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Khalili H, Gholami Kh, Hajiabdolbaghi M, Sairafipoor Z,
Volume 64, Issue 12 (11-2006)
Volume 64, Issue 12 (11-2006)
Abstract
Background: Drug Utilization Evaluation (DUE) studies are performed to define, determine, and finally improve the quality of drug usage. These types of studies are especially valuable for drugs with a narrow therapeutic index or specific indication, or for expensive medications. In Iran, vancomycin is only available by prescription for methicillin-resistant staphylococcal and enterococcal infections. It is obvious that extensive and irrational use of this drug can increase bacterial resistance to this antibiotic. The goal of this study was to assess vancomycin utilization.
Methods: In a descriptive cross-sectional study performed during the fall and winter of 2004, this vancomycin DUE was done in the Infectious Disease Department of Imam Khomeini Hospital in Tehran. All of the patients receiving vancomycin were enrolled in this study. The Centers for Disease Control (CDC) and American Society of Hospital Pharmacists (ASHP) protocols have been used to perform this study.
Results: Of the 565 inpatients at this hospital, 39 subjects (7%) received vancomycin. Vancomycin utilization among these patients was compatible with CDC and ASHP protocols in only 28% and 35% of the patients, respectively.
Conculusion: Vancomycin is predominantly administered empirically, rather than being based on the antibiogram. This may be due to the routine protocol of the ward or the physician doubting the reliability of the antibiogram.
Samiee H, Tavoli Z, Ghanbari Z, Poormand Gh, Taslimi Sh, Eslami B, Tavoli A,
Volume 67, Issue 9 (12-2009)
Volume 67, Issue 9 (12-2009)
Abstract
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Background: Stress incontinence
is the most common type of urinary incontinence which has been treated by
different surgical techniques. The objectives of our study were to compare the
laparoscopic Burch colposuspension with Trans- obturator Tape (TOT) procedure.
Methods: This randomized clinical trial was conducted on 40 patients with stress incontinence referred to Arash
hospital from 2007 to 2009. All patients were randomly divided in two groups (laparoscopic Burch and TOT). Patient information was using obtained demographic,
I-QOL (Which contained 22 questions), UDI-6 (urinary symptoms), ISI (Severity of urinary
incontinence) questionnaires and urodynamic test.
Results: The data collected from 19 patients in TOT group and 16 patients in laparoscopic Burch groups. The objective cure rate which was
determined by no urinary leakage during stress and were analyzed urodynamic evaluation
was 75% in laparoscopic and 84.2% in TOT (p=0.53). Result of ISI questionnaire with showing the subjective cure rate following surgery had
no significant difference between two groups (p=0.23). UDI-6 questionnaire was used to compare the
result of both groups before and after surgery and showed that the improvement
in Urgency was significant in TOT in compare to Burch
(p=0.04). I-QOL score significantly increased in both groups after six months of operation
(p<0.05). But the
differences were not statistically significant.
Conclusion: Based on our results subjective
and objective cure rate were not significantly different between TOT and laparoscopic Burch
colposuspension.
Soheila Aminimoghaddam , Fatemeh Mahmoudzadeh , Andisheh Maghsoudnia , Fatemeh Ghaemmaghami ,
Volume 72, Issue 9 (12-2014)
Volume 72, Issue 9 (12-2014)
Abstract
Background: Endometrial carcinoma is considered the most common gynecological cancer in the world. Pelvic and para-aortic lymphadenectomy is widely advised based on FIGO staging system. Intra-operative frozen sections analysis is used to identify pa-tients at high risk for pelvic and para-aortic nodal metastasis evading lymphadenec-tomy in low-risk patients. However there is still some controversy concerning the effi-ciency of IFS. The aim of this study was to determine the validity and precision of fro-zen section diagnosis and gross examination of uterine specimen compared to the final histological results in patients with endometrial cancer. Methods: Patients diagnosed as endometrial cancer based on office biopsy using a Pipelle or D&C who underwent surgical staging were compared for frozen section anal-ysis and permanent diagnosis. Patients with the history of radiotherapy or other types of cancer or co existence malignancies were excluded. Results: There was no relation between the tumor size and lymph node involvement and the results were not significant (P= 0.1). Frozen section analysis was significantly accurate and correct in predicting final histopathological results (P< 0.0001). It has been shown that in more than 90% of patients the diagnosis made by frozen section analysis was in accordance with final pathology with considerable sensitivity and spec-ificity. Gross examination was also precise in determining myometrial microscopic in-vasions (P< 0.0001). Conclusion: Although the sample size of the studied population was small but our study results support the previous data and suggest that in early stages and low grade tumors, gross examination and frozen section diagnosis are conveniently predictive of lymph node metastasis. These data might be useful for prediction of tumor invasion using frozen section and gross examination in low grade tumors and early stages and for doing complete surgical staging and lymph node sampling. However the im-portance of surgical staging always must be considered in patients who need systemat-ic lymphadenectomy. In overall these data might help to come up with new guidelines for surgical risk assessment in endometrial cancer.
Ali Mohammad Mosadeghrad , Ali Akbari Sari , Taraneh Yousefinezhadi ,
Volume 75, Issue 4 (7-2017)
Volume 75, Issue 4 (7-2017)
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.
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. |
Shadi Khazaei, Shahrbanoo Keyhanian , Mahila Monajati , Shahram Ala, Ebrahim Salehifar ,
Volume 75, Issue 9 (12-2017)
Volume 75, Issue 9 (12-2017)
Abstract
Background: Methotrexate (MTX) is commonly used in the hematology-oncology units and is frequently associated with adverse effects. High-dose methotrexate (HDMTX) is indicated in the treatment of acute lymphoblastic leukemia (ALL), osteosarcoma, systemic non-Hodgkin lymphoma and primary central nervous system (CNS) lymphoma. The side effect profile of MTX varies markedly according to dose. The aim of this study was to evaluate the uses and adverse effects of HDMTX in a cancer center in north of Iran.
Methods: This cross-sectional descriptive study carried out in Emam Sajjad Hospital, Ramsar, Iran from June 2016 to July 2017. Doses more than 500 mg/m2 of MTX was considered as a high-dose. Hydration status, evaluation of the renal and hepatic function, blood tests, urine pH, doses and frequencies of leucovorin administration, measurement of serum levels of MTX and side effects were evaluated. Recommendations of UpToDate 2017 were considered as standards of administration of HDMTX.
Results: Forty-four courses of HDMTX were evaluated in this study. HDMTX were prescribed for lymphoma (30 cases), ALL (8 cases) and osteosarcoma (6 cases). In all patients, hydration was done with 1340.9±894 normal saline plus 25 ml sodium bicarbonate 8.4%, one to two hours before HDMTX. The solution used for dilution of MTX was 5% dextrose (1022.7±105.5 ml). Urine pH was not measured in any patient. The frequency of leucovorin administration was 5.64±3.03 times with doses of 17.6±1.7 mg/m2 every 6 hours. Serum levels of MTX were not measured in any patient. Blood urea nitrogen and creatinine measurement was carried out before administration of HDMTX in all patients. The most common adverse effects were nausea (64.4%), anxiety (44%) and headache (43.2%).
Conclusion: The appropriate aspects of HDMTX usage were good hydration, urine alkalinization with bicarbonate and administration of leucovorin in patients receiving HDMTX, whereas monitoring of serum levels of MTX and administration of bicarbonate based on urinary pH were not done in any of the patients.
Methods: This cross-sectional descriptive study carried out in Emam Sajjad Hospital, Ramsar, Iran from June 2016 to July 2017. Doses more than 500 mg/m2 of MTX was considered as a high-dose. Hydration status, evaluation of the renal and hepatic function, blood tests, urine pH, doses and frequencies of leucovorin administration, measurement of serum levels of MTX and side effects were evaluated. Recommendations of UpToDate 2017 were considered as standards of administration of HDMTX.
Results: Forty-four courses of HDMTX were evaluated in this study. HDMTX were prescribed for lymphoma (30 cases), ALL (8 cases) and osteosarcoma (6 cases). In all patients, hydration was done with 1340.9±894 normal saline plus 25 ml sodium bicarbonate 8.4%, one to two hours before HDMTX. The solution used for dilution of MTX was 5% dextrose (1022.7±105.5 ml). Urine pH was not measured in any patient. The frequency of leucovorin administration was 5.64±3.03 times with doses of 17.6±1.7 mg/m2 every 6 hours. Serum levels of MTX were not measured in any patient. Blood urea nitrogen and creatinine measurement was carried out before administration of HDMTX in all patients. The most common adverse effects were nausea (64.4%), anxiety (44%) and headache (43.2%).
Conclusion: The appropriate aspects of HDMTX usage were good hydration, urine alkalinization with bicarbonate and administration of leucovorin in patients receiving HDMTX, whereas monitoring of serum levels of MTX and administration of bicarbonate based on urinary pH were not done in any of the patients.
Zabih Allah Rasti , Alireza Shamsoddini , Seyed Nasser Hosseini ,
Volume 76, Issue 3 (6-2018)
Volume 76, Issue 3 (6-2018)
Abstract
Background: Tenderness, pain, muscle weakness, and limited range of motion (ROM) are symptoms of myofascial pain syndrome, which leads to restrictions on physical, occupational and social activities and ultimately reduction of productivity and quality of life. Different methods of rehabilitation are used to improve the symptoms of these patients. One of the new methods is the use of kinesio tape. The aim of this study was to evaluate the effect of kinesio tape on neck pain and disability and also muscle strength in myofascial pain syndrome.
Methods: In this single-blind randomized clinical trial, from June to November 2017 in Imam Hossein Hospital of Mashhad, Iran, thirty individuals (male and female) with Myofascial pain syndrome were divided into two groups (treatment and control), randomly by lottery. In treatment group, the kinesio tape with appropriate tension was applied directly over pain place and on upper trapezius muscle; and control group received placebo kinesio tape (kinesio taping without tension). In this study, before and three days after application of kinesio taping, numerical pain rating scale (NPRS), neck disability index (NDI) and manual muscle testing (MMT) were used to assess pain, disability and strength, respectively.
Results: To compare the effect of treatment, the mean of variables were compared with independent sample t-test before and after treatment. Pain and strength of upper trapezius were significantly different in both groups (P< 0.05), but in neck disability there was not significantly difference (P< 0.05). Then, for a closer examination, the paired t-test were used to compare the mean of disability before and after the treatment and result showed a significantly different in the treatment group and was not significantly different in the control group.
Conclusion: According to the results of this study, kinesio tape can reduce neck pain, increase the strength of upper trapezius, and ultimately reduce the disability of neck in myofascial pain syndrome. Therefore, this method can be used in rehabilitation clinics to improve the symptoms of patients with myofascial pain syndrome.
Methods: In this single-blind randomized clinical trial, from June to November 2017 in Imam Hossein Hospital of Mashhad, Iran, thirty individuals (male and female) with Myofascial pain syndrome were divided into two groups (treatment and control), randomly by lottery. In treatment group, the kinesio tape with appropriate tension was applied directly over pain place and on upper trapezius muscle; and control group received placebo kinesio tape (kinesio taping without tension). In this study, before and three days after application of kinesio taping, numerical pain rating scale (NPRS), neck disability index (NDI) and manual muscle testing (MMT) were used to assess pain, disability and strength, respectively.
Results: To compare the effect of treatment, the mean of variables were compared with independent sample t-test before and after treatment. Pain and strength of upper trapezius were significantly different in both groups (P< 0.05), but in neck disability there was not significantly difference (P< 0.05). Then, for a closer examination, the paired t-test were used to compare the mean of disability before and after the treatment and result showed a significantly different in the treatment group and was not significantly different in the control group.
Conclusion: According to the results of this study, kinesio tape can reduce neck pain, increase the strength of upper trapezius, and ultimately reduce the disability of neck in myofascial pain syndrome. Therefore, this method can be used in rehabilitation clinics to improve the symptoms of patients with myofascial pain syndrome.
Ali Mohammad Mosadeghrad , Ali Akbari-Sari , Taraneh Yousefinezhadi ,
Volume 76, Issue 5 (8-2018)
Volume 76, Issue 5 (8-2018)
Abstract
Background: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. This study aimed to evaluate the hospital accreditation system.
Methods: This descriptive and cross-sectional study was carried out between November 2015 and February 2016 using a questionnaire covering accreditation standards, methods, surveyors, implementation and effects. The study population consisted of 161 hospital managers in Tehran province, Iran. Overall 87 hospital managers were surveyed through stratified random sampling.
Results: The mean score of managers’ satisfaction of hospital accreditation system was 2.93 out of 5 score. About 16 percent of managers were satisfied with the hospital accreditation system. Hospital managers were most satisfied with accreditation effects (3.14) and least satisfied with accreditation standards (2.54). Hospital managers were satisfied with surveyors’ attitude, number of survey days and the number of surveyors in the accreditation team. They were least satisfied with the lack of consistency among surveyors, lack of transparency of standards, too many standards and low competency of surveyors. Hospital managers mostly believed that accreditation should be done by Ministry of Health, compulsory, and every two years. About 97 percent of managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey.
Conclusion: Accreditation was moderately successful in Tehran hospitals. Accreditation had the most effect on improving patient safety and meeting patients' rights and least effect on improving employees' job satisfaction and involving doctors in quality improvement. Strengthening Iran hospital accreditation system, training managers and employees on implementing standards, and providing necessary resources make it possible to achieve accreditation goals.
Methods: This descriptive and cross-sectional study was carried out between November 2015 and February 2016 using a questionnaire covering accreditation standards, methods, surveyors, implementation and effects. The study population consisted of 161 hospital managers in Tehran province, Iran. Overall 87 hospital managers were surveyed through stratified random sampling.
Results: The mean score of managers’ satisfaction of hospital accreditation system was 2.93 out of 5 score. About 16 percent of managers were satisfied with the hospital accreditation system. Hospital managers were most satisfied with accreditation effects (3.14) and least satisfied with accreditation standards (2.54). Hospital managers were satisfied with surveyors’ attitude, number of survey days and the number of surveyors in the accreditation team. They were least satisfied with the lack of consistency among surveyors, lack of transparency of standards, too many standards and low competency of surveyors. Hospital managers mostly believed that accreditation should be done by Ministry of Health, compulsory, and every two years. About 97 percent of managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey.
Conclusion: Accreditation was moderately successful in Tehran hospitals. Accreditation had the most effect on improving patient safety and meeting patients' rights and least effect on improving employees' job satisfaction and involving doctors in quality improvement. Strengthening Iran hospital accreditation system, training managers and employees on implementing standards, and providing necessary resources make it possible to achieve accreditation goals.
Sara Emamgholipour, Rajabali Darroudi , Abdoreza Mousavi, Samira Alipour , Fakhraddin Daastari,
Volume 80, Issue 11 (2-2023)
Volume 80, Issue 11 (2-2023)
Abstract
Background: Given the limited resources of health system, economic evaluations studies can provide appropriate evidences for resource allocation by clarifying the possible consequences of a decision. Present study aimed to evaluate the implemented approaches for economic evaluation studies of pharmacoeconomic in Iran.
Methods: This study was carried out using the critical review method. All studies related to economic evaluation studies of pharmacoeconomic in Iran, indexed in PubMed and SID databases and Google Scholar search engine, were searched by using appropriate keywords and search strategies until 2021. Further, published papers from Iranian researchers in the field of health economics and pharmacoeconomics and pharmaceutical administration were extracted with the scientometric system of the Health Ministry. Then, retrieved papers were screened by title, abstract, and the whole text. Finally, papers were evaluated by applying the Drummond quality assessment checklist, and finally appropriate ones were selected. Finally, 29 papers were selected and analyzed.
Methods: This study was carried out using the critical review method. All studies related to economic evaluation studies of pharmacoeconomic in Iran, indexed in PubMed and SID databases and Google Scholar search engine, were searched by using appropriate keywords and search strategies until 2021. Further, published papers from Iranian researchers in the field of health economics and pharmacoeconomics and pharmaceutical administration were extracted with the scientometric system of the Health Ministry. Then, retrieved papers were screened by title, abstract, and the whole text. Finally, papers were evaluated by applying the Drummond quality assessment checklist, and finally appropriate ones were selected. Finally, 29 papers were selected and analyzed.
|
Results: Out of total available papers (n=1324), 29 papers had inclusion criteria to evaluate. The selected papers were analyzed based on 10 parameters, including type of analysis, type of comparator, source of clinical effectiveness, time horizon, used model, perspective of the analysis, measured expected outcomes, discounting of costs and outcomes, sensitivity analysis, and subgroup analysis. Most studies have used cost utility analysis. Shortcomings were found in some aspects as follows: some studies did not mention the applied model, or the time horizon. Moreover, some studies had time horizon more than one year, while the cost and consequences were not discounted.
Conclusion: In recent years, economic evaluation studies in the field of pharmacoeconomic in Iran have been center attention in line with global trend. In order to make a decision regarding the allocation of resources based on the findings of economic evaluation studies, these studies should be conducted with the systematic and transparent approach. Therefore, it is necessary to develop a standard framework for implementing and reporting the results of economic evaluation studies in Iran. |
Keywords: cost-benefit analysis, cost-effectiveness analysis,
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