Tehran University Medical Journal

Background: Medical malpractice is a serious problem in the health care system. This study aimed to review the medical negligence in Iran.
Methods: Based on the PRISMA checklist, a search for scientific records was done separately by two researchers. All the articles that had selection criteria were evaluated in terms of methodological quality. Medical malpractice was assessed in four main divisions including negligence, Lack of skill, Carelessness and non-compliance with government regulations). The bias test was performed using the Egger’s test. Revman software was used to analyze the data.
Results: In the present study, 25 studies that examined the country's medical malpractice from April 1994 to March 2018 were included in the meta-analysis. Negligence has been implicated in 1,105 cases of the 2,068 claims. Lack of skill in 255 out of 2068 cases, 432 cases of carelessness and 244 cases of non-compliance with government regulations Were recorded the results of the meta-analysis showed that OR negligence was 0.76 (CI 95%: 0.66-0.87), lack of skill was 0.61 (CI 95%: 0.49-0.76), carelessness was 0.62 (CI 95%: 0.50-0.76) and non-compliance with government regulations was 0.66 (95% CI: 0.60-0.73). In the review of the confirmed negligence ratio of the registered complaint files, only 19 studies mentioned this ratio. The results of the meta-analysis of these 19 studies showed that the OR ratio of the confirmed negligence of complaints was 0.6 (95% CI: 0.41-0.86). From all claims, General surgeons had OR of confirmed medical malpractices, equal to 0.47 (CI 95%: 0.37-0.60), gynecologists with OR equal to 0.49 (CI 95%: 0.36-0.66), general practitioners with OR equal to 0.43 (CI 95%: 0.30-0.63) and orthopedic specialists with an OR of 0.44 (CI 95%: 0.32-0.61).

Background: Ankle sprain is one of the most common sports injuries and accounts for 10 to 30 percent of sports injuries, especially in athletes. This injury can lead to pain, imbalance, and movement restriction, and therefore has a significant impact on athletes' performance. Therefore, the aim of this study was to investigate the effect of dry needling on tissue repair of ligamentous injury in the acute phase of ankle sprain.
Methods: This double-blind clinical trial study was conducted on 52 patients with ankle sprains at Imam Reza Hospital in 2023. Patients were divided into two groups: control and intervention. The control group received conventional treatment including medication and splints, while the intervention group received dry needling in addition to conventional treatments. Data analysis was performed using SPSS version 21 software and descriptive statistics and inferential statistical tests at a significance level of P<0.05.
Results: The results showed that the intervention group showed significant improvement in pain (P=0.002), activities of daily living (P<0.001), sports activities (P<0.001), plantar flexion (P=0.027), dorsiflexion (P=0.003), inversion (P=0.012), and edema (P=0.005) compared to the control group. However, there was no significant difference in symptom severity (P=0.752) and quality of life (P=0.348) between the two groups. Overall patient change analysis showed that most patients in the intervention group improved, while only 7.7% in the control group improved.
Conclusion:  A combination of splinting, medication, and dry needling can be effective in improving pain, daily activities, exercise and recreation, range of motion, and edema in patients with ankle sprains. These findings can provide a basis for implementing new treatment protocols for the management of ankle sprains in athletes and other injured patients. It is recommended that further studies be conducted on the long-term effects of dry needling and other therapeutic interventions to further identify their potential to accelerate the recovery process in patients.
 

Background: The present study is a systematic and comparative review of the studies conducted in the field of hospice centers for patients with acute incurable diseases with a life expectancy of less than six months in the world with the aim of examining the need in Iran and the experiences of other countries, identifying candidates to receive these services, type of services provided, costs and resources in these centers. Methods: The present study was conducted as a systematic review by searching the databases: Scopus, PubMed, Elsevier, and Google Scholar search engine between 2010 and 2023. To search these databases, keywords such as hospice care centers, centers providing health services for patients with life expectancy less than six months, allocation of resources, allocation were used. After selecting the articles, the following topics were extracted from each article and compared: costs, sources of funding, candidates for receiving services, families' views, quality of near-death care, quality of life, quality of death, services provided, therapeutic interventions performed, place of death, length of stay. Results: 6 articles referred to the discussion of cost, and in all articles except one case, the use of hospice was associated with reducing the cost of patients. In one study, the source of funding was philanthropic contributions and in another study, the national budget. In all the reviewed articles, the use of hospice was associated with an increase in the quality of care, quality of end of life and quality of death, and a decrease in therapeutic interventions. The care provided by hospice was also introduced in the form of symptom assessment and management, pain relief, psychosocial support and respite care. Conclusion: Based on the findings of the present study, hospices can play an effective role in reducing treatment costs and, on the other hand, improve the quality of care, life and death in eligible people. In addition, hospices improved the end-of-life quality from the perspective of the deceased's family by reducing invasive interventions and providing physical and spiritual care.