ali janati

Hypertension is one of the most important risk factors of cardiovascular morbidity and mortality that holds a unique place in population health and health care.

Given the exponential rise of high blood pressure as one of the major health problems, this study aimed to investigate the current situation and provide a strengths, weaknesses, opportunities, and threats (SWOT) analysis in the management of hypertension.

A qualitative study of 12 interviews was conducted with policymakers and managers. The sampling method was purposive sampling. Data collection was performed from January to July 2020. A thematic approach was used to analyze the data. The consolidated criteria for reporting qualitative research 32-item (COREQ-32) checklist was applied to ensure quality control in the study design, analysis, and data reporting.

A total of 12 factors were identified as SWOT. The most important strengths included universal coverage of health services, provision of team-based care, and self-care training. The weaknesses were related to the therapeutic approach, long-term planning, and continuity of programs. Cooperation of other sectors with the health system and the existence of health management training centers were noted as opportunities to better implement hypertension management programs and confront threats such as conflicts of interest between guilds and organizations and crises.

High blood pressure can be prevented. The present direction toward health-oriented policies can be changed in all sectors by taking advantage of the existing strengths and opportunities.  

 Polypharmacy is a significant patient safety concern.

 This study aims to estimate the prevalence of polypharmacy, its continuity and associated factors, and common medication classes among a large outpatient population in East Azerbaijan province, Iran.

 A retrospective prescription data analysis was performed. The cohort included all ≥ 20 years old subjects with at least one prescription filled during the main three-month study period (2020 March 1 - 2020 May 31). Polypharmacy was defined as being exposed to more than four different medications during the main study period, and continuous polypharmacy was defined as being exposed to more than four medications during both the main study period and follow-up period (2020 October 1 - 2020 December 31). The frequency and prevalence of polypharmacy, along with predictive factors, were estimated. We performed multivariate logistic regression and estimated odds ratios (ORs) to investigate the risk factors for polypharmacy.

 307,820 patients included (mean age 49.8 years, 62.9% female, mean drug use 3.7 (SD = 2.6). Polypharmacy was observed in 28.3% (CI: 28.1 - 28.4), of which 36.6% experienced continuous polypharmacy. The odds of being exposed to polypharmacy increased with being female, increasing age, and exposure to chronic conditions. The groups of medications most utilized by polypharmacy patients were those indicated for gastro-esophageal reflux diseases, beta-blocking agents, antidepressants, blood glucose-lowering drugs, and antithrombotic agents.

 Strategies should be formulated to inform healthcare policymakers and providers about the magnitude of the polypharmacy phenomenon, associated factors, and the common medication classes involved.

Traffic injuries are one of the main causes of death worldwide. After decreasing mortality rates and improving the recovery of injured patients, long-term functional consequences need to be addressed. The purpose of this study was to assess the functional outcomes of road traffic injuries and their predictors six months after hospital discharge, based on the preliminary results from PTC.

A cross-sectional study based on PERSIAN Traffic Health and Safety Cohort Study was performed. Data were collected using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) with six domains (cognition, mobility, self-care, getting along with others, life activities, and participation), filled-in by 180 injured adults (age >18 years) at six-month follow-up after hospital discharge during October 2019. These patients were hospitalized after road accidents at two referral trauma centers, (from 23 September 2018 to 20 March 2019).

The majority of participants were men (82.7%), (Mean age =38.8). The mean score of WHODAS 2.0 was 17.8) SD=9.1). The highest score was estimated for the self-care dimension 3.3 (SD=1.8), and the lowest score for getting along with others 2.4 (SD=1.2). Age, gender, physiotherapy, injury localization including head and face, spinal cord, and upper extremity were predictors of WHODAS 2.0 score in various dimensions (p<0.05).

The current study identified some functional disabilities among patients sustaining road traffic injuries. It is evident from the results that a proportion of patients do not recover six months after the injury and suffer a disability, especially in self-care, mobility, and life activities, which potentially prevent them from returning to normalcy. In addition, age, gender, physiotherapy, injury localization was related to WHODAS 2.0 scores.

This qualitative systematic review was conducted to summarize the policies for prevention of common gastrointestinal cancers worldwide. This study was conducted using PubMed, Web of Science, SCOPUS, and ProQuest databases. Two independent reviewers assessed included studies for methodological quality and extracted data by using standardized tools from Joanna Briggs Institute (JBI). Primary study findings were read and reread to identify the strategies or policies used in the studies for prevention of gastrointestinal cancers. The extracted findings were categorized on the basis of their similarity in meaning. These categories were then subjected to a meta‑synthesis. The final synthesized findings were graded according to the ConQual approach for establishing confidence in the output of qualitative research synthesis. From the nine included studies in this review, 39 findings were extracted and based on their relevance in meaning were aggregated into 12 categories. Four synthesized findings were developed from these categories. We used World Health Organization report on 2000 for synthesizing the findings. The four synthesized findings were “service provision”, “resource generation”, “financing”, and “stewardship”. In order to reach a comprehensive evidence informed policy package for the prevention of gastrointestinal cancers, there should be a great communication among the interventions conducted directly on patients, health system infrastructures, and resources.

Cardiovascular disease (CVD) is the most prevalent comorbid condition among patients with diabetes. The objective of this study is to determine the incremental healthcare resource utilization and expenditures (HRUE) associated with CVD comorbidity in diabetic patients.

In a cross-sectional study, patients receiving antidiabetic drugs were identified using the 2014 database of the Iran Health Insurance Organization of East Azerbaijan province (Iran). The frequency of HRUE was the main outcome. Outcome measures were compared between diabetic patients with and without CVD comorbidity during 2014-2016. The generalized regression model was used to adjust for cofounders because of a highly skewed distribution of data. Negative binomial regression and gamma distribution model were applied for the count and expenditure data, respectively.

A total of 34,716 diabetic patients were identified, of which 21,659 (63%) had CVD comorbidity. The incremental healthcare resource utilization associated with CVD compared to non-CVD diabetic patients for physician services, prescription drugs, laboratory tests, and medical imaging was 5.9±0.34 (28% increase), 46±1.9 (46%), 12.9±0.66 (27%), and 0.16±0.40 (7%), respectively (all P<0.001). Similarly, extra health care costs associated with CVD comorbidity for physician services, prescription drugs, laboratory tests, and medical imaging were 10.6±0.67 million IRR (294.4±18.6 USD) (50% increase), 1.44±0.06 million IRR (40±1.6 USD) (32%), 8.36±0.57 million IRR (232.2±15.8 USD) (58%), 0.51±0.02 million IRR (14.1±0.5 USD) (24%), and 0.29±0.02 million IRR (8±0.5 USD) (22%), respectively (all P<0.001).

CVD comorbidity substantially increases HRUE in patients with diabetes. Our findings draw the attention of healthcare decision-makers to proactively prevent CVD comorbidity in diabetic patients.

Today, medical and health tourism is one of the most promising sectors in the tourism industry in the world, which has led the organizations involved ,and the countries interested in developing tourism ,to focus their attention on this aspect of the tourism industry and plan for it. Hence, the aim of this study was to design the marketing model of medical tourism using meta-synthesis method.

The present study was designed as a meta-synthesis research in several stages for East Azerbaijan Province, Iran. Accordingly, after identifying the categories, concepts and marketing codes of medical tourism and evaluating its validity and reliability, the initial conceptual model of the research was formed. Out of 100 retrieved studies, 8 studies completely related to the purpose of the study were included in final analysis. In order to present the marketing model of medical tourism, the qualitative research method of meta-synthesis,s Sandlowski and Barroso (2006) was used.

The conceptual model in the present study consists of 5 dimensions, 10 components and 40 indicators which can show the marketing model of medical tourism. 5 main dimensions included; quality of medical and tourism services, price of medical and tourism services, development of tourism and medicine, medical and tourism facilities and equipment, and information and communication technology.

The results of the research show that the dimensions, components and indicators extracted from the meta-synthesis method are approved by the panel of experts. The findings provide a new model and perspective on how to market medical tourism for the Iranian tourism industry, which will help managers, planners and policy makers of the healthcare system.

Human life is tied with the stress caused by economic, political, social, and cultural problems, which may lead to physical and mental diseases. In such stressful conditions, people make lifestyle changes that put themat high risk for developinghypertension.

Accordingly, this study investigated the prevention and management of hypertensionas a major public health challenge in Iran.

Semi-structured interviews were conducted with managers, health policymakers, social medicine specialists, and faculty members. All interviews were recorded, transcribed verbatim, and analyzedusingthematic content analysis.The MAXQDA18 software was applied to facilitate the organizationof codes and themes.

Interviews were conducted with 17 participants. The analyses resulted in five themes including, educationalpolicies,cultural policies,urban transport policies,organizational policies,and economic policies. A total of 13 subthemes were also extracted from the data.

Findings have indicated the stressors factors, stemming from macro-policies and mismanagement of government.To reduce the burden of hypertension and improve people's living conditions, health-oriented policies should be designed and implemented in all sectors.

Trauma is one of the major causes of mortality across the world. Trauma patients have critical status and need timely, adequate, and organized care. The different consequences of trauma care among service centers around the world and even within a country revealed the need for careful evaluation. This study was designed and executed to collect experts’ opinions on the evaluation steps, related indicators, and improvement strategies in trauma care.

This qualitative study was based on a conventional content analysis approach. 2 focus group discussions (FGD) with 6 participants per FGD and 16 face-to-face in-depth interviews were conducted to collect the required information (from September 2018 to early 2019). Participants were selected through the purposive sampling method. The experts’ viewpoints were classified by the main and sub themes.

Four basic themes extracted from the interviews and focus group discussions including, trauma care importance (sub-themes: the involved individuals’ being young and productive and the effectiveness of trauma care); trauma care indicators (sub-themes: pre-hospital indicators, in-hospital indicators, and post-hospital indicators); stages of trauma care evaluation (sub-themes: evaluation prerequisites, finalization of indicators before the evaluation, determining evaluation time scope, determining evaluation dimensions, external and internal evaluation and use of evaluation results); trauma care improvement (sub-themes: balancing workload in trauma centers, enhancement of information system, considering extra-organizational dimensions in trauma care and empowerment of trauma care providers).

According to experts’ viewpoints, trauma is a very important issue, because it involves young people. They believed that having indicators covering all aspects of care assist health managers and policymakers to understand under-standard performance. These indicators should be used in the form of a specific evaluation program and related to Iran context. Besides, reforming macro policies, planning, development of infrastructures,and education was some recommendations of experts to improve trauma care.

The risk of power outages is a serious risk that in needed situations the emergency power supply system employs in a hospital, such as diesel generators and UPSs can be used. The purpose of this study is to investigate the safety and maintenance standards of emergency power generators of diesel generators in Tabriz hospitals.This is a descriptive analytic cross-sectional study which was done in 2015 in 18 hospitals of Tabriz. Data collected with a checklist which was created based on national standards. This checklist included 87 items which were categorized in 15 groups. Data were analyzed using SPSS v.19.

Average compliance with the safety and maintenance standards of the diesel generator in the standards of 111 questions and the standards of 87 questions were 61.4% and 52.8% respectively. In terms of compliance with the 19 standards, the "ventilation" standards and the "daily visit" standards were the lowest and highest in hospitals, respectively, with 28.94 and 96.24, respectively. There was a significant direct relation between compliance with the standards for diesel generator with hospital bed (P value = 0.01) and total power generation capacity by generators (P value = 0.05)

The results of this study indicate a low level of safety and maintenance for emergency systems in hospitals. These scores are not suitable for a system called "Emergency", and if there are no interventions in this area; hospitals will face many problems in the event of natural disasters and human error.

Emergency department is one of the most important departments in a hospital, the per-formance of which has a great impact on the functionality of other departments and patient satisfaction.The aim of this study was to determine the effect of the emergency department length of stay (EDLOS) ofcritically ill patients on their hospital outcome.

In a descriptive-analytical study, 450 criticallyill patients who referred to the emergency department of Sina and Imam Reza (AS) Hospitals affiliatedto Tabriz University of Medical Sciences in the period between November 2019-September 2020 wereenrolled. The EDLOS was registered based on the time taken to leave the emergency department. Thepatients were followed until their final discharge from hospital and their final outcome was recorded.Data were collected and analyzed using SPSS version 17. The final outcome of the patients was comparedbased on their EDLOS.

In this study, 450 critically ill patients were included. The median oftheir EDLOS was 3 hours and their median duration of hospitalization was 6 days. Among the studiedpatients, 100 patients (22.22%) died. There was no statistically significant relationship between patients’mortality and EDLOS (P <0.05).

Based on the results, there was no statistically significantrelationship between EDLOS and hospital outcome of critically ill patients. Therefore, it can be concludedthat either the time of discharge from the emergency department has been appropriate or the treatmentmeasures required by critically ill patients have been provided in the emergency department with thesame quality as special wards

Regular performance assessment is the basis of effective managerial decision making which is crucial for increasing the productivity of an organization. A distinct characteristic of an effective performance assessment is the implementation of various methods which are aimed at assessing the conformity with multiple indicators and criteria. The aim of the present comprehensive review was to extract the factors affecting the performance assessment of organization.

We conducted a comprehensive search in databases including PubMed, Embase, SID and Magiran in January 2020. Inclusion criteria were articles with the English language and full text available that were about influential factors. Two independent reviewers checked the research process, screening of articles.

Factors influencing an effective and efficient organizational performance assessment categorized in three themes and 22 sub-themes emerged. The themes included: “performance assessment indicators”, “performance assessment criteria” and “background factors in performance assessment”.

Indicators, criteria, and background factors provide a framework for assessing the organization's overall performance. An organization can manage its human resources effectively and efficiently by considering all the effective factors. Identification and classification of influential factors can be of help for managers and decision-makers in creating performance assessment system.

Service quality (SERVQUAL) is a model that measure the quality by comparing expectations and perceptions of recipients of services to identify gaps. Identifying the gap may provide valuable insight for service improving. The students are the main recipients of services in educational organizations. So, this study was conducted to assess the educational services from the perspective of students of Health Services management at Tabriz University of Medical Sciences by the SERVQUAL model.

This descriptive-analytical study was conducted in 2018.  The participants were 85 students of various levels of Health Services management. The SERVQUAL questionnaire including dimensions of empathy, tangibles, reliability, responsiveness and, assurance was used to data collection. Descriptive analysis and T-test, ANOVA and correlation (Pearson and Spearman) tests were used to the data analysis.

The overall mean perceptions and expectations were 3.02 ± 0.5 8 and 3.78 ± 0.73 respectively. There was a negative gap in all dimensions of educational services (mean= -0.76). The greatest negative gap was in the dimension of assurance (-1.05). The other variables were ranked in this order, Responsiveness, Empathy and Reliability and Tangibles.  A statistically significant correlation was observed between the students’ expectations and educational level (P < 0.05).

Students’ expectations were higher than their perception based on results and quality of education based on SERVQUAL model was inappropriate. It is necessary to plan for improving the quality of education in all dimensions particularly in assurance domain.

In May 2014, Iran launched the most far-reaching reform for the health sector, so-called Health Sector Evolution Plan (HSEP), since introduction of the primary health care network, with a systematic plan to bring about Universal Health Coverage. We aimed to analyze the time to first all-caused rehospitalization and all-caused 30-day readmission rate in the biggest referral hospital of Northwest of Iran before and after the reform.

We retrospectively analyzed discharge data for all hospitalization occurred in the six-year period of 2011-2017. The primary endpoints were readmission-free survival, and overall 30-day readmission rate. Using multivariate cox proportional hazards regression and logistic regression, we assessed between-period differences for readmission-free survival time and overall 30-day rehospitalization, respectively.        

Overall, 157969 admissions were included. After adjusting for available confounders including age; sex; ward of admission; length of stay; and admission in first/second half of year, the risk of being readmitted within 30 days after the reform was significantly higher (worse) compared to pre-reform hospitalization (odd ratio 1.22, P<0.001, 95% CI, 1.15-1.30 ). Adjusting for the same covariates, after-reform period also was slightly significantly associated with decreased (deteriorated) readmission-free time compared with pre-HSEP period (HR 1.06, P=0.005, 95% CI 1.01-1.11).

  HSEP seems insufficient to improve neither readmission rate, nor readmission-free time. It is advisable some complementary strategies to be incorporated in the HSEP, such as continuity of care promotion, self-care enhancement, effective information flow, and post-discharge follow up programs.

Dear editor, Recently, Ayalew et al. have published an article, titled, “Drug related hospital admissions; Asystematic review of the recent literatures” in Bull Emerg Trauma in 2019, 7th volume and 4th issue that has been caught our attention [1]. Even though the results of the study are interesting, there are flaws due to the authors’ negligence in the method, which leads to ambiguity in the interpretation of the findings. Therefore, the points expressed in this letter indicate what are needed to be perused in reporting systematic reviews.

Dear editor, Recently, we read with great interest the article authored by Jadidi et al. [1] that was entitled“Is emergency medical services (EMS) in Islamic Republic of Iran practical and efficient in facingEbola?” and published in Bull Emerg Trauma in 2019, in 7th volume and 3rd issue. First of all, wewould like to extend our gratitude to the authors of this article. Although the mentioned study wasappropriate and valuable, there was a fundamental flaw in the method, which has led to an ambiguous interpretation of the findings. Therefore, the purpose of this letter is to raise concerns about the data collection instrument and emphasize the importance of reporting its validity and reliability in crosssectional studies.

Trauma is considered one of the major causes of death around the world. Increased costs of healthcare and differences in the quality of services among trauma centers indicate that measuring the performance of trauma care is necessary. the present study aimed to develop some trauma care performance indicators. This study was implemented between September 2017 and October 2018 in a four-stage process: a comprehensive literature review, sessions with a panel of five experts, two focus group discussions, sixteen semi-structured interviews, and a two-round Delphi survey. The study setting was East Azerbaijan province, Iran. Forty-six experts in different fields of medical sciences confirmed applicable indicators for trauma care assessment. A total of 140 indicators were found through a comprehensive literature review. After conducting expert panels, focus group discussions, and interviews, the number of indicators decreased to 57 cases and were entered into the Delphi survey. In the first phase of the Delphi survey, content validity ratio (CVR), content validity indicator (CVI), and modified kappa values were 0.64, 0.85, and 0.83, respectively. Sixteen indicators were changed or deleted and 6 indicators were separated. The members of the final expert panel agreed on 50 indicators in the second phase of the Delphi survey after omitting 7 indicators. Performanceindicators for trauma care evaluation were introduced in this study. They can be used by policymakers and health service providers to assess and improve performance and compare trauma centers in Iran and developing countries that have health systems similar to the Iranian health system.

Trauma caused by traffic accidents is one of the main causes of mortality in the world. The trauma is a time-dependent condition. Trauma scoring systems help service providers to determine the severity of the injury and mortality risk and provide appropriate and timely services. This study aimed to predict mortality risk in patients with traffic injuries in Tabriz hospitals.

This descriptive cross-sectional study included 11,238 traffic-injured patients. Databases of the emergency medicine service and forensic medicine were used to collect information. Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) scoring system, binary logistic regression model, odds ratio with 95% confidence interval, and sensitivity and specificity were used to predict mortality.

Overall, 71 cases of death were identified. Pedestrians had the most rates of deaths with 31 cases (43.66%). Head trauma with 31 cases (43.66%) was the main cause of death. Mean (standard deviation) of the GAP score was 21.8 (1.8). The death rates in high-, moderate-, and low-risk groups were 22.4%, 3.18%, and 0.42%, respectively. The likelihood of death in people with saturation of oxygen (SO2) ≤95 was 1.96 times higher than those with SO2>95. The likelihood of death increased by 0.001 times each year. Furthermore, when the GAP score was ≤18, sensitivity was 64%, and for the GAP score of ≤10, sensitivity was 15.5%.

GAP score seems to be a reliable and easy-to-use scoring method for predicting traffic injury mortality in an Iranian setting and yields reasonable results concerning international standards.

Dear editor, Recently a study titled, “A Productive Proposed Search Syntax for Health Disaster Preparedness Research”, was worked by Rastegarfar et al. in the Bulletin of Emergency And Trauma [1]. First of all, we would like to thank the editors that help to appear review study. In addition, we would like to extend our appreciation to the authors of this article. Review studies are considered as studies with the highest level of evidence that play an important role in evidence-based decision making [2]. The results of the mentioned study are an interesting; however, we believe that there are some questions regarding the study, which, we would like to present. These questions, if replied, will only apply to improve the quality of the current study and similar studies in the near future.

To identify prevalent domains related to the concept of assessing preparedness of non-hospital centers to provide primary emergency care in order to develop a comprehensive framework. Five databases including PubMed, Scopus, Web of science, Barakat Knowledge Network Systems (BKNS) and Scientific Information Database (SID) were searched in English and/or Persian languages with no time limit until March, 2018. Manual search and grey literature were also done. According to the eligibility criteria, all the studies were independently tracked by two researchers. Studies were appraised using the Mixed Methods Appraisal Tool (MMAT). The findings were synthesized through directed content analysis method. Out of 3014 studies, 15 studies were included for data synthesis. The synthesis of literature resulted in the emergence of 13 domains and 25 sub-domains. Then, they were categorized based on Donabedian’s triple model and a conceptual framework was developed. In this framework, 6 domains were put in input, 6 in processes, and 1 domain in outcome. Of the 15 included studies, 1 study considered 10 domains and 14 other studies considered 4 to 8 domains out of 13 synthesized domains. The most prevalent synthesized domains were “medical supplies and equipment” and “human resources”, which were considered in 15 studies. In this study, a conceptual framework was constructed that identifies elements that significantly affect the preparedness of these centers. This framework may assist managers to take a comprehensive approach to assess these centers.

Dear Editor, The present letter is to concern the article written by Akbari et al.[1] First off, we appreciate the efforts made by the editors of Iranian Journal of Nursing and Midwifery Research to help publish such an important article. However, there seem to be some points neglected by the authors. Review studies are used because of their important role in evidence‑based decision making in health care, ........

Nursing shortage is a growing global challenge in healthcare organizations. Promoting nurses’ organizational commitment may help alleviate nursing shortage. This study sought to evaluate the relationships between organizational commitment, job satisfaction, organizational justice, and self-efficacy among nurses.   This cross-sectional study was conducted on 401 Iranian nurses randomly selected through two-stage cluster sampling. Data were collected using self-administered questionnaires and analyzed using the SPSS (v. 17.0) and the Amos (v. 17.0) software. The goodness of fit indices were as the following: χ2/df = 2.76 (P < 0.001), GFI = 0.93; AGFI = 0.87, NFI = 0.96, RMSEA = 0.068, and CFI = 0.95. Organizational commitment had significant positive relationships with self-efficacy (β3 = 0.28, P < 0.001) and job satisfaction (γ3 = 0.73, P < 0.001), while organizational justice had significant positive relationship with job satisfaction (γ2 = 0.89, P < 0.001). Moreover, job satisfaction had a mediating role in the relationship of organizational justice with organizational commitment. Hospital managers can promote nurses’ organizational commitment through employing strategies to enhance their perceived organizational justice and thereby, improving their job satisfaction.

Overuse and underuse of health care services are progressively recognized in all health systems around the world. There is evidence of overuse and underuse of health care services in Iran. In this study, it was aimed to summarize the evidence of overuse and underuse of health care services in the Iranian health care system.

This study will be conducted in 5 steps using a sequential explanatory multimethod design, literature review, systematic review, qualitative interview, expert panel, and policy Delphi method. This study was approved by Tabriz University of Medical Sciences (ethical confirmation number:  IR.TBZMED.REC.1396.908).

There is a strong evidence of worldwide overuse and underuse of health care services. Designing context-based prevention strategies by conducting comprehensive and systematic studies will improve the appropriate use of routine services and help patients, physicians, and providers make evidence-based decisions.