Model for implementing evidence based health care system in Iran

Regarding the role and importance of paradigm of evidence based practice and its remarkable impact on the effectiveness and efficiency of clinical services and healthcare, development of an integrated system seems necessary in order to manage dispersed data and ensure using evidence in clinical decision making, thus the aim of this study was designing a model for implementing national system of evidence based health care in Iran. This paper is a study of comparative type which has been written in three stages: investigation of structure and process of evidence based practice in selected countries, investigation and analysis of current status in Iran in this regard and recommendation of strategies which make model implementation feasible in the country. Such methods as review of literature, focus group discussion and Delphi technique were used for investigation. According to studies, insuring an evidence based practice culture in the country requires a system called National Evidence Based Health Care System which consists of three subsystems including national system of clinical knowledge management, national evidence-based practice system and integrated national network of clinical effectiveness. The ultimate goal of health care system in every country is maintaining and improving community health. Achievement of this goal depends on effectiveness of delivered services and consistency of the services with national and local priorities. In order to achieve clinical effectiveness, the best practice should be realized in the country, implementation of which requires a set of macro and micro strategies enabling facilitation, promotion or guaranteeing clinical knowledge application in the country

Development, validity and reliability of sexual health measures for spinal cord injured patients in Iran

This study developed and validated a questionnaire to measure the sexual health of patients with spinal cord injuries [SCI]. This was a cross-sectional study conducted at the Brain and Spinal Injury Research Center [BASIR], Tehran, Iran. Extensive review of literature, expert opinions, and encounters with SCI patients were used to develop and validate the questionnaires. There were 40 [32 males, 8 females] patients with SCI that presented for treatment at BASIR who enrolled in the study. Participants completed the questionnaires while they were admitted for medical care and during treatment follow-up visits. Participants completed the questionnaires twice, at a 2-4 week interval. Reliability testing for each measure was performed separately. Cronbach's alpha was used for internal consistency and test-retest was used for reliability. An expert committee approved the face and content validities of the questionnaires, Internal consistency of our questionnaires, was acceptable according to Cronbach's alpha that ranged from 0.73 for the sexual activity measure to 0.90 for the sexual adjustment measure. Test-retest reliability was satisfactory. Intraclass Correlation Coefficient [ICC] of measures ranged from 0.65 for sexual function to 0.84 for sexual activity. The sexual health measures has provided a valid assessment of sexuality-related matters in this sample of patients with SCI, which suggests that evaluation of sexual well-being may be useful in clinical trials and practice settings. Overall, the sexual health measures shows good internal consistency and test-retest reliability

Establishment of health technology assessment in Iran

Health Technology Assessment [HTA] aims at informing healthcare policymakers, managers and practitioners of the "clinical consequences, but also the economic, ethical, and other social implications of the diffusion and use of a specific procedure or technique on medical practice". So considering the policy-oriented nature of HTA that calls for a close integration into the functioning and governance of health systems the present study focuses on executive processes and function of the HTA office of Iran. Data of this review study were collected through documented sources and observations from 2007 to 2010. Health Technology Assessment began its activities as a secretariat in the Deputy of Health in 2007 and it continues as a Health Technology Assessment Office at the Management of Health Technology Assessment, Standardization, and Tariff at the Deputy of curative affairs of MOHME in the beginning of 2010.14 Technology of modern medical equipment and 8 pharmaceutical medicine are assessed, Now many of measures for HTA establishment such as cooperation National Institute of Health Research [NIHR], Holding scientific committee meetings, Establishing the Master's degree of health technology assessment ,Building capacities for health technology assessment through education in major universities of the country. Pay attention to health technology assessment, selection and application of proper technologies in the frameworks of policy-making and managerial strategies and make efforts to develop it with the support of the governmental in Iran is necessary

Influenza A [H1N1] Pandemic in Iran: report of First Confirmed Cases from June to November 2009

Since the declaration of a swine flu pandemic by the World Health Organization [WHO], the Islamic Republic of Iran has launched a surveillance system to test all suspected cases, both in community and hospital settings. From June 1[st] to November 11[th], 2009, there were 2662 [1307 females and 1355 males] RT-PCR confirmed cases of pandemic influenza A [H1N1] detected in Iran. Of these cases, 75% were 5-40 years-old. During this period, 58 patients [2.18%] died. Of the total number of cases, 33 were pregnant women with no reported mortalities amongst them. The prevalence of death had no significance correlation with sex and age [P=0.720 and 0.194, respectively]. Geographic distribution of the reported cases showed the highest rates in central and eastern provinces of Iran. There were two disease phases until November 2009, including an initial exogenous wave which blended into a second wave of indigenous disease, with a peak of cases after the start of the educational year. A review of the epidemiology of these initial phases of disease in Iran can help for better planning and more efficient action in future phases of the disease. It is of utmost importance to strengthen the surveillance system for this disease and appropriately transfer the resultant knowledge to the medical professionals, stakeholders and the general population, accordingly

[ motives of medical students in Tehran university for choosing medicine field and their for their profession: qualitative versus quantitative approach]

It seems that in our country choosing medicine as the field of study in university is mostly due to family and society pressures rather than the applicant's real interest in this field. To determine medical students' motives for choosing medicine and their outlooks for this profession by using two qualitative and quantitative approaches. The qualitative part includes two focus group discussions with interns, and one focus group discussion with fresh students. In the quantitative part, complementary to the qualitative section, the causes of choosing medicine field and the rate of students' and applicants' awareness toward the future statue of their profession were studied. For this purpose, 33 fresh students, 107 interns, and 88 applicants of medicine field after taking the entrance examination were selected through convenient and consecutive sampling and were asked to complete the designated questionnaire. In the qualitative part, everybody agreed that the applicants' own preference is not determining, and almost all of the students mentioned the social prestige of a physician and medical field as the main cause of choosing this field. In the quantitative part, interest in the scientific content of this field [in 42%], the role of physician in health improvement [in 21%], financial income [in 14.3%], the social prestige of physician [in 13%] and the pressure of family and society [in 1%] were mentioned as the main causes of choosing medicine field. On the other hand, participants in the qualitative part of the study didn't have a good outlook for the professional status of general practitioners and some of them believed that continuing studies in medicine field is more difficult than other fields. In the quantitative part of study, as the age of participants increased they more asserted that in medical field the possibility of continuing studies, finding job in good area, and with good income is less compared with other fields. The results of this study revealed that many students have not adequate awareness toward the medicine field and in choosing this field they are mostly under the influence of factors such as the pressure of family and the social prestige of the physicians. Although these aspects were not obvious in the quantitative part of the study, they were confirmed by all of the participants in the qualitative section of the study. This fact denotes the importance of qualitative approaches or the combination of qualitative and quantitative designs. On the other hand, since with increase in the age of students their awareness toward the future statue of their field improves, it is suggested that admission is not confined to academic criteria and appropriate meta-cognitive characteristics of applicants are also considered in admitting the students