fatemeh sadeghi-ghyassi

 A better understanding of health system performance requires evaluating achievements and challenges, thereby providing a basis for effective reforms. This systematic review aims to investigate the challenges and weaknesses of leadership and governance-related health policies in Iran.

 In this qualitative systematic review, we followed the instructions of the Joanna Briggs Institute (JBI). It encompassed qualitative studies assessing challenges and weaknesses of leadership and governance-related health policies. Thematic synthesis was conducted in three stages to identify common themes.

 The primary database search yielded 1890 records, of which 152 were fully assessed, resulting in the inclusion of 57 studies in this review. Thematic synthesis produced 157 structured codes and identified 11 main descriptive themes of challenges in leadership and governance-related health policies. These themes included hospital autonomy policy, challenges to the entire health system, governance of medical universities, healthcare payment systems, sustainable universal health insurance coverage, informal payments, insurance systems, induced demand, strategic purchasing of health services, the family physician program, family physician and rural health insurance programs, and primary healthcare human resources.

 The identified challenges underscore the urgent need for strategic reforms and interventions to overcome the complex issues plaguing the healthcare system. By addressing these challenges, policymakers and top healthcare managers might ensure that the population have access to high-quality care in a more responsive healthcare system.

The quantitative objective of the current systematic review was to identify the potential role of urinary microbiota in bladder cancer (BC) carcinogenesis, invasiveness, progression, and metastasis.

The proposed systematic review was conducted in accordance with critical review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, and the Joanna Briggs Institute (JBI) methodology for systematic reviews. The search strategy aimed to find both published and unpublished studies up to the January 2024. A JBI appraisal checklist was used to assess possible biases.

This systematic review was centered on 27 studies comprising 926 BC patients. Overall, 412 control individuals were compared with BC patients. The most common sampling method was midstream urine collection. Regarding microbial alpha diversity, there was no statistically significant difference between cancerous and healthy samples (n = 8), recurrent and not recurrent (n = 1), responders versus non-responders(n = 1), tumor grades (n = 1), and collection methods (n = 1). However, five studies reported higher diversity in controls, and five other studies reported, conversely, high levels of alpha diversity in BC patients or recurrent cases. Furthermore, a responder (RE) to treatment and a non-muscle invasive bladder cancer (NMIBC) groups demonstrated significant difference with non-responder (NR) and muscle invasive bladder cancer (MIBC), respectively. In terms of beta-diversity, nine studies reported significant diversity between BC patients and controls, one article demonstrated difference between recurrent and not recurrent patients, a study reported significant difference in RE and NR groups whereas another showed opposite, and others (n = 4) did not find any difference between BC, controls, MIBC and NMIBC patients, or between tumor grades. One study reported a difference between the collection method and beta-diversity in males and another reported the difference in females.

The included studies demonstrate that the composition of urinary microbiota is altered in patients with BC. However, the differentially enriched genera in the urine of these patients vary between studies, and there is too much heterogeneity across studies to make any reliable and valid conclusions. Furthermore, well-designed research is necessary to assess the role of microbiota in the carcinogenesis and progression of BC.

 This umbrella review presents comprehensive data on the evidence of the association between cerebral venous thrombosis (CVT) and COVID-19 vaccinations.

 We searched related databases to access issue-related systematic reviews both with meta‐analyses and without it that studied the connotation between COVID 19 vaccination and CVT in any languages on March 1, 2022. Two reviewers independently extracted the data using the JBI Form for Data Extraction in Systematic Reviews and Research Syntheses.

The primary search resulted in 886 titles, and finally, 48 full texts were selected, and of these, 12 qualitative systematic reviews or quantitative meta-analyses were eligible for the umbrella review. No study was excluded based on using the JBI checklist for critical appraisal. The results revealed that cerebral venous sinus thrombosis (CVST) from the COVID-19 vaccine could occur in any age group, in both sexes, and with all types of vaccine. However, young females were the predominantly affected cases. Although more common in adenovirus vaccine types, vaccines consisting of mRNA are not free from side effects. Headache was the most typical clinical symptom. Thrombocytopenia, PF4 IgG Assay, and d-Dimer evaluation were positive in many reported studies.

 The results showed that CVST from the COVID-19 vaccine can happen without age limitation for both sexes and all vaccine types. Although CVST is a life-threatening condition, early diagnosis and, most importantly, its management can be life-saving for patients. The overall balance of risk and benefit in favor of vaccination is positive in all of the included studies in the current umbrella review.

Bell's palsy is a rare adverse event reported in COVID-19 vaccines. Given the importance of neurological manifestations, the necessity to highlight and scrutinize the incidence of them following COVID-19 vaccination is needed. This study aimed to systematically review the reported cases of Bell's palsy following vaccination against COVID-19.  

This systematic review is conducted based on the Cochrane Collaboration Handbook and PRISMA Statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) and using the Joanna Briggs Institute (JBI) methodology for systematic reviews. The inclusion criteria for the included published studies were patient age ≥18 years, history of Bell's palsy after COVID-19 vaccination and established diagnosis in the patients with COVID-19 vaccination. The exclusion criteria were repeated cases and missing clinical information. The search strategy aimed to find both published and unpublished studies in August 2021 and updated by hand searching in May 2022 using the identified keywords and index terms in Cochrane Library, MEDLINE (PubMed), Web of Science, Scopus, ProQuest, and Google scholar. Finally, the reference lists of all identified reports and articles were searched for additional studies. The JBI critical appraisal tools for case reports or case series were used to assess the risk of bias in the included studies.  

During the electronic search, hand search, and reference check, we identified 1281 citations, and in hand searching, we detected additional 15 studies. After omitting duplicated citations and assessing the title, abstract, and full text 15 case-report and two case-series studies were included for the critical appraisal process and were included in this study. Pfizer and Moderna vaccines were the most common vaccines among articles that reported the cases of Bell’s palsy. Left-sided paralysis was more common than right-sided paralysis. The interval between receiving the vaccine and the onset of facial weakness was between 1 and 48 days.    

Further studies with larger sample sizes are necessary to assess the association between Bell's palsy and the dose-response of the COVID-19 vaccine.

In the outbreak of infectious diseases, non-pharmacological intervention might be the only available protection tools. The aim of this systematic review is to investigate whether it is or is not necessary to wear masks in new corona virus (COVID-19) outbreaks in the community.

On February, 28, 2020, related databases were searched with the following keywords: "COVID-19"; "COVID 19"; 2019-nCoV; 2019-CoV; coronavirus; mask* and facemask. We updated the search in March 13, 2020. A total of 982 relevant reports were identified after removing duplicates. Of these, 71 references were screened based on titles and abstracts. After excluding unrelated studies, 36 studies were included in the full-text review and were assessed for eligibility. Finally, 3 articles met our inclusion criteria.

In three wards of hospital with more exposure to infected patients, wearing the N95 respirator while using regular disinfectants and hand hygiene, was a better way to prevent COVID-19 transmission from patients to nurses and physicians when compared to non-users of masks. Another study on family members with a history of travelling to Wuhan, showed that those who had worn a surgical mask only during the hospital visit, were infected. However, the 7 years old child of the family who wore a surgical mask, was not found to be infected by COVID-19. Finally, none of eleven healthcare workers who had unprotected exposure with confirmed cases were infected.

Due to the newness of the COVID-19 virus, no clinical trials have been found regarding the use of the masks in the prevention of the disease, and the level of evidence were low.

Nurses are one of the largest providers of health and treatment services in the healthcare setting. A well-designed information system is one of the necessities for nurses.For this purpose, a proper evaluation of available systems is needed. The aim of this study to evaluate nurses’ perspectives on nursing information systems in hospitals of Tabriz University of Medical Sciences.

This is a cross-sectional study. Two hundred and seventy-five nurses participated in this study. The evaluation instrument was HIS-monitor and 41 specific questions that were related to nurses in four criteria were selected. The validity of the questionnaires was confirmed by experts and the reliability of the instrument was calculated by Cronbach Alpha (α =0.88). Data were analyzed by SPSS Statistics version 16 using descriptive and analytic statistics.

50.8% stated that the studied NIS supports nursing admission process well or very well and 47.7% believed that these NISs improve access to patient-related information and documentation of nursing care (48.1%). 25% evaluated the function of NIS in the nursing care plan poor or very poor.

According to the results, the status of nursing information systems is approximately acceptable and more attention is needed in designing and manufacturing hospital software.

Current study Aimed to compare effectiveness and cost effectiveness of laser devices in BPH surgery. Study tries to provide clear evidence which could be used in prior approval and funding of such new emerging technologies.
A systematic search of related databases was performed to find Randomized clinical trials¡ systematic reviews¡ Meta analyses and health technology assessment studies which had been published up to 2008.key words are: Laser¡ Holmium YAG laser (HOLEP)¡ Tolmium Laser¡ Transurethral Resection of the Prostate (TURP) and prostate. Data for clinical effectiveness was retrieved from the literature. Two Laser Assisted Technologies were analyzed in terms of efficacy¡ effectiveness and cost-effectiveness and compared with Trans-Urethral Resection of the Prostate (TURP) method from the perspective of Iran Ministry of Health. We used standard costing for analysis of costs. One-way sensitivity analysis was performed for the examination of calculated ICER in different probable scenarios.
Literature review stressed that there is no statistically significant difference in clinical effectiveness of Lasers assisted devices and TURP technique. The length of hospital stay and severity of side effects are clinically and statistically lower in Laser Assisted devices. Estimated unit-cost of treatment for Tolmium¡ Holmium and TURP was 3403541¡ 3019261 and 2455794 (RLS) from MOH perspective and 340354¡ 4719261 and 4325794 from societal perspective.
Sensitivity analysis showed that¡ in most of the study scenarios TURP was dominant intervention because of low treatment costs. Tolmium laser only with the assumption of dual applicability and 200 patients per year would be considered as a cost-effective technology.

To determine the attitudes and beliefs of Iranian urologists toward Evidence Based Medicine (EBM) and investigation of the barriers of evidence based practice (EBP). A self- administrated, Likert scale questionnaire designed in Persian and filled up by censuses selected urologist from Iranian Urology Association (IUA). Data were entered to Predictive Analytics Soft Ware version 18.0 and descriptive statistics were obtained for all parts of the questionnaire. A total of 111 out of 500 Iranian urologists who attended in IUA annual meeting, responded to the questionnaires. Mean attitude score of respondents was 30.4 (SD:. , range 16-40). Attitude score showed statistically significant association to previous participation in EBM workshops (P =. 01). Of participants 96% believed EBP will improve patient care and 76.2% of them appreciated the impact of use of research utilization and application of evidence based guidelines on clinical decision making and the outcome of surgery. The main barriers to EBP stated as lack of time (64.8%), facilities (53.4%), and training in EBM (29.4%). The urologists have positive attitudes towards EBP. However, regarding lack of time, pre-appraised databases or EBP guidelines can be helpful. Evidence based workshops and familiarity with evidence databases is recommended for Iranian urologists. In addition, health care system and policy makers could play a major role to provide a culture of EBP.

Greenlight Photoselective Vaporization of the Prostate (PVP) is a minimally invasive method of treatment for clinical benign prostatic hyperplasia with fewer side effects. The aim of this study is evaluation of safety، effectiveness and cost effectiveness of PVP in compare of transurethral resection of prostate in Iran. A systematic search was done in Cochrane، TRIP database، MEDLINE، NHS EED، NIHR HTA، CRD، Health star database، ProQuest، Psycoinfo and Google Scholar to find randomized control trials، systematic reviews and HTA reports. The searched keywords were Green light laser (PVP or KTP) and prostate. The cost analysis was done by the prespective of social and providers. Complication rate in 12 included evidences ranged from 0-9. 3%. The complication rate of TUR-P was more than PVP. Changing in flow rate reducing residual urine، improving patient symptom and QOL and operative outcome Length of operation was varied from no significant to significant different in favor of TURP. Unit cost in both social and provider view، was significantly high in PVP in comparison of TURP. Increasing the number of patients did not change the cost analysis. PVP is a safe method for treatment of clinical BPH، but there is a lack of evidence for evaluation of effectiveness. Overall unit cost for PVP was significantly more than TURP for this reason this method has to use in very selective cases in limited centers.

Our aim was to compare the cost effectiveness of holmium laserprostate enucleation (HOLEP) versus trans-urethral resection of prostate. We searched all available databases for any controlled trialscomparing HOLEP and TURP from January 2000 to February 2009. Two independentreviewers studied and appraised the selected evidences. Then, effectiveness and costeffectiveness of HOLEP was evaluated. We identified four randomized controlled trials and one systematic review according to the inclusion criteria. Most of the studies had moderate quality ofevidence with limited sample sizes. Overall success rate of HOLEP was comparablewith TURP; but, some secondary outcomes such as pick flow rate twelve monthsafter the surgery was better in HOLEP. A comparison between the original costsand those obtained from sensitivity analysis showed that the cost parameters weresensitive to the number of the patients treated. Increasing the number of the patientsfrom 200 to 300 changed the study’s results in favor of the new techniques. Since the holmium and thulium laser sets are sensitive to the number of the patients and multipurpose, they potentially can be applied for stone fragmentation.Thus, utilization of these equipments will divide the costs between two groups ofthe services. In economic terms, these properties lower overhead costs and justifythe purchasing of these equipments.

To compare the efficacy and cost-effectiveness of Femtosecond laser versus mechanical Microkeratome corneal flap creation in correction of refractive errors. In this review, a comprehensive search of Medline, SCOPUS, Cochrane,TRIP database, supplemented by HTA and economic databases was performed. Wesearched for randomized controlled trials (RCTs) of Femtosecond laser which includedmechanical Microkeratome in other arm. The quality of the retrieved studies wasappraised by two independent reviewers and appropriate articles were finalized. A total of 1142 articles were identified, of which, 1059 were excluded after review of the titles and abstracts and 83 articles remained. Systematic reviews andRCTs were evaluated through CASP international worksheet. Eventually, 61 titleswere excluded, leaving 22 articles to be reviewed.Safety: There was no individual evidence to cover all safety components aboutFemtosecond laser, but in summary, this modality seems a safe method for cornealflap creation.Effectiveness: No statistically significant difference was shown in visual acuityand refractive errors. The important secondary end point of this review was diffuseLamellar keratitis in 17% of the Femtosecond group versus 5% in mechanicalMicrokeratome. Inflammation was low-grade and improved during the first 3 monthsof follow-up period with a low dose medication without corneal scarring. The twogroups was comparable in all clinical outcomes including Unorrected Visual Acuity(UCVA), Best Special Corrected Visual Acuity (BSCVA), manifest refraction, wavefront aberrometry, Schirmer test, and Tear Break up time (TBUT).Cost Analysis: Results showed that marginal cost incurred due to Femtosecondtechnology adoption may vary from 27 to 117 € (resulted from sensitivity analysis). Itis clear that additional cost may be a small proportion of LASIK procedure total cost. Although Femtosecond flap creation is a modern method with a good quality of corneal flap, but, there is no high-quality evidence to show superiorityof Femtosecond laser in clinical outcomes. Although the efficacy and cost of thesystems is almost equal, traditional method still remains as the standard approach.