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Introduction: Ethical issues are among the first concerns and important issues in the daily care of nurses, so that nurses always try to maintain and observe them in order to provide better and more basic care to patients. Moral intelligence (MI) can provide a framework for the proper functioning of nurses. The main purpose of this study was to determine the relationship between patient safety culture and the MI of nurses working in hospitals in Iran, Guilan province. Methods: In the present study which was descriptive and correlational research, the sample was 400 nurses from Iran. Data were collected by a standardized and modified questionnaire "Hospital Survey on Patient Safety Culture (HSOPSC)", and "Lennick & Kiel’s Moral Intelligence Scale". The collected data were analyzed by Spearman correlation and Friedman test via SPSS software version 13. Results: The findings of the study showed that the relationship between the patient safety culture and MI, was significant, and the total MI score (P

Background: In the context of Persian traditional medicine, there are several therapeutic strategies for managing diseases, ranging from lifestyle changes to herbal remedies. Objectives: Given the application of Persian traditional medicine in the management of chronic diseases, the burden of chronic illnesses, and the public’s recourse to traditional medicine specialists, this study aimed to assess the cost-effectiveness of traditional medicine dietary regimens for the treatment of non-alcoholic fatty liver disease from the perspective of the payer. Methods: In this study, we investigated the cost-effectiveness of providing nutrition counseling for lifestyle modification (changes in the aforementioned Setteh-e-Zarurieah) by a traditional medicine specialist compared to receiving counseling from a nutritionist for nonalcoholic fatty liver disease from the payer’s perspective. The outcomes measured were changes in aspartate aminotransferase (AST) and alanine aminotransferase (ALT) enzymes, body mass index (BMI), and the grade of fatty liver. Cost and effectiveness data were entered into Excel software, and the ICER ratio was calculated. Results: The results indicated that the dietary regimen prescribed by Persian traditional medicine when compared to the nutritionist’s recommended diet, resulted in a lower decrease in AST and ALT enzymes but led to a greater decrease in BMI (mean change = 0.42) and a significant change in the grade of fatty liver (OR = 9.75). Since the costs of tests, ultrasounds, and visits were equal in both groups, the cost difference was zero. In the first scenario, where traditional medicine is considered an alternative therapy and liver enzymes are the primary focus, providing nutritional counseling services by Persian traditional medicine may not be cost effective. However, if we consider the grade of fatty liver and BMI as the primary variables, providing nutritional counseling services by Persian traditional medicine may be cost-effective. Conclusions: Based on the available evidence, the treatment of fatty liver using Persian traditional medicine can be considered an effective and cost-effective complementary (or alternative) intervention. Considering the long-term costs imposed by the health system and insurance organizations, it is predicted that adding visits to Persian traditional medicine specialists may reduce overall healthcare system costs.

Abstract Background In the present COVID-19 crisis, one of the greatest challenges for research funding at both the international and national level is selecting the best research topic to achieve efficiency and equity in health research and to address the knowledge gap urgently raised due to the event. Despite international recommendations, countries should consider their context-specific situation and define local research priorities. We aimed to exercise a priority-setting activity to identify the knowledge gaps and suggest research priorities in response to the COVID-19 epidemic in Iran. Methods First, we tried to identify the contextual knowledge gaps based on an online survey, performing key informant interviews (i.e. health professionals, policy-makers and managers) and media analysis. We also performed a literature review and considered international research priorities for COVID-19. Subsequently, we prepared a list of research questions and challenges to respond to the COVID-19 crisis in Iran using a systems approach. Then we mapped approved COVID-19 research projects in the country to research questions. Finally, we compared the identified research questions (not challenges) with the prioritized research from international organizations and then prioritized them for Iran. Results We found risk factors and epidemiological dissemination patterns of the virus and its consequences in an epidemiology domain, implementation of clinical and hygiene in a clinical management domain, genetic studies for targeting prevention and treatment in a candidate treatment and vaccine research and development (R&D) knowledge domain, examination of the manifestations of ethics in society instead of ethics in research in an ethics domain, “care, access and health system” and “public health and participation in response to public health and clinical research” as two sub-domains of a social sciences domain, and finally, no new questions in either the virology, transmission, diagnosis or animal and environmental domain. Conclusions In the event of global health crises like COVID-19, prioritization of research questions can be done globally, but some of the research priorities are context-specific and may vary by regional needs. To better manage research resources, researchers must respond to the challenges faced in each country based on its political, economic, social and cultural characteristics, and to make evidence-informed decisions, global knowledge gaps must be customized in each country.

Abstract Context: In the first stage of viral replication, COVID-19 may cause a remarkable inflammatory response in patients. Paxlovid is an oral antivirus medicine that functions through the inhibition of one of the essential enzymes to viral replication, called protease. The present study intends to help policymakers decide on using Paxlovid in COVID-19 treatment. Evidence Acquisition: This rapid review searched databases including Cochrane, PubMed, and Google Scholar by the end of July 2022. The inclusion criteria were randomized clinical trials investigating the safety and effectiveness of Paxlovid oral medicine at different doses in COVID-19 patients, compared with placebo or other routine care methods. Results: Based on the results (from three studies meeting the inclusion criteria), Paxlovid has no serious side effects, but when used, the patients must be checked for renal and hepatic failure, as well as drug interactions. Patients treated with this medicine within five days after the symptom onset were hospitalized, with 1% (6/607) in the Paxlovid group and 6.7% (41/612) in the placebo group. Also, no fatalities were reported in the Paxlovid group until day 28, while 10 (1.6%) patients died in the placebo group. Conclusions: Paxlovid is very effective in outpatient treatment and comes in a combination pack containing nirmatrelvir 150 mg and ritonavir 100 mg film-coated tablets, to be taken twice daily for five days after the symptom onset in adults and children (over 12 years old and a minimum weight of 40 kg) who have mild to moderate symptoms of COVID-19 in order to prevent severe disease, which may lead to hospitalization and death. However, there is high uncertainty about the possibility of drug interactions. Keywords: Paxlovid; Rapid Review; COVID-19; Pandemic; Health Technology Assessment

Background: Considering the importance and position of the health sector in socio-economic development programs, it is necessary to be aware of the current situation and to recognize its issues and problems. Determining costs and the amount of profit or even loss in the health sector helps in managing costs. The purpose of this study was to evaluate the cost of common laboratory services and compare them with the tariffs approved by the Ministry of Health and Medical Education in the selected hospital of Tehran University of Medical Sciences. Materials and Methods: The present study was a cross-sectional and retrospective study. In this study, activity-based costing technique was used. The study population was the laboratory of the selected hospital of Tehran University of Medical Sciences. Data collection tools were information forms, software, interviews and direct observation. The analysis was performed using Excel 2016 software and finally, the cost price was compared with the approved tariff. Results: The findings indicated that the highest and lowest costs were related to the cost of manpower and energy carriers, respectively. The highest cost was related to the urine analysis test and the lowest was related to the sodium and potassium tests. Conclusion: The results of this study showed that the cost of conventional laboratory services in the selected hospital of Tehran University of Medical Sciences and the tariffs approved by the Ministry of Health and Medical Education in 2019 were different.

Abstract Background: The health system is facing limited financial resources in all countries. Resource allocation is one of the tasks of the health system. Prioritizing interventions is one of the strategies that can help health policymakers in allocating financial resources. Rare diseases require more attention than other diseases due to their high cost and complex treatments. The countries use different policies to determine the effectiveness of interventions in the field of rare diseases. The purpose of this study is to refer to some policies in the field of allocating resources for rare diseases and to explain the importance of determining the threshold of cost-effectiveness for rare diseases in Iran. Methods: This research is a review study. First, a study was conducted on how to prioritize health interventions in the world and the thresholds of cost-effectiveness in different countries. Articles related to the research topic were then searched in accessible databases in Iran such as SID, Google Scholar and Medline. Finally, the obtained articles were screened and analyzed based on a thematic approach. Results: The World Health Organization (WHO) has set a threshold for determining the cost-effectiveness of health system interventions, that is determined and calculated based on the per capita GDP of each country. There are many differences between countries on policies related to the treatment of rare diseases, medicines, health care budgets and patient access. Conclusions: Due to the very high cost of treating rare diseases, it is impossible to use the threshold used for general disease interventions in rare diseases and it is necessary to use a higher threshold for rare diseases. In addition to cost-effectiveness, budget, justice, feasibility, and other criteria that are considered important at the national level should be considered.