do they do and what can they do?

BACKGROUND: Nongovernmental organizations (NGOs) as entities out of the health sector can play various roles and functions at different levels of the health systems. The present study was conducted to investigate NGOs' potential and actual functions in Iran's health system. MATERIALS AND METHODS: This exploratory study was carried out in two parts from April 2020 to December 2020 in Tehran, Iran. For the first part, the statute of 65 NGOs was used for document review, and in the second part, the required data were collected using semi-structured interviews with 26 key informants from the governmental sector and NGOs. Data were analyzed using the framework analysis method and MAXQDA software. RESULTS: According to data analysis, the results of this study were classified into two sections of NGOs' current functions and expected functions in Iran's health system. The current functions of NGOs in Iran's health system include service delivery, educational, research, and information activities, financing, supportive and facilitation activities, and advocacy. Other functions in which NGOs could play a role include health system management, education, and service providing and support activities. CONCLUSION: In this study, the various roles of NGOs in Iran's health system were explained. NGOs can act actively as the consulting and executive hand alongside the public sector in the lowest to the highest levels of Iran's health system. Hence, health sector managers and policymakers must facilitate NGOs' involvement in the health sector and use their capacities and capabilities to improve health and increase public access to health-care services.

Toward a theory-led meta-framework for implementing health system resilience analysis studies: a systematic review and critical interpretive synthesis.

INTRODUCTION: The variety of frameworks and models to describe resilience in the health system has led researchers and policymakers to confusion and the inability to its operationalization. Therefore, the purpose of this study was to create a meta-framework using the Critical Interpretive Synthesis method. METHOD: For this purpose, studies that provide theories, models, or frameworks for organizational or health system resilience in humanitarian or organizational crises were systematically reviewed. The search strategy was conducted in PubMed, Web of Science, Embase, and Scopus databases. MMAT quality appraisal tool was applied. Data were analysed using MAXQDA 10 and the Meta-ethnography method. RESULTS: After screening based on eligibility criteria, 43 studies were reviewed. Data analysis led to the identification of five main themes which constitute different framework dimensions. Health system resilience phases, attributes, tools, and strategies besides health system building blocks and goals are various dimensions that provide a systematic framework for health system resilience analysis. DISCUSSION: This study provides a systemic, comprehensive framework for health system resilience analysis. This meta-framework makes it possible to detect the completeness of resilience phases. It examines the system's resilience by its achievements in intermediate objectives (resilience system attributes) and health system goals. Finally, it provides policy solutions to achieve health system resilience using tools in the form of absorptive, adaptive, and transformative strategies.

Collaboration between the government and nongovernmental organizations in providing health-care services: A systematic review of challenges.

BACKGROUND: Given the expanding range of health influencing factors, increasing expectations from the health systems, and general challenges such as insufficient resources, the health services needed by people cannot be provided completely by the governments alone. Therefore, nongovernmental organizations (NGOs)-government collaboration is considered a common approach in health-care provision for different communities. Since the NGO-government collaboration is complicated and usually influenced by many challenges and issues, the present study was conducted to identify collaboration challenges between the government and NGOs in providing health-care services. MATERIALS AND METHODS: Using a systematic review method and searching in ISI Web of Science, Scopus, PubMed, and Embase databases, using related keyword/terms, between March 2020 and June 2020, studies on NGO-government collaboration in the health area were collected without time limitation. After completing the article selection process, those articles that consistent with the research purpose were chosen for the final analysis. RESULTS: From 4236 initially collected studies, 16 studies were chosen for the final analysis. Based on the content analysis of the selected articles, 70 challenges were identified in the NGO-government collaboration to provide health-care services. These challenges were divided into five main themes: structural issues, process issues, issues related to roles and responsibilities, trust and communications issues, and control and power relation issues and 11 subthemes. CONCLUSION: The present study provides significant challenges by NGO-government collaboration in providing health-care services. Awareness of these challenges plays an important role in promoting such collaborations and enables these organizations to highly exploit the strengths of each other, resulting in a collaboration with win-win situation.

Utilization of integrated health kiosks: A systematic review.

Background: In some countries, integrated health kiosks are used to provide some services and information. However; it is still not officially included in many countries' health systems. The purpose of this study was to gather and summarize different aspects of using health kiosks in countries. Methods: Five English databases, including Web of Science, Cochrane Library, PubMed / Medline, Embase and Scopus, were explored from 2001 to 2018, using words related to three concepts: health, design and development, and kiosk. Different dimensions of health kiosks utilization in the world were identified and analyzed thematically. Results: Out of 918 search results, 37 articles were included in the study and analyzed. Most of them were conducted in the United States and addressed the development, implementation, design, or feasibility of utilizing integrated health kiosks. The different aspects of kiosk utilization were categorized into 6 dimensions: services provided, deployment location, user characteristics and variables of accepting kiosks, notable design and construction points, their benefits and effectiveness, and finally, the challenges of using kiosks. Conclusion: This study found that health kiosks are promising, cost-effective and multifunctional tools; if included in the formal health system of countries, they may improve health indicators in countries. However, before deploying, their challenges and concerns need to be investigated and addressed.

Prevalence rate of laboratory defined aspirin resistance in cardiovascular disease patients: A systematic review and meta-analysis.

BACKGROUND: Cardiovascular disease (CVD) is the first cause of mortality worldwide, with all the healthcare systems facing this very challenging issue. Aspirin continues to be the major gold-standard treatment worldwide in the prevention of thrombotic disease in patients with CVD, even though not all individuals respond to antiplatelet therapy in a similar way, being resistant to aspirin. The aim of this study was to determine the prevalence of laboratory defined aspirin resistance in CVD patients worldwide. METHODS: Relevant articles were identified through searching EMBASE, PubMed/ MEDLINE, ISI /Web of Science, Scopus, and the Cochrane Library, from January 2000 to February 2018. The methodological quality of the included studies was critically appraised using the Newcastle-Ottawa scale. The pooled prevalence of laboratory defined aspirin resistance was computed using the Der Simonian-Laird random-effect model. RESULTS: We included 65 studies, with a total of 10,729 patients. The overall prevalence of laboratory defined aspirin resistance in CVD patients was 24.7% ([95%CI 21.4-28.4]. Women were found to be at increased risk of laboratory defined aspirin resistance compared to men, with an odds ratio of 1.16 [95%CI 0.87-1.54]. CONCLUSION: Doctors and healthcare providers should pay special attention to aspirin resistance since lack of awareness could cause problems and increase mortality in these patients, if not properly treated with higher aspirin doses.

Barriers and facilitators of deploying health kiosk in Iran: A qualitative study.

INTRODUCTION: It is less than a decade in Iran that integrated health kiosks have been limitedly provided to public by private sector. Considering the significant benefits of them, this study aimed to identify the barriers and facilitators for deploying kiosks in Iran's formal health system in three phases, "design and construct, implement, and use." MATERIALS AND METHODS: This was a qualitative study in Iran, and the data were collected through 20 semi-structured interviews with experts in 2019. Participants were selected by purposeful method with the most diversity in terms of background and work experience; the interview texts were coded in MAXQDA10 software and analyzed through framework analysis. Participants' viewpoint was used to verify the data and observers' review to confirm them. RESULTS: The barriers for designing and constructing kiosks were identified in the form of two main themes: the overall structure of the country and the structure of the health system; the obstacles for implementing were categorized in one main theme, lack of sources; and the barriers to use were also fall into four themes related to people, policymakers, service providers, and designers of kiosks. The facilitators at construction and implementation phases included the overall structure of the country and the structure of health system. At the use stage, the facilitators related to people, health and insurance policymakers, and owners and constructers were identified. CONCLUSION: It is possible to deploy health kiosks in the Iranian formal health system, although there are some time-consuming and costly barriers which can be overcome by the strengths and opportunities of the system.

Bevacizumab and erlotinib versus bevacizumab for colorectal cancer treatment: systematic review and meta-analysis.

Background Improving the survival of patients diagnosed with metastatic colorectal cancer requires the use of chemotherapy to be managed with minimum adverse effects. Randomized control trials (RCTs) have shown promising results with a combination of bevacizumab and erlotinib to block two important tumor growth pathways, namely vascular endothelial growth factor and epidermal growth factor receptor. Aim of the Review We aimed to examine the efficacy and safety of the combination of bevacizumab and erlotinib with bevacizumab alone in the maintenance treatment of metastatic colorectal cancer, by examining PFS, OS, overall response rate (ORR), and toxicity. This study performed a systematic review meta-analysis using existing randomized clinical trial. Methods Randomized controlled trials were systematically reviewed from PubMed, Cochrane library, SCOPUS, CRD, and Google scholar databases. After evaluating the quality of studies through the Cochrane checklist, data of the relevant studies were extracted. This meta-analysis included outcomes of overall survival, progression-free survival of the disease through the hazard ratio, and the upper and lower confidence intervals for the third and fourth degree side effects of relative risk. To perform the meta-analysis for both types of survival, two fixed and random effect models were used. Results A total of three trials, providing data of 682 patients who received maintenance treatment, were included in this meta-analysis. Conclusion The combination of bevacizumab and erlotinib significantly increased the overall survival compared to using bevacizumab alone [HR = 0.78, 95% CI 0.66-0.93]. This combination, effectively increased progression-free survival [HR = 0.81, 95% CI 0.7-0.93] too. The side effects of diarrhea and grade III rash were more frequent in the group administered bevacizumab plus erlotinib. The combination of bevacizumab and erlotinib, in the maintenance treatment of metastatic colorectal cancer, significantly improved the overall survival and progression-free survival of patients, and the resulting side effects were easily treatable.

The effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on the treatment of aphasia caused by cerebrovascular accident (CVA).

Background: Aphasia is a common outcome of Cerebrovascular Accident (CVA) in which clinical interventions have limited effectiveness. Some evidence suggests that noninvasive stimulation of the brain can have beneficial effects in the treatment of CVA induced aphasia. In patients with motor aphasia, repetitive Transcranial Magnetic Stimulation (rTMS) is used to facilitate long-term improvement in speech ability. Since identifying effective methods for treating CVA induced aphasia can be very important in subsequent decision-making and treatment interventions, the objective of this study was to evaluate the effect of low-frequency TMS in Broca's area in the right hemisphere on the treatment of CVA induced motor aphasia. Methods: This clinical trial enrolled 24 patients with a clinical diagnosis of motor aphasia caused by CVA using convenient sampling. In this study, the effect of stimulation of Broca's area in the right hemisphere was examined by low-frequency rTMS (one Hz) on aphasia caused by CVA. To conduct verbal fluency test in patients, their correct responses to the selected images before and after rTMS during a certain time were recorded and compared by non-parametric Wilcoxon test using SPSS16 and the significance level was considered <0.05. Registration ID of this research in IRCT is IRCT2014052417814N1. Results: The study findings suggested a significant difference between Wilcoxon test results of patients before and after rTMS (z= -4.401), and it was found that using low-frequency rTMS in the right hemisphere was effective on improving dysarthria in the study population with 95 percent confidence interval (p<0.001). Conclusion: According to the findings, low-frequency rTMS has the potential to be considered as a treatment for patients with nonfluent aphasia caused by CVA.

Designing a model of hospital information system acceptance: Organizational culture approach.

Background: The significance and influence of organizational culture on Information Technology acceptance, especially in healthcare field, has been recognized as a source of organizational inertia. This study aimed at developing a model of Hospital Information System (HIS) acceptance for non-teaching hospitals of Iran University of Medical Sciences to encourage the authorities to promote organizational culture and successful application of HIS. Methods: The proposed model was developed according to Michigan Organizational Assessment Questionnaire (MOAQ), Harrison, Hofstede models, and Comparative Values Framework (CVF). The questionnaires were designed based on the model and distributed among 400 HIS users in the hospitals under study, who were selected using stratified random sampling. The structural equation modeling method was used for data analysis in LISREL software. Results: According to the final model, the influences of developmental culture on perceived usefulness, the relationship of 4 types of organizational culture with mandatoriness according to CVF, and the relationships of hierarchical and developmental culture with system use were attested. The relationships between supervision and 4 variables of HIS acceptance were confirmed. Furthermore, the influence of process/ result oriented culture on user satisfaction was demonstrated. The normed chi square index (2.60) revealed that the final model was fitted to the data. The indices were as follow: GFI= 0.95, CFI= 0.97, AGFI= 0.88, RMSEA= 0.064. Conclusion: The components and structural relationships in the model of this study are applicable in the related hospitals, and using this model can promote organizational culture and acceptance of HIS by the users.

Safety culture in the maternity unit of hospitals in Ilam province, Iran: a census survey using HSOPSC tool.

INTRODUCTION: Improving quality of maternal care as well as patients' safety are two important issues in health-care service. Therefore, this study aimed to assess the culture of patient safety at maternity units. METHODS: This cross-sectional study was conducted among staffs working at maternity units in seven hospitals of Ilam city, Iran. The staffs included in this study were gynecologists and midwifes working in different positions including matron, supervisors, head of departments and staffs. Data were collected using the Hospital Survey on Patient Safety Culture (HSOPSC). RESULTS: This study indicated that 59.1% of participants reported fair level of overall perceptions of safety and 67.1% declared that no event was reported during the past 12 months. The most positively perceived dimension of safety culture was teamwork within departments in view of managers (79.41) and personnel (81.10). However, the least positively perceived dimensions of safety culture was staffing levels. CONCLUSION: The current study revealed areas of strength (teamwork within departments) and weakness (staffing, punitive responses to error) among managers and personnel. In addition, we found that staffs in Ilam's hospitals accept the patient safety culture in maternity units, but, still are far away from excellent culture of patient safety. Therefore, it is necessary to promote culture of patient's safety among professions working in the maternity units of Ilam's hospitals.

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.

The effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on the treatment of aphasia caused by cerebrovascular accident (CVA).

Background: Aphasia is a common outcome of Cerebrovascular Accident (CVA) in which clinical interventions have limited effectiveness. Some evidence suggests that noninvasive stimulation of the brain can have beneficial effects in the treatment of CVA induced aphasia. In patients with motor aphasia, repetitive Transcranial Magnetic Stimulation (rTMS) is used to facilitate long-term improvement in speech ability. Since identifying effective methods for treating CVA induced aphasia can be very important in subsequent decision-making and treatment interventions, the objective of this study was to evaluate the effect of low-frequency TMS in Broca's area in the right hemisphere on the treatment of CVA induced motor aphasia. Methods: This clinical trial enrolled 24 patients with a clinical diagnosis of motor aphasia caused by CVA using convenient sampling. In this study, the effect of stimulation of Broca's area in the right hemisphere was examined by low-frequency rTMS (one Hz) on aphasia caused by CVA. To conduct verbal fluency test in patients, their correct responses to the selected images before and after rTMS during a certain time were recorded and compared by non-parametric Wilcoxon test using SPSS16 and the significance level was considered <0.05. Registration ID of this research in IRCT is IRCT2014052417814N1. Results: The study findings suggested a significant difference between Wilcoxon test results of patients before and after rTMS (z= -4.401), and it was found that using low-frequency rTMS in the right hemisphere was effective on improving dysarthria in the study population with 95 percent confidence interval (p<0.001). Conclusion: According to the findings, low-frequency rTMS has the potential to be considered as a treatment for patients with nonfluent aphasia caused by CVA.

Examining the relationship between critical-thinking skills and decision-making ability of emergency medicine students.

BACKGROUND AND AIMS: Critical-thinking ability would enable students to think creatively and make better decisions and makes them make a greater effort to concentrate on situations related to clinical matters and emergencies. This can bridge the gap between the clinical and theoretical training. Therefore, the aim of the present study is to examine the relationship between critical-thinking ability and decision-making skills of the students of Emergency Medicine. MATERIALS AND METHODS: This descriptive and analytical research was conducted on all the students of medical emergency students (n = 86) in Shahrekord, Iran. The demographic information questionnaire, the California Critical Thinking Skills Test, and a decision-making researcher-made questionnaire were used to collect data. The data were analyzed by SPSS software version 16 using descriptive and analytical statistical tests and Pearson's correlation coefficient. RESULTS: The results of the present study indicate that the total mean score for the critical thinking was 8.32 ± 2.03 and for decision making 8.66 ± 1.89. There is a significant statistical relationship between the critical-thinking score and decision-making score (P < 0.05). CONCLUSIONS: Although critical-thinking skills and decision-making ability are essential for medical emergency professional competence, the results of this study show that these skills are poor among the students.

A content analysis of health-related advertisements in Islamic Republic of Iran broadcasting (IRIB).

BACKGROUND: Media advertisements especially radio and TV are one of the most important and effective ways for health promotion and consumption of healthy productions worldwide. Ministry of Health and some other ministries in Iran agreed to control and restrict the advertising of unhealthy products and services. Therefore, adequate supervision and monitoring should be done in this field. A content analysis of Health-related Advertisements was done in Islamic Republic of Iran Broadcasting (IRIB) Methods: This study was a cross-sectional research and collecting of data was carried out in 2012. Ten selected TV and radio channels were recorded from 6 a.m. to 12 p.m. for two successive months in the special weekdays. Broadcasted advertisements data were extracted by the trained observers according to a checklist and analyzed using SPSS 18 software and described with descriptive statistics. RESULTS: The percentage of different types of advertising were including 73.9% unrelated to health, 21.9% harmless health related, 2.9% less healthy, 1.3% harmful or harmful with a probability of abuse. Non-harmful to health advertisements included 95.86% of total advertisements out of ten TV and radio channels; and the remained advertisements (4.14%) were related to the harmful, less healthy foodstuff and detrimental services and products. Also, 0.8% of the advertisements were shown during children programs. CONCLUSION: The main findings of the current study revealed that majority of the advertisements of Islamic Republic Broadcasting were unrelated to health. It seems advertising of harmful for health in IRIB was less than 5%, and the levels of these type ads were less than the other countries. Even so, the policymakers need to pass and enforce some executive and governing law for the prevention of broadcasting unhealthy advertisements to increase the society health level and prevent the diseases resulted from unhealthy products causing the considerable damages in a long time.