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Background This study aimed to conduct a policy analysis on allocating Coronary Care Unit (CCU) beds and clarifies the well-suited model for allocating CCU beds in Iran. Methods As a multiphase study, this was conducted in 4 steps, including a literature review, semi-structured interviews, an analysis of the policymaking process, and the Delphi study. The bed allocation models, their criteria, and the challenges of CCU bed allocation were explored through a literature review and semi-structured interviews. The CCU beds allocation policy was analyzed using Walt and Gilson's Health Policy Triangle (HPT). The Delphi method chose the suitable model for the optimal allocation of CCU beds in Iran. Results Findings were reported in four dimensions of the policy analysis triangle, including content, context, process, and actors. Various social, economic, environmental, and political factors affect policy development. Allocating policy emphasizes fair distribution of resources and full access to health services and encourages the private sector. Achieving efficiency of hospital bed utilization put bed allocation on the agenda in Iran. Thorough literature review, 11 models and 14 indicators were found. After conducting interviews, the number of indicators increased to 58 cases, and the CCU bed allocation challenges were identified. The Trend Model was picked through the Delphi study as a framework for CCU bed allocation. Conclusion Using the results of the present study and the proposed model can help to allocate hospital beds, especially CCU beds, optimally and efficiently. However, challenges and barriers identified by this study require consideration during the development of the proposed model. Also, managers and policymakers require information about the most effective strategies to reduce the need for CCU beds in the future. It is recommended that future studies and scenario planning be considered prior to the optimal allocation of hospital beds.

Background This study aimed to conduct a policy analysis on allocating Coronary Care Unit (CCU) beds and clarifies the well-suited model for the allocation of CCU beds in Iran. Methods As a multiphase study, this was conducted in 4 steps including a literature review, semi-structured interviews, an analysis of the policymaking process, and the Delphi study. The models of bed allocation and their criteria, and also the challenges of CCU bed allocation, were explored through literature review and semi-structured interviews. The CCU beds allocation policy was analyzed using Walt and Gilson's Health Policy Triangle (HPT). The suitable model for the optimal allocation of CCU beds in Iran was chosen by the Delphi method. Results Findings were reported in four dimensions of the policy analysis triangle, including content, context, process, and actors. Various social, economic, environmental, and political factors affect policy development. Allocating policy emphasizes fair distribution of resources, and full access to health services, and encourages the private sector. Achieving efficiency of hospital bed utilization put bed allocation on the agenda in Iran. Thorough literature review, 11 models and 14 indicators were found. After conducting interviews, the number of indicators increased to 58 cases and the CCU bed allocation challenges were identified. The Trend Model was picked through the Delphi study as a framework for CCU bed allocation. Conclusion Using the results of the present study and the proposed model can help to allocate hospital beds, especially CCU beds, optimally and efficiently. However, challenges and barriers identified by this study require consideration during the development of the proposed model. Also, managers and policymakers require information about the most effective strategies to reduce the need for CCU beds in the future. It is recommended that future studies and scenario planning be taken into consideration prior to the optimal allocation of hospital beds in the future.

Introduction: Acute respiratory failure (ARF) is rare in pregnancy and occurs in less than 0.1% of pregnancies, it is one of the most common admissions of pregnant women to the intensive care unit and one of the leading causes of maternal mortality. The aim of this study was evaluation of the causes of ARF in pregnant women admitted to Shahid Sayyad Shirazi Hospital from 2014 to 2019. Material and Methods: This was a retrospective cross-sectional descriptive-analytical in pregnant women with respiratory disorders chief complaints. All cases of pregnant women admitted (1226 cases) were reviewed. Data were analyzed using SPSS version 26. Results: In total, 75 patients were enrolled in the study and their records were reviewed. The mean age of patients was 28.47 ± 5.06 years. Fifteen patients (25%) had ARF. The results showed that 13.3% of pregnant women with ARF needed to use mechanical ventilation (P=0.038). Also, women with history of chronic lung disease (CLD) are at higher risk for ARF (46.7% vs. 33.3%, P

Uterocutaneous fistula is a rare complication. Here we report a 31-year-old pregnant woman with a history of cesarean section and diabetes who came to our clinic with labor pains and reduced fetal mobility. Nine days after the cesarean section, she referred to us again with a complaint of bloody discharge in the surgical wound. With further examination, uterocutaneous fistula was diagnosed in this patient and due to infection at the surgical wound and inside the fistula, antibiotic treatment was put on the agenda. This report shows the importance of the cause, diagnosis, and management of this complication.

Objectives This study was conducted to evaluate the efficacy of rectal progesterone suppositories on pregnancy outcomes of pregnant women diagnosed with PPROM at the gestational age of 26–34 weeks, as well as on maternal and neonatal outcomes. Methods This is a double-blind, randomized clinical trial in pregnant women with PROM with gestational age of 26–24 weeks, conducted between February 2020 and December 2020 in Sayyad Shirazi Hospital, Gorgan, Iran. Results According to the results of the present study; Rectal progesterone suppository in pregnant women with PPROM is associated with improved delivery outcomes such as neonatal APGAR score, increased latent delivery stage without complications or severe and dangerous complications, without increased risk of mortality and NICU hospitalization in infants, so prescribing suppository rectal progesterone in pregnant women with PPROM with a gestational age of 26 to 34 weeks is associated with positive outcomes and is recommended based on the findings and opinions of the researchers. Conclusions According to the results of the present study; Rectal progesterone suppository in pregnant women with PPROM is associated with improved delivery outcomes such as neonatal APGAR score, increased latent delivery stage without complications or severe and dangerous complications, without increased risk of mortality and NICU hospitalization in infants, so prescribing suppository rectal progesterone in pregnant women with PPROM with a gestational age of 26 to 34 weeks is associated with positive outcomes and is recommended based on the findings and opinions of the researchers.

Introduction: Medical humanities are one of the most important interdisciplinary needs. Since the most important discussion in this field is how to achieve it, the purpose of this study is to analyze it from the perspective of humanities experts in the Iran. Method: The present study is a national wide qualitative study that was conducted in 2019. Considering the saturation criterion, data were collected through 22 semi-structured interviews and two open questionnaires from the participants. Study analysis was performed by thematic analysis method. Results: The participants were critical of the current situation of medical humanities in the country because there is no effective and serious relationship between humanities and medical sciences. To achieve this, four themes of institutional knowledge development, neighborhood (non-institutional development), policies and sociability were extracted. Conclusion: The development of medical humanities requires macro-policies in the country to be done with organizational institutional support. In these policies, proximity between the two areas and attention to the field of culture are also suggested. In this regard, it is suggested to have a native approach in returning to the traditions and roots of humanities and especially the history of literature in medical education.

Background: To estimate the resource use and costs associated to the initial phase of treatment for colorectal cancer in Iran. Methods: A retrospective study was conducted using routinely collected data within Electronic Health Records System (SEPAS), a national database representing public hospitals in Iran between March 20, 2016 and March 19, 2017. Primary end points included healthcare resource use, direct medical and non-medical costs of care in the 12-month study period. Results: The study population included 657 patients with colorectal cancer who underwent surgery and the follow-up chemotherapy. We estimated a total direct cost of $21,407 per patient. The results indicated that direct medical costs were primarily driven by inpatient hospital care, followed by surgery, chemotherapy, and diagnostic services. Conclusion: The initial 12-month of treatment for colorectal cancer, including surgery and the follow-up chemotherapy, is resource intensive. The total direct costs associated to the disease are remarkable, with Inpatient hospital services being the main contributor followed by surgery and chemotherapy.

Background A limited number of studies have specifically examined the value of quality-adjusted life-years (QALYs) from the patient’s perspective. Objective The goal of this study was to investigate the worth of QALYs from the perspectives of patients with diabetes using health and willingness-to-pay (WTP) measures. Methods A hypothetical treatment characterized by a permanent cure was presented to 149 patients with diabetes in Tehran, Iran, to elicit the monetary value that they attach to QALYs. The QALY gains of the participants were determined using the EuroQol-5 Dimensions, 3 Levels instrument, the visual analogue scale, and the time trade-off method. A mixed closed-ended WTP model supported by an open-ended question was used to ascertain the monetary value of a QALY gained. Finally, we used each respondent’s ratio of WTP to QALY gained and the mean of the ratios to estimate the worth of a QALY to all respondents. Results In total, 96% of respondents were willing to pay out of pocket for the restoration of full health, whereas 4% exhibited a zero WTP because of an inability to pay. The mean WTP per QALY varied depending on the health measure and discount rate used, ranging from $US1191 to $US5043 in sensitivity analysis, which is equal to 0.23–0.95 of Iran’s gross domestic product (GDP) per capita in 2015. Conclusion Applying the upper limit of the World Health Organization’s (WHO) cost-effectiveness threshold (i.e., three times the local GDP per capita) in resource allocation decisions requires caution and investigation, particularly in low- and middle-income countries with limited healthcare resources. To generalize our findings, especially for application to decision making, additional surveys involving more representative samples from different settings are recommended. Electronic supplementary material The online version of this article (10.1007/s41669-018-0111-2) contains supplementary material, which is available to authorized users.