Showing 27 results for Outcome
Shirzad Azhari, Hosein Safdari, Massoud Shabehpoor, Hosein Nayebaghaie, Zohreh Amiri,
Volume 12, Issue 4 (2-1999)
Abstract
To determine the factors affecting the outcome of patients with traumatic acute
subdural hematoma, we reviewed the records of7 4 consecutive comatose patients
with a Glascow coma scale Score (GCS) of less than 8 who had been admitted to
Imam Hosein Medical Center from 1990 to 1996 and had undergone a uniform
treatment protocol.
The overall mortality rate was 73% and 23% had functional recovery, but 4%
were severely disabled or vegetative. The following variables had a statistically
significant correlation with poor outcome: age over 65 years (p<0.05), preoperative
GCS of 3 or 4 (p<0.05), bilateral absent pupillary light reflexes (p<0.05), and
immediate and sustained coma from the moment of injury to operation without any
lucid interval (p<0.00l). The time interval between injury and operation, sex,
mechanism of injury, and associated craniocerebral injuries were not significantly
correlated with outcome. In patients with immediate post-traumatic
unconsciousness, the extent of primary brain injury is the crucial factor to predict
the outcome. However, in patients with a lucid interval, the mass effect of
hematoma seems to be more important, therefore prompt surgical decompression
in addition to management of secondary brain insults improves the outcome
remarkably.
A Navabi Shirazi, A Alavian Ghavanini, S Sajjadi,
Volume 14, Issue 4 (2-2001)
Abstract
In order to compare early post-operative results in primary versus two-stage
repair of tetralogy of Fallot at Shiraz University of Medical Sciences, onehundred
and eleven patients with tetralogy of Fallot with right ventricle to pulmonary
artery continuity and no other major associated anomaly were repaired in one
center by one surgeon in a one or two-stage protocol. Those patients who were
initially palliated with shunt were either referred from other centers for total correction,
presented with cyanotic spells, or were shunted due to their severe and
diffuse right ventricular outflow tract obstruction or pulmonary artery branch stenosis
or hypoplasia. Hospital mortality and ratio of right to left ventricle pressure
after correction were compared between the primary and the two-stage groups as
early outcome indices. The patients were also divided to those who needed a
trans-annular (TAP) or a sub-annular patch and were compared.
In the primary group, 25 (37.3%) of the patients needed TAP, while in the
two-stage group 28 (63.6%) needed TAP. Requirement for TAP was increased
significantly with two-stage correction (p= 0.006, relative risk= 1.71, 95% CI=
1.16-2.5). Mortality was significantly higher in the primary group (p= 0.03, relative
risk= 3.94, 95% CI= 0.93-16.76). In the primary group TAP significantly
increased the mortality risk (p= 0.006, relative risk= 5.04, 95% CI= 1.5-16.89). In
the two-stage group, there was no significant difference in the mortality rate between
the patients with and without TAP. The TAP group had statistically significant
less time interval between shunt and total correction.
Our patients generally did better on two-stage repair, because of their older
age at operation. The long period of low pulmonary blood flow has induced unbalanced.
ventricles for them and exaggerated right ventricular outflow tract obstruction
due to muscle hypertrophy. In such patients, shunting will prepare the
left ventricle for accepting the extra blood volume that will reach it after total
correction.
Jahanbakhsh Samadikhah, S. Hadi Hakim, Azin Alizadeh Asl, Rasoul Azarfarin,
Volume 18, Issue 4 (11-2005)
Abstract
This study sought to compare the clinical features and outcome of a first acute
myocardial infarction (AMI) with onset of symptoms during or within 30 minutes of
exercise, at rest and in bed.
Information collected using a standard questionnaire was used to relate activity at
the onset of symptoms and in-hospital outcome in 500 consecutive patients admitted to
our heart center with a first AMI between 2000-2002.
Patients with exercise-related onset were more likely to be younger and male.
Those with onset in bed were more likely to be older and have a history of stable or
unstable angina. By way of comparison between patients whose symptoms began at
rest and exercise, those with exercise-related onset had lower in-hospital mortality
after adjusting for age and gender [odd's ratio (OR) 0.53, 95% confidence interval
(CI) 0.39-0.93 (p= 0.03)]. Compared with patients whose symptoms began at rest,
patients with onset in bed had a higher mortality rate [OR 1.42,95% CI 1.03 -1.98
(p= 0.028)].
The incidence of moderate or severe left ventricular dysfunction was also lower
for exercise -related onset [OR 0.79,95% CI 0.6-1.01 (p= 0.32-but not statistically
significant)] and higher when onset was in bed [OR 1.5, 95% CI 1.2-1.77 (p=0.039)].
There is an association between activity at onset and outcome of AMI. Differences
in pathophysiology or in the population at risk could explain this observation.
M. Bakhshaee, Sh. M. R. Sharifian, M. M. Ghasemi, M. Naimi, T. Moghiman,
Volume 20, Issue 4 (2-2007)
Abstract
Abstract
Background: The aim of this study was to determine the auditory performance of congenitally deaf children and the effect of cochlear implantation (CI) on speech intelligibility.
Methods: Aprospective study was undertaken on 47 children in a pediatric tertiary referral center for CI. All children were deaf prelingually and were younger than 8 years of age. They were followed up until 5 years after implantation. Auditory performance was assessed by using the categories of auditory performance (CAP) scale and speech intelligibility rating which evaluated the spontaneous speech of each child before and at frequent intervals for five years after implantation.
Results: Pre-lingually deaf children showed significant improvement in auditory performance after implantation. Six months after implantation 91% of children had the ability to respond to speech sounds. At the end of year one, 96% of children could discriminate speech sounds and 84% of children who reached the three year interval could understand common phrases without lip-reading. After cochlear implantation, the difference between the speech intelligibility rating increased significantly each year for 3 years (p<0.05) and did not plateau up to 5 years after implantation. The changes in auditory performance and speech development were parallel.
Conclusion: The results indicated the ability of cochlear implantations to significantly improve auditory receptive skills and subsequently speech development in young congenitally deaf children.
F. Sabzi, H. Teimouri,
Volume 21, Issue 4 (2-2008)
Abstract
Abstarct
Background: Base deficit is a non-respiratory indicator of acid base status that evaluates the severity of shock at the cellular level. Base deficit results from cellular metabolism of pyruvate under anaerobic conditions. In this situation, base deficit is a sensitive marker of the magnitude of anaerobic metabolism and tissue oxygen deficit [1]. Several studies have shown a strong positive correlation between base deficit and the risk of morbidity and mortality in clinical situations such as circulatory shock, extracorporeal support and in children after operation for complex congenital heart disease.
Methods: 136 consecutive cases with coronary artery disease and valvular heart disease were scheduled in the study. 20 variables were determined during the preoperative, intraoperative and postoperative periods. Statistical univariate analysis was performed differentiating patients whose initial base deficit after weaning from cardiopulmonary bypass was -8 meq and these whose base deficit was equal or more than -8 meq.
Results: 39 patients had base deficit levels less than -8 (Group A) and 91 had a level of > -8 meq/L (Group B). Patients with a base deficit level of -8 meq/L or more were older and most of them were women. The prevalence of left ventricular ejection fraction less than 30% and coronary artery disease was not significantly higher in patients with base deficit of > -8 meq/L . No difference was found according to the presence of hypertension or diabetes in patients with base deficit levels of –8 or higher than in those with base deficit levels less than –8 (P >0.05). In the univariate analysis of preoperative variables, there were no differences with respect to factors such as age, sex, diabetes, preoperative hemoglobin level, hypertension, emergency operation and redo operation. Congestive heart failure was different between the two groups (P < 0.05). Three variables had a statistically significant difference in the univariate analysis and two of them were highlighted by the linear logistic model.
Conclusion: The value of base deficit which was measured during the immediate postoperative open-heart surgery period is correlated with the volume of fresh frozen plasma and blood transfusion after open heart surgery and using of intra-aortic balloon pump after surgery.
Sam Haji Aliloo Sami, Mikail Alt Jafarbay, Mehdi Ramezan Shirazi, Hajir Gharati,
Volume 24, Issue 1 (5-2010)
Abstract
Abstract
Background: Parosteal osteosarcoma is rare low-grade malignancy which arises
on the surface of the metaphysis of long bones it has a low propensity to metastasize.
Different surgical treatment options including marginal resection, wide resection
and amputation were recommended for the tumor. The purpose of the study was to
assess the results of different surgical treatment of the lesion.
Methods: Thirty five consecutive patients with parosteal osteosarcoma were
managed with four surgical techniques (Marginal resection, wide resection and prosthesis, wide resection and allograft application, and amputation) between 1378 -
1387, and the results were retrospectively reviewed. The mean age of the patients
when the surgery was performed was 30.37 (range, eleven to seventy one years), and
the mean duration of postoperative follow - up was 51 months (range, eight months to
ten years).
Results: The mean time between the onset of symptoms and initial physician encounter
was 15.98 months (range, 1.5 months to 60 months). None of the patients had
metastasis preoperatively while three pulmonary metastases were detected postoperatively. Six patients had regional tumor recurrence postoperatively. The mean time of the recurrence postoperatively was 18.8 months (range, nine months to forty eight months). Three of thirty five patients assessed in the study died of pulmonary metastasis. All had dedifferentiated grading with different staging (Two patients had a
stage of IIB and one with IIA). Medullary invasion was seen in one of them. One of
the three patients was treated with Indomethacin for two years due to the misdiagnosis
of myositis ossificans.
Conclusion: Wide resection of parosteal osteosarcoma produces a satisfactory
long - term out come. However, individually - based treatment should be selected for
each patient with parosteal osteosarcoma.
Masoumeh Mohkam, Abolfazl Afjeii, Paiam Payandeh, Masoud Zadkarami, Mohammad Kazemian, Hossein Fakhraii, Shahin Nariman, Fatemeh Abdollah Gorgi,
Volume 24, Issue 4 (2-2011)
Abstract
Abstract
Background: Clinical Risk Index of Babies (CRIB), Score for Neonatal Acute Physiology
(SNAP), an update of the Clinical Risk Index for Babies score (CRIB II) and
Score for Neonatal Acute Physiology - Perinatal Extension (SNAP-PE) are scoring devices
developed in neonatal intensive care units. This study reviewed these scoring systems
in critically ill neonates to determine how well they could predict mortality.
Methods: This prospective cohort study was conducted at the neonatal intensive care
units of Mofid and Mahdieh hospitals between March 2006 and May 2009. We evaluated
CRIB, CRIB II, SNAP, SNAPII and SNAP-PE score for each neonate and the final
scores were then obtained. The predictive accuracy of these parameters were expressed
as area under the receiver operative characteristic curve, sensitivity, specificity, positive
predictive value and negative predictive value.
Results: Of 404 neonate evaluated 53% were male. Primary diagnoses were respiratory
distress syndrome, gastrointestinal obstruction, sepsis, prematurity, and neuromuscular
diseases. The authors detected mortality in 20.5% and found a significant difference
in scoring systems between survived and death groups. The mean CRIB score in
survived neonates was 2.57±3.66 and in death neonates 8.43±4.66 (p value<0.001). We
also found that the SNAP score had the highest area under the curve and the highest sensitivity,
specificity, positive predictive value, negative predictive value and we had the
lowest score for CRIB II.
Conclusion: We concluded that the neonatal scoring systems could be a useful tool
for prediction of mortality in NICUs and SNAP can predict the mortality better than the
others.
Kaykhosro Mardanpour, Mahtab Rahbar,
Volume 25, Issue 2 (7-2011)
Abstract
Abstract
Background: Unstable Pelvic fracture, a result of high energy antero-posterior compression injury, has been managed based on internal fixation and open reduction. The mode of fixation in Unstable Pelvic fracture has, however, been a subject of controversy and some authors have proposed a need to address the issue of partial breach of the pelvic ring elements in these injuries. This study was performed to evaluate the functional and radiological results of treatment of pelvic ring fractures by open reduction, internal fixation.
Methods: Thirty eight patients with unstable pelvic fractures, treated from 2002 to2008 were retrospectively reviewed. The mean age of patients’ was 37 years old (range 20 to 67). Twenty six patients were men and 12 women. The most common cause was a road traffic accident (N=37, 97%). There were 11 type-C and 27 type-B fractures according to Tile’s classification. Thirty six patients sustained additional injuries. The most prevalent additional injuries were lower extremity fractures. Open reduction, internal fixation as a definite management was applied for all patients. Quality of reduction was graded according to the grades proposed by Matta and Majeed’s score was used to assess the clinical outcome. The mean period of follow-up was 25 months (ranged from 6 to 109 months). About 81.6% of patients had either good or excellent radiological reduction.
Results: The functional outcome was excellent in 66%, good in 15%, fair in 11% and poor in 7% of the patients. There were 4 postoperative infections. No sexual function problem was reported. Nerve deficits recovered completely in 2 and partially in 3 of 11 patients with preoperative neurologic deficiency. There was no significant relation between functional outcome and the site of fracture
Conclusion: Unstable pelvic ring fracture injuries should be managed surgically by rigid stabilization that must be carried out as soon as the general condition of the patient permits, and even up to two weeks.
Hamid Reza Javadi, Abbas Allami, Navid Mohammadi, Rezvan Alauddin,
Volume 28, Issue 1 (1-2014)
Abstract
Background :Impact of substance abuse on outcome of hospitalized patients with acute myocardial infarction (MI) is a frequent question. Available studies show disagreements over its impact, thus we performed this study to find a clear answer.
Methods : In a cross sectional study, 304 patients (include 152 consecutive opium dependents and equal number of independents) with acute MI admitted to coronary care units (CCU) in Bou-Ali Sina Hospital of Qazvin University of Medical Science were enrolled. Data on demographics (e.g. age, sex and education), identified MI risk factor (smoking and diabetes), clinical findings (e.g. Killip class and in-hospital mortality), ECG findings (e.g. localization of infarction and arrhythmia), echocardiographic examinations (e.g. ejection fraction and regional wall motion abnormality) and laboratory findings (lipid profile, glycemic situation) were gathered.
Results : The mean age was 63.01±12 years for opium users and 64.3± 10 for non-users. Educational level was higher in patients who used opium. No significant differences were found between opium users and non-users in rate of hypertension, diabetes mellitus, hyperlipidemia, and cigarette smoking. The mean duration of experienced chest pain in hospital stay was significantly higher in non-opium users compared to opium users (1.78± 0.63 vs.1.52±0.54) (p< 0.001). Higher Killip class and arrhythmia have been identified as the most important independent predictors of early in-hospital mortality (in both groups).
Conclusion : The higher Killip class and age identified as the most important independent predictors of early in-hospital mortality and addiction do not act as a major risk or protecting factor in this context. Nevertheless, we believe that a more comprehensive study with follow up of patients should be carried out for evaluation of opium addicted patients, their outcome after MI, and a better decision making for their treatment.
Farzad Omidi-Kashani, Ebrahim Ghayem Hasankhani, Hamid Reza Noroozi,
Volume 28, Issue 1 (1-2014)
Abstract
Background :The incidence of recurrence in patients undergoing primary discectomy due to lumbar disc herniation (LDH), is regularly reported as 5-15%. In this study we aimed to evaluate surgical outcome of instrumented transforaminal lumbar interbody fusion (TLIF) in the patients suffering from recurrent LDH.
Methods : We retrospectively studied 51 patients (30 female, 21 male) from August 2007 to October 2011. The mean age and follow-up of the patients was 46.4±14.8 (ranged 29-77 years old) and 31.4±6.8 (ranged 25-50 months), respectively. Clinical improvement was assessed by Oswestry Disability Index (ODI), visual analogue scale (VAS), and subjective satisfaction rate, while fusion was appraised radiologically. Data analysis was by one sample Kolmogorov-Smirnov, paired t, and Mann-Whitney tests.
Results : Surgery could significantly improve mean leg and lumbar VAS and ODI from preoperative 7.4±2.5, 7.8±3.1, and 72.1±21.5 to postoperative 3.4±3.6, 3.5±2.6, and 27.5±18.0, respectively at the last follow-up visit. Subjective satisfaction rate was excellent in 24 patients (47.1%), good in 14 (27.5%), fair 11 (21.6%), and poor in two (3.9%). We had one patient with iatrogenic partial L5 nerve root injury and one with unknown late onset refractory postoperative back pain. Fusion rate was 100% and instrument failure was nil.
Conclusion : In surgical treatment of the patients with recurrent LDH, bilaterally instrumented TLIF is a relatively safe and effective procedure and can be associated with least instrument failure and highest fusion rate while no postoperative bracing is also needed.
Mohammad Razi, Mohammad Mahdi Sarzaeem, Gholam Hossein Kazemian, Farideh Najafi, Mohammad Amin Najafi,
Volume 28, Issue 1 (1-2014)
Abstract
Background :Disruption of anterior cruciate ligament (ACL) is a common ligamentous injury of the knee. The choice of graft for (ACL) reconstruction remains controversial. This prospective, randomized clinical trial aimed to compare clinical results of bone-patellar tendon-bone (BPTB) grafts and four-strand semitendinosus-gracilis (ST) grafts for ACL reconstruction over a 3-year follow-up interval.
Methods :Seventy-one patients with an average age of 29± 4.5yearswere treated for torn ACL between 2008 and 2009. Forty-sixpatients underwent reconstruction with BPTBautograft, and 41 were treated with STautograft.At the time of final follow-up, 37 patients in patella group and 34 patients in hamstring group were evaluated in terms of return to pre-injury activity level, pain, knee stability, range of motion,IKDC (International Knee Documentation Committee) score and complications.
Results : At 36thmonth of follow-up, 34 (92%) and 28 (82%) patients in BPTB and ST group, respectively had good-to-excellent IKDC score (p > 0.05). Theactivity levelswerehigher in BPTB group(p> 0.05). At 3rd yearof follow up, the Lachman test was graded normal, for 23 (62%) and 11 (32%) patientsin BPTB and ST group, respectively(p=0.019).Regarding the pivot-shift test, 29 (79%) and 15 (44%) patients in patella and hamstring group, respectively had normal test at the latest follow-up (p=0.021).There were no significant differences in terms of thigh circumference difference, effusion, knee range of motion, pain and complications.
Conclusion : Theresults indicate a trend toward increased graft laxityand pivot-shift grades in patients undergoing reconstruction with hamstring autograft compared with patella tendon. However, the two groups had comparable results in terms of activity level and knee function.
Ali Jafarian, Fezzeh Elyasinia, Mohammad Reza Keramati, Farham Ahmadi, Reza Parsaei,
Volume 29, Issue 1 (1-2015)
Abstract
Background: Peripheral arterial disease is a source of morbidity and mortality. Surgical vascular reconstruction is a treatment option but probability of failure and complications are important concerns. In this study, we evaluated outcome of surgical infrainguinal reconstruction and factors affecting graft patency for a period of one year.
Methods: In this cohort study, 85 consecutive patients with chronic ischemia who underwent lower extremity surgical vascular reconstruction (including 52 femoropopliteal and 25 femorofemoral bypass) from March 2007 to Feb 2009 were recruited. Graft patency was evaluated before discharge from hospital and one year after the surgical operation using duplex ultrasonography. Association between possible risk factors and graft patency were evaluated.
Results: In general, 71% (37 patients) of femoropopliteal and 52% (13 patients) of femorofemoral reconstructions were patent during the follow up period. Diabetes mellitus, hypertension, smoking, opium use and ischemic heart disease were significantly associated with decreased rate of patency (p<0.05).
Conclusion: Assessing risk factors that predict perioperative mortality and graft patency is essential for selecting patients that would benefit from surgery. Omitting surgical reconstruction and endovascular intervention may be preferable especially when multiple risk factors are present or in the absence of critical limb ischemia.
Malek Amini, Afsoon Hassani Mehraban, Hamid Haghni, Ali Asghar Asgharnezhad, Mohammad Khayatzadeh Mahani,
Volume 30, Issue 1 (1-2016)
Abstract
Background: Participation is mostly cultural and familial based, and there is not any assessment scales for evaluating kids’ participation in Iranian context, therefore the purpose of this study was developing children’s participation assessment scale for Iranian children.
Methods: Development of this scale occurred in two phases; phase I: planning: following reviewing the literature and adopting and compiling some items of available evaluation tools in the area (such as CAPE, CPQ, CLASS, Life-H) and receiving advice from two expert panels, the preliminary94-item questionnaire was prepared. Phase II: construct: the survey study was carried out on40 children and 21 of their parents to assess the popularity of the activity in Iran; thus, the items of the questionnaire reduced to 92 and after face and content validity, the final version prepared with 71 items.
Results: The final 71-item questionnaire was developed in two parent-report and child-report versions. The 71 items based on the literature and expert panels’ advice were categorized in 8 areas of occupation according to Occupational Therapy Practice Framework (ADL, IADL, Play, leisure, social participation, education, work, and sleep/rest).
Conclusion: Iranian children’s participation assessment is a useful and culturally relevant tool to measure participation of Iranian children. It can be used in rigorous clinical and population-based research.
Shayesteh Hajizadeh, Fahimeh Ramezani Tehrani, Masoumeh Simbar, Farshad Farzadfar,
Volume 31, Issue 1 (1-2017)
Abstract
Background: LBW is an important factor that can affect infant mortality and represents an index of economic and social development. It is expected that an increase in the density of midwives attending family physician programs will lead to a decrease in LBW in health centers. This study aimed to compare the percentage of LBW infants before and after the implementation of the family physician program in health centers with and without an increase in midwives density.
Methods: This cross-sectional study compared the percentage of LBW infants before and after the implementation of family physician programs in rural health centers with and without changes in midwives density in Kurdistan. In this study, we included 668 mothers of 2-month-old children and administered structured interviews in 2005 and 2013. Data were analyzed using the difference-in-differences and the Matchit statistical models.
Results: The Matchit model showed a significant average percentage increase 0.08 (0.006–0.17) in LBW infants born between 2005 and 2013 in health centers where the density of midwives increased compared with those where it remained unchanged. The difference-in-differences model showed that the odds ratio of LBW infants is increased by more than twice among participants who had a history of caesarean section.
Conclusion: The results of this study showed that an increase in the density of midwives in a family physician program did not have an impact on reducing the percentage of LBW infants born between 2005 and 2013, in health centers where the density of midwives augmented compared to those where it remained unaltered; it indicated that the increase in the density of midwives alone was not efficient. On the other hand, the results of our study show an increase in the risk of infants born at a LBW due to caesarean section. It is recommended that obstetricians and gynecologists must strictly control pregnancies and avoid unnecessary termination of pregnancy.
Seyedeh Zahra Masoumi, Maryam Kashanian, Elaheh Arab, Narges Sheikhansari, Raihaneh Arab,
Volume 31, Issue 1 (1-2017)
Abstract
Background: Pregnancy is one of the most important periods of a woman’s life and is influenced by many different factors. For years, it was assumed that teenage pregnancy can cause poor pregnancy outcome.
The purpose of this study was to compare some pregnancy complications between 2 groups of 15 to 19 and 20 to 35 year- old primigravida pregnant women
Methods: This was a cross- sectional study conducted on the data sheets of primigravida women who delivered their babies in a teaching hospital. A total of 3040 eligible women entered the study; of them, 280 (9.3%) were in the 15 to 19 years age group and 2756 in the 20 to 35 years age group. The 2 groups were compared for preeclampsia, PROM, preterm birth, SGA, placental abruption, and placenta previa. A logistic regression model was used for data analysis.
Results: The women of the 2 groups significantly differed in BMI and socioeconomic background. The rate of preeclampsia (p=0.008), PROM (p=0.002), and preterm delivery (p=0.001) were less in the 15 to 19 years age group. The rate of placental abruption, placenta previa, IUFD, and SGA was not significantly different between the 2 groups. After multivariate regression analysis, preeclampsia (adjusted odd ratio= 2.157; 95% CI= 1.38- 4.21) and preterm delivery (adjusted odd ratio= 2.443; 95% CI= 1.78- 5.13) were found to be higher in the 20 to 35 years group.
Conclusion: The risk of poor pregnancy outcome is not higher in teenage pregnancies compared to pregnancies in the 20 to 35 years age group if confounding factors, including socioeconomic factors, are carefully controlled.
Pouran Raeesi, Touraj Harati-Khalilabad, Aziz Rezapour, Samad Azari, Javad Javan-Noughabi,
Volume 32, Issue 1 (2-2018)
Abstract
Background: In the recent decades, most studies have paid more attention to community expenditures in health sector and health outcomes. This study provides econometric evidence linking countries’ health expenditures to 3 health outcomes: (1) infant mortality, (2) under 5 mortality and (3) life expectancy within 4 different health care systems.
Methods: In this study, we used the econometric method to estimate the effect of health expenditure on health status. Panel data were collected and grouped for 25 countries according to the health care system over 15 years (2000-2015). The random effects model was selected over the fixed effects model based on the Hausman test to assess the effect of different factors on the 3 mentioned health outcomes.
Results: A significant relationship was found between health expenditures and health indicators. The effect of private health expenditures on health outcomes in countries with mixed health financing system and traditional sickness fund insurance was higher than public expenditures. Also, after comparing the results between different health care systems, we found that the effect of health expenditure on the health outcome in countries with national health system (NHS) was more than other health care systems.
Conclusion: To improve health status, health policymakers should focus on the factors that lie inside the health care system. Therefore, since private and public health expenditures have different effects on health outcomes in each health care system, countries should choose an optimal combination of private and public health expenditures.
Hadis Sourinejad, Arezoo Shayan, Shiva Niyati, Lida Moghaddam-Banaem,
Volume 33, Issue 1 (2-2019)
Abstract
Background: The prevalence of metabolic syndrome has been rising worldwide in recent decades. Determining the associations between metabolic syndrome and its components in midpregnancy with neonatal anthropometric indices and outcomes is a major challenge in both public health and clinical care.
Methods: This prospective cohort study was performed on 238 pregnant women at 24-28 weeks of gestation. Metabolic syndrome was recognized with 3 or more of the following criteria: triglyceride ≥ 247 mg/dL; HDL < 61 mg/dL; GCT ≥ 140 mg/dL; prepregnancy body mass index ≥ 30 kg/m2; and blood pressure ≥ 130/85 mmHg. Statistical analysis was performed through descriptive statistics, including mean, standard deviation, frequency, and percentage, Mann-Whitney test, Chi-square test, Fisher’s exact test, linear and logistic regression in SPSS 21.0. P values < 0.05 were considered significant.
Results: There was a significant association between blood hypertriglyceridemia in weeks 24-28 and anthropometric indices, including weight, height, and jaundice, in the first 24 hours of birth. Metabolic syndrome also had a significant relationship with jaundice (P=0.002). The results of linear regression analysis revealed that metabolic syndrome was positively associated with birth weight (B=0.18, P=0.003) and height (B=0.18, P=0.009). Among the components of metabolic syndrome, the results showed a direct relationship between increased blood triglyceride of the mother and newborn’s weight (B=0.11, P=0.011) and height (B=0.14, P=0.007). Also, increased BMI had a significant direct relationship with the newborn’s weight (B=0.11, P=0.023) and height (B=0.12, P=0.023). Moreover, decreased HDL had a significant reverse relationship with the newborn’s weight (B=0.09, P=0.042).
Conclusion: Presence of metabolic syndrome and its components in midpregnancy may influence neonatal outcomes, especially anthropometric indices. However, more studies should be conducted to further investigate these relationships.
Amir Javanmard, Kianoush Abdi, Abbas Ebadi, Samaneh Hosseinzadeh,
Volume 34, Issue 1 (2-2020)
Abstract
Background: Spinal cord injury (SCI) has serious impacts on the patient’s function. Therefore, their participation is important as one of the major indicators of the quality of life. This study reviews instruments that evaluate participation among people with spinal cord injury.
Methods: Four electronic databases (WebofScience, Scopus, MEDLINE/PubMed, SID) were searched for studies published in the English language between 2000 and 2019 in one or more peer-reviewed journals on the measurement properties (reliability, validity and/or responsiveness) in all populations including adults with SCI. Instruments assessed based on special criteria designed for disability outcome measures.
Results: Six instruments were included: Incontinence - Activity Participation Scale, Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P), World Health Organization's disability assessment tool-II (WHODAS-II), ICF Measure of Participation and ACTivities Screener (IMPACT-S), Impact on Participation and Autonomy (IPA) , Participation measure for Post-Acute care (PM-PAC). Evidence related to the reliability and validity was reported for all of the instruments. Only WHODAS-II, USER-P, and IMPACT were compared with each other in recent publications. Responsiveness was not obtained for any of the instruments.
Conclusion: As the underlying structure of every instrument is different, the concept of the evaluated participation varies between instruments. The proper instrument for examining participation of the patients with SCI should be selected based on a thorough analysis of the individual's condition and context. Innovative models of disability should be the basis of emerging instruments for evaluation of participation, as well as empirical studies and modern measurement technologies that fill the gap between the perceived participation of the individual and the research's record.
Mohammad Ebrahim Khamseh, Zahra Abbasi Ranjbar, Zahra Banazadeh, Mani Mirfeizi, Manouchehr Mohammadbeiki, Zohreh Mozafari, Kamnoosh Razazian, Mojtaba Malek,
Volume 35, Issue 1 (1-2021)
Abstract
Background: Type 2 diabetes (T2D) is a progressive disease that should be managed with insulin in case of oral glucose lowering drugs (OGLDs) failure. If basal insulin is not sufficient, rapid acting insulin will be added before the largest meal. We assessed the impact of adding one prandial insulin to a basal based regimen and insulin glargine in patients with type 2 diabetes to measure the percentage of subjects achieving the HbA1c target by the end of 24 weeks of treatment in routine clinical practice.
Methods: This study was a 24-week observational study of patients with T2D not adequately controlled with OGLDs and basal insulin, for whom the physician had decided to initiate prandial insulin. The study endpoint was assessed at visit 1 (baseline), visit 2 at week 12 (±1 week) and visit 3 at week 24 (±1 week). The percentage of patients who achieved HbA1c targets was assessed at week 24. Statistical analyses were performed using IBM SPSS for Windows v 19 (IBM, Armonk, New York, USA). Logistic regression analysis was used to detect predicting factors of achieving the HbA1c target by week 24. P<0.05 was considered as significant level.
Results: Four hundred and eighteen patients with a mean±SD age of 56.24±9.85 years and a mean±SD duration of diabetes of 12.50±7.16 years were included. The median total daily dose of basal insulin was 24 units, while prandial insulin was started with 6 (4, 10) U/day, titrating up to 10 (8, 18) U/day at week 24. The daily dose of prandial insulin was the only factor that could significantly predict achieving targeted HbA1c by week 24 [OR: 1.04; 95% CI: 1.007,1.079; p-value: 0.019]. At week 24, 96 (22.9%) subjects achieved the HbA1c target with one prandial insulin.
Conclusion: The results of our study suggest that “basal plus therapy” can lead to good glycemic control with a low risk of hypoglycemia and weight gain in patients with type 2 diabetes.
Leila Shahmoradi, Reza Safdari, Hossein Ahmadi, Maryam Zahmatkeshan,
Volume 35, Issue 1 (1-2021)
Abstract
Background: Clinical decision support systems (CDSSs) interventions were used to improve the life quality and safety in patients and also to improve practitioner performance, especially in the field of medication. Therefore, the aim of the paper was to summarize the available evidence on the impact, outcomes and significant factors on the implementation of CDSS in the field of medicine.
Methods: This study is a systematic literature review. PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and ProQuest were investigated by 15 February 2017. The inclusion requirements were met by 98 papers, from which 13 had described important factors in the implementation of CDSS, and 86 were medicated-related. We categorized the system in terms of its correlation with medication in which a system was implemented, and our intended results were examined. In this study, the process outcomes (such as; prescription, drug-drug interaction, drug adherence, etc.), patient outcomes, and significant factors affecting the implementation of CDSS were reviewed.
Results: We found evidence that the use of medication-related CDSS improves clinical outcomes. Also, significant results were obtained regarding the reduction of prescription errors, and the improvement in quality and safety of medication prescribed.
Conclusion: The results of this study show that, although computer systems such as CDSS may cause errors, in most cases, it has helped to improve prescribing, reduce side effects and drug interactions, and improve patient safety. Although these systems have improved the performance of practitioners and processes, there has not been much research on the impact of these systems on patient outcomes.
