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Background Identifying the challenges of implementing clinical practice guidelines (CPGs) can provide valuable information for decision-makers and health policymakers at the national and local levels. The implementation of CPGs requires the development of strategies to facilitate their use. This research aimed to determine the challenges, barriers and solutions for implementing CPGs from the expert point of view in Bushehr University of Medical Sciences.Methods This qualitative research uses content analysis conducted in 2022 in southern Iran. In-depth interviews were conducted with the physicians and experts in the health system. Interviewing continued until reaching the saturation level. Altogether, 22 experts were interviewed. The interview guide was used to explore experts’ opinions. All the interviews were recorded and then transcribed. Finally, coding and data analysis was done using MAXQDA 2022 software.Results The analysis revealed 4 main themes and 20 subthemes. The four main themes included challenges related to physicians, medical education, the health system and patients. The most common themes were the lack of sufficient training (related to the medical education system), equipment and infrastructure, and the lack of adaptation of clinical guidelines (related to the health system). The solutions included 4 main themes and 19 subthemes.Conclusion The most mentioned topic by the experts was training CPGs in medical schools. In Iran’s current medical education system, the training of CPGs is not included in the curriculum. It is proposed to reform the medical education system in Iran. In addition, health inequalities such as lack of access to equipment, supplies and insurance in under-resourced areas and disparities in research/training/medical education should be addressed to improve the validity of guidelines.

Abstract Background Neonatal sepsis, particularly gram-negative (GN) bacteria-induced, is a significant cause of morbidity and mortality in newborns. Healthcare professionals find this issue challenging because of antibiotic resistance. This study aims to combine findings to identify the prevalence of GN bacteria and their antibiotic resistance in Iranian neonates with sepsis. Methods This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search was performed through international databases, including (PubMed/MEDLINE, EMBASE, Scopus, and Web of Science), Iranian local databases (Magiran, Iranmedex, Irandoc, Scimed, and SID), and the first 100 records of Google Scholar. Analytical cross-sectional study checklist from the Joanna Briggs Institute (JBI) was used for the quality assessment of included studies. Comprehensive Meta-Analysis Software Version 2 was used to conduct the meta-analysis. The between-study heterogeneity was investigated by I2 statistics. Results The prevalence of GN bacteria was estimated to be 53.6% [95% CI: 45.9– 61.1: P = 0.362] in Iranian neonates with sepsis, based on 31 studies with a sample size of 104,566. klebsiella pneumoniae (K.pneumonia) (23.2% [95% CI: 17.5–30.0, P

Abstract Background This study aimed to evaluate the socio-demographic, clinical, and laboratory risk factors in hospitalized COVID-19 patients during the first 6 months of the SARS-CoV-2 epidemic. Method This retrospective hospital-based cross-sectional study included all laboratory-confirmed cases of the COVID-19 virus that were admitted to the Shohadaye-Khalije-Fars Hospital in Bushehr, Iran, from February 22, 2020 to September 21, 2020. The patients' records were reviewed during the hospitalization period. The global COVID-19 clinical platform, i.e., the World Health Organization Rapid Case Report Form was used as the data collection tool. We conducted the survival analysis using the Kaplan–Meier and the Stepwise Cox regression analyses. Results The analysis included 2108 confirmed cases of COVID-19 with a mean age of 47.81 years (SD 17.78); 56.8% men, 43.2% women and 6.3% (n = 133) deaths. After adjustment, it was found that factors associated with an increased risk of death consisted of chronic kidney disease, intensive care unit admission, cancer, and hemoptysis. The 7-day survival rate was 95.8%, which decreased to 95.1%, 94.0%, and 93.8% on days 14, 21, and 28 of hospitalization, respectively. Discussion and conclusion Older COVID-19 patients with manifestation of hemoptysis and a past medical history of chronic kidney disease and cancer, should be closely monitored to prevent disease deterioration and death, and also should be admitted to the intensive care unit.

Background: Since the high rate of inappropriate MRI prescription has a significant financial burden on the health system, the specialists’ opinion, as the people engaged in prescribing such orders, would help the policymakers to solve the problem more efficiently. The present study investigates specialists' opinions about the reasons behind the inappropriate prescription of MRI in 2021. Method and Materials: This study was exploratory-descriptive qualitative research. The interviews were semi-structured. They were all recorded. Then the interviews were coded and analyzed using MAXQD2022. Results: Sixteen specialists participated in the present study. The reasons for inappropriate prescription were classified into 3 subjects: physician-related, patient-related, and health system-related factors. The reason for the prescription part, the negative motivation of physicians, and the pressure of patients were focused on Developing and implementing indication-based guidelines by the insurance system and educating society presented as solutions Conclusion: It seems the reasons for the inappropriate prescription of MRI are not considering the indications, the patients' pressure and the doctors' motivation to visit more patients and spend less time on physical examination. Induced demand of physicians is another reason. Experts suggested community education, indication-based insurance coverage, and increased MRI costs. Developing appropriate national guidelines for prescribing MRI and monitoring its implementation by the insurance system can be one of the best approaches to preventing inappropriate prescribing of MRI.

Background: Despite growing evidence, there is still uncertainty about potentially modifiable risk factors for neonatal early-onset sepsis (EOS). This study aimed to identify potential clinical risk factors for EOS based on a literature review and expert opinions.Methods: A literature search was conducted in PubMed (MEDLINE), Cochrane, Embase, and Scopus databases. Articles in English, published up to May 2021, on clinical risk factors for neonatal EOS were included. Initially, a questionnaire on risk factors for EOS was developed and validated. The fuzzy Delphi method (FDM) was used to formulate the final version of the questionnaire. The validity of the risk factors was assessed using the Chi square test. P

Introduction: Evidence-based medicine is considered as a new and reliable approach which has new discussions on judgment to find the best evidence or qualitative evidence. This study was designed in Bushehr province for designing, implementing, and evaluating physician empowerment courses in evidence-based MRI prescriptions in the training hospitals of Bushehr University of Medical Sciences in 2021. Methods: The present study was an educational scholarship which was conducted in Bushehr province. This study was performed in two phases in accordance with Glassic criteria. A number of five workshops were designed and conducted by researchers using the ADDIE Model in systemic educational design. The course was designed through the review of texts and interviews with experts and in-depth group discussions (FGD) with the presence of seven experts. After that, this training course was evaluated and the end-of-course test was performed using the Kirkpatrick model. In order to evaluate the reaction of participants during the training course, a questionnaire was designed and its face validity and content validity were approved by experts. In addition, a four-choice test was designed based on the presented scientific content to evaluate the learning level of participants. A number of 40 questions were designed for five workshops. Descriptive statistics (frequency, mean) were used in SPSS22 for data analysis. Results: In terms of gender, 53.7 % were male and 46.3 % were female. In terms of age, 24.4 % were in the age group of 31-35 years. In terms of improving awareness, 34.1 % of participants were at a very good level after the empowerment course. Learning findings indicated that 85.7 % of participants in the final test received a passing score while 14.3 % failed. Conclusion: In general, the findings of the study indicated that holding an empowerment course for physicians in Bushehr improved their awareness and knowledge. In fact, such improvement in awareness and knowledge can reduce unnecessary prescriptions and treatment costs but improve the quality of services.

Abstract Background Policymaking in the pharmaceutical sector plays a pivotal role in achieving the health systems’ goals. Transparency in the pharmaceutical policy could increase confidence in decision-making processes. This study aims to assess transparency in the public pharmaceutical sector of Iran. Methods This qualitative study with a content analysis approach was conducted in 2017 using the World Health Organization tool to explore pharmaceutical transparency. The perceptions of the various stakeholders of the health system through semi-structured interviews with a maximum variation of stakeholders were obtained in eight functions, including registration, licensing, inspection, promotion, clinical trials, selection, procurement, and distribution of medicines. Results There are some problems in two main categories: (1) General problems, including lack of transparency, conflict of interest, centralization, and monopoly. (2) Ethical problems include illegal payments, gifts, bribes, conflicts of interest, hidden power, hoarding, relationship-oriented behavior, medicine trafficking, and counterfeit medicine. Suggested solutions include evidence-based decision-making, the use of transparent and accountable processes, standardization, needs assessment, declaring a conflict of interest, skilled human resources, and tracking prescription. Conclusion Despite the development of effective pharmaceutical policy in the health care system and government interventions for the control of the market, in some functions, reviewing the pharmaceutical policy is essential. Additionally, declaring a conflict of interest statement must be at the core of policy development to provide greater transparency.

Background: Low back pain (LBP) is currently the most common musculoskeletal disorder and a major cause of disability. A remarkable percentage of diagnostic imaging prescriptions are not necessary, therefore, this study aimed to determine the necessity of lumbar MRI prescriptions in Bushehr teaching hospitals in 2018. Materials and Methods: This cross-sectional descriptive-analytical study recruited a sample size of 273 individuals from a population of all patients presenting to Bushehr teaching hospitals for low back pain and undergoing lumbar MRI. Data were collected using a questionnaire with demographic questions and prescription-related questions. SPSS 24 software was used for data analysis. Results: Of the 273 patients studied, 54% were female and 46% male. The mean age of patients was 43 years and 72% of all patients were between 21 and 50 years old. MRI was deemed unnecessary for approximately 44% of patients. Furthermore, MRI results were reported absolutely normal in 30% of the patients. Conclusion: It can be concluded that many MRI services provided are not clinically necessary, and given the high hospital costs, especially for MRI, it is necessary to use valid indications to prevent ordering unnecessary tests, and imposed requests. Such indications will reduce the costs incurrd to healthcare system and patients.

Background: Many prevalent disorders were observed in and around the knee joint. Magnetic resonance imaging (MRI) was a modern and costly diagnostic technology that was progressively applied worldwide. This study was conducted in the Bushehr educational hospitals in 2018 with the purpose of determining the necessity of knee MRI prescriptions. Methods: This paper was a kind of cross-sectional descriptive-analytical study. The statistical population of the study was all patients who were prescribed knee MRI due to the appearance of knee problems and referred to the MRI Center of Bushehr University of Medical Sciences in 2018. The sampling method was convenient sampling. The sample in this study included 274 patients. The indications and data collection form of Vojdani et al.'s study were used to specify the necessity of the mentioned prescriptions. In this study, SPSS 22 software was applied to analyze data. Also, the Chi-Square test was used to for analyzing the data. Results: Among the total studied population in this study, MRI prescription was evaluated inappropriately for approximately 24 % of patients. In this study, the appropriateness of the prescriptions had a significant relationship with age, job, education level, physician prescribing, and requesting MRI (P-value < 0.05). Conclusion: It could be deduced that about a quarter of MRI was not appropriate to clinical prescription. Regarding the high cost of hospital and the necessity of their reduction, induced demand would be prevented by using valid indications. Therefore, reducing unnecessary prescriptions yielded to fewer costs of the health system and patients.

Corrigendum: Design, Implementation, and Evaluation of Physicians Empowerment Course for Evidence-Based MRI Prescription at Bushehr University of Medical Sciences in 2021 Hedayat Salari 2,3, Atefeh Esfandiari 2,3 2 Department of Medical Education, Virtual University of Medical Sciences, Tehran, Iran 3 Department of Health Policy & Management, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran In the above article, which was published in the Volume 6, Issue of 1, March 2022, affiliations of Hedayat Salari and Atefeh Esfandiari have been corrected.

Introduction: As physicians have not sufficient time for updating their clinical information, medical librarians could play an important role to satisfy their needs. This study aimed to identify the obstacles towards the role-playing of medical librarians in facilitating the scientific communications among physicians and paramedical practitioners based on the viewpoint of medical professionals in Bushehr University of Medical Sciences, Bushehr, Iran. Methods: This qualitative study was conducted using semi-structured interviews. Interviews were continued until all relevant themes and domains saturated. Sampling was done purposefully. In this study, 10 physicians and paramedical practitioners were chosen to ask the questions. Results: According to the interviews, five barriers were identified entitled attitude, individual, structural, technical, and organizational aspects towards the role-playing of medical librarians in facilitating the scientific communications among physicians and paramedical practitioners. The most important obstacle was a personal obstacle. Conclusion: Using the results of this research and the identified challenges, it is possible to use the structural and organizational reforms as well as changes in attitudinal and behavioral factors to facilitate the scientific communication between physicians and paramedical staff of the Shohada of Persian Gulf Hospital in Bushehr. The results of this study can be used to solve the organizational problems of libraries. Moreover, this research can be used to formulate a plan for personal training of medical librarians.

Background Although preventable, healthcare-associated infections (HAIs) continue to pose huge health and economic burdens on countries worldwide. Some studies have indicated the numerous causes of HAIs, but only a tiny literature exists on the multifaceted measures that can be used to address the problem. This paper presents stakeholders’ opinions on measures for controlling HAIs in Iran. Methods We used the qualitative research method in studying the phenomenon. Through a purposive sampling approach, we conducted 24 face-to-face interviews using a semi-structured interview guide. Participants were mainly key informants, including policy-makers, health professionals, and technical officers across the national and subnational levels, including the Ministry of Health (MoH), medical universities, and hospitals in Iran. We performed thematic framework analysis using the software MAXQDA10. Results Four main interdisciplinary themes emerged from our study of measures of controlling HAIs: strengthening governance and stewardship; strengthening human resources policies; appropriate prescription and usage of antibiotics; and environmental sanitation and personal hygiene. Conclusion According to our findings, elimination of HAIs demands multifactorial interventions. While the ultimate recommendation of policy-makers is to have HAIs among the priorities of the national agenda, financial commitment and the creation of an enabling work environment in which both patients and healthcare workers can practice personal hygiene could lead to a significant reduction in HAIs in Iran.

Background: Evidence Based Medicine can be define as the process of systematically finding, critically appraising, and using recently published researches as a basis for making decisions regarding individual patients.One of the most prevalent MRI procedures is Brian MRI. This study aimed to identifying and developing appropriate indications for prescriptions of Brain MRI in Iran. Methods: This is a consensus based study using one of the practical methods, RAND Appropriateness Method. The study sample were among experts in the treatment and diagnostic field of brain disorders. The experts consisted of nine specialists: Four neurosurgeons and five neurologists, all of whom were faculty members and worked in educational hospitals. The list of indications and scenarios sent to 9 experts for scoring. They scored the scenarios according to RAM instruction. Results: A total of 104 indications and scenarios were extracted. After that, Finally80scenarios fall in the category of appropriate scenarios, 20 in uncertain and4 in the category of inappropriate scenarios. Conclusion: Currently a huge number of medical imaging prescriptions may be unnecessary in Iran and there is need for developing clinical practice guidelines. The findings of this study can be used for developing national guidelines, conducting research to assess whether the criteria are followed in practice and whether their application can curb the growing rate of unnecessary care in all countries. In Iran, a limited amount of resources are allocated to the health sector

Background: Osteoarthritis is the most common joint disease in humans, which is the greatest cause of physical disability among the elderly in developed countries. Homeopathy is a specific therapy that treats patients based on precise stimulation of the immune and vital systems by certain homeopathy medications. Given the widespread use of this technology, in this article, we compared homeopathy Health Technology with non-steroidal anti-inflammatory drugs in the treatment of osteoarthritis. Methods: In this study, Health Technology Assessment (HTA) was employed to compare homeopathy treatment with non-steroidal anti-inflammatory drugs (NSAIDs), by reviewing clinical trials. The study population included patients with knee osteoarthritis; the intervention group included homeopathy, and the control group comprised routine medical treatment (NSAID) and outcomes measured included efficacy, safety, and cost effectiveness. The most important electronic medical databases were searched for relevant articles published from 2000 to 2016, including The Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL); Center for Reviews and Dissemination, University of York (CRD; NHS EED), Trip; PubMed; EMBASE and Google Scholar. Results: Effectiveness was measured by indicators of pain and motor function. Total changes in VAS index revealed about 34 units decrease in the intervention group, while there was 12 units reduction in the control group. Reducing the consequences of pain and knee function problems were 10 points more in the intervention group in comparison to the control group. Safety outcomes were measured via skin reactions (and sensitivity) which were lower in the intervention group. In terms of cost-effectiveness, the results revealed that for each unit of pain relief, more cost was spent in homeopathy method. Conclusion: Given that the overall costs of both treatments were low, even with the higher effectiveness and safety of homeopathy treatment, compared with NSAIDs, homeopathy is preferable.

Background: Mobile technologies are widely used in healthcare. The purpose of this study was to compare the effectiveness and cost-effectiveness of fixed computed tomography (CT) and magnetic resonance imaging (MRI) with the mobile ones. Methods: In this systematic review, PubMed, Cochrane Library, Scopus and CRD database were searched from 1995 to 2015. The data on safety and effectiveness of technologies were extracted from included studies. Because the review showed no significant differences in the performance of mobile CT and MRI compared to the fixed ones, then a cost minimization approach was used to explore the cost-effectiveness of three scenarios. Results: Twenty two articles were included in the review that showed no statistically significant differences in the performance of mobile MRI and CT scan compared to the fixed ones. The cost minimization approach showed that the third scenario based on purchasing a common mobile MRI and CT scan; and using it by two or more hospitals that are in rational distance from each other is associated with the lowest costs, so it is the most cost-effectiveness strategy. Conclusion: The performance of Mobile CT and mobile MRI is comparable to the fixed ones; and using a combined mobile CT and MRI by two or three hospitals is the most cost-effective approach.

Background: Injuries and fatalities from road traffic Injuries are global public health concerns, and a major problem in the Iran. This study aimed to explore strategies to control road traffic Injuries (RTI) in Iran. Methods: We conducted a qualitative study to explore possible ways to reduce the occurrence of road traffic Injuries in Iran in 2016. Interviewees were purposively sampled from various sectors due to multidisciplinary nature of RTIs. Participants were mainly representatives from the police, Ministry of Road, Municipal, emergency services and Ministry of Health. Besides, public health authorities, researchers, and university professors were interviewed. We conducted in-depth interviews using generic guides. Data was analyzed using MAXQDA 10 software. Through content analysis, we interpreted core themes relevant to the accomplishment of our study objectives. Results: Themes that emerged from our study include; road traffic management, governance, education, improving accident database, enforcement, driving license restrictions, and construction of pedestrian overpass. Conclusion: This study revealed key informants’ views regarding available and affordable solutions to reduce RTIs in Iran. Many applicable strategies are identified in the control of RTIs in Iran. Although some solutions such as highway construction and/or expanding rail transportation have been suggested as effective measures for reducing accident, but they are costly and may not be fully applied in developing countries like Iran.

BackgroundInformal payments for health care, which are common in many countries, can have negative effects on health care access, equity and health status as they lead people to forgo or delay seeking care, or to sell assets to pay for care. Many countries are putting reforms in place with the aim of reducing informal payments. In order to be successful, such policies should be informed by the underlying causes of such payments. This study attempts to explore why, how, and in what ways informal payments occur. MethodsWe conducted face-to-face interviews with a purposeful sample of 45 participants, including patients, healthcare providers and officials, in Kerman province in Iran, in 2010. The research participants were asked about the nature of informal payments, the reasons behind both asking and making those payments. We analysed the data using content analysis. ResultsWe found that people make informal payments for several reasons, namely cultural, quality-related and legal. Providers ask for informal payments because of tariffs, structural and moral reasons, and to demonstrate their competence. Informal payments were found to be more prevalent for complex procedures and are usually asked for directly. ConclusionInformal payments are present in Iran’s health system as in other countries. What makes Iran’s condition slightly different from other countries is the peculiarity of reasons behind asking informal payments and the disadvantages associated with these kinds of payments. Iran could overcome this dilemma by precise investigation of the reasons to inform appropriate policy formulation. Some policies such as raising salaries, justifying the tariffs and cost-sharing, defining a benefits package of services, and improving accountability and transparency in the health system could be taken by the government to alleviate the problem.

MRI is a new and expensive diagnostic technology, which has been used increasingly all over the world. Low back pain is a worldwide prevalent disorder and MRI technique is one of the several ways to diagnose it. This paper aims to identify the appropriateness of lumbar spine MRI prescriptions in Shiraz teaching hospitals using standardized RAND Appropriateness Method (RAM) criteria. Methods This study consisted of two phases. The first phase involved a qualitative enquiry and the second phase had a quantitative cross-sectional nature. In the first phase RAM was used for developing lumbar spine MRI indications and scenarios. In the second phase, the finalized scenarios were compared with the history and physical examination of 300 patients with low back pain. The rate of appropriateness of lumbar spine MRI prescription was then calculated. Results Of 300 cases of lumbar spine MRI prescriptions, approximately 167 (56%) were considered inappropriate, 72 (24%) were uncertain, and 61 (20%) were deemed to be appropriate. The economic burden of inappropriate prescriptions was calculated at 88,009,000 Rials. In addition, the types of expertise and physical examination were considered as related factors to appropriateness of prescriptions. Conclusion In conclusion, a large proportion of lumbar spine MRI prescriptions, which result in financial burden on the insurance companies and the patients alike is unnecessary. This study suggests that policy makers consider this evidence while decision-making. Our findings highlight the imperative role of Health Technology Assessment (HTA) and Clinical Practice Guidelines (CPGs). As a result, developing local clinical guidelines may create the commitment needed in physicians in prescribing appropriate prescriptions within the health sector. The study further recommends that appropriate scenarios should be considered as a criterion for payment and reimbursement.

Introduction: Faculty members are considered the most important elements of higher educational systems so their recruitment and retention is one of the success factors for universities. Theoretically, social capital is one of the factors that may affect on faculty retention. This study was aimed to study the relation between organizational social capital and retention of faculty members in Kerman University of Medical Sciences during year 2011. Methods: This was a cross- sectional and descriptive-analytical study. It was conducted in all colleges of Kerman University of Medical Sciences. A sample of 150 faculty members was selected via multistage sampling. They completed two valid and reliable questionnaires already developed by others. Data were analysed by regression models and path analysis. Results: In this study, the mean of social capital and retention among the faculty members of Kerman University of Medical Sciences were 3.16±.96 and 3.13±.61 respectively (out of 5). The results showed that there is a direct and positive bilateral (r=0.65) correlation between social capital and retention of faculty members in Kerman University Medical Sciences. Conclusion: There are positive and significant relashionship between social capital and retention of fculty members in other words, the increse of social capital among faculty members will accompany an increase in the probability of their retention. Social capital is one of the factors that may strongly affect faculty retention, so managers can rely on the factors affecting the improvement of social capital to increase their retention, but other factors should not be neglected at all.