Publications by authors named "Morteza Arab-Zozani"

55 Publications

Outcome evaluation of COVID-19 infected patients by disease symptoms: a cross-sectional study in Ilam Province, Iran.

BMC Infect Dis 2021 Sep 3;21(1):903. Epub 2021 Sep 3.

Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.

Background: Novel coronavirus disease-19 (COVID-19) was declared as a global pandemic in 2020. With the spread of the disease, a better understanding of patient outcomes associated with their symptoms in diverse geographic levels is vital. This study aimed to evaluate clinical outcomes of COVID-19 patients by disease symptoms in Ilam province, Iran.

Methods: This was a cross-sectional study. Data were collected from integrated health system records for all hospitals affiliated with the Ilam University of Medical Sciences between 26-Jan-2020 and 02-May-2020. All patients with a confirmed positive test were included in this study. Descriptive analyses, chi-square test, and binary logistic regression model were performed by using SPSS version 22.

Results: The mean age of participants was 46.47 ± 18.24 years. Of the 3608 patients, 3477 (96.1%) were discharged, and 129 (3.9%) died. 54.2% of the patients were male and were in the age group of 30-40 years. Cough, sore throat, shortness of breath or difficulty breathing, and fever or chills were the most common symptoms. Patients with symptoms of shortness of breath, abnormal radiographic findings of the chest, and chest pain and pressure were relatively more likely to die. According to binary logistic regression results, the probability of death in patients with shortness of breath, abnormal chest radiographic findings, and chest pain was 1.34, 1.24, and 1.32 times higher, respectively, than for those without.

Conclusion: Our study provides evidence that the presentation of some symptoms significantly impacts outcomes of patients infected with SARS-CoV-2. Early detection of symptoms and proper management of outcomes can reduce mortality in patients with COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12879-021-06613-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414471PMC
September 2021

Intimate Partner Violence in the Middle East Region: A Systematic Review and Meta-Analysis.

Trauma Violence Abuse 2021 Aug 12:15248380211036060. Epub 2021 Aug 12.

Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.

Background And Objective: Intimate partner violence (IPV) is a clinical and social problem globally, especially in the Middle East. This study aimed to analyze the prevalence of IPV and its types against women in the Middle East region.

Method: PubMed, Scopus, and Web of Science were searched in January 2020. From 1995 to 2020, all studies performed in the Middle East, investigating at least one type of abuse against women and written in English, entered the study. All included studies were appraised using Joanna Briggs Institute Checklist, which was adapted for prevalence studies. The random effect model of meta-analysis was performed using the Mantel-Haenszel method by comprehensive meta-analysis software. Each type of abuse as event rate with 95% CI was calculated for each variable. Heterogeneity was investigated using the statistic test.

Results: Fifty-five studies encompassing 138,692 participants were included in our meta-analysis. The rate of overall abuse was 26.3 ( = 55, 95% CI: [15.8, 40.5], = .002). The highest rate of abuse in the included studies was reported for psychological abuse 48.6% ( = 46, 95% CI: [39.8, 57.5], = .758). The rate of abuse for physical, economical, sexual, and injury were 28.4% ( = 53, 95% CI: [22.1, 35.7], = .0001), 19% ( = 10, 95% CI: [9.8, 33.7], = .0001), 18.5% ( = 45, 95% CI: [13.6, 24.6], = .0001), and 18.4% ( = 5, 95% CI: [7.1, 40.2], = 0.008), respectively. The overall abuse reported by World Health Organization Multi-Country Domestic Violence (DV)Questionnaire was 25.7% ( = 17, 95% CI: [18.4, 34.7], = .0001). This value was 41.8% ( = 11, 95% CI: [29.7, 55], = .223) for the Conflict Tactics Scale Questionnaire.

Conclusion: Although this review highlights the lack of or insufficient IPV data in some contexts and inconsistencies in defining and measuring IPV among studies, the evidence shows that a moderate to high pattern of abuse has been observed in the study population. Due to this region's unique cultural-religious characteristics, it is urgent to reduce this phenomenon.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/15248380211036060DOI Listing
August 2021

Barriers and facilitators to patient engagement in patient safety from patients and healthcare professionals' perspectives: A systematic review and meta-synthesis.

Nurs Forum 2021 Aug 2. Epub 2021 Aug 2.

Department of Family Medicine, McGill University, Montreal, Canada.

Aims: To explore patients' and healthcare professionals' (HCPs) perceived barriers and facilitators to patient engagement in patient safety.

Methods: We conducted a systematic review and meta-synthesis from five computerized databases, including PubMed/MEDLINE, Embase, Web of Science, Scopus and PsycINFO, as well as grey literature and reference lists of included studies. Data were last searched in December 2019 with no limitation on the year of publication. Qualitative and Mix-methods studies that explored HCPs' and patients' perceptions of barriers and facilitators to patient engagement in patient safety were included. Two authors independently screened the titles and the abstracts of studies. Next, the full texts of the screened studies were reviewed by two authors. Potential discrepancies were resolved by consensus with a third author. The Mixed Methods Appraisal Tool was used for quality appraisal. Thematic analysis was used to synthesize results.

Results: Nineteen studies out of 2616 were included in this systematic review. Themes related to barriers included: patient unwillingness, HCPs' unwillingness, and inadequate infrastructures. Themes related to facilitators were: encouraging patients, sharing information with patients, establishing trustful relationship, establishing patient-centred care and improving organizational resources.

Conclusion: Patients have an active role in improving their safety. Strategies are required to address barriers that hinder or prevent patient engagement and create capacity and facilitate action.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nuf.12635DOI Listing
August 2021

A Systematic Review and Meta-Analysis of Stature Growth Complications in β-thalassemia Major Patients.

Ann Glob Health 2021 06 8;87(1):48. Epub 2021 Jun 8.

Cardiovascular Disease Research Center & Department of Molecular Medicine, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran.

Background: Blood transfusion is a traditional treatment for β-thalassemia (β-thal) that improves the patients' anemia and lifespan, but it may lead to iron overload in parenchymal tissue organs and endocrine glands that cause their dysfunctions as the iron regulatory system can't excrete excess iron from the bloodstream.

Objective: To evaluate the prevalence of iron-related complications (short stature, growth retardation, and growth hormone deficiency) in β-thalassemia major (TM) patients.

Methods: We performed an electronic search in PubMed, Scopus, and Web of Sciences to evaluate the prevalence of growth hormone impairment in β-thalassemia major (TM) patients worldwide. Qualities of eligible studies were assessed by the Joanna Briggs Institute checklist for the prevalence study. We used Comprehensive Meta-Analysis (Version 2) to calculate the event rate with 95% CIs, using a random-effects model for all analyses.

Findings: Seventy-four studies were included from five continents between 1978 and 2019; 70.27% (Asia), 16.21% (Europe), 6.75% (Africa), 2.70% (America), 1.35% (Oceania), and 2.70% (Multicenter). The overall mean age of the participants was about 14 years. The pooled prevalence of short stature (ST) was 48.9% (95% CI 35.3-62.6) and in male was higher than female (61.9%, 95% CI 53.4-69.7 vs. 50.9%, CI 41.8-59.9). The pooled prevalence of growth retardation (GR) was 41.1% and in male was higher than in female (51.6%, 95% CI 17.8-84 vs. 33.1%, CI 9.4-70.2). The pooled prevalence of growth hormone deficiency (GHD) was 26.6% (95% CI 16-40.8).

Conclusion: Our study revealed that near half of thalassemia patients suffer from growth impairments. However, regular evaluation of serum ferritin levels, close monitoring in a proper institute, suitable and acceptable treatment methods besides regular chelation therapy could significantly reduce the patients' complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5334/aogh.3184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8194969PMC
June 2021

The efficacy and safety of Favipiravir in treatment of COVID-19: a systematic review and meta-analysis of clinical trials.

Sci Rep 2021 05 26;11(1):11022. Epub 2021 May 26.

MSN Labs Americas, Bogotá, Colombia.

The novel coronavirus outbreak began in late December 2019 and rapidly spread worldwide, critically impacting public health systems. A number of already approved and marketed drugs are being tested for repurposing, including Favipiravir. We aim to investigate the efficacy and safety of Favipiravir in treatment of COVID-19 patients through a systematic review and meta-analysis. This systematic review and meta-analysis were reported in accordance with the PRISMA statement. We registered the protocol in the PROSPERO (CRD42020180032). All clinical trials which addressed the safety and efficacy of Favipiravir in comparison to other control groups for treatment of patients with confirmed infection with SARS-CoV2 were included. We searched electronic databases including LitCovid/PubMed, Scopus, Web of Sciences, Cochrane, and Scientific Information Database up to 31 December 2020. We assessed the risk of bias of the included studies using Cochrane Collaboration criteria. All analyses were performed using the Comprehensive Meta-Analysis software version 2, and the risk ratio index was calculated. Egger and Begg test was used for assessing publication bias. Nine studies were included in our meta-analysis. The results of the meta-analysis revealed a significant clinical improvement in the Favipiravir group versus the control group during seven days after hospitalization (RR = 1.24, 95% CI: 1.09-1.41; P = 0.001). Viral clearance was more in 14 days after hospitalization in Favipiravir group than control group, but this finding marginally not significant (RR = 1.11, 95% CI: 0.98-1.25; P = 0.094). Requiring supplemental oxygen therapy in the Favipiravir group was 7% less than the control group, (RR = 0.93, 95% CI: 0.67-1.28; P = 0.664). Transferred to ICU and adverse events were not statistically different between two groups. The mortality rate in the Favipiravir group was approximately 30% less than the control group, but this finding not statistically significant. Favipiravir possibly exerted no significant beneficial effect in the term of mortality in the general group of patients with mild to moderate COVID-19. We should consider that perhaps the use of antiviral once the patient has symptoms is too late and this would explain their low efficacy in the clinical setting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-021-90551-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8155021PMC
May 2021

Assessment of medical equipment maintenance management: proposed checklist using Iranian experience.

Biomed Eng Online 2021 May 21;20(1):49. Epub 2021 May 21.

Tabriz Health Services Management Research Center, Iranian Center of Excellence in Health Management, Student Research Committee, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.

Background: Effective maintenance management of medical equipment is one of the major issues for quality of care, for providing cost-effective health services and for saving scarce resources. This study aimed to develop a comprehensive checklist for assessing the medical equipment maintenance management (MEMM) in the Iranian hospitals.

Methods: This is a multi-methods study. First, data related to factors which affect the assessment of MEMM were collected through a systematic review in PubMed, ProQuest, Scopus, Embase, and web of science without any time limitation until October 2015, updated in June 2017. Then, we investigated these factors affecting using document review and interviews with experts in the Iranian hospitals. In the end, the results of the first and second stages were combined using content analysis and the final checklist was developed in a two-round Delphi.

Results: Using a combination of factors extracted from the systematic and qualitative studies, the primary checklist was developed in the form of assessment checklists in seven dimensions. The final checklist includes 7 dimensions and 19 sub-categories: "resources = 3," "quality control = 3," "information bank = 4," "education = 1," "service = 3," "inspection and preventive maintenance = 2" and "design and implementation = 3."

Conclusions: Developing an assessment checklist for MEMM provide a comprehensive framework for the proper implementation of accurate assessment of medical equipment maintenance. This checklist can be used to improve the profitability of health facilities and the reliability of medical equipment. In addition, it is implicated in the decision-making in support of selection, purchase, repair and maintenance of medical equipment, especially for capital equipment managers and medical engineers in hospitals and also for the assessment of this process.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12938-021-00885-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8138970PMC
May 2021

Estimating Utility Values for Health States of DFU Patients Using EQ-5D-5L and cTTO.

Int J Low Extrem Wounds 2021 May 3:15347346211014392. Epub 2021 May 3.

48516Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Health-state utility values of diabetic foot ulcer (DFU) patients are necessary for clinical praxis and economic modeling. The purpose of this study was to estimate utility values in DFU patients using the EuroQol-5-dimension-5-level (EQ-5D-5L) and composite time trade-off (cTTO). The EQ-5D-5L and cTTO were used for estimating utility values. Data were collected from 228 patients referred to the largest governmental diabetes center in the South of Iran, Yazd province. When appropriate, independent sample -test or analysis of variance test was used to test the difference in the utility values in each of the demographic and clinical characteristics of the patients. Finally, the BetaMix was used to identify predictors of the utility values. The means of EQ-5D-5L and cTTO values were 0.55( 0.21) and 0.67( 0.23), respectively. Anxiety and pain were the most common problems reported by the patients. The difference between the mean EQ-5D-5L values was significant for age, grade of ulcer, number of comorbidities, and having complications. In addition, variables of gender, age, grade of ulcer, and having complications were significant predictors of the EQ-5D-5L. The difference between the mean cTTO values was significant for age, employment status, grade of ulcer, number of comorbidities, and having complications. Moreover, variables of gender, age, grade of ulcer, number of comorbidities, and developing complications were significant predictors of cTTO. The current study provided estimates of utility values for DFU patients for clinical praxis and economic modeling. These estimates, similar to utilities reported in other studies, were low. Identifying strategies to decrease anxiety/depression and pain in patients is important to improve the utility values.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/15347346211014392DOI Listing
May 2021

Experiences of critical care nurses fighting against COVID-19: A qualitative phenomenological study.

Nurs Forum 2021 Jul 24;56(3):571-578. Epub 2021 Apr 24.

Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.

Aim: This study sought to describe the experiences of critical care nurses caring for patients infected by coronavirus disease 2019 (COVID-19).

Design: A qualitative phenomenological design was used.

Methods: We enrolled 15 nurses who provided care for patients infected by COVID-19 purposively and through snowballing, using a phenomenological approach in critical care units of Iran's public hospitals between May and June 2020. The semi-structured interviews were carried out either via face-to-face or telephone and were analyzed using the 7-step method of Colaizzi.

Results: The experiences of nurses caring for patients infected with COVID-19 were categorized into four challenges, including psychological (eight subthemes), organizational (six subthemes), social (six subthemes), and professional (five subthemes). In general, based on the current classification, there seems to be a mixture of positive and negative effects on the psychological, social, and professional challenges and the negative effect only on the organizational challenges.

Conclusions: Positive and negative emotions and experiences have coexisted for the critical care nurses since the COVID-19 outbreak. Emotional support and psychological counseling play an important role in maintaining nurses' optimal mental health during the COVID-19 crisis. Adequate protective equipment, financial and nonfinancial supports, effective communication, training and hiring of staff, and appropriate work shifts are also required to reduce nurses' negative experiences when providing care for the affected individuals.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/nuf.12583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250885PMC
July 2021

High Prevalence of Metabolic Syndrome and Its Related Demographic Factors in North of Iran: Results from the PERSIAN Guilan Cohort Study.

Int J Endocrinol 2021 29;2021:8862456. Epub 2021 Mar 29.

Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Introduction: The prevalence of metabolic syndrome has increased in recent decades around the world and is currently reaching epidemic levels as it is a major public health and clinical concern. The aim of this study was to evaluate the prevalence of metabolic syndrome and its related demographic factors in a population-based study.

Methods: In this cross-sectional study, the target population consisted of 10520 individuals aged 35-70 years in Phase 1 of the Persian Guilan cohort study (Guilan site/Some'e Sara) that was conducted in 2014-2017. Demographic, anthropometric, blood pressure, and biochemical data were used in this study. The IDF definitions were used to diagnose the metabolic syndrome.

Results: The prevalence of the syndrome according to IDF and ATP definition was 42.87% (95% CI: 41.92-41.81) and 40.68% (95% CI: 39.74-41.62), respectively. The prevalence of components for central obesity, high triglyceride, HDL cholesterol, blood glucose, and hypertension components was 75.8%, 43.1%, 40.6%, 39.2% and 37.9%, respectively. All demographic variables were related to the syndrome, and among them age, gender, and residence were identified as independent and strong predictive variables in the regression model. More than 92% of the population had at least one component of the syndrome.

Conclusion: The results of the study show a high prevalence of metabolic syndrome risk factors. It is essential to educate healthy lifestyle behaviors and further health education in the high-risk groups identified in this study, especially the elderly, women, and rural residents.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2021/8862456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024063PMC
March 2021

The Economic Burden of Abortion and Its Complication Treatment Cares: A Systematic Review.

J Family Reprod Health 2020 Jun;14(2):60-67

Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.

Abortion related procedures contribute to a significant economic burden because it resulted in prolonged hospital stays for patients. We aimed to gather available evidence on the economic burden of abortion and post-abortion complication treatment cares worldwide. PubMed, Web of Science, Scopus, and Embase databases were searched through November 2019. Two researchers independently conducted the quality assessment and data extraction process. The latest web-based tool adjusted the estimates of costs expressed in one specific currency and price year into a specific target currency (the year 2016 $US). Totally, 2082 records were retrieved and 32 studies were deemed eligible for qualitative synthesis. The mean total costs per patient with abortion or post-abortion care ranged from $23 to $564. The annual costs ranged from 189,000 $US to 134 million $US. Abortion and post-abortion care impose a substantial economic burden on society. Understanding the burdensome of abortion or pregnancy termination among policymakers provides vital information and enables informed decisions to be made to establish health care priorities and allocating scarce resources.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/jfrh.v14i2.4354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865195PMC
June 2020

A systematic review and meta-analysis of pregnancy and COVID-19: Signs and symptoms, laboratory tests, and perinatal outcomes.

Int J Reprod Biomed 2020 Dec 21;18(12):1005-1018. Epub 2020 Dec 21.

Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.

Background: Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 appeared in December 2019 in Wuhan, China.

Objective: To investigate the clinical manifestations including signs and symptoms, laboratory results, and perinatal outcomes in pregnant women with COVID-19.

Materials And Methods: Scholarly databases such as PubMed via LitCovid hub, Embase, Scopus, Web of sciences, and Google scholar were searched on April 7, 2020. Meta-analysis was performed via comprehensive meta-analysis software using the Mantel-Haenszel method. The event rate with 95% CI was calculated for each variable.

Results: Ten studies were selected. The pooled prevalence for fever, post-partum fever, cough, myalgia, fatigue, dyspnea, sore throat, and diarrhea were 66.8%, 37.1%, 35%, 24.6 %, 14.9%, 14.6%, 11.5%, and 7.6%, respectively. Laboratory test results were 49.8% for lymphopenia, 47.7% for leukocytosis, 83.7% for elevated neutrophil ratio, 57% for elevated C-reactive protein, and 71.4% for decreased lymphocyte ratio. The rate of cesarean section for delivery in all cases was 84%. Of the newborns of the corona-positive mothers, only one had a positive test result. Also, there was only one death due to a decreased lymphocyte ratio.

Conclusion: Fever was the most common sign and symptom in pregnant women with COVID-19. Among the laboratory tests, the highest amount was related to elevated neutrophil ratio. It seems that due to the differences between pregnant women and the general population, special measures should be considered to treat these patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18502/ijrm.v18i12.8022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7778754PMC
December 2020

Knowledge, Attitudes, and Practices Among the General Population During COVID-19 Outbreak in Iran: A National Cross-Sectional Online Survey.

Front Public Health 2020 10;8:585302. Epub 2020 Dec 10.

Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.

Emerged in December 2019, coronavirus disease 2019 (COVID-19) is one of the largest pandemics ever. During the early phase, little was known about public knowledge, attitudes, and practices (KAP) relating to coronavirus disease. This study was designed to determine KAP of Iranians toward COVID-19. A cross-sectional online survey was carried out in Iran from February 25 to April 25 using a self-administered questionnaire on 1,480 people. COVID-19-related KAP questions were adapted from other internationally validated questionnaires specific for infectious diseases. All participants were aware of COVID-19. When asked unprompted, 80% of respondents could correctly cite fever, difficulty in breathing, and cough as signs/symptoms of COVID-19. Most of our sample population knew that staying at home and isolated (95.3%) as well as constant handwashing and using disinfectants (92.5%) could prevent COVID-19. However, there were also widespread misconceptions such as the belief that COVID-19 can be transmitted by wild animals (58%) and by air (48.3%). Unprompted, self-reported actions taken to avoid COVID-19 infection included handwashing with soap and water (95.4%), avoiding crowded places (93%), cleansing hands with other disinfectants (80.), and covering mouth and nose when coughing or sneezing (76.1%). The Internet and social media (94.5%) were the main coronavirus information sources. However, the most trusted information sources on coronavirus were health and medical professionals (79.3%). The majority of participants (77.0%) wanted more information about coronavirus to be available. Our findings suggest that people's knowledge and attitude toward COVID-19 at the time of its outbreak was at a high level.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2020.585302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758225PMC
January 2021

Exploratory factor analysis of gender-based metabolic syndrome components: Results from the PERSIAN Guilan cohort study (PGCS).

Clin Nutr ESPEN 2020 12 30;40:252-256. Epub 2020 Sep 30.

Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran; Caspian Digestive Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran. Electronic address:

Background: One of the important issues related to metabolic syndrome is the underlying factor that remains controversial. The purpose of this study was estimating exploratory factor analysis (EFA) to reveal underlying factors that may explain the observed variants of metabolic syndrome (MetS) components in a population-based study.

Methods: In this cross-sectional study, the target population consisted of 10,520 individuals aged 35-70 years from Phase 1 of the PERSIAN Guilan cohort study conducted between 2014 and 2017. Exploratory factor analysis (EFA) of components of the metabolic syndrome, including waist circumference (WC), systolic (SBP) and diastolic (DBP) blood pressure, triglyceride (TG), high-density lipoprotein (HDL) and fasting blood glucose (f-Glc) was performed across the population as well as by gender.

Results: EFA results in the whole population based on eigen values > 1 showed two factors that explain 55.46% of the total variance. Taking factor loadings above 0.3, the first factor included systolic blood pressure, diastolic blood pressure, and waist circumference - called the blood pressure factor. Also, the second factor included triglycerides, negative-loaded HDL, and fasting blood glucose, which was named as lipid factor. In terms of gender, the first factor was similar to the whole population pattern, but in the second factor, in addition to the two components of blood lipids, waist size for men and in fasting blood glucose for women was launched.

Conclusion: Hypertension and lipids were substantial factors, and obesity is an important factor in this study. Hypertension, having the highest factor load, can generally be a valuable screening parameter for cardiovascular and metabolic risk assessment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clnesp.2020.09.011DOI Listing
December 2020

Health-Related Quality of Life and its Associated Factors in COVID-19 Patients.

Osong Public Health Res Perspect 2020 Oct;11(5):296-302

Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Objectives: Health-related quality of life (HRQoL) is one of the most important outcome measures for patients. The purpose of this study was to evaluate HRQoL and related factors in Coronavirus disease 2019 (COVID-19) patients.

Methods: A total of 420 COVID-19 patients who had been discharged from hospital were selected using a systematic sampling. The EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients were used to gather the data. The test and analysis of variance were employed to test the difference between mean EQ-5D-5L scores, and the BetaMix model was used to investigate factors associated with EQ-5D-5L scores.

Results: The mean score for the patients who completed the EQ-5D-5L questionnaire ( = 409) was 0.6125. The EQ-5D-5L scores were significantly higher in males, patients with younger age, those with a low level of education, the employed, patients who worked in uncrowded workplaces, patients without diabetes, and those who were not admitted to intensive care unit. The BetaMix model showed that gender, age, education, employment status, having diabetes, heart failure, and admission to the intensive care unit were significant independent predictors of the EQ-5D-5L index values.

Conclusion: The mean score for EQ-5D-5L in COVID-19 patients was low in this study. Some of the factors, especially aging and having diabetes, should be considered in the aftercare of patients to improve their HRQoL.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.24171/j.phrp.2020.11.5.05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577388PMC
October 2020

Survival Rate of Colorectal Cancer in Eastern Mediterranean Region Countries: A Systematic Review and Meta-Analysis.

Cancer Control 2020 Jan-Dec;27(1):1073274820964146

Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Colorectal cancer (CRC) is the second most common cause of cancer-related deaths worldwide. Survival rates are among the most important factors in quality control and assessment of treatment protocols. This study was aimed to assess the survival rate of colorectal cancer in Eastern Mediterranean Region Countries. In the present study we comprehensively searched 6 international databases including PubMed/Medline, ProQuest, Scopus, Embase, Web of Knowledge and Google Scholar for published articles until November 2018. The Newcastle-Ottawa Quality Assessment Form for Cohort Studies was applied to evaluate the quality of included studies. The heterogeneity of papers was assessed with the Cochran Test and I-Square statistics. Meta-regression test was performed based on publication year, sample size and Human Development Index (HDI) of each study. Among the total of 1023 titles found in the systematic search, 43 studies were eligible to be included in the present meta-analysis. According to the results, the 1-year, 3-year and 5-year survival rate of patients with Colorectal Cancer was 88.07% (95% CI, 83.22-92.92), 70.67% (95% CI, 66.40-74.93) and, 57.26% (95% CI, 50.43-64.10); respectively. Furthermore, Meta-regressions did not show significant correlations between survival rate and year, sample size or Human Development Index. Survival rates, especially the 5-year survival rate in the EMRO were less than European countries and the USA. Documented and comprehensive evidence-based findings of the present meta-analysis can be used to enhance policies and outcomes of different medical areas including prophylaxis, treatment and health related objectives in colorectal cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1073274820964146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791530PMC
June 2021

Sharing Solidarity Experiences to Overcome COVID-19.

Ann Glob Health 2020 09 3;86(1):114. Epub 2020 Sep 3.

Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, IR.

Solidarity in the general sense means unity or agreement of feeling or action, especially among individuals with a common interest; or mutual support within a group. There are different ways of standing in solidarity in different kinds of literatures. One of the most important ways is to advocate. Advocacy is a win-win strategy and a process of supporting and enabling people to express their views and concerns. In the end, I think sharing different types of solidarity can be one of the drivers that stimulate the solidarity itself, and I call on everyone to contribute to this sharing. I hope that this solidarity, which began in the world with the beginning of COVID-19, will not end with its end and will last forever because our world needs coexistence. This may be the only gift to the world from COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5334/aogh.3035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473217PMC
September 2020

Medical Overuse in the Iranian Healthcare System: A Systematic Scoping Review and Practical Recommendations for Decreasing Medical Overuse During Unexpected COVID-19 Pandemic Opportunity.

Risk Manag Healthc Policy 2020 11;13:1103-1110. Epub 2020 Aug 11.

Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.

Purpose: To perform an inclusive search for original studies that report medical overuse in the Iranian healthcare system and discovering the area of overuse.

Patients And Methods: A systematic search of the literature is conducted in bibliographic databases including PubMed, Embase, Scopus, Web of Sciences, Cochrane and Scientific Information Database using a comprehensive search strategy without time limit until the end of 2018, updated by 1 July 2020, accomplished by reference tracking, author contacting and expert consultation to identify studies on the overuse of medical care.

Results: We reviewed 4124 published articles based on predetermined inclusion criteria. The author's consensus included a total of 41 articles. Of these, 32 were in English and 9 in Farsi, published between 1975-2019. The result categorized into two distinct clinical areas: treatment (18 articles) and diagnostic (23 articles) services. Almost all of the studies only described the magnitude of unnecessary overuse. Unnecessary overuse of antibiotics, MRI, and CT-scan were the most reported topics. The ranges of their overuse proportion were as follows: antibiotic (31 to 97%); MRI (33 to 88%), and CT-scan (19 to 50%).

Conclusion: Our review showed, even so, the magnitude of unnecessary overuse of medical services is high but there are only a few interventional studies in clinical and administrative level for finding effective methods for decreasing these unnecessary services. Researchers should be encouraged to conducting interventional studies. We suggest the ministry of health to use the golden opportunity of COVID-19 epidemic for designing Iran national policy and action plan for controlling and preventing unnecessary healthcare services and including a section for "Interventional Research" in the action plan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/RMHP.S262908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429239PMC
August 2020

Estimating global injuries morbidity and mortality: methods and data used in the Global Burden of Disease 2017 study.

Inj Prev 2020 10 24;26(Supp 1):i125-i153. Epub 2020 Aug 24.

Department of Pharmacy, Adigrat University, Adigrat, Ethiopia.

Background: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

Results: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

Conclusions: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/injuryprev-2019-043531DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571362PMC
October 2020

Leadership and Management Competencies for Hospital Managers: A Systematic Review and Best-Fit Framework Synthesis.

J Healthc Leadersh 2020 22;12:59-68. Epub 2020 Jul 22.

Iranian Center of Excellence in Health Management (IceHM), Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.

Objective: Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system. To improve their management competence, understanding of management competency requirements is important. The purpose of this study was to synthesize the evidence related to the leadership and management competencies in healthcare organizations through the best-fit method.

Methods: A systematic review of literature published between 2000 and 2020 was performed to identify studies focusing on confirming and/or identifying the competency requirements of hospital managers. The best-fit framework synthesis method was used to map the identified competencies and associated behavioral items against the validated management competency assessment program (MCAP) management competency framework.

Results: Twelve studies were identified for inclusion in the review. The mapping of the identified competencies and behavioral items generated a competency model for hospital managers that can apply for different healthcare context. The new competency model includes the following seven core leadership and management competencies: evidence-informed decision-making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism.

Conclusion: This review and the mapping of the competencies identified in previous studies against the validated MCAP framework has resulted in the recommendation for an extended leadership and management competency framework for health service managers. It provides guidance for the formulation of training and development directions for the health service management workforce in a different healthcare context.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/JHL.S265825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383104PMC
July 2020

Following PRISMA in a Systematic Review: Obligation or Authority?

Int J Prev Med 2020 19;11:70. Epub 2020 Jun 19.

Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ijpvm.IJPVM_400_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7373081PMC
June 2020

Favipiravir for treating patients with novel coronavirus (COVID-19): protocol for a systematic review and meta-analysis of randomised clinical trials.

BMJ Open 2020 07 31;10(7):e039730. Epub 2020 Jul 31.

Department of Public Health, School of Health, Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.

Introduction: An outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was reported in Wuhan, China, in mid-December 2019, and declared a pandemic by the WHO on 11 March 2020. Due to the unknown nature of the disease and the lack of specific drugs, several potential treatments were used for patients. This systematic review and meta-analysis will evaluate studies of the effects of favipiravir in COVID-19 pneumonia.

Methods And Analysis: We will search electronic databases including LitCovid hub, PubMed, Scopus, ISI Web of Sciences, Cochrane and Embase using keywords related to COVID-19 and favipiravir. We will search the reference lists of all included studies and reviews. We will also search for clinical trial registries, such as ClinicalTrials.gov, for the ongoing clinical trials. All randomised clinical trials investigating the safety and efficacy of favipiravir compared with other control groups for the treatment of patients with confirmed infection with SARS-CoV-2 will be included. Patients' survival at the end of the treatment as well as the follow-up will be the primary outcome of the treatment, followed by the time and rate of the patient with a negative COVID-19 test. The desired secondary outcome will consist of a decreased rate of symptoms, proportion of intensive care unit (ICU) transfers, length of the hospital stay, ICU treatments, the quality of life and additional adverse events. Data synthesis will be conducted using CMA V.2. Two independent investigators will be screening titles, abstracts and full texts of included studies, based on eligibility criteria. These investigators will then independently extract the data and appraise the quality of said studies. All potential discrepancies will be resolved through consultation with the third reviewer. Statistical heterogeneity will be assessed using a standard I test. A funnel plot, Egger's test and Begg's test will be used for detecting asymmetry to explore possible publication bias.

Ethics And Dissemination: All findings of this systematic review and meta-analysis will help identify the safety and efficacy of favipiravir for patients with COVID-19. Given that the design of the study is a systematic review, there is no need to follow the code of ethics protocol. The results of this study will be published in a reputable journal.

Prospero Registration Number: CRD42020180032.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2020-039730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397976PMC
July 2020

COVID-19 in Iran: the Good, the Bad, and the Ugly Strategies for Preparedness - A Report From the Field.

Disaster Med Public Health Prep 2020 Jul 27:1-3. Epub 2020 Jul 27.

Social Determinants of Health Research Center, Faculty of Health, Department of Public Health, Birjand University of Medical Sciences, Birjand, Iran.

The emergence of coronavirus disease 2019 (COVID-19), a novel unknown virus that is challenging whole countries all over the world, has prompted different strategies from various governments. Iran, as one of the first countries to experience the onset of the virus outbreak, made and implemented some policies that should be assessed, so that lessons may be learned for the future. Although some negative actions and policies, such as delays in cancellation of international flights especially from China, not taking the disease seriously and comparing it with seasonal influenza, and the like, are hard to ignore, some impressive actions are also vividly clear. Policies, such as social distancing, dramatically increasing social awareness about preventive actions in terms of public health, and using masks and hand washing, were cost-effective policies that resulted in successful control of the virus in the first onset. While some quite clearly ineffective decisions were made by Iranian authorities, the huge catastrophic effect of sanctions cannot be forgotten. Possibly in level situations with similar countries, Iran will have far better results regarding preparedness for future pandemics like COVID-19.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/dmp.2020.261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588722PMC
July 2020

Mapping the cancer-specific FACT-B onto the generic SF-6Dv2.

Breast Cancer 2021 Jan 25;28(1):130-136. Epub 2020 Jul 25.

Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Introduction: The health-related quality of life (HRQoL) data extracted from cancer-specific questionnaires are often non-preference based, while patient preference-based utility data are required for health economic evaluation. This study aimed to map Functional Assessment of Cancer Therapy-Breast (FACT-B) subscales onto the Short Form six Dimension as an independent instrument (SF-6Dv2) using the data gathered from patients with breast cancer.

Methods: Data for 420 inpatient and outpatient patients with breast cancer were gathered from the largest academic center for cancer patients in Iran. The OLS and Tobit models were used to predict the values of the SF-6Dv2 with regard to the FACT-B subscales. Prediction accuracy of the models was determined by calculating the root mean square error (RMSE) and mean absolute error (MAE). The relationship between the fitted and observed SF-6Dv2 values was examined using the Intraclass Correlation Coefficients (ICC). Goodness of fit of models was assessed using the predicted R (Pred R) and adjusted R (Adj R). A tenfold cross-validation method was used for validation of models.

Results: Data of 416 patients with breast cancer were entered into final analysis. The model included main effects of FACT-B subscales, and statistically significant clinical and demographic variables were the best predictor for SF-6Dv2 (Model S3 of OLS with Adj R = 61.02%, Pred R = 59.25%, MAE = 0.0465, RMSE = 0.0621, ICC = 0.678, AIC = -831.324, BIC = -815.871).

Conclusion: The best algorithm developed for SF-6Dv2 enables researchers to convert cancer-specific instruments scores into preference-based scores when the data are gathered using cancer-specific instruments.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12282-020-01141-9DOI Listing
January 2021

Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017.

Inj Prev 2020 10 24;26(Supp 1):i96-i114. Epub 2020 Apr 24.

Faculty of Health Sciences - Health Management and Policy, American University of Beirut, Beirut, Lebanon.

Background: Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods: We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings: In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation: Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/injuryprev-2019-043494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7571366PMC
October 2020

Features and Limitations of LitCovid Hub for Quick Access to Literature About COVID-19

Balkan Med J 2020 06 15;37(4):231-232. Epub 2020 Apr 15.

Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4274/balkanmedj.galenos.2020.2020.4.67DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285668PMC
June 2020

Letter to the editor on the article "Cement augmentation of sacroiliac screws in fragility fractures of the pelvic ring-A synopsis and systematic review of the current literature".

Injury 2020 04 12;51(4):1138-1139. Epub 2020 Feb 12.

Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.injury.2020.02.018DOI Listing
April 2020

The survival rate of hepatocellular carcinoma in Asian countries: a systematic review and meta-analysis.

EXCLI J 2020 13;19:108-130. Epub 2020 Jan 13.

GI Cancer Screening and Prevention Research Center, Guilan University of Medical Sciences, Rasht, Iran.

Hepatocellular carcinoma or Liver cancer (LC) is the sixth most common cancer and the fourth cause of death worldwide in 2018. There has not been a comprehensive study on the survival rate of patients with LC in Asia yet. Therefore, the present study was conducted to evaluate the survival rate of patients with LC in Asian countries. The methodology of the present study is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. The researchers searched five international databases including Medline/PubMed, Scopus, Embase, Web of Knowledge and ProQuest until July 1, 2018. We also searched Google Scholar for detecting grey literature. The Newcastle-Ottawa Quality Assessment Form was used to evaluate the quality of selected papers. A total of 1425 titles were retrieved. 63 studies met the inclusion criteria. Based on the random-effect model one-year, three-year and five-year survival rate of LC were 34.8 % (95 % CI; 30.3-39.3), 19 % (95 % CI ; 18.2-21.8) and 18.1 % (95 % CI ;16.1-20.1) respectively. According to the results of our study, the LC survival rate in Asian countries is relatively lower than in Europe and North America.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.17179/excli2019-1842DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003639PMC
January 2020

Shared decision making: How can it be helpful in reducing medical overuse due to medical misinformation mess?

J Eval Clin Pract 2020 Apr 3;26(2):602-603. Epub 2020 Feb 3.

Social Determinants of Health Research Center, Department of Community and Family Medicine, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/jep.13358DOI Listing
April 2020

Survival Rate of Prostate Cancer in Asian Countries: A Systematic Review and Meta-Analysis.

Ann Glob Health 2020 01 2;86(1). Epub 2020 Jan 2.

Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, IR.

Background: Prostate cancer is one of the most common health issues among men, especially older men. In recent years, incidences of prostate cancer is increasing.

Objective: The aim of this study was to provide a comprehensive estimate of the survival of prostate cancer in Asian countries.

Methods: We searched five international databases including Medline/PubMed, Scopus, Embase, Web of Knowledge and ProQuest until June 1, 2018. The Newcastle-Ottawa Quality Assessment was used to evaluate the quality of selected papers. The review protocol was registered in PROSPERO (CRD42019117044).

Results: A total of 714 titles were retrieved. Thirty-seven studies met the inclusion criteria. Based on the random-effect model one-year, five-year and ten-year survival rate of prostate cancer were 81% (95% CI 77.8-84.2), 61.9% (95% CI 59.5-64.3) and 36.2% (95% CI 9.2-63.2) respectively. Survival rates based on HDI level for five-year were 30.07, 43.43 and 70.84 percent for medium, high and very high levels, respectively.

Conclusion: According to the results of our study, the prostate cancer survival rate in Asian countries is relatively lower than in Europe and North America.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5334/aogh.2607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6966336PMC
January 2020

History of Health Technology Assessment in Iran.

Int J Technol Assess Health Care 2020 13;36(1):34-39. Epub 2020 Jan 13.

Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran.

This article describes the characteristics of the health system and reviews the history of health technology assessment (HTA) in Iran, including its inception, processes, challenges, and lessons learned. This study was conducted by analyzing existing documents, reports, and guidelines related to HTA and published articles in the field. HTA in Iran has been established since the late 2000s and was first introduced as a secretariat by the Deputy of Health at the Ministry of Health and Medical Education. The mission of the HTA office is to systematically assess technologies to improve evidence-informed decision making. Despite its 10 years of existence, HTA in Iran still faces some challenges. The most pressing problems currently facing HTA in Iran include conflicts of interest among researchers performing the HTAs, the absence of a systematic structure for identifying and introducing new technologies, the lack of interest in HTA results among high-level policy makers, and the lack of external oversight for HTA projects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S0266462319003489DOI Listing
December 2020
-->