Reliability analysis of a newly developed questionnaire for quality control of follow-up visits in polyiran study

Background: The PolyIran study is a large-scale pragmatic cluster randomized controlled trial of fixed-dose combination therapy (Polypill) for prevention of cardiovascular diseases (CVD) in Iran. The PolyIran Quality Control Program (PIQCP) including a new questionnaire was developed to assess the quality of data collection during follow-up visits. The aim of this study was to assess the inter-rater reliability of PIQCP questionnaire. Methods: The study was conducted in 26 (11%) randomly selected clusters (from a total of 236 PolyIran clusters). All participants within these 26 clusters were enrolled. The quality scores were measured according to the PIQCP guidelines by two independent raters. The intraclass correlation coefficients (ICC) were measured. In addition, the quality scores were categorized into good (370%) and poor (<70%). The kappa coefficient was used to assess inter-rater agreement for this categorical quality scores. Results: A total number of 945 PolyIran participants were enrolled of which, 501 (53%) were from intervention arm. In 934 participants (98.8%), the quality score could be successfully identified by both raters. The ICC (95%CI) ofthe overall quality scores was 0.985 (0.983-0.987). It was 0.976 (0.972-0.980) and 0.988 (0.986-0.990) in intervention and control arms, respectively. We found excellent agreement between the two raters in identifying participants with good and poor quality scores (kappa = 0.988, P < 0.001). The kappa values were 0.972 (P < 0.001) and 1.000 (P < 0.001) in intervention and control arms, respectively. Discussion: Our results suggested that the PIQCP questionnaire is a reliable tool for assessing quality of data collection in PolyIran follow-up visits. Using this measure will help us in efficient monitoring of the PolyIran follow-ups and may ensure high quality data. © 2016, Academy of Medical Sciences of I.R. Iran. All rights reserved

Determinant criteria for designing Health benefit package in selected countries

Health benefit package described as primary health interventions that provided with government using general funds for all regardless their financial ability. This study was aimed at determine appropriate pattern for Iran using comparative survey of Health benefit package in various countries. A review exploration was done, scholars was selected population of both developed and developing countries, required information was also extracted by articles, searches and reports of reliable sources and date were analyzed by SPSS, in brief. The vast majority frequencies was respectively allocated to accessibility (40.7%), cost- effectiveness (29.6%), prioritize, efficacy and cost (22.2%). most countries located in WHO African region were selected cost-effectiveness and accessibility, WHO southeast Asia region were selected, coverage, prioritize, efficacy and quality and finally most WHO Europeans region were elected effectiveness and services costs for including services in Health benefit package. According to most Health benefit package designer emphasis on criteria including accessibility and costeffectiveness, to design Health benefit package for Iran, these criteria must be noticed

The prevalence of metabolic syndrome in the north of Iran. An epidemiologic comparative study

Background and Objective: The metabolic syndrome (MetS) increases the risk of cardiovascular diseases and the main aim of this study is to explorer prevalence of it in the north of Iran with comparison of Turkman and non-Turkman ethnic groups in 2012. Material and Methods: This is a cross-sectional study that conducted on the 248 subjects aged 25-70 years (Turkman=88 and non-Turkman=160). Individuals were chosen randomly from 25 clusters. Waist circumference was measured with the subject standing at the end of normal breathing; blood pressure was measured in three times and 5 ml of venous blood drawn after 8-12 h fast in the morning for laboratory test. Biochemical analysis including fasting blood glucose, triglyceride and high-density lipoprotein (HDL) cholesterol was assayed using a commercially kit (Pars Azmoon, Karaj, Iran). ATP-III method and SPSS 16.0 software (Chicago II, USA) were used for diagnosis of MetS and for statistical analyzes, respectively. P-value < 0.05 considered statistically significant. Results: Compare to Turkman group, the mean of FBG (fasting blood glucose), triglyceride and waist circumference are 15.9 mg/dl, 30.2 mg/dl and 6.5 cm were more in non-Turkman group, respectively (P<0.05 for all). The Pearson's correlation coefficient is positive between age and MetS (r=0.287, P=0.01). Generally, MetS was common in 37.9 of subjects and it was 14.7 in non-Turkman more than in Turkman people (P=0.015). Prevalence rate of MetS in men and women was 29.7 and 43.5, respectively (P=0.001). Conclusion: In the north of Iran, the prevalence of MetS is high and it was in non-Turkman ethnic group more than in Turkman group and in women more than in men while gender differences only was shown in non-Turkman ethnic group

Assessing quality of healthcare service by the SERVQUAL model: A case study of a field hospital

Aims: Identifying quality gap of services provided by hospital lead to preparing improvement projects and programs. This study intends to determine the quality gap in healthcare services provided by Shahid Elmi Field Hospital from the view point of Patients. Methods: In this cross-sectional study, 100 patients admitted to the hospital in 2011 were selected randomly for the study. The data gathered through SERVQUAL Standard Questioner. The content validity and reliability was confirmed by specialist opinions and Cronbach's alpha coefficient, respectively. Data analysis was conducted using descriptive statistics and two-sample t, Pearson correlation and ANOVA tests, using SPSS version 18. Results: According to the patients' views, there is a positive quality gap in delivered services. The highest mean score of the negative and positive quality gap were related to Responsiveness (-0.02) and access (0.035) respectively. There was a significant relation between the frequency of referral and the quality empathy (p=0.05). Conclusion: According to the results, the delivered services of the studied Field hospital is higher than the expectations of patients. It is recommended that processes related to delivery of services, in all dimensions of services' quality particularly responsiveness and assurance, should be identified and reengineered

A systematic review of the use of telemedicine in the military forces worldwide

Context: Considering the pivotal role of telemedicine in providing healthcare services for remote areas, some of the military medical centers, especially in developed countries, use different types of telemedicine programs. Objectives: The present study aimed at identifying the implemented telemedicine projects in military medicine worldwide and introducing their features. Evidence Acquisition: The current systematic review was performed in 2018. PubMed, Scopus, Embase, and Web of Science databases were searched for articles published from 2014 to 2018 by a combination of related keywords, and the related original articles were then selected based on the inclusion and exclusion criteria. Data were collected by a data extraction form, and then the data were summarized and reported based on the study objectives. Results: Of the 173 articles retrieved from the first round of search, 12 were included in the study; five (41.66) studies had used the synchronous (real-time telemedicine) method. The United States, with nine studies, had the highest number of projects in military telemedicine. Most studies (n = 7) were performed on tele-psychology and the application of telemedicine in psychology. All selected studies reported the positive effects of telemedicine on providing healthcare for military forces. Conclusions: The proper utilization of telemedicine equipment is effective in saving time for both patients and healthcare providers, reducing costs, supporting in natural disasters, and satisfying patients with military medicine. To achieve telemedicine program objectives, they should be set precisely. Considering the importance of timely healthcare services, it is suggested to utilize synchronous methods and tools such as video conferencing. © 2020, Author(s)

Evaluation of the standard battery of in vitro genotoxicity tests to predict in vivo genotoxicity through mathematical modeling: A report from the 8th International Workshop on Genotoxicity Testing

In human health risk assessment of chemicals and pharmaceuticals, identification of genotoxicity hazard usually starts with a standard battery of in vitro genotoxicity tests, which is needed to cover all genotoxicity endpoints. The individual tests included in the battery are not designed to pick up all endpoints. This explains why resulting data can appear contradictory, thereby complicating accurate interpretation of the findings. Such interpretation could be improved through application of mathematical modeling. One of the advantages of mathematical modeling is that the strengths and weaknesses of each test are taken into account. Furthermore, the generated predictions are objective and convey the associated uncertainties. This approach was explored by the working group “Predictivity of In Vitro Genotoxicity Testing,” convened in the context of the 8th International Workshop on Genotoxicity Testing (IWGT). Specifically, we applied mathematical modeling to a database with publicly available in vitro and in vivo data for genotoxicity. The results indicate that a mammalian in vitro clastogenicity test and a mammalian cell gene mutation test together provide strong predictive weight-of-evidence for evaluating genotoxic hazard of a substance, although they are better in predicting absence of genotoxic potential than in predicting presence of genotoxic potential. Remarkably, the bacterial reverse mutation (Ames) test did not significantly change these predictions when used in combination with in vitro mutagenicity and clastogenicity tests using cells of mammalian origin. However, in case only data from a bacterial reverse mutation test are available for the assessment of genotoxic potential, these do bear weight of evidence and thus can be used. Genotoxicity assays are generally executed in tiers, in which the bacterial reverse mutation test often is the starting point. Thus, it is reasonable to suspect that early in development test results from the bacterial reverse mutation test have influenced the composition of the database studied here. We performed several tests on the robustness of the database used for the analyses presented here, and the forthcoming results do not indicate a strong bias. Further research comparing in vitro genotoxicity data with in vivo data for additional compounds will provide more insights whether it is indeed time to reconsider the composition of the standard in vitro genotoxicity battery