Showing 5 results for Akbari Sari
Morteza Arab Zozani , Seyyed Alireza Hosseini , Ali Akbari Sari , Mitra Mahdavi-Mazdeh, Seyyed Reza Majdzadeh , Ashraf Velayati ,
Volume 73, Issue 5 (August 2015)
Abstract
Background: Everolimus is an immunosuppressive agent with a novel mode of action but has a different clinical role with calcineurin inhibitors (CNI). The aim of this study was to evaluate the safety and effectiveness of everolimus compared with sirolimus and tacrolimus in preventing kidney transplantation rejection.
Methods: Search was conducted for finding randomized clinical trials (RCT) until the end of 2013 in main databases include Cochrane, Medline and other related databases in February 2014. To find the ongoing trials two databases were searched (Clinicaltrial.gov and irct.ir/fa/). Two independent reviewers checked studies for quality and eligibility and finally extracted the data. Data extraction was performed using Cochrane data extraction form for clinical trial. Discrepancies were resolved via consultation with third person. The studies examined in term of heterogeneity with I2 and Chi-square test. The mata-analysis was carried out using RevMan 5.2 (Wintertree Software Inc, Ontario, Canada) when there was homogeneity.
Results: Finally, seven reports from six RCTs included in this study. All reports were in english language and total numbers of participant in these studies were 824. No studies were found in comparison of everolimus and sirolimus and all seven reports were combination of everolimus, tacrolimus and other relative drugs. Follow up time of studies were different from 6 to 36 months. Due to the heterogeneity of included studies, only two studies were entered into meta-analysis. The recorded mean values for glomerular filtration rate, serum creatinine and creatinine clearance were between 60-80 ml/min, 50 to 80 ml/min and 1.2 to 1.9 mg/dl respectively. The results of meta-analysis in three outcomes include serum creatinine, creatinine clearance and glomerular filtration rate were significantly in favor of low dose tacrolimus plus everolimus.
Conclusion: In general, everolimus showed better results in combination with tacrolimus. Given the available evidence in this study, everolimus in combination with low dose tacrolimus showed better safety and effectiveness in preventing kidney transplantation rejection.
Ali Mohammad Mosadeghrad , Ali Akbari Sari , Taraneh Yousefinezhadi ,
Volume 75, Issue 4 (July 2017)
Abstract
Background: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results (outputs/ outcome) by an independent professional accreditation body using pre-established optimum standards. Hospital accreditation has an important role in improving the quality, safety, effectiveness and efficacy of health care services. The effectiveness of an accreditation system depends on the quality and conformity of its methods, standards and surveyors. This study aimed to evaluate the hospital accreditation method from the perspective of Iranian hospital managers.
Methods: This descriptive, applied and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire. The study population consisted of 914 hospital managers. Overall 547 hospital managers were surveyed through stratified random sampling. SPSS software was used for data analysis.
Results: Almost 71.7 percent of hospitals achieved grade one and above in the first round of national accreditation survey. The mean score of managers’ satisfaction of hospital accreditation method was 3.21±0.63 out of 5 (Average). About 38 percent of hospital managers were satisfied with the hospital accreditation method. Most complaints were related to lack of reliability among surveyors and their low knowledge, skills and experience. Hospital managers were satisfied with surveyors’ attitude and adequacy of the number of survey days. Hospital managers mostly believed that accreditation is better to be done by Ministry of Health, compulsory, and every two years. About 95 percent of hospital managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey.
Conclusion: Hospital managers were moderately satisfied with the national accreditation system. Developing job description and person specification for accreditation surveyors and recruiting them accordingly, and providing professional education and training for them help improve the effectiveness of Iranian hospital accreditation method. The method of hospital accreditation in Iran has to be changed. Self-assessment, unannounced surveys, review of hospital key performance indicators and patient satisfaction surveys should be added to the current scheduled on-site surveys to enhance the credibility of the accreditation result. |
Ali Mohammad Mosadeghrad , Ali Akbari Sari , Taraneh Yousefinezhadi,
Volume 76, Issue 12 (March 2019)
Abstract
Background: Hospital accreditation is an external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. Accreditation has an important role in improving the quality, safety, effectiveness and efficiency of hospital services. This study aimed to examine the effects of hospital accreditation program from hospitals managers’ perspective.
Methods: This descriptive and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire designed to examine accreditation effects on hospital performance, hospital employees, patients, and the society. The study population consisted of 914 hospital managers in Iran. Overall, 547 hospital managers were surveyed through stratified random sampling.
Results: About 71% of hospitals achieved grade one and above accreditation status. The mean score of accreditation positive effects in hospitals was 3.16±0.66 out of 5 (Average). Almost 38% of managers were satisfied with the accreditation results in their hospitals. Hospital accreditation program was successful in improving patient and staff safety, reducing medical errors and enhancing staff competencies. Its success in improving communication, promoting organizational culture, continuous quality improvement, resource utilization, and reducing nosocomial infections and hospital mortality rates was moderate. Accreditation was less successful in improving staff satisfaction, getting physicians involved in process improvement, practicing evidence based medicine, attracting patients and increasing hospital income. A statistically significant correlation was found between hospital size and accreditation results (P=0.038, r=-0.090). There was no correlation between using quality management models and getting better accreditation results (P=0.085). However, there was correlation between using accreditation consultants and positive accreditation results (P=0.045, r=-0.087). Utilizing hospital resources, organizational learning, continuous quality improvement and effective communication had the most effect on accreditation success.
Conclusion: The accreditation program had a moderate effect on hospital performance. It is costly to implement accreditation standards in hospitals. Hence, changes should be made to the accreditation system including accreditation standards and methods in order to have more positive effects on the staff and hospitals’ performance.
Reihaneh Pirjani, Ali Akbari Sari, Mahbobeh Shirazi, Amin Nakhostin Ansari, Maryam Rabiei, Amene Abiri,
Volume 80, Issue 3 (June 2022)
Abstract
Background: Streptococcus beta group (GBS: Group B Streptococcus) is a gram-positive coccus that colonizes in the rectovaginal area. About 4.6% to 31.3% of women of childbearing age carry GBS infection. GBS colonization is a risk factor for subsequent infections in pregnant women that can be transmitted to the fetus through vertical transfer and aspiration of infected amniotic fluid. 2% of cases lead to an invasive infection in the baby. In most countries, treatment is done according to the CDC (Centers for Disease Control and Prevention) protocol which is based on culture results. According to studies conducted in our country, treatment is based on risk factors. Therefore, during this study, we decided to compare the results of treatment based on risk factors and treatment based on culture results and other maternal and neonatal complications in these two groups.
Methods: This case-control study was performed on 98 pregnant women aged 35 to 37 weeks who were referred to the perinatal clinic of Arash Hospital from April 2018 to the end of March 2020 and also 200 pregnant women with a GBS risk factor. Samples of rectovaginal discharge of 98 pregnant women were sent to a selected laboratory for culturing. In this group, treatment was performed based on the culture result. The control samples included 200 pregnant mothers who were treated based on risk factors without culture. Then the two groups were compared in terms of pregnancy outcomes.
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Results: Out of 98 subjects, 24 (24.5%) had positive rectovaginal culture. Individuals treated with antibiotics based on positive culture results did not show a significant difference in terms of observed pregnancy outcomes compared with the control group.
Conclusion: The prevalence of GBS colonization was significantly higher in patients with a history of vaginal discharge than in those without a history. Due to the small number of studies conducted in Iran, it is recommended to conduct studies with a larger sample size in order to explain a more appropriate protocol in terms of effectiveness and economics.
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Ahmad Tahmasebi-Ghorrabi , Zahra Heydarifard, Behrouz Nemati, Majid Davari, Alireza Delavari, Hamideh Salimzadeh , Ali Akbari Sari ,
Volume 81, Issue 9 (December 2023)
Abstract
Background: Screening is a cost-effective method for prevention, early detection of the disease and reducing the burden of the third deadliest cancer in the world, i.e. colorectal cancer. This study aimed to analyze the cost-effectiveness of colonoscopy screening compared to sigmoidoscopy for colorectal cancer in high-risk individuals in Iran.
Methods: This economic evaluation study was conducted using the cost-effectiveness method between July 2016 and February 2017. Evaluation of the effectiveness of screening methods was done using a systematic review. Cost evaluation was also done using the costs obtained from the tariff approved by the Iranian Ministry of Health in 2015 for colonoscopy and sigmoidoscopy. Finally, the combined model of decision tree and Markov was used to evaluate the cost effectiveness. Incremental Cost Effectiveness Ratio (ICER) formula was used for cost effectiveness analysis considering the final outcome of 5-year survival of high-risk individuals. Excel and TreeAge software were used for data analysis.
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Results: The effectiveness of sigmoidoscopy and colonoscopy in increasing 5-year survival is 11 and 15.7%, respectively, and colonoscopy screening is 4.7% more than sigmoidoscopy. The cost of colonoscopy and sigmoidoscopy screening was calculated as 1000 and 19920 billion Rials, respectively. Based on cost-effectiveness analysis, the cost of treating patients in the case of screening with colonoscopy and sigmoidoscopy is lower than without screening. The ICER ratio of colonoscopy and sigmoidoscopy compared to no screening was -4/441/389/160 and -4/757/954/940 Rials respectively, and colonoscopy compared to sigmoidoscopy was -3/699/785/880 Rials, respectively. Finally, the use of colonoscopy leads to spending 3/699/785/880 Rials less in exchange for obtaining 4722 additional survivals with the prevention of colorectal cancer compared to sigmoidoscopy.
Conclusion: Screening by colonoscopy and sigmoidoscopy methods are effective in reducing the incidence and death of colorectal cancer compared to no screening. Screening by colonoscopy is a dominant option for the high-risk population in Iran. Colonoscopy screening is more cost effective compared to sigmoidoscopy. However, decisions about colorectal cancer screening and screening methods depend on local resources and personal preferences.
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