Publications by authors named "Mohammad Ali Heidarnia"

5 Publications

  • Page 1 of 1

Prioritizing barriers to implement clinical governance in teaching hospitals of Iran: A mixed method study.

Med J Islam Repub Iran 2019 18;33:140. Epub 2019 Dec 18.

Department of Community Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Clinical governance, as a program to improve the quality of health care, was introduced in all hospitals in Iran in 2009. However, implementation assessments revealed that the program was not adopted in many hospitals. This study aimed to determine and prioritize barriers to clinical governance program implementation in hospitals of Shahid Beheshti University of Medical Sciences. This qualitative study was performed in the first part of this exploratory mixed methods study. A purposive sample of 25 individuals who were involved in the implementation of the program was selected. They participated in semi-structured interviews and the data were analyzed using content analysis. In the second part (quantitative), a questionnaire was prepared based on the first phase of the study, and 74 stakeholders completed the questionnaire, which included all extracted obstacles to the establishment of clinical governance. They rated these obstacles with a 5-point Likert scale. A total of 9 themes were discovered in the qualitative part of the study. These themes were prioritized as follow: (1) weak organizational leadership, (2) insufficient human resources, (3) inappropriate organizational culture, (4) inadequate financial resources, (5) insufficient knowledge of personnel and management, (6) inappropriate monitoring and evaluation, (7) lack of coordination (8) deficiencies in policies and procedures, and (9) incomplete registration system and inadequate documentation. The results of this study showed that significant barriers exist in implementation of the clinical governance program in hospitals. These problems have to be addressed in order for the implementation procedure to be successful.
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http://dx.doi.org/10.34171/mjiri.33.140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7137863PMC
December 2019

Relationship of Social Determinants of Health with the Three-year Survival Rate of Breast Cancer

Asian Pac J Cancer Prev 2017 04 1;18(4):1121-1126. Epub 2017 Apr 1.

Department of Community Medicine, Medical School, Shahid Beheshti University of Medical Sciences,Tehran, Iran.

Background: Social determinants of health are among the key factors affecting the pathogenesis of diseases. Considering the increasingly high prevalence of breast cancer and the association of social determinants of health with its occurrence, related morbidity and mortality and survival rate, this study sought to assess the relationship of three-year survival rate of breast cancer with social determinants of health. Materials and Methods: This cohort study was conducted on males and females presenting to the Cancer Research Center of Shohada-E-Tajrish Hospital from 2006 to 2010 with definite diagnosis of breast cancer. Data were collected via phone interviews. Kaplan-Meier and Cox regression was fitted using SPSS (version 18) and PH assumption was tested by STATA (version 11) software. Results: The study was performed on 797 breast cancer patients, aged 25-93 years with mean age of 54.66 (SD=11.86) years. After 3 years from diagnosing cancer 700 (87.8%) patients were alive and 97 (12.2%) patients were dead. Using log rank test, there was relationship between 3-year survivals with age, education, childhood residence, sibling, treatment type, and district were significant (p<0.05). Using Cox PH regression, 3-year survival was related to age, level of education, municipal district of residence and childhood condition (p<0.05). Conclusion: Social determinants of health such as childhood condition, city region residency, level of education and age affect the three-year survival rate of breast cancer. Future studies must focus on the effect of childhood social class on the survival rates of cancers, which have been paid less attention to.
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http://dx.doi.org/10.22034/APJCP.2017.18.4.1121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5494225PMC
April 2017

Changing pattern of infective endocarditis in Iran: A 16 years survey.

Pak J Med Sci 2013 Jan;29(1):85-90

Dr. Babak Sharif Kashani, MD, Assistant Professor, Department of Cardiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: To investigate the changes in characteristics of patients with infective endocarditis in Iran and comparing the results with the changing profiles of Infection Endocarditis (IE) in other countries.

Methodology: We studied all patients with definite or possible IE seen at four referral teaching hospitals in Iran from Jan. 1995 to Dec. 2010. The data was analyzed both collectively and separately in two consecutive eight-year periods, i.e. 1995-2003 and 2004-2010.

Results: A total of 286 episodes of IE, 172 males and 114 females, were reviewed from which 162 ones were in the first eight-year time period and 124 episodes in the second one. Mean age of the patients was significantly increased in the second eight-year period (24.2±11 vs 39.4±15 years old, p value = 0.01). Increase in the episodes caused by Staphylococcus aureus was significant (40.7% vs 22.8%, p value = 0.01). The mean size of the vegetation was noticeably higher among IDUs than non-IDUs (1.53±0.1cm vs 0.76±0.2cm, p value < 0.001). As well as extra cardiac complications, mortality rate was noticeably higher among the patients with vegetation size ≥ 1cm (34.4% vs 16.3%, p value = 0.003). There was not a significant difference regarding the mortality rate between the conservatively and surgically treated patients (20.7% vs 22.9%, p value = 0.07).

Conclusion: The most important changing characteristic of IE which influences the outcome of the disease seems to be vegetation size which can account for as the outcome predictor.
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http://dx.doi.org/10.12669/pjms.291.2682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809170PMC
January 2013

Social determinants of health and 5-year survival of colorectal cancer.

Asian Pac J Cancer Prev 2013 ;14(9):5111-6

Department of Community Medicine and Health, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran E-mail :

Background: Early in the 21st century, cancers are the second cause of death worldwide. Colon cancer is third most common cancer and one of the few amenable to early diagnosis and treatment. Evaluation of factors affecting this cancer is important to increase survival time. Some of these factors affecting all diseases including cancer are social determinants of health. According to the importance of this disease and relation with these factors, this study was conducted to assess the relationship between social determinants of health and colon cancer survival.

Materials And Methods: This was a cross-sectional, descriptive study for patients with colon cancer registered in the Cancer Research Center of Shahid Beheshti University of Medical Science, from April 2005 to November 2006, performed using questionnaires filled by telephone interview with patients (if patients had died, with family members). Data was analyzed with SPSS software (version 19) for descriptive analysis and STATA software for survival analysis including log rank test and three step Cox Proportional Hazard regression.

Results: Five hundred fifty nine patients with ages ranging from 23 to 88 years with mean ± standard deviation of 63 ± 11.8 years were included in the study. The five year survival was 68.3%( 387 patients were alive and 172 patients were dead by the end of the study). The Cox proportional hazard regression showed 5-year survival was related to age (HR=0.53, p=0.042 for>50 years versus<50 years old) in first step, gender (HR=0.60, p=0.006 for female versus male) in second step, job (HR=1.7, p=0.001 for manual versus non manual jobs), region of residency (HR=3.49, p=0.018 for west versus south regions), parents in childhood (HR=2.87, p=0.012 for having both parents versus not having), anatomical cancer location (HR=2.16, p<0.033 for colon versus rectal cancer) and complete treatment (HR=5.96, p<0.001 for incomplete versus complete treatment).

Conclusions: Social determinants of health such as job, city region residency and having parents during childhood have significant effects in 5-year survival of colon cancer and it may be better to consider these factors in addition to developing cancer treatment and to focus on these determinants of health in long-time planning.
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http://dx.doi.org/10.7314/apjcp.2013.14.9.5111DOI Listing
December 2014

Associations of Demographic and Socioeconomic Factors with Complete Treatment and Follow-up of Colon Cancer.

Iran J Cancer Prev 2012 ;5(4):203-9

Dept. of Community Medicine and Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Cancer is the second cause of death in the world, and colon cancer is the third cause of death and is one of the most common cancers which will cure with early diagnosis, treatment and sufficient follow up. Assessing factors which affect this cancer is important for prolonging patient survival. Socioeconomic factors are among effective factors of cancer morbidity and mortality. Because mortality rates for colon cancers vary by socioeconomic characteristics, this study has been performed to recognize the relationship between socioeconomic factors with treatment and follow up of colon cancer.

Methods: This was a cross-sectional, descriptive study for patients with colon cancer registered in Cancer Research Center of Shahid Beheshti University of Medical Sciences from April 2005 to November 2006. Patients were selected randomly, and the study was conducted using questionnaires filled by interviewing the patients via phone (if a patient was dead, the questions were asked from their family members). Data analysis was done using SPSS (version 19) software.

Results: The study was performed on 520 colon cancer patients with age range of 23-88 years. The mean age of the patients was 63 (S.D.=11.8) and the median age was 64. Two hundred thirty seven (45.4%) patients were female and 283 (54.4%) were male. Using Chi-square test, age<60 (p=0.002) and female gender (p=0.034) had a significant correlation with complete treatment and there was a significant relationship between complete follow up and age<60 (p=0.037), academic education (p=0.02) and having insurance (p=0.021). Multiple logistic regression tests were used to evaluate concurrent effects of variables on treatment and follow up. Correlated variables to complete treatment include: age<60 (p=0.001), and female gender The Odds Ratio (OR) of completing treatment for patients under 60 years of age versus patients above 60 years was 3.13 (95% C.I. 1.55 to 6.34), and the OR of completing treatment for women versus men was 1.91(95% C.I. 1.33 to 2.74). Correlated variables to follow up were academic education ( ) and having insurance . The OR of cancer follow up in illiterate patients versus college-educated patients was 0.45 (95% C.I. 0.24 to 0.82), and the OR of cancer follow up in patients without insurance versus patients with health was 0.46 (95% C.I. 0.21 to 0.98).

Conclusion: Age is a correlated factor on completing colon cancer treatment. Women have more complete colon cancer treatment than men. Academic education and having insurance were the most important factors among socioeconomic factors observed in a five-year follow up after treatment. As the population of the old is increasing, executing effective interventions to improve treatment and follow up procedures for old patients is of prime importance. It seems that increasing the insurance contribution in follow up measures may lead to increase in the regular follow up and may affect patients' survival.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209573PMC
October 2014