Tuberculosis surveillance using a hidden markov model

Routinely collected data from tuberculosis surveillance system can be used to investigate and monitor the irregularities and abrupt changes of the disease incidence. We aimed at using a Hidden Markov Model in order to detect the abnormal states of pulmonary tuberculosis in Iran. Data for this study were the weekly number of newly diagnosed cases with sputum smear-positive pulmonary tuberculosis reported between April 2005 and March 2011 throughout Iran. In order to detect the unusual states of the disease, two Hidden Markov Models were applied to the data with and without seasonal trends as baselines. Consequently, the best model was selected and compared with the results of Serfling epidemic threshold which is typically used in the surveillance of infectious diseases. Both adjusted R-squared and Bayesian Information Criterion [BIC] reflected better goodness-of-fit for the model with seasonal trends [0.72 and -1336.66, respectively] than the model without seasonality [0.56 and -1386.75]. Moreover, according to the Serfling epidemic threshold, higher values of sensitivity and specificity suggest a higher validity for the seasonal model [0.87 and 0.94, respectively] than model without seasonality [0.73 and 0.68, respectiveiy]. A two-state Hidden Markov Model along with a seasonal trend as a function of the model parameters provides an effective warning system for the surveillance of tuberculosis

[Desired attributes of outpatient services from the perspective of patients: using a choice- based conjoint analysis technique]

Patients' perception of various aspects of health services could provide useful insights to improve health services. In the present study the technique of Choice- Based Conjoint Analysis [CBCA] was used to elicit patients' views on desired attributes of outpatient services. Five attributes related to outpatient services provided by hospital clinics, were surveyed. They included appointment making, waiting time, forming medical records, and presence of medical students and other patients in the examination room. There were 200 patients selected through convenient sampling method. Data were gathered via structured interviews and analyzed by logit regression model. The three main attributes preferred by respondents were: no presence of other patients [57%], appointment making [17%], and forming medical records [15%]. The scenario with maximum utility consisted of the following: telephone appointments, having medical records, no presence of medical students and other patients in the examination room, and the maximum waiting time of half an hour. The sequence of the priorities preferred by the outpatients was found to be firstly, examination by consultants in private, secondly, telephone appointments, and finally, formation of medical records. CBCA could be a potentially useful technique for eliciting the preferences of health service users

[Assessment of the quality of methodology reporting in the randomized trials]

Abstract writing is one of the secondary services for summarizing the content of documents. It represents the major information and is used as an overview of the text. However, abstracts should be written and indexed on the basis of some criteria to provide sufficient and reliable information about the main text. This study aimed to assess the abstracts of Randomized Controlled Clinical Trials [RCTs] indexed in PubMed on the basis of the CONSORT abstract checklist. This was a descriptive cross-sectional survey. The study sample included 314 RCTs indexed in PubMed with the affiliation of Iran and Tehran University of Medical Sciences up to the end of 2010. The abstracts were evaluated by the CONSORT checklist in which the items were scored 0-8. The Mean score for quality was 4.7 +/- 1.02 out of 8. None of the abstracts were assigned as the most qualified [Score=8] and the highest score was 7. Among the RCT designs, parallel trial designs were the most common ones. Indications of the type of randomization, the blinding type, and the number of participants involved were found not to be well reported qualitatively. The findings indicated that the items designated for RCTs abstracts were not thoroughly taken into consideration. It seems that training of researchers and authors is required for betterment of the quality of reporting in abstracts. In addition, journal editors should provide guidelines for authors to report this type of studies correctly

[ survey of the levels of evidence of nursing theses and dissertations in type 1 medical universities of Iran, 1991-2010]

Availability of scientific research at high levels of evidence, provide an appropriate context for evidence-based nursing. This study aims to identify the levels of evidence of nursing theses and dissertations in type-one medical universities of Iran in a period of twenty years. This is a descriptive survey on 1810 nursing theses and 54 dissertations. The abstract and/or method section of the theses and dissertations during 1991-2010 was reviewed and then their levels evidence were determined by comparing these data with the table of evidence-based research assessment. Descriptive analysis on data was performed using SPSS-PC [v.16]. A large percentage of the theses [60.7%] and dissertations [92.6%] were at the 6[th] level of evidence. First and 5[th] levels of evidence were not seen in Msters Theses, and none of the 1[st], 4[th] and 5[th] levels of evidence was found in PhD dissertations. The lowest percentages [1.9%] of theses were situated at the 4[th] level. Only 7.4% of the dissertations were at the 2[nd] and 3[rd] levels of evidence. The trend of theses and dissertations changed into performing research at the 2[nd] and 3[rd] levels of evidence. The results revealed that the majority of theses and dissertations in all educational fields and faculties are at the lowest [6[th] level of evidence during the studied period. Thus, regarding the importance of evidence-based practice for increasing the quality of nursing care, investigating approaches to promote and improve the level evidence of nursing theses and dissertations is recommended

[Qualitative evaluation of central library's web sites of medical universities in Iran with WEBQEM]

The homepage is the initial place at which the users are directed towards having access to the available resources. This makes web designing of high importance to university administrators and authorities. The purpose of this study was to conduct a qualitative evaluation of websites with WEBQEM in libraries of Medical Universities in the Islamic Republic of Iran. This study was a descriptive survey which was conducted on 24 websites. Data were gathered on the basis of WEBQEM checklists. Data analysis was performed by using SPSS software version 13. The evaluation was carried out by applying four criteria of WEBQEM. The websites' reliability was evaluated as "Very Good", with the average score of 0.82, and its efficiency as "Good" with the average score of 0.64. Usability and functionality scored an average of 0.5 and 0.52, respectively. Finally, half of the websites, on which this study was conducted, were evaluated as "Good "while the other half were as "Average". Considering the average scores obtained by using the four main criteria of the study, it was conceived that the in terms of functionality and usability of these web sites had some shortcomings. Although reliability and efficiency scored average, some of the websites were not of the expected quality by the main criteria

[ effect of jaw relaxation on pain anxiety of burn dressing: Randomized clinical trial with control group]

Patients with burns, experience high levels of anticipatory anxiety during dressing changes. Anxiety tends to increase after each dressing and during time; on the other hand this anxiety cannot be completely managed by anxiolytic drugs. Nurses contribute to pain management by using pharmacological and non-pharmacological interventions. Relaxation techniques are one of the most used approaches in pain anxiety management. However there is not enough information about the effects of these techniques on pain anxiety of these patients. The aim of this study was to determine the effect of jaw relaxation on pain anxiety of burn dressing. This study was a randomized clinical trial with control group. One hundred patients hospitalized in Shahid Motahari Burn Center in Tehran within July to December, 2009 were recruited by convenience sampling and were randomly assigned to either experimental or control groups using minimization. Experimental group practiced jaw relaxation for 20 minutes before entering dressing room. Data were assessed with Burn Specific Pain Anxiety Scale [BSPAS] and analyzed using descriptive statistics, Chi-Square test, dependent and independent t-test and Fisher's exact test by SPSS-PC [17]. Significant statistical difference was seen between the level of pain anxiety before and after intervention in experimental group. Moreover, after intervention there were a significant difference between the level of pain anxiety after dressing in experimental and control groups. There weren't significant difference between pain anxiety after intervention, before and after dressing in experimental group. Nurses can independently decrease the pain anxiety of burned patients and its subsequent physical and psychological burden by teaching the simple and inexpensive technique of jaw relaxation. Further studies are suggested to assess the effect of this technique on pain anxiety of patients with other disease except burns who suffer from painful procedures