Payavard Salamat

Investigating the Prevalence of Self-Medication with Antibiotics and Related Factors among those who Refer to Health Care Centers in the City of Kerman

Mohsen Momeni

Background and Aim: Nowadays, due to people using antibiotics without prescription, the resistance of the bodies to antibiotics has been a major health issue in the world. This study aimed to investigate the consumption of antibiotics without prescription among the people that go to the health care centers of Kerman.
Materials and Methods: This descriptive-analytical study was conducted from April to September 2019, cross-sectionally on 331 people who were referred to the health care centers of Kerman city by the available sampling method. In this research, a valid questionnaire was used to collect information. Data was analyzed with SPSS statistical software, using t-test and chi-square statistical tests.
Results: The average age of the referred people in this study was 38.6±10.76 years, 135 (40.4%) were males and 194 (60.6%) were females. More than two-thirds of people had a higher education than deploma degrees. The self-medication prevalence with antibiotics was 32.9%. The most common cause of self-inflicted use of antibiotics is unwillingness to pay (34.4%), the most common types of antibiotics used are amoxicillin (25%) and azithromycin (24%), and the most common form of medicine used is pills (55.5%). Respiratory infections were also the most common cause of self-inflicted use of antibiotics (42.2%). Pharmacies were the most common source of information about how to use antibiotics (53.9%). Also, self-medication with antibiotics in married people (P=0.015). people with self employed jobs (P=0.031) and people without medical insurance (P<0.001) were significantly more than the other studied group.
Conclusion: The results of the present study showed self-medication with antibiotics is highly prevalent in Kerman city, and policy makers should take interventions to increase people’s awareness of the risks and side effects of self-inflicted use of antibiotics, as well as drug resistance created as a result, in order to reduce the self-inflicted use of these drugs.

The Reasons Why Laws and Policies Developed in Irans Health Sector are not Implemented Effectively

Alireza Heidari

Background and Aim: Many health policies are not implemented or incompletely implemented after approval. This issue significantly reduces the popularity and responsiveness of the top managers of the health system and leads to service disruption in the target community. Therefore, this study was conducted to explain the existing challenges in the implementation of health policies.
Materials and Methods: A qualitative study was conducted in 2021. The participants in the study were 20 scientific and executive experts. The data was collected using an interview guide and the in-depth individual interview method and was analyzed using the content analysis method using thematic analysis with Graneheim and Lundman's approach.
Results: The challenges include the policies formulation (lack of evidence-informed decision-making, lack of attention to the details of the implementation, the change of the initial text of the policy, conflict of interests, unclarity the executives, the lack of proper integration between the political and technical components of the policies, the weak participation of the main stakeholders, the lack of the same understanding of policies concept between policy makers and executives and lack of budget forecasting), challenges of policies implementation (uncertainty about roles of executive organizations, lack of executive attachment, conflict of interest, lack of project management, change of formulated policies with change of executives, little belief among executives, lack of executive guarantee, lack of operational plan) and challenges of policies evaluation (Inadequate supervision and the absence of an informational and supervisory dashboard).
Conclusion: Using effective solutions to solve the challenges extracted in the stages of formulation, implementation and evaluation of health policies can lead to achieving the goals of the formulated policies and improving the health of the society.

The Comparison of Ketorolac, Paracetamol and Pethidine on Postoperative Pain Control for Outpatient Transurethral Lithotripsy

Majid Razavi

Background and Aim: Treatment of acute postoperative pain is one of the most important measures to improve recovery. Different methods of local and regional anesthesia, and also numerous intravenous drugs have been used. In this study, the analgesic effect ketorolac, paracetamol and pethidine in the postoperative pain control of outpatient transurethral lithotripsy was evaluated.
Materials and Methods: This clinical trial was performed on 96 patients who were candidates for outpatient transurethral lithotripsy in Mashhad Imam Reza Hospital. In randomized double blinded study, at the end of the operation, 30 mg of intravenous ketorolac to the first group, 1 gram paracetamol in half an hour to the second group and 50 mg of pethidine to the third group were injected. Pain was assessed every 10 minutes to half an hour and then, every half an hour to 4 hours by numerical rating scale (NRS). Finally, the data were analyzed by SPSS v16 software. The relationship between quantitative variables was analyzed by analysis of variance and the qualitative variables was assessed by Chi-square test and P<0.05 was considered significant.
Results: There was no significant difference between three groups in demographic information. The pain intensity in the first 10 minutes after surgery was the same between the groups (P=0.372), but the pain intensity at 20, 30 and 60 minutes after surgery was significantly different in the three groups (P.values 0.005, 006, and 0.001 respectively), and was lower in the pethidine group. In other hours after surgery, no significant difference in pain control was observed between the three groups. The need for additional analgesia was higher in the paracetamol group than in the other two groups (P=0.025) in the first hour. Hemodynamic changes and surgical complications such as nausea and vomiting were the same in both groups.
Conclusion: The present study showed that pethidine causes better pain relief than ketorolac and paracetamol in the first hour after surgery, but after 60 minutes there is no significant difference between these three groups.

Estimating the Cost of student Training Using Activity-Based Costing (ABC) Method in the Department of Health Management and Economics at the School of Public Health, Tehran University of Medical Sciences

Mahmoud Zamandi

Background and Aim: The role of accurate information in decision-making and programs implementation has highlighted the need to design an appropriate costing system. The present study aimed to estimate the cost of student Training in the Department of Health Management and Economics at the School of Public Health, Tehran University of Medical Sciences using activity-based costing.
Materials and Methods: This research was an applied, descriptive, and cross-sectional study. In this study, all information was collected through interviews with seven officials, financial and administrative staff, and also by using available documents in the faculty. To analyze the costs, the administrative and educational sections were classified into three levels including overhead, middle, and final activity centers, and, using appropriate bases and Microsoft Excel 2013 software, costs of overhead, middle, and final activity centers, and finally, the total cost of each student was calculated.
Results: In this study, the total cost of education for each Ph.D. and master’s student in the department of health management and economics was estimated as 1.95 billion and 376 million IR Rials, respectively. So that the cost of each year of Ph.D. and master’s student education was 433 and 150 million IR Rials, respectively. Out of the total costs of the Department of Health Management and Economics, only 22% of the costs were related to overhead and middle activity centers, and 78% of the costs were exclusive to the final activity center, and the majority of these costs (97%) were related to the personnel, especially the faculty members.
Conclusion: The cost of training Ph.D. students due to the high coefficient of the degree and thus increasing the importance (cost share) of the field, receiving a scholarship from the Ministry of Health and a longer period of study, was estimated to be about 5 times that of a master’s degree. The Ministry of Health and universities can design and implement targeted research programs with the help of faculty members and graduate students, especially Ph.D. students, to solve problems and improve the health of the community, thus improving resource efficiency and productivity.

Investigating the Role of Artificial Intelligence in Management of Diabetes in Iran: A Systematic Review

Fatemeh Ameri

Background and Aim: Diabetes is one of the most common metabolic diseases in Iran and the fifth leading cause of death all over the world. Its spread around the world has created new methods in biomedical research, including artificial intelligence. The present study was carried out to review the studies conducted in the area of artificial intelligence and diabetes in Iran.
Materials and Methods: This study was carried out using a systematic review method. Valid domestic databases, including Irandoc, Magiran, Sid and Google Scholar search engine, were reviewed using the keywords of artificial intelligence and diabetes in Persian both individually and in a combined manner without time limitation until June 20, 2021. A total number of 7495 articles were retrieved, which were screened in different stages (exclusion of duplicates (1824), title and summary of the articles (5884) and full text (30) and finally 20 articles that met the criteria desired by the researchers were carefully reviewed.
Results: Among the retrieved articles, 20 articles met the inclusion criteria, of which 16 articles dealt with methods based on artificial intelligence and 4 articles dealt with the design of new systems based on artificial intelligence. Also, 10 articles examined the role of artificial intelligence in prediction, 8 articles in diagnosis, and 2 articles dealt with the control and management of diabetes. Most of the articles were related to the use of data mining methods such as artificial neural network, decision tree, etc. (16 articles). Some studies also evaluated and compared artificial intelligence methods on application, accuracy and the sensitivity of artificial intelligence in diagnosing and predicting diabetes (10 studies).
Conclusion: A systematic review of articles revealed that the use of data mining methods for diabetes management in Iran has been associated with good progress, but there is a need to design artificial intelligence systems and algorithms and more measures should be taken in the area of diabetes control and management.

The Impact of the Covid-19 Pandemic on Medical Tourism in Iran: An Interrupted Time Series Analysis

Ehsan Zarei

Background and Aim: Medical tourism refers to travel for receiving health services abroad. The COVID-19 crisis affected a wide range of tourism-related businesses, including medical tourism, and caused a decrease in the supply and demand of health services in this market. This study aimed to investigate the impact of the COVID-19 pandemic on Medical Tourism in Iran.
Materials and Methods: This cross-sectional study was conducted in Iran in 2021. The data used in this study were extracted from the information system of the Ministry of Health from 2018 to 2021, which includes the number, origin, and destination of medical tourists, per capita revenue, and monthly revenue two years before and one and a half years after the COVID-19 pandemic. For data analysis, t-tests of independent groups and interrupted time series regression were used in SPSS and EViews 10 software.
Results: The COVID-19 pandemic has caused a 42% decrease in the average monthly number of medical tourists, a 45% decrease in the monthly revenue, and a 10% decrease in the per capita income per tourist (P<0.05). The arrival of medical tourists from the Republic of Azerbaijan, Bahrain, Iraq, and Oman has decreased by more than 80%, and the largest decrease in the number of tourists has been related to Ahvaz, Urmia, Tabriz, and Shiraz. In all diagnostic groups except obstetrics and gynecology, there has been a decrease between 50 to 70% The declining trend of medical tourism indicators was stopped in the second year of the COVID-19 pandemic and has continued as a constant trend.
Conclusion: The COVID-19 crisis has hurt the number of international patients and their revenue in Iran. Relative success in controlling COVID-19 can return to a pre-pandemic situation that requires appropriate policies and administrative measures by government and industry players, such as policies to facilitate patient entry, marketing measures, branding and creating a positive image of the country to potential clients, use of telemedicine facilities for consultations and follow-up, etc.

A Survey of Medical Students’ Views of Tehran University of Medical Sciences about Clerkship Programs during the Covid-19

Maryam Eslami

Background and Aim: The curriculum as the heart of the educational system is one of the effective factors in achieving the goals and mission of the university and its evaluation is of particular importance. Since medical education deals with human life and clerkships also play an essential role in shaping the professional abilities of medical students, this research was conducted with the aim of determining the desirability of clerkship programs from the point of view of medical students of Tehran University of Medical Sciences during the Covid-19 pandemic based on the nine elements of Francis Klein.
Materials and Methods: In this study, a descriptive-survey method was used. The statistical population was 487 medical students of Tehran University of Medical Sciences, who were undergoing the clerkship stage at the time of the research, and the questionnaire was provided to them in the form of a census. The number of samples was determined based on Morgan’s table of 215 people. The research tool was a standard questionnaire, the validity of which was confirmed by professors in the field of educational sciences, and its reliability was calculated using the Cronbach’s alpha method of 0.794. Descriptive statistics (including statistical tables, graphs, central and dispersion indices) and inferential statistics (including one-sample t-tests and independent two-sample t-tests) were used for data analysis.
Results: The results showed that clerkship programs from the point of view of medical students of Tehran University of Medical Sciences during the covid-19 disease, considering that the t-statistic of all research variables is less than 1.96 (educational objectives t=-4.735, educational content t=0/666, learning activities t=-7.812, teaching strategies t=-4.246, educational materials and resources t=-0.970, grouping of learners t=-5.223, learning space (place) t=-4.029, learning time t=-5.043, and learning evaluation t=-7.348) were not desirable in terms of all elements. It was also found that there is no significant difference in attitudes between male and female students regarding the desirability of these programs except for the element of educational goals.
Conclusion: According to the results of the research, the medical clerkship programs of Tehran University of Medical Sciences are facing challenges during the Covid-19 pandemic. Therefore, it is necessary to provide a program that is compatible with the conditions and can meet the educational needs of the learners.

Determining Information Security Requirements in the Telemedicine Network from the Point of View of Managers and Employees of the Information Technology Unit of Birjand University of Medical Sciences and Teaching Hospitals

Fatemeh Zangooei Seno

Background and Aim: Today along with information technology development, telemedicine technology has expanded dramatically. Sinse telemedicine technology relies on data transmission, it is essential to pay attention to issues such as network security, confidentiality, and privacy of patients. Therefore, the aim of this study was to determine the importance of information security requirements in telemedicine networks based on managers and employees of the information technology unit of the University and teaching hospitals of Birjand city
Materials and Methods: This descriptive cross-sectional study was conducted in year 2021. The research population was The managers and employees of the information technology unit of the university and teaching hospitals of Birjand city (40 people), who were surveyed by the census. The study tool was a researcher-made questionnaire that confirmed its validity by faculty members and experts, and its reliability was calculated with Cronbach’s alpha (0.83). After collecting the data, they were entered into the SPSS software and were analyzed using descriptive statistics.
Results: The results showed that the security requirement related to information transportation is more important than other requirements. Also in the field of human resources, providing detailed documentation and training guides for users of the systems was with an average of (4.47). In the medical diagnosis equipment field, telemedicine network systems are equipped with emergency power was with an average of (4.72). In the storage and access to information context, installing antiviruses and anti-malware on all systems was with an average of (4.75), and also in the field of information transfer, encryption of important and sensitive files and information was with an average of (4.69) were the most important security needs.
Conclusions: As the results showed, security requirements related to information transfer have more importance than other requirements; Initially, information security can be guaranteed by creating security policies, updating and monitoring their implementation, as well as training employees. However, in order to transfer sensitive medical information, encryption and qualification verification methods, secure information transfer protocols, virtual and private networks (VPN) and other new technologies can be used in this field. Of course, necessary preparations should be made to create appropriate technical infrastructure for the implementation of security policies in information transmission.