مقالات رزومه دکتر فروزان اکرمی

 Emerging COVID-19 pandemic has posed numerous ethical challenges to frontline healthcare professionals.

 This study aimed to explain the ethical challenges experienced by physicians and nurses in caring for COVID-19 patients during the early phases of the pandemic.

 This qualitative study was conducted using by content analysis approach. Twenty-two semi-structured in-depth interviews were conducted with 18 physicians and nurses working in medical centers and hospitals of the public or private sectors, in Tehran, the capital of Iran, from July to October 2020. The Graneheim and Lundman approach was applied to analyze the data. MAXQDA 10 software was used to facilitate the data analysis process.

 The ethical challenges are categorized into four categories (and 11 subcategories), including poor professional care, preference for public interests over individual care, difficult decision-making, and moral distress. Most participants experienced poor professional care, non-compassionate care, lack of family-centered care, being forced to choose, lack of emotional and anger control and coping skills, an undermined ethical climate, and emotional fatigue during the early phases of the pandemic.

 The findings indicate the attenuation of professional care and the need to develop evidence-based ethical and clinical guidelines concerning the resulting insights. In addition, devising appropriate interventions is recommended for their psycho-emotional support.

Dear Editor‑in‑Chief,Value‑based education is known as one of the affecting factors of professional dignity of medical practitioners, as well as their informed decision‑making in critical clinical settings. Critical situations are the best opportunities to convey professional and moral practice and also the most difficult .

 Sexual health has been considered as a necessary condition for achieving reproductive health, rather than being a part of it. This study aimed to identify the challenges of sexual health in Iran and the strategies for its improvement.

 In this qualitative study using content analysis, a semi-structured interview was used to collect data. The participants were 16 experienced experts who were selected using a purposive sampling method. After individual interviews and theoretical data saturation, data analysis was performed using the deductive content analysis method.

 Five main themes including the taboo of sexuality and low public awareness, unconventional sexual behaviors and emerging social ills, stigma and discrimination, lack of the political commitment of the government, and lack of statistical indicators and not utilization of existing capacities were identified as the challenges of sexual health in Iran. The strategies to address them included: Public education and empowerment with a special focus on the adolescents and young people, adopting policies and revising the related laws in line with social changes; gaining the political support of the government, promoting the right attitude with a focus on banishing stigma and discrimination against groups with high-risk sexual behaviors, collecting indicators and designing interventions using human resources and existing capacities, and promoting professional ethics and gender equity.

 For addressing the challenges and achieving the highest levels of sexual health in Iran, it requires the political commitment of the government, revising laws, and inter-sectoral cooperation to design and implement multidisciplinary and multidimensional interventions.

Estimation of the survival of very preterm infants is necessary to make decisions and design interventions in order to improve their quality of care. This survey aimed to estimate the survival of very preterm infants born at 23 up to 33 weeks of gestational age (GA) in Iran.

This population-based retrospective cohort study included 8536 infants born before 33 weeks of GA, from March 21st to December 22nd  2013 in Iran. The primary data were extracted from the Iranian national maternal and neonatal registration network (IMAN). All infants who have been discharged alive, followed up by telephone contact up to one year after birth. The Kaplan-Meier and Log-rank tests were performed to estimate survival and to compare survivals, respectively, using SPSS version 26 and R 3.5.2 softwares.

The overall survival was estimated at 56.70% (95% C.I: 55.60%-57.80%) at the end of the follow-up period. Total death rate was estimated at 43.30% and was significantly decreased with increasing birth weight (p<0.0001). Survival was increased significantly with increasing GA (p<0.0001), from 5.7% at 23 weeks to 79.6% at 32 weeks. The estimated cumulative proportion of death until the end of the neonatal period had a decreasing trend and then had a steady trend until the end of the follow-up period. The hazard ratio of quadruple or more birth and GA were 1.46 (p=0.021) and 0.83 (p<0.001), respectively.

The overall estimated survival of very preterm infants was not high. Even with modern perinatal technology and care, early deaths of very preterm infants were still common.

Despite the implementation of a safe motherhood program in many countries, unsafe abortion continues to be a matter of reproductive health. Thus, urgent efforts to make abortion legal and safe have been recommended in developing countries. The present study was done to determine the knowledge of midwives and obstetricians about the therapeutic abortion law as well as their attitude about the ethical pitfalls.

In this descriptive knowledge and attitude study, a researcher-made questionnaire was used to gather data, after estimating the appropriate Cronbach’s Alpha coefficient. A total of 162 midwives and obstetricians working in public and private medical centers affiliated to Shahid Beheshti University of Medical Sciences in 2018 were included in the study by convenience sampling method.

According to the results, 9.3% of participants had a low level, 72.8% had a moderate level, and only 17.9% had a good level of knowledge. The total mean score of knowledge was 7.17±1.7. The mean score of knowledge in the group of obstetricians (7.60±1.74) was significantly higher than midwives (6.94±1.54), (t=2.29, P=0.024). There was a significant correlation between participants’ age and their knowledge (r=0.912, P=0.001). Also, 47.53% of the participants believed that the therapeutic abortion law has some pitfalls. The most frequent attitude was about the restriction of the therapeutic law up to 19 weeks for fetal indications.

The level of participants’ knowledge was low to moderate. The findings indicated the need for training the professional standards related to prenatal genetic screening and therapeutic abortion

Preterm deliveries and premature babies are among challenges for families and communities. A family-centered care model is a model that helps families become less challenged by preterm birth and learn how to care for their premature infants. The aim of this study was to evaluate the implementation of family-centered care in the Iranian neonatal intensive care units (NICUs).

This national cross-sectional study was conducted on a total of 23 NICUs of 9 universities of medical sciences, where students were trained in the neonatology fellowship course, in seven provinces of Iran. Family-centered developmental care was assessed in six different domains, including the philosophy of nursery, family communication, family support, family resources, admission and discharge planning, and decision-making. In addition, a total of 29 items were asked. The data were analyzed using Stata software (version 13) using descriptive statistical tests.

The mean scores in all domains were weak, and the total score for all domains was 34.18 (95% CI: 33.75-34.60) out of 100. The mean scores were 30 in the philosophy of nursery, 43.47 in family communication, 26.71 in family support, 35 in family resources, 45 in admission and discharge planning, and 25 in decision-making. The lowest score was reported for decision-making, and the highest score was reported for admission and discharge planning.

Since family-centered developmental care in Iran is not favorable, the obtained findings suggest the development of a suitable plan to upgrade family-centered developmental care as well as comprehensive NICU care, including developmental care, with regard to other domains.

Given the importance of evidence-based decision-making, this study aimed to evaluate epi-demiological and clinical characteristics as well as associate factors of mortality among admitted COVID-19cases.

This multicenter, cross-sectional study was conducted on confirmed and suspected COVID-19cases who were hospitalized in 19 public hospitals affiliated to Shahid Beheshti University of Medical Sciences(SBMU), Tehran, Iran, between February 19 and May 12, 2020. Epidemiological and clinical characteristics ofthe infected cases were compared between the deceased and survivors after discharge. Case fatality rates (CFRs)were calculated across all study variables. Single and multiple logistic regressions were used to explore the riskfactors associated with COIVD-19 mortality.

Out of the 16035 cases that referred to the hospitals af-filiated to SBMU, 16016 patients (99.93% of Confirmed and 99.83% of suspected cases) were hospitalized. 1612patients died with median hospitalization days of 5 (interquartile range (IQR): 2-9) and 3 (1-7) for confirmed andsuspected COVID-19 cases, respectively. The highest death rate was observed among ages>65 (63.4% of con-firmed cases, 62.3% of suspected cases) and intensive care unit (ICU)/critical care unit (CCU) patients (62.7% ofconfirmed cases, 52.2% of suspected cases). Total case fatality rate (CFR) was 10.05% (13.52% and 6.37% amongconfirmed and suspected cases, respectively). The highest total CFR was observed in patients with age>65 years(25.32%), underlying comorbidities (25.55%), and ICU/CCU patients (41.7%). The highest CFR was reportedfor patients who had diabetes and cardiovascular diseases (38.46%) as underlying non-communicable diseases(NCDs), and patients with cancer (35.79%).

This study showed a high CFR among suspected andconfirmed COVID-19 cases, and highlighted the main associated risk factors including age, sex, underlyingNCDs, and ICU/CCU admission affecting survival of COVID-19 patients.

Blood is a public resource of human origin and its transfusion process is essential to individual and public health. This study aimed to develop a national code of ethics for blood donation and transfusion (BDT). This was a qualitative research with a multi methods approach in which a combination of methods including situational analysis, focus group discussion and expert panels were used. After situational analysis and orientation, the code of ethics for BDT was developed based on the findings of a content analysis within the framework of the four principles of biomedical ethics. The results were categorized into two sections: situational analysis and underpinnings measures, and the clauses of the code. The Iranian Blood Transfusion Organization has carried out three essential supportive measures over the past decades: approval of insurance coverage of blood recipients against communicable diseases; inclusion of 14 blood services in the book of “Relative Value Units of Health Services”; and formation of the National Ethics Committee of Transfusion Medicine. After recognition and orientation, the national code of ethics for BDT was adopted and imparted to blood donation centers. The code consists of two sections: “Blood Transfusion Centers: Donors and Donation” in 19 clauses, and “Hospitals: Patients” in 8 clauses. The national code of ethics for BDT establishes moral norms in order to protect the rights of blood donors and recipients. It could also serve as a basis for addressing the related ethical challenges and right decision-making in the area of BDT.