Epidemiological Patterns of Road Traffic Crashes During the Last Two Decades in Iran: A Review of the Literature from 1996 to 2014

Context: Despite considerable attention given to health statistics of road traffic crashes (RTCs), the epidemiological aspects of injuries resulting from RTCs are not fully understood in Iran and other developing countries. The aim of this review was to study the epidemiological pattern and issues arising due to RTCs in Iran. Evidence Acquisition: The scope of this study involves data from a broad range of published literature on RTCs in Iran. Data collection for this study was conducted by searching for keywords such as traffic accidents, traffic crashes, motorcycle accidents, motorcycle crashes, motorcycle injury, motor vehicle injury, motor vehicle crashes and motor vehicle accidents, Iran and Iranian in various databases such as Embase, PubMed, Google Scholar, Scopus, Magiran, Iranian scientific information database (SID) and IranMedex. Results: This study comprised of 95 articles. It is evident from this review that a large number of severe RTCs occur due to collision of two or more vehicles and most of the victims are males aged between 30 and 39 years. Male pedestrian, drivers and passengers are more likely to be severely injured in comparison to females. One of the most prevalent causes of death among adults involved in the RTCs are head injuries and the majority of deaths occur prior to hospitalization. Mortality rates for RTCs are higher in summer, especially during midnight among all age groups. The most common individual and environmental risk factors associated with RTCs include lack of attention, getting trapped in the car, listening to music, fatigue and sleepiness, duration and distance and negligence of seatbelt usage while driving. Conclusions: The findings of the current study will be beneficial in prevention of RTCs and its associated complications and hence will be vital for policy makers, health service managers and stakeholders

Patient safety culture in hospitals of Iran: A systematic review and meta-analysis

Background: Nowadays, for quality improvement, measuring patient safety culture (PSC) in healthcare organizations is being increasingly used. The aim of this study was to clarify PSC status in Iranian hospitals using a meta-analysis method. Methods: Six databases were searched: PubMed, Scopus, Google Scholar, Cochrane Library, Magiran, SID and IranMedex using the search terms including patient safety, patient safety culture, patient safety climate and combined with hospital (such as "hospital survey on patient safety culture"), measurement, assessment, survey and Iran. A total of 11 articles which conducted using Hospital Survey on Patient Safety Culture (HSOPSC) questionnaire initially were reviewed. To estimate overall PSC status and perform the meta-analyses, Comprehensive Meta-Analysis (CMA) software v. 2 was employed. Results: The overall PSC score based on the random model was 50.1. "Teamwork within hospital units" dimension received the highest score of PSC (67.4) and "Non-punitive response to error" the lowest score (32.4). About 41 of participants in reviewed articles evaluate their hospitals' performance in PSC as 'excellent/very good'. Approximately 52.7 of participants did not report any adverse event in the past 12 months. Conclusion: The results of this study show that Iranian hospitals' performances in PSC were poor. Among the 12 dimensions of HSOPSC questionnaire, the "Non-punitive response to error" achieved the lowest score and could be a priority for future interventions. In this regard, hospitals staff should be encouraged to report adverse event without fear of punitive action

Cardiovascular patients� experiences of living with pacemaker: Qualitative study

BACKGROUND: A pacemaker implantation is considered major life event for cardiovascular patients, so they will probably have very interesting experiences of living with this device. The aim of this study was to explore the experiences of cardiovascular patients living with the pacemaker. METHODS: In this qualitative study, 27 patients were chosen through purposive sampling to achieve data saturation, and their experiences were examined using semi-structured interviews. The patients� statements were recorded with their consent and analyzed using content analysis method. RESULTS: Participants� experiences included three main themes: �Problems and limitations,� �feeling and dealing with pacemaker�, and �sources of comfort� and 10 sub-themes including: physical problems, financial problems, social problems, the first encounter, the feeling of living with the pacemaker, how to cope with pacemaker, satisfaction with pacemaker, good family support, hospital and hospital staff performance, and role of religious beliefs. CONCLUSION: Planning to solve social problems, identifying and changing feelings of patients using pacemakers, reinforcing the resources of comfort especially family support seem to be necessary steps for improving quality of life and impact of using pacemaker. © 2015 Isfahan University of Medical Sciences(IUMS). All rights reserved

Perspectives of faculty members toward Iranian National Olympiad for medical students: A qualitative study

Objective - Regarding to the status of medical science Olympiads in medical science pedagogy, the views of beneficiaries are needed to be examined on them, in particular, faculty members who are the most interested group in the given issue. As such, the purpose of this study is the evaluation of views of the faculty members on the mission and performance of medical science Olympiads in Iran. Material and Methods - The data for this qualitative study were collected through semi-structured interviews and then were analyzed using the content-analysis method. Finally, 95 members of faculty board were selected from universities of medical sciences in Iran and data collection continued till data saturation. Results - Four themes including: points of strength in Olympiads, points of weakness in Olympiads, attitudes of faculty members to Olympiads, and suggestions for better performance of the Olympiads were extracted. The points of strength consisted of: mission, the performing procedures, and the scientific level of the competitions. The points of weakness included: mission, the performing procedures, and the scientific level of the competitions. Most of the participants (79) had positive attitude toward the Olympiads. Participants presented 8 strategies in order to manage the competitions better. Conclusion - It necessary to do more researches to identify the related problems and to use the required. Applying instructor's points and views on the strengths, weakness, and suggestions can be efficient in policy making, designing and performing medical Olympiads. © 2016, Azami-Aghdash S., Ghojazadeh M., Nazavar R., Yaghoubi S., Vahedi L

Perspectives of cardiac care unit nursing staff about developing hospice services in Iran for terminally ill cardiovascular patients: A qualitative study

Introduction: The present study was conducted aiming to determine the points of view of cardiac care units' nursing staff about designing and providing Hospice services in Iran for cardiovascular patients in the final stages of life. Materials and Methods: In this qualitative study, the perspectives of 16 Cardiac Care Unit (CCU) nurses selected purposefully among hospitals of Tabriz-Iran University of Medical Sciences were investigated using semi-structured interviews and were analyzed in content analysis method. Results: 33 themes were finally extracted. Some nurses were for and some were against designing and providing Hospice services in Iran. The main reasons identified for supporting this plan included: Possibility of designing and providing these services consistent with high ethical values of Iranian society; approval of authorities due to increasing the load of chronic diseases and aged population; need of families due to the problems in taking care of patients and life concerns; better pain relief and respectful death; decrease of costs as a result of lower usage of diagnostic-therapeutic services, less use of expensive facilities and drugs, and better usage of hospital beds. Conclusion: Growing load of chronic diseases has made the need for Hospice as a necessary issue in Iran. In order to provide these services, studying the viewpoints of health service providers is inevitable. Therefore using and applying the results of this study in planning and policy making about designing and providing these services in Iran for cardiovascular patients in their final stages of lives could be helpful. © 2015, Medknow Publications. All rights reserved

Developing performance indicators for clinical governance in dimensions of risk management and clinical effectiveness

Objective: This study has been designed and conducted to develop domestic indicators for evaluating the performance of clinical governance in dimensions of risk management and clinical effectiveness. Design: This study implemented a 5-stage process including conducting a comprehensive literature review, expert panel (~1000 h per person per session, 11 experts), semi-structured interviews, a 2-round Delphi study (33 experts were in attendance) and a final expert panel (8 experts were in attendance). Setting: East Azerbaijan-Iran Province. Participants: Fifty-six specialists and experts in different fields of medical sciences. Main Outcome Measures: Importance and applicability of indicators. Results: Using a thorough literature review, 361 indicators (129 risk management indicators in 4 dimensions and 232 clinical effectiveness indicators in 18 dimensions) were found. After conducting expert panels and interviews, the number of indicators decreased to 168 cases (65 risk management indicators in 4 dimensions and 103 clinical effectiveness indicators in 12 dimensions). Two rounds of Delphi identified four indicators that were omitted. The members of the final expert panel agreed on 113 indicators (43 risk management indicators in 4 dimensions and 70 clinical effectiveness indicators in 11 dimensions). Conclusion: In this study, indicators for assessing clinical governance in domains of risk management and clinical effectiveness were designed that can be used by policy-makers and other authorities for improving the quality of services and evaluating the performance of clinical governance. Those indicators can be used with slight modifications in other countries having healthcare systems similar to that of Iran. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved

Assessing and Improving Fitness to Drive in the Elderly People: A Scoping Review of Policies and Guidelines

Background: This study has been conducted to analyze the processes, models, and policies to assess fitness to drive and improving driving in the elderly in the world. Methods: The Arkesy and O’Malley frameworks were employed. Articles with at least one aspect of driving eligibility in the elderly were included. Expected data were collected using appropriate keywords from PubMed, Web of Science, Scopus, Embase, IranDoc, SID, and MagIran. Data were analyzed using the Content Analysis method. Results: Out of 675 records, 24 papers and reports were included in the study that all of them were High-Income Countries (HICs). Among the studies that referred to the baseline age, the highest frequency was 70 yr old (4 studies). Vision assessment was the main item to judge driving fitness (mentioned in 75% of the studies). The in-person (5 studies) was the most common method of renewal. General practitioners were the principal performers to measure driving fitness (7 studies). Thirteen studies referred to the road tests as part of the driver's license renewal process. In most all reports and papers, there were policies on empowering the elderly driver, including providing safe driving tips, optional driving skills tests, holding retraining courses, etc. The most frequently supporting policies included introducing alternative transportation. Conclusion: Most HICs have worthwhile experience in measuring and improving the fitness to drive in the elderly and enforce different laws according to social and political conditions. Utilizing these experiences by considering economic and social differences can be useful and practical for middle and low-income countries.

Breast cancer screening barriers from the womans perspective: A meta-synthesis

Background: The principal aim of health service providers in the field of breast cancer is to detect and treat lesions at an appropriate time. Therefore, identification of barriers to screening can be very helpful. The present study aimed to systematically review the qualitative studies for extracting and reporting the barriers of screening for breast cancer from the womans perspective. Materials and Methods: In this systematic review; Pubmed, Google Scholar, Ovid Scopus, Cochrane Library, Iranmedex, and SID were searched using the keywords: screening barriers, cancer, qualitative studies, breast and their Persian equivalents, and the needed data were extracted and analyzed using an extraction table. To assess the quality of the studies, the Critical Appraisal Skills Programme (CASP) tool was used. Results: From 2,134 related articles that were found, 21 articles were eventually included in the study. The most important barriers from the point of view of 1,084 women were lack of knowledge, access barriers (financial, geographical, cultural), fear (of results and pain), performance of service providers, women's beliefs, procrastination of screening, embarrassment, long wait for getting an appointment, language problems, and previous negative experiences. Articles' assessment score was 68.9. Conclusions: Increasing women's knowledge, reducing the costs of screening services, cultural promotion for screening, presenting less painful methods, changing beliefs of health service providers, provision of privacy for giving service, decreasing the waiting time, and providing high quality services in a respectful manner can be effective ways to increase breast cancer screening

Inequity in household's capacity to pay and health payments in Tehran-Iran-2013

Background: Health inequality monitoring especially in Health care financing field is very important. Hence, this study tends to assess the inequality in household's capacity to pay and out-ofpocket health carepaymentsin Tehran metropolis. Methods: This cross-sectional study was performed in 2013.Thestudy population was selected by stratified cluster sampling, and they constitute the typical households living in Tehran (2200 households). The required data were collected through questionnaires and analyzed using Excel and Stata v.11. Concentration Index on inequality was used for measuring inequality status in capacity to pay and household payments for health care expenses; and also the concentration index for out-of-pocket payments and capacity to pay was used to determine the extent of inequality. The recall period for inpatient care was one year and 1 month for outpatient. Results: The average of out-of-pocket payments for receiving the outpatient services was determined to be 44.33US and for each inpatient1861.11 US. Concentration index for household's outof- pocket payments for inpatient health care, out-of-pocket payments for outpatient health care and health prepayments were calculated 0.13, -0.10 and -0.11, respectively. Also, concentration index in household's capacity to pay was estimated to be 0.11whichindicatedinequality to the benefit of the rich. The households used financing strategies like savings, borrowing or lending to pay their health care expenditures. Conclusion: According to this study, the poor spend a greater portion of their capacity to pay for outpatient and inpatient health care costs and prepayment, in comparison to the rich. Thus, supporting the vulnerable groups of the society to decrease out-of-pocket payments and increasing the household's capacity to pay through government support in order to improve the household economic potential, must be considered very important

A Protocol Study for a Systematic Review and Metaanalysis of the Psychometric Properties of the Five Cs Model of Positive Youth Development Scales

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