ABSTRACT
Objectives@#The health system reform process is highly political and controversial, and in most cases, it fails to realize its intended goals. This study was conducted to synthesize factors underlying the failure of health system reforms. @*Methods@#In this systematic review and meta-synthesis, we searched 9 international and regional databases to identify qualitative and mixed-methods studies published up to December 2019. Using thematic synthesis, we analyzed the data. We utilized the Standards for Reporting Qualitative Research checklist for quality assessment. @*Results@#After application of the inclusion and exclusion criteria, 40 of 1837 articles were included in the content analysis. The identified factors were organized into 7 main themes and 32 sub-themes. The main themes included: (1) reforms initiators’ attitudes and knowledge; (2) weakness of political support; (3) lack of interest group support; (4) insufficient comprehensiveness of the reform; (5) problems related to the implementation of the reform; (6) harmful consequences of reform implementation; and (7) the political, economic, cultural, and social conditions of the society in which the reform takes place. @*Conclusions@#Health system reform is a deep and extensive process, and shortcomings and weaknesses in each step have overcome health reform attempts in many countries. Awareness of these failure factors and appropriate responses to these issues can help policymakers properly plan and implement future reform programs and achieve the ultimate goals of reform: to improve the quantity and quality of health services and the health of society.
ABSTRACT
We conducted this study to evaluate and compare the sensitivity and specificity of various para-clinic parameters in detecting prostate cancer. In this cross-sectional study, 220 patients who underwent prostate biopsies for either high serum PSA level or abnormal digital rectal examination. Sensitivity and specificity of serum PSA, free to total PSA ratio and transrectal ultrasonography findings were calculated. Based on the pathological findings in 220 cases, 25% were diagnosed with prostate cancer. The mean age of patients with prostate cancer was 69.11 +/- 8.6 years. Mean serum PSA level among prostate cancer patients was significantly higher than in other patients [19.5 +/- 17.5 ng/dl vs. 10.5 +/- 8.1 ng/dl] [P=0.003]. The sensitivity and specificity of PSA for detecting prostate cancer, considering cut-off value of 4 ng/dl, was 92% and 2%, respectively. Free to total PSA ratio with cut-off value of 10% revealed 82% sensitivity and 17% specificity. Moreover, hypoechoic lesions detected by transrectal ultrasound had a sensitivity and specificity of 34% and 93%, respectively. Combination of different PSA related parameters with tranrectal ultrasound findings might increase sensitivity and specificity in detecting prostate cancer and reduce unnecessary biopsies