Towards greater impact in health technology assessment: System dynamic approach for new and emerging technologies in Iran

PURPOSE

As classical health technology assessment models fail to predict the complexities of related impacts, the application of modeling techniques such as systems dynamics simulation (SD) is essential. This study aimed to develop an SD model to predict the outcomes of access to a new medicine in Iran.

METHODS

This study extracted the important and influential variables in providing access to new pharmaceutical technologies by comprehensively reviewing previous research and combining the technical knowledge of experts in this field. The variables were incorporated into the systems thinking framework and modeled using dynamic systems tools, followed by simulation and testing in VENSIM. The model was piloted for deferoxamine and deferasirox in thalassemia. Various tests were used to evaluate the validity and reliability of the model. The model was designed for a ten-year horizon (2018-2028) for medicines selected as the pilot.

RESULTS

The variables extracted from the panel of experts encompassed the primary and short-term impacts of access to newly emerged medicine and long-term impacts regarding the economy, health, and society. After modeling, the leverage points presented for the problem with the greatest impact or effectiveness in access to new medicine included the policy determining the amount of medicine supply, the import and production of medicine, the prevalence and incidence of disease, insurance coverage, and treatment adherence.

CONCLUSION

The SD models allow the researchers to evaluate the efficiency and health outcomes of a new pharmaceutical more precisely in the health system in Iran.

Terrorist attacks in Iran: A counter-terrorism medicine analysis

INTRODUCTION

Terrorism is a combined phenomenon, the concept of which is strongly affected by the spatial and temporal situation. Terrorist attacks can affect the demand for and delivery of healthcare services and often put a unique burden on the first responders, hospitals, and health systems. This study provides an epidemiological description of all -terrorist-related attacks in Iran from 1979 to 2020.

METHODS

Data were collected using a retrospective search through Global Terrorism Database (GTD). GTD was searched using internal database search functions for all incidents that occurred in Iran from January 1, 1979, to December 31, 2020. The target type, attack type, primary weapon type, perpetrator group, country where the incident occurred, and the number of fatalities and injuries were collected, and the results were analyzed.

RESULTS

In total, 543 terrorist attacks were identified in the study period, which resulted in the fatality of 1,150 people and the injury of 3,792 people. It indicates 2.12 fatalities and 7,009 injuries per incident. Explosives were used in 301 attacks (55.63 percent), followed by incendiary weapons in 177 attacks (32.71 percent). The most significant types of attacks are bombings in 290 attacks (52.3 percent), followed by assassination in 99 attacks (17.9 percent), and armed assaults in 81 attacks (14.6 percent).

CONCLUSION

Due to a decreasing trend of terrorist incidents in Iran, we can state that national security and stability have improved in Iran. However, the development of security promotion policies and passive defense approaches can help prevent the occurrence of such incidents.

Emergency medical services preparedness in mass casualty incidents: A systematic review

OBJECTIVE

The role of emergency medical services (EMS) preparedness in mass casualty incidents (MCIs) is crucial. MCIs are increasing worldwide, and EMS must enhance preparedness for them. For this purpose, the main components of EMS preparedness should be identified. This study aimed to describe the components of EMS preparedness in response to MCIs.

DESIGN AND SETTING

This systematic review was conducted based on the Preferred Reporting Item for Systematic Reviews and Meta-analyses guideline. The articles published from January 1970 to February 2022 were searched to discover the main components of EMS preparedness in MCIs. The electronic databases including PubMed, Cochrane Library, Scopus, Science Direct, and ProQuest were searched using predetermined keywords. Ten articles were selected and included in this review.

RESULTS

After reviewing the articles, we identified the components of EMS preparedness in MCIs. Accordingly, 16 main components were extracted and classified into four categories, ie, individual improvement, group improvement, resources, and operations.

CONCLUSION

MCIs are so complicated that they require adequate prehospital preparedness. This study described the components of EMS preparedness in MCIs. The authorities in EMS will benefit from this framework in planning and responding to MCIs.

Comparing the Clinical Effectiveness of Telerehabilitation with Traditional Speech and Language Rehabilitation in Children with Hearing Disabilities: A Systematic Review

Introduction: The use of telerehabilitation for the treatment of speech and language disorders in the field of hearing is increasing. A comprehensive study comparing telerehabilitation's effectiveness with traditional rehabilitation can help us understand it better. Therefore, this systematic review aimed to compare the effectiveness of telerehabilitation with traditional rehabilitation for speech and language disorders in children with hearing disabilities in 2023. Methods: A systematic search was conducted in PubMed, PubMed Central, Cochrane, Scopus, Google Scholar, Science Direct, and the Web of Science from 2000 to February 28, 2023. The articles were selected based on keywords, determined criteria, and reviewed in terms of title, abstract, and full text. Finally, articles that were relevant to our aim were evaluated. Results: The initial search resulted in the extraction of 1,788 articles. After reviewing the articles and applying the inclusion and exclusion criteria, nine articles were selected for analysis. Four (44.44%) and 3 (33.33%) studies were case-control and quasi-experimental studies, respectively. Four (44.44%) studies were conducted in the United States. SPSS, Preschool Language Scales, fifth edition (PLS-5), and microphone were the most common tools, each of which included 4 (44.44%), 3 (33.33%), and (333.33%) studies. Conclusions: Traditional rehabilitation and telerehabilitation can effectively improve the speech and language skills of children with hearing disabilities. However, it is always suggested to use traditional rehabilitation first to achieve better results.

Factors disrupting the continuity of care for patients with chronic disease during the pandemics: A systematic review

Background and Aims

Continuous routine care is necessary to prevent long-term complications of chronic diseases and improve patients' health conditions. This review study was conducted to determine the factors disrupting continuity of care for patients with chronic diseases during the pandemic.

Methods

All original articles published on factors disrupting continuity of care for patients with chronic disease during a pandemic between December 2019 and June 28, 2023, in PubMed, Web of Science, Scopus, and ProQuest databases were searched. Selection of articles, data extraction, and qualitative evaluation of articles (through STROBE and COREQ checklist) were done by two researchers separately. Data graphing form was used to extract the data of each study and then the data were classified by thematic analysis method.

Results

Out of 1708 articles reviewed from the databases, 22 were included. The factors disrupting the continuity of care for patients with chronic diseases during the epidemics were classified into two main categories: patient-side factors and health system-side factors. Patient-side factors including psychological, individual and social, disease-related, and health system-side factors including provider access, health system institutional, and infrastructural and financial problems were among the subcategories disrupting the continuity of care for patients with chronic diseases during the pandemic. Based on the studies, psychological factors and access to the provider were among the most frequent factors affecting the continuity of care for patients with chronic diseases in the pandemic.

Conclusion

Considering the factors disrupting the continuity of care and applying appropriate interventions based on them, can guarantee the continuity of providing services to chronic patients in health crises.

Disasters in pediatric dentistry: a systematic review

BACKGROUND

Disasters can harm many people, especially children, in unpredictable and public ways. One of the neglected aspects of children's health in disasters is oral and dental hygiene, which can affect their physical and mental well-being. This systematic review explores how dentistry can help children in disasters, focusing on two aspects: providing oral health care and identifying disaster victims.

METHODS

A thorough search of databases, such as PubMed, Cochrane Library, Scopus, Embase, ProQuest, and Web of Science, was done to find English-language publications from 1930 to August 31, 2023. The screening, data collection, and quality assessment followed the PRISMA guidelines.

RESULTS

Out of 37,795 articles found in the databases, seven research articles were chosen. Five articles were retrospective, and two articles were prospective. The results showed that dentistry for children is very important in disasters by giving information about the oral and dental problems and identifying the victims. The results also showed some of the challenges and difficulties in giving dental care for children in disaster situations, such as changing control, referral systems, and parental fear of infection.

CONCLUSION

Dentistry for children can improve the health and well-being of children affected by disasters.

Application of Telemedicine in the Ambulance for Stroke Patients: A Systematic Review

INTRODUCTION

The use of telemedicine for the prehospital management of emergency conditions, especially stroke, is increasing day by day. Few studies have investigated the applications of telemedicine in Emergency Medical Services (EMS). A comprehensive study of the applications of this technology in stroke patients in ambulances can help to build a better understanding. Therefore, this systematic review was conducted to investigate the use of telemedicine in ambulances for stroke patients in 2023.

METHODS

A systematic search was conducted in PubMed, Cochrane, Scopus, ProQuest, Science Direct, and Web of Science from 2013 through March 1, 2023. The authors selected the articles based on keywords and criteria and reviewed them in terms of title, abstract, and full text. Finally, the articles that were related to the study aim were evaluated.

RESULTS

The initial search resulted in the extraction of 2,795 articles. After review of the articles, and applying the inclusion and exclusion criteria, seven articles were selected for the final analysis. Three (42.85%) studies were on the feasibility and intervention types. Also, randomized trials, feasibility, feasibility and prospective-observational, and feasibility and retrospective-interventional studies were each one (14.28%). Six (85.71%) of the studies were conducted in the United States. The National Institutes of Health Stroke Scale (NIHSS) and RP-Xpress were the most commonly used tools for neurological evaluations and teleconsultations.

CONCLUSION

Remote prehospital consultations, triage, and sending patient data before they go to the emergency department can be provided through telemedicine in ambulances. Neurological evaluations via telemedicine are reliable and accurate, and they are almost equal to in-person evaluations by a neurologist.

Investigating the quality of Iranian hospitals' websites and their association to the Province's share of medical tourism

BACKGROUND

Nowadays, virtual methods are among the most important and influential marketing instruments in various industries, such as medical tourism. This study aims to investigate the quality of Iranian hospitals' web pages and their association with the province's share of the medical tourism industry in Iran and the ownership type of hospitals.

METHODS

In this analytical cross-sectional study, the quality of hospitals' websites was investigated through a 36-item self-administered questionnaire which was validated, and its reliability was verified (Cronbach's alpha = 74%.). The questionnaire was categorized into three sections: hospital services and facilities, hospital's medical tourism-related services, and tourism information of the destination province. The census method was used for data collection. Data analysis was performed using the independent t-test and analysis of variance in SPSS software (version 25), and a P-value < 0.05 was considered statistically significant.

RESULTS

A total of, 102 hospitals with an IPD (International Patients Department) were included in the study, and 21.6% did not have an English-language page and were excluded from the study. The mean total score was 47 ± 7.5, indicating low-quality content. Public hospitals had lower quality scores than semi-private and private hospitals. The total quality score, information about the hospital and its services, and the score of information about medical tourism-related services were associated with the province's share of national medical tourism.

CONCLUSION

According to the obtained results and the possible role of website quality in increasing provinces' medical tourism development, the IPD page on hospital websites should be revised and regularly updated to make them more informative for prospective medical tourists.

Factors affecting the preparedness of Helicopter Emergency Medical Services (HEMS) in disasters: a systematic review

BACKGROUND

One of the most significant advantages of Helicopter Emergency Medical Service (HEMS) in disaster relief efforts is their ability to reach inaccessible or remote areas quickly. This is especially important in the aftermath of natural disasters such as earthquakes, floods, or hurricanes, where roads may be blocked or damaged, and conventional ground transportation may not be available. There are many factors can affect the performance of Helicopter Emergency Medical Service (HEMS) in disasters. This study aims to investigate the factors affecting the Helicopter Emergency Medical Service (HEMS) in disasters.

METHODS

The systematic search in Cochran Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest, and Google Scholar databases between the first of January in 1975 and the thirty-first of May in 2023. The articles were selected based on the keywords of the authors. At last, the criteria were extracted from the selected ones.

RESULTS

The primary search included 839 articles. After studying their title, abstract, and full context, only nine articles, including two qualitative and seven quantitative ones, were chosen for analysis. After analysis and extracting data from the final studies, the preparation factors were categorized into 6 general classes of human resources: training and practicing, management, instructions and standards, equipment, and structure. Among these, the role of training is highlighted by holding practice and maneuvers to improve and prepare the personnel and manage disasters and incidents.

CONCLUSION

The results obtained from this systematic review provide a total view of the factors affecting the preparation of the air ambulance during disasters and incidents. It is recommended that senior managers and policy makers use the findings of the present study to identify the factors which affect preparedness of HEMS in disasters and take the necessary measures to eliminate to obstacles.

Preparedness of Iranian nurses against COVID-19: An analytical study

Background and Aims

The reasons for the unfavorable performance of hospitals in providing care to Coronavirus Disease 2019 (COVID-19) patients include the lack of preparation, knowledge, and relevant skills, making it necessary to evaluate the preparedness of nurses to respond to COVID-19. Therefore, the present study aimed to investigate the preparedness of hospitals affiliated with Shahrekord University of Medical Sciences during the COVID-19 pandemic in 2022.

Methods

In this analytical study, data were collected from 350 randomly selected nurses who worked in three hospitals affiliated with Shahrekord University of Medical Sciences; demographic information tools and the preparation of nurses for COVID-19 patients were used to collect the data. We analyzed the data using SPSS software version 26.

Results

The mean and standard deviation of the total preparation score was 118.85 ± 0.98. The lowest (6.80 ± 0.18) and highest (23.35 ± 0.19) average values belonged to risk assessment and management and COVID-19, respectively. The score of nurses' preparedness to deal with COVID-19 was not statistically correlated with age, work experience, and so on. The average preparation score was significantly different in different treatment departments (operating room and COVID-19).

Conclusion

The preparation of nurses was low in dealing with COVID-19. Thus, managers of nursing services should design and implement educational programs to strengthen the nurses' weaknesses and ultimately increase their awareness and skills in dealing with disasters.

Pregnancy in Wartime: An Opportunity for Making Peace through Health

The Article Abstract is not available.    

Emergency medical services preparedness in mass casualty incidents: A qualitative study

Background and Aims

The effective response of emergency medical services in mass casualty incidents (MCIs) calls for sufficient preparation. The components of preparation must be determined first to achieve this goal. This study aimed to describe the elements of preparedness of emergency medical services for MCIs.

Methods

A qualitative study was carried out on emergency medical service systems in Iran (from April 2022 to mid-March 2023), using in-depth semistructured interviews with participants who were managers and members of the incident command team, experts, technicians, paramedics, and telecommunicators of emergency medical services. Interviews were carried out face-to-face and via telephone. The data were collected using voice recorder and transcript and analyzed by content analysis method. This study was conducted using the consolidated criteria for reporting qualitative research.

Results

Thirty-six participants were included in the study. A total of 834 codes were analyzed. Thirteen components were extracted from the study and classified as five categories including "Strengthening management and organization," "individual and group empowerment," "capacity expansion," "technology and infrastructure development," and "operational response measures."

Conclusion

Emergency medical service preparedness in response to MCIs is a critical issue. For improving preparedness, the main components must be identified. The study results described the elements of emergency medical service preparedness, which could be used as a framework for developing the national model of emergency medical service preparedness in MCIs.

Knowledge and attitude of students of medical sciences universities regarding health tourism: A cross-sectional study

Background and Aims

Health tourism is already one of the most important sources of revenue for many countries all over the world, but it appears that it has not progressed as much in Iran. The aim of this study was to determine the knowledge and attitudes of students of Iranian medical sciences universities about this subject, which could have a great impact on the future of this industry in Iran.

Methods

In this cross-sectional study, the students of medical sciences universities in Iran were selected through convenience sampling; they filled out an online 36-item self-administrated questionnaire. The data were analyzed using SPSS software (version 25). Descriptive statistics of knowledge and attitude were provided. Also, independent samples t-test and analysis of variance were used as statistical tests and p value <0.05 was considered as the significant level.

Results

Overall, 390 students with a mean age of 24 ± 1.5 years and a female-to-male ratio of 1.9 participated in this study. The respondents answered 38% of the questions correctly in the knowledge section. Age, ethnicity, education level, job experience, experience of a health tourism-related job, participation in health tourism courses, and geographical region of the province of residence showed a significant association with the participants' knowledge. Also, most participants had an almost positive attitude regarding the potential for development of the industry.

Conclusion

According to the results obtained, the students' knowledge about health tourism was not desirable; however, their attitudes were almost positive. Therefore, educational interventions are highly recommended to be conducted in this regard.

Self-help application for obsessive-compulsive disorder based on exposure and response prevention technique with prototype design and usability evaluation: A cross-sectional study

Background and Aims

Obsessive-compulsive disorder (OCD) is a relatively common disorder that, due to its debilitating nature, significantly affects personal abilities, job performance, social adjustment, and interpersonal relationships. There are significant barriers to accessing evidence-based cognitive-behavioral therapy as a first-line treatment for obsessive-compulsive disorder. Mobile health applications (Apps) offer a promising way to improve access to evidence-based therapies while overcoming these barriers. The present study was to design and evaluate a prototype of a self-help application for people with OCD (the most common pattern of OCD) based on the exposure and response prevention (ERP) technique.

Methods

This work was developed in four different phases. (1) Needs assessment: a thorough literature review, reviewing existing related programs and apps, and interviewing patients and psychiatrists; (2) Creating a paper prototype: considering the functional features identified in the previous phase using wireframe sketcher software. (3) Creating a digital prototype: developing an actual prototype using Axure RP software based on the information obtained from an expert panel's evaluation of the paper prototype. (4) Prototype usability evaluation: through a heuristic evaluation with experts and usability testing with patients using the SUS questionnaire.

Results

After requirement analysis, requirements were defined in the areas of information and educational elements, and functional capabilities. Prototypes designed based on identified requirements include capabilities such as in-app online self-help groups, assessing the severity of the symptoms of the disorder, psychological training, supportive treatment strategies, setting personalized treatment plans, tracking treatment progress through weekly reports provided, anxiety assessment, and setting reminders.

Conclusion

The results of the heuristic evaluation with experts made it possible to identify how to provide information and implement the capabilities in a way that is more appropriate and easier for the user.

Strategies for maintaining and strengthening the health care workers during epidemics: a scoping review

INTRODUCTION

During epidemics such as COVID-19, healthcare workers (HCWs) face several challenges, leading to a shortage and weakening of human resources. To address this issue, employing effective strategies is essential in maintaining and strengthening human resources during outbreaks. This study aimed to gather and classify strategies that could retain and strengthen human health resources during epidemics.

METHODS

In this scoping review, all studies published about strategies for maintaining and strengthening HCWs in epidemics were collected from 4 international databases, including PubMed, Embase, Scopus, and Web of Science. The English language articles published after 2000 up until June 2022 recommended specific strategies regarding the research question. Then, they were analyzed and classified according to thematic analysis based on Braun and Clarke 6 phases protocols.

RESULTS

In total, 9405 records were screened, of which 59 articles were included, and their full texts were reviewed. Fifty factors were identified and classified into five themes: Instruction, Protection, Supporting, Caring, and Communication. Most of the suggestions were conducted in high-income countries and related to the Supporting theme.

DISCUSSION

The majority of strategies discussed in the literature addressed only one or two aspects of human resources. This study provides a holistic perspective on these issues by providing a thematic map of different strategies for strengthening and maintaining HCWs during epidemics. Considering the multidimensionality of human nature, it is suggested that policymakers and managers of health systems provide facilities that simultaneously address a wide range of needs.

Identifying the components and effective factors in disaster education to improve adolescents' resilience: A thematic analysis

BACKGROUND

Education is considered one of the critical elements of behavioral changes in societies with a high risk of disasters. Meanwhile, the role of adolescents, as the key and the largest group of stakeholders in planning for disaster preparedness and response, has often been neglected. The current study aimed to extract the components and effective factors in disaster education to increase adolescents' resilience in disasters in Iran.

MATERIALS AND METHODS

This qualitative study was done by inductive approach through in-depth semi-structured interviews conducted with 21 key informants and 11 adolescents selected through purposive sampling. To extract the components and factors affecting education to increase adolescents' resilience in disasters, the data were analyzed by thematic analysis.

RESULTS

The effective factors in increasing adolescents' disaster resilience were classified into four categories, namely, social participation, need-based education, scope of influence, and governance perspectives, and 19 subcategories.

CONCLUSION

This study provided an overview and a comprehensive understanding of disaster education to increase adolescents' resilience. Recognizing these factors can help effectively in developing disaster education programs to improve adolescents' resilience against disasters. By encouraging natural hazard habits in this age group, it can also potentially increase the society's resilience in future.

Lifestyle assessment in individuals with spinal cord injuries caused by accidents and disasters in qualitative studies published from 1990 to 2020: A meta-synthesis of qualitative study

Background and Aims

As a debilitating disorder, spinal cord injuries (SCIs) can bring about a range of physical, psychological, and social consequences in individuals and even have effects on their lifestyle indicators. The present study was thus to reflect on lifestyles among people with SCIs developing from accidents and disasters.

Methods

Using a meta-synthesis of qualitative research, all articles recruiting qualitative methods to examine patients with SCIs, published from 1990 to 2020, were retrieved by the researchers, good at the Persian and English languages, from the databases of ScienceDirect, MD Consult, Pedro, ProQuest, PubMed, SID, MedLib, Magiran, Scopus, Google Scholar, Iranmedex, the Cochran Library, CINAHL, and Blackwell, tapping the keywords of "spinal cord injury, SCI, manmade disaster, natural disaster, content analysis, concept analysis, thematic analysis, lifestyle, quality of life, QoL, grounded theory, meta-synthesis, mixed-methods research, historical research, ethnography, and phenomenology" in both languages for their inclusion in this study and further analyses.

Results

With reference to the inclusion criteria, 18 articles were extracted, and after all 10 studies in line with the research topic were reviewed and analyzed. Ultimately, six main themes, namely, compromise, self-reliance, income-generating activities, mental status, inability, and issues of sexuality were extracted, demonstrating their importance to individuals suffering from SCIs.

Conclusion

During the initial stages following SCIs, the abilities to engage in participatory practices and individual's power of decision-making diminish because of physical, social, psychological, and environmental constraints. It was accordingly recommended to have a holistic perspective and respect all aspects of life in individuals with SCIs.

The Effect of L-Arginine Oral Supplementation on the Improvement of Cardiovascular Function and Pulmonary Artery Pressure in Patients with Major and Intermedia β-Thalassemia

Background

Thalassemia is the most common inherited anemia in worldwide. Heart failure is the most common cause of mortality and morbidity in patients with major and intermedia β-thalassemia. This study aimed to evaluate the effect of oral administration of L-arginine on the improvement of systolic Pulmonary Artery Pressure (PAP) and cardiac function in patients with major and intermedia β-thalassemia.

Methods

This randomized clinical trial was done on 88 patients with β-thalassemia admitted to Ali Asghar Hospital, Tehran, Iran between 2020 and 2021. Echocardiography was performed for all the patients before the intervention. Afterwards, the patients were randomly divided into two groups of placebo and L-arginine. The patients underwent echocardiography after eight weeks and were compared with respect to the results.

Results

The mean blood transfusion interval was 20.21 d in the placebo group and 17.14 d in the L-arginine group (P=0.082). The results revealed no significant difference between the two groups regarding the mean levels of Hemoglobin (Hb) and ferritin, frequency of splenectomy. However, the mean PAP significantly decreased from 32.88 to 26.02 in the L-arginine group (P=0.009), but did not change in the placebo group. Nonetheless, no significant change was observed in the mean Ejection Fraction (EF) before and after L-arginine administration.

Conclusion

L-arginine administration prevented the increase of PAP and was effective in preventing cardiovascular disorders including increased systolic PAP in patients with major and intermedia B-thalassemia. However, the results have to be confirmed in further studies with larger sample sizes.

Factors facilitating and inhibiting the social participation of the elderly in health-oriented activities in Shiraz, Southern Iran

BACKGROUND

The social participation (SP) of the elderly is one of the factors that contribute to the improvement of their well-being. SP, one of the most important factors of active ageing, is mainly influenced by a number of facilitating or inhibiting factors.

AIMS

This study aimed to identify the factors that prevent and facilitate the SP of the elderly population in Iran.

METHODS

A cross-sectional study carried out in Shiraz, southern Iran in 2021. Participants were selected using a convenience sampling method. Shiraz is divided into 11 districts and the largest park in each district is selected for data gathering. The questionnaires were completed by 612 people aged over 60. Data were collected using the Canadian Elderly Survey Project scale and a health-related lifestyle questionnaire and were analyzed using t-test, ANOVA, Pearson's correlation, and ANCOVA.

RESULTS

The mean SP score of the elderly in Shiraz was 24.2 out of 60, which is below the midpoint. The results of the covariance analysis revealed that the SP had a significant relationship with the experience of physician consultation, cost barriers, age, marital status, income level, and education level (P < 0.001). Moreover, the results of Pearson correlation revealed a significant correlation between SP and different dimensions of health-oriented activities (< 0.001).

CONCLUSIONS

This study revealed that the main barriers to older people's participation in health-related activities are cost and access barriers, such as transportation issues. Moreover, higher income level and higher educational attainment have been recognized as the main facilitators of SP in the elderly. In this regard, it can be suggested to apply a combination of health promotion strategies, financial support programs, and development of optimal transportation infrastructure to increase the SP of the elderly.

The need to reorganize health research systems in pandemic crisis: A prospective study

Background and Aims

A pandemic has posed a major challenge to health systems all over the world. All countries have realized that the only way to get real growth and development and solve their problems is to use what they have learned from research.

Methods

A descriptive and analytic type of study was conducted with the help of experts in the field of health research. The components affecting the research system were obtained via process approach and content analysis methods, and then the position of each component was identified by the Mic Mac technique.

Results

Seventeen influential structural components in the health research system were identified. The leadership and management components had the most direct and indirect influence among other components. The health promotion component had a greater dependency than the other components.

Conclusion

All health systems need to provide adequate financial resources and manpower to provide a useful research system. Human resources are the most important inputs to such a system. Components such as the research process, research sustainability, quality, or innovation in research can play a balancing role. Having the right infrastructures for creating, transferring, developing, and getting access to knowledge makes it possible to do systematic science. It is hoped that this science will be used in other results of the health research system, like improving the effectiveness or promoting health.

Metaverse: A Modern Approach to Medical Tourism Industry

The Article Abstract is not available.  

Resilient Nurses in the COVID-19 Compared With Non-COVID-19 Wards

INTRODUCTION

Owing to daily exposure to high job stress, nurses need to use coping techniques. One of the coping strategies helping a person to cope with stressful situations effectively is resiliency skills. The aim of this cross-sectional study was to examine the factors related to nurses' resiliency during the coronavirus disease 2019 (COVID-19) epidemic.

METHODS

The resiliency of 288 nurses, 145 nurses from the COVID-19 wards , and 143 nurses from other wards were compared using 25-item Connor & Davidson Resilience Questionnaire. This study was conducted in 2021 in four referral hospitals at Shiraz.

RESULTS

The mean age of participants was 32 y. The average resilience score in the in the participants worked in COVID-19 wards was 95.30 for men and 87.72 for women, and in the non-COVID-19 wards was 85.82 for men and 88.48 for women. The mean resiliency scores of nurses working in COVID-19 and non-COVID-19 wards did not show a statistically significant difference. Factors affecting resilience included age, employment status, gender, and job expectancy.

CONCLUSIONS

In this study, the resiliency of nurses working in COVID-19 wards did not differed from that of working in non-COVID-19 ones. This result should be further investigated and elaborated. Health policymakers should consider job expectation, gender, age, and employment status of nurses when making plans for future pandemics.

Virtual reality applications for rehabilitation of COVID-19 patients: A systematic review

BACKGROUND AND AIMS

The COVID-19 pandemic has changed people's lifestyles as well as the way healthcare services are delivered. Undoubtedly, the difficulties associated with COVID-19 infection and rehabilitation and those associated with quarantine and viral preventive efforts may exacerbate the need for virtual reality to be used as a part of a complete rehabilitation strategy for these individuals. Thus, the present research aimed to evaluate the potential uses of virtual reality for the rehabilitation of individuals suffering from COVID-19.

METHODS

From 2019 to March 1, 2022, a systematic search was conducted in PubMed, Cochran Library, Scopus, Science Direct, ProQuest, and Web of Science databases. The papers were selected based on search terms and those that discussed the use of virtual reality in the rehabilitation of COVID-19 patients were reviewed. Each step of the study was reviewed by two authors.

RESULTS

A total of 699 papers were found during the first search. Three papers were chosen for further investigation after a thorough evaluation of the publications' titles, abstracts, and full texts. Cross-sectional studies, randomized controlled clinical trials, and case reports comprised 33%, 33%, and 33% of the publications, respectively. Based on the results, people suffering from COVID-19 were the focus of two papers (66%) that employed immersion virtual reality for cognitive rehabilitation, whereas one study (33%) used non-immersive virtual reality for physical rehabilitation. In two papers (66%), virtual reality was also offered to patients in the form of a game.

CONCLUSION

According to the results of the present research, virtual reality games may enhance functional and cognitive consequences, contentment levels among patients, and their ability to take charge of their own health care. In light of the obstacles faced by COVID-19 patients, alterations in the delivery of healthcare, and the significance of rehabilitation in this group during quarantine, new techniques have been considered for these patients to maintain treatment, return to regular life, and enhance their standard of life.

Health care workers' mental health in the face of COVID-19: a systematic review and meta-analysis

BACKGROUND

Healthcare workers are leading the way in treating patients with coronavirus disease 2019 (COVID-19). Due to the high levels of psychological stress, this group is more likely to experience psychological issues. These psychological problems in healthcare providers include depression, anxiety, insomnia, stress and post-traumatic stress disorder (PTSD). The goal of this systematic review and meta-analysis was to find out how common these problems were in the face of COVID-19.

METHODS

On 20 February 2022, systematic searches were conducted in the PubMed, Cochrane Library, Scopus, EMBASE, Science Direct, Web of Science and ProQuest databases. Two authors selected articles based on search keywords. As a last step, articles about the prevalence of psychological problems among healthcare workers in the face of COVID-19 were looked at and analysed for five different outcomes.

RESULTS

The initial search yielded 18,609 articles. After reviewing the titles, abstracts and full texts of the articles, 44 were chosen for the final analysis and 29 were subjected to a meta-analysis. Insomnia, anxiety, depression, PTSD and stress are among the psychological issues faced by healthcare workers. Furthermore, the highest pooled prevalence of depression, anxiety, insomnia, PTSD and stress was 36% (95% confidence interval (CI) 24-50%), 47% (95% CI 22-74%), 49% (95% CI 28-70%), 37% (95% CI 19-59%) and 27% (95% CI 6-69%).

CONCLUSIONS

In this meta-analysis, insomnia was found to be the most common mental health problem, followed by anxiety, PTSD, depression and stress in healthcare workers in the face of the COVID-19 pandemic. Generally, the pooled prevalence of these mental health problems was higher among physicians, nurses and older staff in the subgroup analysis. As a result, health policymakers and managers of the health care system should think about effective interventions to promote mental health, paying particular attention to these two groups.Key pointsStudies conducted in China reported more mental problems than in other countries.Health policymakers and health system managers should hold training programs to promote healthcare workers' mental health with a particular focus on more vulnerable groups.The prevalence of PTSD, stress, anxiety, depression and insomnia were higher among physicians, nurses and older staff.Health systems at both national and local levels have to take older physicians, nurses and healthcare providers into consideration while designing interventions.

Lessons Learned From the AIDS Crisis in Lordegan, Iran, 2019

AIDS is an acquired immunodeficiency syndrome caused by human immunodeficiency virus (HIV) [1, 2]. AIDS is among the major challenges to the health system in all countries. This health challenge has spread to all countries and all age groups, especially those 25-34 years. The probability of transmission of AIDS ranges from 70% by blood transfusion to 30% by sexual intercourse, mother-to-child transmission, and other blood products [3-5].

Explaining factors affecting the participation of nongovernmental organizations (NGOs) in disaster management: A systematic review

BACKGROUND AND OBJECTIVE

Numerous disasters have occurred over the recent years. Moreover, there has been a considerable rise in the number of victims, injured people, and damages caused by disasters worldwide. Governments cannot meet needs alone due to the complicated nature of crises and accidents. Therefore, nongovernmental organizations (NGOs) and communities must assist the states during disasters. The present study aimed to derive the factors affecting the participation of NGOs in disaster management using a systematic review in 2022.

DESIGN

This systematic review was done using ISI, Science Direct, Scopus, PubMed/MEDLINE, ProQuest, and Cochran Library based on the preferred reporting items for systematic reviews (PRISMA) standard from January 1, 2000 to December 31, 2021. The articles were selected based on the search keywords (population, intervention, comparison, outcome (PICO)). After studying the titles, abstracts, and full texts of the articles, the factors affecting the participation of NGOs in disaster management were derived.

RESULTS

The final assessment was done on 13 articles. Cooperation and coordination with other organizations, education, communication between NGOs, social empowerment, access to adequate references, and flexibility were the criteria with the highest frequency.

CONCLUSION

As multiple NGOs take part in responding to disasters and performing relief operations, establishing a unified command and supervision system for effective coordination and collaborations among NGOs and other stakeholders is highly suggested. Further research is needed to develop a -measurement tool for assessing the effectiveness of NGOs' activities during disasters.

Estimation of Increasing the Surge Capacity of Shaheed Rajaei Trauma Hospital in Shiraz City, Iran

Background: The present study aimed to evaluate the surge capability of Shahid Rajaee Trauma Hospital in Shiraz City, Iran, in response to a mass causality incident. Materials and Methods: This descriptive study was conducted in Shahid Rajaee Hospital in Shiraz in 2017. The Delphi technique was used in this study. Three checklists were used for the Emergency Department, Operating Room, and Intensive Care Unit. The surge capacity was calculated for each unit based on the formulas derived from different studies. Results: The surge capacities of the Emergency Department, Intensive Care Unit, and Operating Room were obtained 36%, 20%, and 17.5%, respectively. Shahid Rajaee Hospital of Shiraz can quickly increase its capacity by 27% based on the scenario defined in this study. However, if an accident leads to more causalities, it will likely face several limiting factors for increasing the surge capacity. Conclusion: Due to the critical role of hospitals in the crisis, it seems that the studied hospital should look for ways to increase its surge capacity to cope with unexpected accidents as soon as possible.

Predictors of Mortality Among COVID-19 Patients With or Without Comorbid Diabetes Mellitus

Late in 2019, the first case of COVID-19 was detected in China, and the disease caused a pandemic state worldwide. Up to now, many studies have investigated the impact of comorbid diseases, especially diabetes mellitus, on COVID-19 outcomes. In this study, we aimed to assess the para-clinic characteristics of COVID-19 patients with or without diabetes mellitus to identify factors indicative of poor prognoses. In this prospective study, 153 in-patients with COVID-19 were followed up from 1 March to 19 April. Paraclinical information of these patients was gathered from their medical records. Afterward, the association between these factors among both diabetic and non-diabetic patients was assessed in the correlation analyses. Discharge and expiration of 77.1% and 22.9% of the study participants resulted in a 1063 person-day follow-up for patients who were discharged healthily and 384 person-day follow-ups for expired patients. 41.8% of the participants had diabetes mellitus. Lymphocytopenia and Neutrolhilia prevalences increased during hospitalization; comparing with their initial prevalences. Thirty-seven patients got acute respiratory distress syndrome; of those, 35 died. The mean of the initial C reactive protein level was 42.49, and serum creatinine of 1.39. The study showed that higher initial neutrophil count, increasing neutrophil count more than 15000 and decreasing lymphocyte count below 1000 during hospitalization; development of acute respiratory distress syndrome and being intubated; initial C reactive protein and serum creatinine level were associated with higher mortality rates in COVID-19 victims.

Congenital Factor VII Deficiency Presenting With Isolated Recurrent Hematuria: A Case Report

Factor VII deficiency is a rare congenital coagulopathy disorder. In most cases, this disorder is diagnosed in childhood. Common symptoms of congenital factor VII deficiency are different and consist of cutaneous, mucosal hemorrhage, gastrointestinal bleeding, and joint bleeding. CNS hemorrhage is a fatal and severe complication of congenital factor VII deficiency. The incidence of gross hematuria is a rare symptom of factor VII deficiency. Isolated presentation of hematuria is rarer and usually is accompanied by bleeding in other sites. The patient reported here is a 6-month-old girl who was diagnosed with congenital Factor VII deficiency following episodes of isolated gross hematuria. We decided to report this case to demonstrate if there is no other organic cause in the investigation of a child with recurrent hematuria, we should also consider a coagulation factors deficiency. Since isolated hematuria is a rare symptom in the coagulation factors deficiency, the coagulation tests may be of less interest.

Designing and Validation of the Nurses' Preparedness to Response to COVID-19 Questionnaire in Iran

OBJECTIVE

Nurses are considered key members to respond to incidents and disasters. As many patients are hospitalized during the coronavirus disease (COVID-19) pandemic, and nurses are directly in contact with these patients; their preparedness enables them to respond to this situation more effectively and protects their health. Therefore, the present study aimed to design and validate a questionnaire to measure the nurses' preparedness in response to COVID-19 in Iran in 2020.

METHODS

This study was a mixed research aiming to develop and validate a psychometric research instrument in 2020. Based on the review of the literature regarding COVID-19 and other viral respiratory infections, the items were extracted, rewritten, and validated. In the quantitative phase, the validity of the questionnaire was evaluated in terms of face, content, and construct validity, and its reliability was evaluated based on internal consistency and stability (Cronbach's alpha and Intra-class Correlation Coefficient [ICC]). To fill out the questionnaire, the nurses were selected by random sampling. Data analysis was done by the SPSS software, version 23 (IBM Corp, Armonk, NY).

RESULTS

The designed questionnaire included 9 dimensions and 50 items. The dimensions included (1) Incident Command System (ICS); (2) risk assessment and management; (3) information and communication management; (4) psychological approaches; (5) personal protective equipment; (6) prevention of contamination, isolation, and quarantine; (7) education and training; (8) patient management; and (9) features of the new coronavirus. The content and face validity of the questionnaire were approved by the specialists and experts of nursing and health in disasters and emergencies. The content validity ratio was > 0.7 for all items. The content validity index was also approved for all items. The Cronbach's alpha coefficient and ICC were respectively 0.71 and 0.72 for the total questionnaire. The total score was determined based on 5 ranges, including 50-89 (very low preparedness), 90-129 (low preparedness), 130-170 (medium-level preparedness), 171-210 (high preparedness), and 211-250 (very high preparedness).

CONCLUSION

Nurses' preparedness to respond to this pandemic requires multilateral measures. Measuring the nurses' preparedness can clarify the challenges in hospital measures taken to respond to this crisis. Evaluating the nurses, determining the challenges and priorities, and finding solutions to resolve them can improve the nurses' performance in providing health care services. Preparation of nurses during pandemics can reduce the damages to this group and maximize their efforts to protect the patients. Thus, health planners and policy-makers should try to promote the nurses' awareness and preparedness.

Lessons Learned of Tehran-Zahedan Train Derail, Iran, 2019

Background: There has been a significant increase in the number of train crashes worldwide, mainly due to the extension of the rail network and the use of the most sophisticated and cutting-edge technology. Incident Report: The Tehran-Zahedan train had 260 passengers on board and left for Tehran City at 14:50 local time on Wednesday, September 25, 2019. The accident happened at 16:20 local time at 100 km distance from Zahedan City. Results: Five train cars derailed 2 km from Shorou Station, where four people died, and 157 were injured. According to the investigations, the accident occurred due to the unscrewing of some bolts and spring washers. There were 170-180 screws and spring washers removed along 50-60 m, which resulted in the creation of a dangerous point and derailment of the train. This study examined the challenges, strengths, and learned lessons of the incident. Conclusion: Concerning standard and vast rail networks in Iran and the latest train crashes that mainly occurred just outside the cities, accessibility to the accident scene should be considered one of the most important physical vulnerability indexes. As a result, accessibility to special firefighting and rail rescue train car at some stations in crowded routes effectively decreases the consequences of such accidents.

Sniffer dogs as a screening/diagnostic tool for COVID-19: a proof of concept study

BACKGROUND

Sniffer dogs are able to detect certain chemical particles and are suggest to be capable of helping diagnose some medical conditions and complications, such as colorectal cancer, melanoma, bladder cancer, and even critical states such as hypoglycemia in diabetic patients. With the global spread of COVID-19 throughout the world and the need to have a real-time screening of the population, especially in crowded places, this study aimed to investigate the applicability of sniffer dogs to carry out such a task.

METHODS

Firstly, three male and female dogs from German shepherd (Saray), German black (Kuzhi) and Labrador (Marco) breeds had been intensively trained throughout the classical conditioning method for 7 weeks. They were introduced to human specimens obtained from the throat and pharyngeal secretions of participants who were already reported positive or negative for SARS-COV-2 infection be RT-PCR. Each dog underwent the conditioning process for almost 1000 times. In the meantime another similar condition process was conducted on clothes and masks of COVID-19 patient using another three male and female dogs from Labrador (Lexi), Border gypsy (Sami), and Golden retriever (Zhico) breeds. In verification test for the first three dogs, 80 pharyngeal secretion samples consisting of 26 positive and 54 negative samples from different medical centers who underwent RT-PCR test were in a single-blind method. In the second verification test for the other three dogs, masks and clothes of 50 RT-PCR positive and 70 RT-PCR negative cases from different medical center were used.

RESULTS

In verification test using pharyngeal secretion, the sniffer dogs' detection capability was associated with a 65% of sensitivity and 89% of specificity and they amanged to identify 17 out of the 26 positive and 48 out of the 54 true negative samples. In the next verification test using patients' face masks and clothes, 43 out of the 50 positive samples were correctly identified by the dogs. Moreover, out of the 70 negative samples, 65 samples were correctly found to be negative. The sensitivity of this test was as high as 86% and its specificity was 92.9%. In addition, the positive and negative predictive values were 89.6 and 90.3%, respectively.

CONCLUSION

Dogs are capable of being trained to identify COVID-19 cases by sniffing their odour, so they can be used as a reliable tool in limited screening.

The Development of Swedish Military Healthcare System: Part II-Re-evaluating the Military and Civilian Healthcare Systems in Crises Through a Dialogue and Study Among Practitioners

Introduction

Historical changes have transformed Sweden from being an offensive to a defensive and collaborative nation with national and international engagement, allowing it to finally achieve the ground for the civilian–military collaboration and the concept of a total defense healthcare. At the same time, with the decreasing number of international and interstate conflicts, and the military’s involvement in national emergencies and humanitarian disaster relief, both the need and the role of the military healthcare system within the civilian society have been challenged. The recent impact of the COVID-19 in the USA and the necessity of military involvement have led health practitioners to anticipate and re-evaluate conditions that might exceed the civilian capacity of their own countries and the need to have collaboration with the military healthcare. This study investigated both these challenges and views from practitioners regarding the benefits of such collaboration and the manner in which it would be initiated.

Material and Method

A primary study was conducted among responsive countries using a questionnaire created using the Nominal Group Technique. Relevant search subjects and keywords were extracted for a systematic review of the literature, according to the PRISMA model.

Results

The 14 countries responding to the questionnaire had either a well-developed military healthcare system or units created in collaboration with the civilian healthcare. The results from the questionnaire and the literature review indicated a need for transfer of military medical knowledge and resources in emergencies to the civilian health components, which in return, facilitated training opportunities for the military staff to maintain their skills and competencies.

Conclusions

As the world witnesses a rapid change in the etiology of disasters and various crises, neither the military nor the civilian healthcare systems can address or manage the outcomes independently. There is an opportunity for both systems to develop future healthcare in collaboration. Rethinking education and training in war and conflict is indisputable. Collaborative educational initiatives in disaster medicine, public health and complex humanitarian emergencies, international humanitarian law, and the Geneva Convention, along with advanced training in competency-based skill sets, should be included in the undergraduate education of health professionals for the benefit of humanity.

The Role of Family Caregiver's Sense of Coherence and Family Adaptation Determinants in Predicting Distress and Caregiver Burden in Families of Cancer Patients

Background:

Most cancer patients' families suffer from maladaptation which increases family distress and caregiving burden. This study was conducted to explore the relationship between these maladaptation indicators, and the sense of coherence (SOC) of family caregivers alongside other family resilience determines among family caregivers of cancer patients.

Methods:

A total of 104 family caregivers of cancer patients were included in this cross-sectional study. They answered three questionnaires to assess family resilience factors: Family Inventory of Resources for Management (FIRM), Family Crisis Oriented Personal Evaluation Scales (F-COPES), and SOC scale. In addition, family maladaptation factors were determined by two instruments, including Family Distress Index (FDI) and Caregiver Burden Inventory (CBI).

Results:

The results of this study showed that the FIRM and the SOC together were responsible for 35% and 43% of the variances in FDI and CBI scores, respectively (P < 0.001). “Reframing”, the subscale of the F-COPES, significantly predicted the variances of FDI (β = −0.26, P = 0.01) and CBI scores (β = −0.21, P = 0.04). Moreover, “Mastery and health”, the subscale of the FIRM, significantly predicted the variances of FDI (β = −0.38, P < 0.01) and CBI scores (β = −0.21, P = 0.02).

Conclusions:

Family caregiver's SOC alongside other family resilience determinants plays a significant role in alleviating family distress and caregiver burden. It is suggested that palliative care providers consider family caregivers' SOC in developing a psychological intervention plan to improve family resilience in families of cancer patients.

Civil-Military Coordination (CIMIC) Model in Natural Disasters in Iran

Objective:

The present study aimed at codifying a native model of civil-military coordination (CIMIC) in natural disasters in Iran.

Methods:

This manuscript is a part of a larger study. The present cross-sectional study was conducted in 2019 using a two-stage Delphi technique. The factors confirmed by the technique were prioritized via a pairwise questionnaire. In doing so, 24 elites and experts in civil-military coordination were presented with the indicators in the course of classic Delphi technique and pairwise comparison. At the end, the nationalized model was finalized by sending the model to ten experts and asking their ideas.

Results:

The results obtained from the two rounds of Delphi indicated that 36 coordination factors could be classified into three primary classes of staff, stuff, and system. All factors were confirmed by the experts. Considering the weight of each class, “staff” and “stuff” classes were considered to be the highest and lowest priorities, respectively.

Conclusion:

Application of the coordination factors in the context of military and civil organizations leads to a better response to natural disasters. The organizations in charge of responding to disasters should be obliged to apply this model in the highest organizational commitment level as the final goals of disaster management. The results of the present study can be applied for codification of a comprehensive plan for assessing the civil-military coordination in natural disasters.

Report of Field Assessment in the Flooded Areas of Iran, 2019

Background: Iran is a disaster-prone country, which in recent years has been affected by heavy rainfall and consequent flooding. In March 26, 2019, heavy rainfall in northern parts of Iran resulted in flooding. The situation became more critical when central and western provinces were affected, finally causing significant damages in 25 provinces. The most affected areas were Golestan, and Khuzestan provinces with significant damages to their infrastructure, killing 76 people. Materials and Methods: This qualitative study aims to describe the findings and results of field visits in flood-hit provinces of Lorestan, Khuzestan and Golestan. All interviews were held with experts in late April 2019. Results: Golestan province was in recovery phase and Lorestan and Khuzestan provinces were in response phase. Due to the acute conditions of these two mentioned areas, it was not possible to visit all areas. In Lorestan Province Treatment and Emergency Situations; In Golestan Province Health Status and in Khuzestan Province Pre-hospital Care and Rescue Support were visited and evaluated. The field visited results indicate the presence of government forces and people in the field and provide comprehensive assistance to the flood-affected areas. Conclusion: There are numerous hazards each year, but few documented lessons are available for researchers. Due to the importance of applying lessons for community development it is imperative that special attention be paid to the discussion of emergency and disaster research and the presence of specialized researchers to record lessons learned. Although organizations make significant efforts during disasters, the specialized research force for recording these achievements in disasters remains neglected. Therefore, it is valuable to document and apply appropriate documentation to promote interventions and responses to possible future events.

Efficacy of Mass Quarantine as Leverage of Health System Governance During COVID-19 Outbreak: A Mini Policy Review

On January 23, 2020, the Chinese government announced the city lockdown of Wuhan. Since then, there have been controversial debates among experts about the efficacy of mass quarantine, the oldest and probably one of the most effective methods for controlling infectious disease outbreaks. The impact of health policymaking section of health system governance becomes visible to all stakeholders and the public in such emergency contexts. The success and failure of such policies should be evaluated in order to find the proper course of action for the local and international communities. In this review, we aim to investigate the efficacy of mass quarantine in China during the coronavirus disease 2019 (COVID-19) pandemic. We found good quality evidence for the effectiveness of mass quarantine during the current stage of COVID-19 pandemic, and these strategies seem to have been highly effective in controlling the spread of the disease.

Hospital Safety Index analysis in Fars Province hospitals, Iran, 2015-2016

BACKGROUND AND OBJECTIVES

Hospitals are the vital part of disaster management and their functionality should be maintained and secured. However, it can be the target of natural and man-made disasters. In Iran, Fars Province is prone to major incidents and disasters in its hospitals at any time during the course of a year. This study aimed to examine the Hospital Safety Index (HSI) in all hospitals (public and private) affiliated to Shiraz University of Medical Sciences (SUMS).

MATERIALS AND METHODS

This cross-sectional study was conducted during 2015-2016, using the World Health Organization's HSI checklist. All 58 hospitals in Fars Province affiliated to SUMS were included. The hospital assessment team was formed to collect the data retrospectively and by visiting and interviewing hospital's authority based on the checklist. The collected data were analyzed using Microsoft Excel.

RESULTS

The results showed that in the above-mentioned years, the structural safety of hospitals reached the highest optimal level, whereas functional safety reached the lowest level. The results of the studies conducted in 2016 showed that during this year, the overall hospital safety level improved (6 and B).

CONCLUSION

Although safety in hospitals located in Fars Province has improved due to continuous disaster mitigation and preparedness activities, there is still space for more improvement to achieve and maintain higher levels of safety in hospitals. Paying attention to this, the authors recommend that proper policies, legislation, and intra and inter-institutional coordination are the requirements for a successful outcome.

Developing a Model for Hospitals' Emergency Department Preparedness in Radiation and Nuclear Incidents and Nuclear Terrorism in Iran

Objective

To develop a national model for hospitals' Emergency Department (ED) preparedness when facing radiation and nuclear incidents as well as nuclear terrorism in Iran.

Methods

This analytical study was carried out in 2019 via Delphi technique in two rounds and prioritization using a pairwise questionnaire. Using classic Delphi technique and pairwise comparison, the components were given to 32 specialists in emergency medicine, nuclear medicine, medical physics, nuclear physics, radiobiology and radiation protection, health in disaster and emergency, and passive defense. Finally, the national model was developed by holding two focus group sessions.

Results

The results from the two rounds of Delphi technique showed that 31 factors of preparedness were classified into three main classes, namely staff, stuff, and structure (system). Only three factors were excluded and the rest were agreed upon by the specialists. Given the weight of each class, it was found that staff preparedness and stuff preparedness had the highest and lowest priorities, respectively.

Conclusion

Comprehensive preparedness requires enhancing and promoting cultural, social, economic, and political levels. Indeed, all preparedness levels should be promoted in alignment with each other. Hence, governments should align their policies to manage such incidents.

Needs Assessment for Standardized Educational Program for Iranian Medical Students in Crisis and Disaster Management

INTRODUCTION

Early education and training are mandatory to raise the knowledge and awareness of the healthcare staff. Iran is a disaster prone area with a high number of emergencies. This study aimed to assess the need for disaster and emergency management education for Iranian medical students.

METHODS

Using two-round Delphi technique in 2017, 15 experts within the field of disaster and emergency management were asked for their opinions concerning the education required for Iranian medical students. Highly important educational domains and their sub-domains selected with an agreement of above 70-80% were prioritized by AHP technique.

RESULTS

Of 41 identified and prioritized educational subjects, four main groups were obtained: 1) crisis and disaster primary concepts, 2) disease control skills, 3) management skills, and 4) medical care skills. The medical care skills had the highest priority (with a weight of 0.546), compared to other areas after the final analysis.

CONCLUSION

Different areas of competency are needed to raise awareness and preparedness in medical students in combating crisis and disasters. We propose a curriculum for Iranian medical students and suggest it to be used for other professionals, who are involved in the process of disaster management.

Needs Assessment for Standardized Educational Program for Iranian Medical Students in Crisis and Disaster Management

INTRODUCTION

Early education and training are mandatory to raise the knowledge and awareness of the healthcare staff. Iran is a disaster prone area with a high number of emergencies. This study aimed to assess the need for disaster and emergency management education for Iranian medical students.

METHODS

Using two-round Delphi technique in 2017, 15 experts within the field of disaster and emergency management were asked for their opinions concerning the education required for Iranian medical students. Highly important educational domains and their sub-domains selected with an agreement of above 70-80% were prioritized by AHP technique.

RESULTS

Of 41 identified and prioritized educational subjects, four main groups were obtained: 1) crisis and disaster primary concepts, 2) disease control skills, 3) management skills, and 4) medical care skills. The medical care skills had the highest priority (with a weight of 0.546), compared to other areas after the final analysis.

CONCLUSION

Different areas of competency are needed to raise awareness and preparedness in medical students in combating crisis and disasters. We propose a curriculum for Iranian medical students and suggest it to be used for other professionals, who are involved in the process of disaster management.