محمد مرادی جو

Breast cancer (BC) is the most common type of cancer among Iranian women. The cost of breast cancer treatment is high, and many families struggle to afford it.

This study was conducted with the aim of determining the out-of-pocket (OOP) health expenditure and factors affecting it in BC patients in Shahid Jalil Hospital affiliated to Yasuj University of Medical Sciences, Iran.

This study was conducted in a cross-sectional descriptive-analytical way. Based on the inclusion criteria, the health expenditure of 82 patients with BC were collected. The data was gathered from Shahid Jalil Hospital, affiliated with Yasuj University of Medical Sciences. It includes inpatient and outpatient information from the Iran Health Insurance Organization, as well as patient-declared costs in 2022. The study data analyzed using descriptive statistics methods including frequency, percentage, mean and standard deviation, and stepwise linear regression to investigate the effect of variables on the amount of OOP health expenditure in SPSS 21 software.

The OOP expenses for BC patients accounted for 32.89% of the total direct medical expenses. Of the OOP costs, 47.18% were attributed to drug expenses, 16.19% to laboratory costs, 11.74% to imaging expenses, 11.20% to visit costs, 8.40% to hospitalization expenses, 2.84% to doctor’s services, and 2.45% to physical therapy-related expenses. Factors such as age, place of residence, occupation, education, and household income were among the factors that had a significant effect on OOP payments (P < 0.05). Marital status, housing situation, and social coverage had no significant effect on patients' OOP payments (P > 0.05).

BC patients incur a lot of expenses, and about 32.89% of these expenses are OOP payments. It is essential for insurance organizations to increase their coverage, while also requiring additional support from the government for patients with breast cancer in obtaining necessary medication and medical supplies.

In the ever-evolving healthcare landscape, nurses are at the forefront of patient care. Nurses’ procedural skills are the lifeblood of quality care. Artificial Intelligence (AI) is a useful game changer that can change how we approach nursing practice. This scoping review of reviews was conducted with the aim of determining the potential of AI in improving nurses’ clinical, educational, decision-making, informational, and research skills.

Eight electronic databases (PubMed, Scopus, Web of Science, Embase, CINAHL, ProQuest, Microsoft Academic, and OpenGrey) were searched to find all studies (peer-reviewed and grey literature) published up to September 2024 using the keywords AI, nursing skills, and related terms. The Google Scholar search engine was used to find relevant sources and complete the search coverage. Data collected from included studies on each role that AI could play in nurses' skills were analyzed using narrative methods.

finally, thirty review studies were included. Accordingly, AI has a beneficial effect on six main themes (education, decision, clinical practice, research, information, and psychiatric nursing) and thirty-three subthemes.

The results of our study showed that AI plays a fundamental role in improving the clinical, educational, decision-making, informational, and research skills of nurses. The integration of AI technologies not only fosters better patient outcomes but also equips nurses with the tools necessary for continuous professional development and efficiency. Future research should continue to explore specific applications and address any barriers to implementation to fully realize the benefits AI can bring to the nursing profession.

The month of "Ramadan" is a remarkable instance of strong influences of culture and religion in Iranian people's behaviors and habits. Studies have reported different results in the rate of incidence, hospitalizations, time pattern and risk factors affecting stroke during fasting. This study was conducted with the aim of determining the incidence and factors related to stroke in the month before, during and after fasting in Yasuj, Iran.  This retrospective cross-sectional study was conducted on stroke patients referred to Yasuj hospitals, Iran from January 2018 to December 2020 (Shaban, Ramadan and Shawwal 1443 AH). Complete medical records of 40 stroke patients with inpatient records were used. Stroke cases were separated by month, based on age, gender and other risk factors, as well as the time of incidence of stroke. Data were analyzed using SPSS v.28 software. According to the findings of this study, 23 patients (57.5%) were male and 17 patients (42.5%) were female. The number of hospitalized patients with stroke in the months of Shaban, Ramadan and Shawwal were 12, 12 and 13 respectively. No significant correlation was observed in terms of the incidence of stroke during the month of Ramadan and other two months. In addition, there was no any significant difference between different months in terms of the studied variables (stroke history, cardiovascular diseases, hypertension, hyperlipidemia, and smoking).  This study indicated that fasting in Ramadan does not increase the incidence of stroke. Proper medical advice can significantly prevent strokes during Ramadan.

Context: 

There are several neoadjuvant treatment strategies for HER2-positive breast cancer (BC). Studies have investigated different aspects of these strategies and presented different findings.

 This study aimed at collecting and interpreting economic evaluation studies related to neoadjuvant treatment strategies for HER2-positive BC.

 In this systematic review, PubMed, Web of Science (WOS), ScienceDirect, and Scopus databases were searched without a time limit between May and October 2023. Google Scholar search engine was also used to complete the search process. Two authors independently determined the eligibility of the study. To assess the quality of the studies, the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines were used. Disagreements were resolved by discussion or consultation with a third researcher. As this review is descriptive, numerical data were not extracted for statistical analysis.

 Out of 234 studies found in the first stage, 21 studies from 14 countries were included. The strategies that have been approved by studies include THP (taxol, trastuzumab, pertuzumab), PTD (Pertuzumab in combination with trastuzumab and docetaxel), TH (docetaxel and trastuzumab), T-DM1 (trastuzumab emtansine), and HP (trastuzumab plus pertuzumab).

 The findings of this systematic review show that the reported strategies in the treatment of HER2-positive BC patients are cost-effective in different settings. While the findings of this review provide largely positive results, the characteristics of each strategy should be considered.

Clinical Practice Guidelines (CPGs) can be adapted to local conditions to prevent any resources from being wasted. Adaptation of CPGs implies a systematic view of developed guidelines through maintaining evidence-based principles in order to find the ones most relevant with patients' conditions and its integration with the cultural and regional requirements of the target population and health system facilities. The main purpose of the study was to describe, interpret and compare different frameworks for adaptation of clinical guidelines and proposing a comprehensive framework for Iran.  

This study was based on a review and comparative analysis of adaptation frameworks of CPGs. Initially, all adaptation frameworks were collected by systematic search in the literature. We searched the following electronic databases: PubMed, Scopus, Trip Database, Science Direct, and Google Scholar. Then, based on the stages of the comparative study, frameworks were described, interpreted, juxtaposed, and compared. Finally, a comprehensive framework for the adaptation of clinical guidelines was proposed by consulting a panel of experts.  

Our literature search resulted in 26 frameworks, of which 18 were potentially relevant. Based on inclusion/exclusion criteria, nine frameworks were included in the study and have been described, interpreted, and compared. The proposed comprehensive framework for the adaptation of clinical guidelines consists of ten main steps.  

The proposed comprehensive framework is an appropriate tool for the adaptation of clinical guidelines in Iran that can be used in other countries. However, further validation of the framework requires case studies and expert consultation to determine its application to the adaptation of clinical guidelines.

Enhanced external counterpulsation (EECP) is believed to be a non-invasive treatment for coronary artery disease and angina. The aim of this study was to determine the safety and effectiveness of EECP in refractory angina patients through a systematic reviews and meta-analysis. We conducted a comprehensive search of the literature published on PubMed, Cochrane library, Scopus, ScienceDirect, Trip Database and Google Scholar databases using appropriate keywords and specific strategy with no time limit. Having selected and screened the studies based on the defined inclusion and exclusion criteria and evaluating their quality based on the Cochrane checklist. For the meta-analysis,the Mantel-Haenszel method or the generic Inverse Variance was used. Analyses were done with Review Manager 5.2 software. A number of 299 studies were initially reviewed and finally, seventeen studies were included in the meta-analysis based on the inclusion and exclusion criteria. Also, thirteen outcomes were analyzed and the results of meta-analysis in twelve outcomes including (Systolic Blood Pressure (7 studies), Diastolic Blood Pressure (7 studies), Pulse Pressure (4 studies), Mean Arterial Pressures (4 studies), Heart Rate (6 studies), Angina episodes (7 studies), Walking distance (2 studies),Canadian Cardiovascular Society classification (6 studies), Flow-Mediated Dilation (3 studies), Daily Nitrate Usage (4 studies), Exercise Treadmill Test-Time (2 studies), ST-segment depression (2 studies)demonstrated a significant clinical advantage in the EECP treatment effectiveness in patients with angina. No significant difference was observed regarding EECP usefulness (P = 0.18) in the outcome of brachial artery diameter (2 studies). Based on the meta-analysis, the results indicate the safety and effectiveness of EECP in patients with angina pectoris and indicate the usefulness of this treatment in these patients. In general, the authors believe that the general conclusion in this regard requires some studies with a large sample size and a control group assignment.

 Carpal tunnel syndrome (CTS) is the most common type of peripheral entrapment neuropathy that occurs in the wrist area in a space called the carpal tunnel. Low-level laser therapy (LLLT) and ultrasound are among the most common methods of physical modalities for treating CTS; the effectiveness of these two methods and superiority of one over the other is not agreed among experts.

 In present systematic review and meta-analysis study, the most important databases including PubMed, Cochrane Library, Scopus, Centre for Reviews and Dissemination, Science Direct, Trip Medical Database, and Google Scholar were searched using appropriate keywords and specific strategies without time limitation to collect data. The collected data was analyzed using meta-analytic method and random effects model. The heterogeneity among studies was examined using I2. The data was analyzed using Review Manager Software.

 From among 108 related studies, 49 cases were entered in the first stage. After the final examination, 6 studies were selected for meta-analysis. The total number of patients in these six studies was 403; 204 subjects were in the LLLT group and 199 subjects were in the ultrasound group. The results of meta-analyses showed that there was no significant difference between these two therapeutic methods in terms of pain relief, symptom severity scale (SSS), functional status scale (FSS), motor latency, sensory latency, handgrip strength, and motor amplitude.

 Based on meta-analyses, there was no significant difference between two LLLT and ultrasound methods; in other words, they had similar effectiveness in improving the condition of patients with CTS. However, the authors believed that arriving at conclusions in this area requires high-quality and large size studies.

Context: Breast cancer is the second most common type of cancer worldwide and the most frequent one among women. Some studies suggest a favorable role of antioxidants on breast cancer, but this is still controversial.
The main objective of this article was to determine the safety and efficacy of antioxidant supplements on breast cancer.
Data Sources: In order to gather evidence, main databases (MEDLINE, PubMed, Cochrane Library, Science Direct, Trip, Google Scholar, Institute of Scientific Information (ISI), SCOPUS, and EMBASE) as well as relevant websites were searched without time limit up to November 2016. We searched with appropriate keywords and strategies. After the quality assessment of studies, study data were extracted by 2 reviewers. Because all the outcomes were dichotomous, relative risk by using the fixed-effects model proposed by Mantel-Hanzel was used in the meta-analysis. I² values were used for the evaluation of heterogeneity. Analyses were conducted, using review manager and CMA Software.
Out of 825 studies, 652 studies were entered firstly and 14 RCTs were selected after the final review. There was not significant difference between Antioxidant and Placebo group in breast cancer incidence (P = 0.88), quality of life (P = 0.79), daily hot-flash score (P = 0.87) and toxicity such as nausea-vomiting (P = 0.87), diarrhea (P = 0.17), constipation (P = 0.35), fatigue (P = 0.14), alopecia (P = 0.22), anemia (P = 0.67), headaches (P = 0.73), leukopenia (P = 0.2), and Neutropenia (P = 0.08).
The results of our meta-analysis do not support the effectiveness of antioxidants in reducing the risk of breast cancer. Also, this study showed that there is no sufficient clinical evidence to support the effectiveness of these supplements during the treatment of patients with breast cancer. It is recommended that clinician do not emphasize on these supplements in breast cancer treatment.

The elderly population following the improvement in health status and life expectancy in developing countries is increasing. Malnutrition causes decreased quality of life and increased mortality in elderly. This study aimed to review systematically and meta-analysis of studies assessing the prevalence of malnutrition among Iranian elderly people over 60 yr of age using Mini Nutritional Assessment (MNA).
This systematic review and meta-analysis was conducted in 2016 to estimate the overall malnutrition prevalence. Data were collected using the following keywords: prevalence, elderly, aging, malnutrition, nutrition, nutritional assessment, nutritional status, health status, mini nutritional assessment, MNA and Iran in PubMed, Scopus, Google Scholar, Iranmedex, Magiran, and SID. Computer software CMA: Two were applied to estimate the overall prevalence of malnutrition.
Seventeen of 811 articles were included in our analyses. The overall estimated prevalence of malnutrition among elderly based on the random effect model was 12.2% (95% CI 8-18.5). In subgroups, the prevalence of malnutrition among elderly living in home based on the fixed effect model was 9.2% (95% CI 7.1-11.9) and prevalence of malnutrition among elderly residents of nursing homes based on the random effect model was 21.6% (95% CI 12-38.6).
Given the increase in the elderly population in future and the prevalence rate of malnutrition among them as well as the higher prevalence of malnutrition in elderly care centers, more attention to this population group is a matter of necessity.

The role of scrub in the prevention of post-surgery infections is well-known. This study aimed to investigate the inputs and process of surgical scrub in operating rooms of the largest heart hospital of northwest Iran.
This study took place with a before-after design as a clinical audit in 2014. A check list developed based on national and international standards of surgical hand scrub was used as the study instrument. Checklists were completed by observation of surgical team scrubbing in real situation. Descriptive statistics and graphs were used to describe the results.
A compliance degree with the standards for prerequisites, equipment, general items, process and time of scrub was observed as 58%, 55%, 33%, 68% and 22%, respectively. The compliance degree after the intervention was 72%, 66%, 66%, 85% and 61%, respectively. Improvement was observed in all studied aspects of scrub. The total score of compliance with the standards changed from 47% to 70%. The main issues were incorrect order of scrubbing the areas of the hands, incorrect way of scrubbing the arms, insufficient scrubbing the arms (not above elbow), and lack of awareness about hospital’s policy on scrub time.
The results showed defects in the surgical scrub of the studied hospital and that the compliance with the standards can be improved by simple interventions. Periodical audit and observation of the scrub and then feedback is recommended.

Low Level Laser Therapy was introduced as an alternative non-invasive treatment for osteoarthritis, but its effectiveness is still controversial. The main objective of this article was to determine the safety and efficacy of LLLT in patients with knee osteoarthritis. In order to gather evidence, main medical databases as well as relevant websites were browsed without time limit. We searched with appropriate keywords and strategies. After quality assessment of studies, study data were extracted by two reviewers. Standard mean difference proposed through Inverse Variance was used in the meta-analysis using the random-effects model. Twelve values were used for the evaluation of heterogeneity. A total of 823 studies, 14 RCTs were selected after final review. There was a significant difference between LLLT and Placebo in pain at rest (p=0.02), pain at activity (p=0.01), total pain (p=0.03), WOMAC function (p=0.01), WOMAC stiffness (p=0.02) and WOMAC total (p

During the last decade, the rapid expansion of universal neonatal hearing screening (UNHS) has brought into focus questions about the most appropriate screening technology for this indication.
The main aim of this study was to examine the cost-effectiveness of automated auditory brainstem response (AABR) and otoacoustic emissions (OAE) in universal neonatal hearing screening programs.
This economic study was performed in Iran. A decision tree model was applied for economic evaluation of the AABR and OAE devices used in UNHS. The main inputs of our model included the prevalence of hearing loss in Iran, device sensitivity, specificity and cost per case, as well as definite diagnosis of each newborn. Upon collection, these inputs were analyzed with TreeAge economic analysis software. Sensitivity analysis was conducted upon examining the probability of uncertainty concerning the inputs.
For a one-year period and a one-million population of newborns, the UNHS entails a cost of $3,310,700 and detects 4,650 newborns with hearing loss, using the AABR device. However, if the OAE device is used, the cost will be expanded to $3,414,100 and 3,850 newborns with hearing loss will be detected. Consequently, the AABR device costs $103,400 less than the OAE device, and detects 800 more cases than the OAE device. Sensitivity analysis results revealed that the prevalence rate or costs of the gold standard had no effect on displacing the dominant technology.
In this study, it was found that the AABR is the cost-effective alternative compared to OAE. AABR dominates OAE, because it has lower expected costs and higher effectiveness.

Context: Metformin has been used for diabetic patients. This medicine might decrease the risk of breast cancer. The main objective of this article was to determine the breast cancer risk in diabetic patients and its association with metformin and sulfonylurea.
Evidence Acquisition: In order to gather evidences, main databases [MEDLINE, PubMed, Cochrane library, Science Direct, Trip, Google Scholar, Institute of Scientific Information (ISI), SCOPUS and EMBASE] as well as relevant websites have searched without time limitation up to June 2015. We have searched with appropriate keywords and strategies. After quality assessment of studies, consequences of risk and mortality for breast cancer have extracted. RevMan and comprehensive meta-analysis software has used, if needed, for meta-analysis.
A total of 423 studies, 352 studies have entered firstly and 11 studies have selected after final review. According to the significance of heterogeneity (I2 = 94%) in these studies, meta-analysis have scrutinized by step by step removing the studies to investigate the reason of heterogeneity. So the relative risk of breast cancer was significant in favor of metformin (RR: 0.63, 95% CI (0.56 - 0.70), Pv In this study, we have concluded that the incidence of breast cancer in patients with type 2 diabetes who have used metformin might be less than who have used sulfonylurea. However, this finding should consider carefully and needed to be confirmed with further studies.

Discharges against medical advice (DAMA) is a common problem of hospitals that could lead increasing the complications and readmission. For this, the aim of this study is to investigate the frequency and effective factors of DAMA in patients with cardiovascular disease in hospital cardiac care units (CCU) of East Azerbaijan, Iran.
This cross-sectional study was performed, in 2013, in Tabriz University of Medical Sciences, Iran. Required information was extracted using valid and reliable forms of medical records of 2000 patients admitted to 20 CCU in 17 hospitals of East Azerbaijan, by two trained interviewers. Data analysis was performed using descriptive statistics (frequency, mean, percentage, etc.), chi-square test, and linear regression model using the SPSS software. The tests were considered a statistically significant level of 0.05%.
The results showed that 272 patients (13.6%) were DAMA from the hospital. The frequency of DAMA was in men more than women. The most frequency of discharge has occurred in the range of 40-80 years old. Results of linear regression showed that there was a significant correlation between DAMA and type of insurance, history of myocardial infarction (MI), comorbid disease, cause of hospitalization, location of hospital, and staying In this study, the rate of DAMA was relatively high compared with similar studies and it is considered as a concern problem that should study the reasons and its effective factors and plan effective interventions to reduce them.