maryam seyed-nezhad

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.

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.

Referral system is one of the principles and foundations of primary health care services. One of the most important challenges and problems of the referral system is the lack of public awareness of its nature, services and benefits. The aim of this study was to provide a model for accepting the referral system from the perspective of patients.

This study was a mixed method that was conducted in three steps in 1400. The first step included the development of a questionnaire, the second step was a survey study, and the third step was the design of the acceptance model of the referral system from the perspective of patients. The statistical population included 384 patients covered by the Rural Insurance Fund referring to the Imam Khomeini Hospital Complex. The data were analyzed using SPSS v20 software. Also, Second-order Confirmatory Factor Analysis (S-CFA) was performed using LISREL v8.5 software.

Cronbach's alpha ratio for the whole questionnaire was 0.85 and intra-cluster correlation coefficient was 0.69. The results of confirmatory factor analysis showed that patient-centeredness, rules and regulations, responsiveness, coordination, security, accessibility, effectiveness, efficiency, personal beliefs and social influence significantly affected the acceptance of the referral system from patients' perspectives.

It is necessary for managers and policy makers before and during the implementation of the referral system to consider the factors affecting the acceptance of the referral system from the perspective of patients. For the appropriate implementation of the referral system, special attention should be paid to all the influencing factors so that patients can easy and convenient access health services anywhere and anytime.

Clinical Practice Guidelines (CPGs), are "recommendations intended to optimize patient care based on systematic reviews of available evidence and assessment of the benefits and harms of alternative care options". CPGs play an important role in improving the quality of care, reducing the diversity of treatment methods, reducing medical errors, managing health costs and increasing patient safety. This study was conducted with the aim of analyzing the decisions, consequences and policy trends of using CPGs in Iran during the period 2001-2021.

This study was a type of health policy analysis, carried out using analysis of the policy process approach. Data were collected through reviewing policy documents (n=79) and qualitative interviews (n=27). Analysis of policy documents was done using the content analysis method, the software used being Excel software, while for analysis of the interviews the framework analysis method was used, the software being the MAXQDA10 software.

The policy of using CPGs in Iran started in 2001 and has improved over the past two decades. During the period 2016-2021 a total of 836 CPGs (knowledge products) were published, but according to the participants, many of these CPGs or knowledge products did not have the necessary quality and were not used by physicians. The findings of this study also showed that in Iran there is a suitable atmosphere for implementing CPGs and the policies of using them are sound policies; however, there is a huge gap between the development and implementation of CPGs.

Although the process of applying CPGs has improved in Iran, their implementation faces challenges and, thus, they have not been fully implemented. Therefore, there is a need to adopt new standard methods and approaches to improve the quality and reliability of CPGs. Certainly, the support of the government, Ministry of Health and Medical Education, the medical community, insurance organizations and other stakeholders, along with proper collaboration and appropriate policy formulations, are essential to achieve success.

Referral system is one of the principles and foundations of primary health care services. One of the most important challenges and problems of the referral system is the lack of knowledge of people and patients of its nature, services and benefits. The purpose of this study was to identify the factors affecting the acceptance of the referral system by patients.

This was a qualitative study conducted in 2021 using the framework (structural) analysis method. The participants were 18 experts in the field of referral system and 14 patients referred to the outpatient and inpatient wards of Imam Khomeini Hospital Complex in Tehran selected by purposive sampling. Data were collected by Semi-structured interviews and analyzed using the MAXQDA.

Factors influencing the acceptance of the referral system by patients were found to be the following: (1). Factors related to the stewardship and governance of the health system (responsibility and accountability, appropriate levels of health services, patient-centered care, and rules and regulations); (2). Factors related to the health services access (financial, physical and cultural); (3). Factors related to service providers (trusting healthcare staff, professional skills of service providers, and their behavioral and communication skills); (4). Factors related to the service delivery process (quality of service delivery, attention to patients' wants and needs, use of technology in service delivery, monitoring service delivery, and service coverage); (5). factors related to the recipients of the services (satisfaction, education, awareness and communication).

Considering the importance and key role of patients in the success of the referral system, health planners and policy makers should pay special attention to the factors identified in this study.

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.

The design of a benefit package is a key tool for directing health systems to the universal health coverage. Deciding on service prioritization takes into account information on cost-effectiveness, the impact of financial protection, and equity in access to services. To this end, health technology assessment (HTA), which has legal backing and evidence-based protocols, can be used. Therefore, this study aimed to determine the role of health technology assessment in the package of designing.

This review study has been used to collect and analyze the available evidence. The search was conducted to identify related studies in the electronic database (Cochrane Library, Scopus, PubMed, Trip and Google Scholar) without any time limit and by August 2018 with proper keywords and strategies for each database.

Out of the 132 articles studied, only 2 studies were selected according to inclusion and exclusion criteria. These two studies describe the experience of Thailand and the Netherlands in the role and application of health technology assessment in determining the benefits package. The Thai study describes the hierarchy and sequence of how to determine the choice of services to be included in the benefits package, and in the Dutch study, it refers to the policy and implementation levels and the infrastructure needed to establish a health technology assessment system to determine the benefits package.

Given the advancement of technologies (drugs, equipment, and diagnostic tests), cost growth and the lack of resources in the health system, it is suggested to select a benefit package focusing on health technology assessment studies. HTA is useful for informing health system decision makers about package coverage because it increases transparency, participation and accountability in the process. Accordingly, a 5-step model is recommended to determine the benefits package.

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.

Parents do not have the sufficient perception of the care their suffered children receive. This study aimed to investigate the relationship between barriers to care with parents’ perceptions of primary care and quality of life in thalassemia major children in Kerman, Iran.

The study was Descriptive-analytical and Cross sectional study. It was conducted in 2015. The sample included 150 children aged 6 to 15 years with thalassemia major and either of their parents. Data were collected using 3 standardized questionnaires: barriers to care questionnaire (BCQ), parents’ perceptions of primary care (P3C), and the pediatric health related quality of life (PedsQL). To determine the association between demographic characteristics and barriers to care, the t-test and ANOVA were used. Correlation coefficient was used to determine the relationship between barriers to care and parents’ perceptions of primary care and health-related quality of life (HRQoL).

The mean and SD of BCQ was 63.93 (out of 100) and ±9.08, and the mean and SD for parent's perceptions of primary care (P3C) was 51.12 (out of 100) and±17.98. The mean score and SD of HRQoL reported by the children and their parents were (41.01 and ±22.38) and (40.63 and ±21.04), respectively. Perceived barriers to care was significantly related to the parents' perceptions of primary care (P<0.0001), HRQoL reported by children (P=0.021) and quality of life reported by parents(P= 0.020).

This study could provide important information for policy makers, managers, doctors, nurses and other health care team members and help them to develop and implement effective interventions to support children with chronic diseases and their families